- Meeting abstracts
- Open Access
21st Brazilian Diabetes Society Congress
Diabetology & Metabolic Syndrome volume 10, Article number: 27 (2018)
A1 A randomized control trial evaluating the effect of acupuncture on glycemic control in dm2 using the freestyle libre® glucose monitoring system
Sérgio Vencio1, Adriana Caiado2, Douglas Morgental2, Natália Bufaiçal Rassi Carneiro3, Rafael Caiado Vencio3
1UFG, Goiás, Brazil; 2Comunidade Espírita Ramatís, Goiânia, Brazil; 3Pontificia Universidade Católica de Goiás, Goiás, Brazil
Correspondence: Sérgio Vencio
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A1
Introduction: Acupuncture is a widely used technique for the treatment of diabetes in Asian countries. Nevertheless, there are few studies with appropriate methodological rigor evaluating its effectiveness and promoting a standardized procedure in the western world. The FreeStyle libre glucose monitoring system has specific characteristics, being diverse from the traditional monitoring methods. It does not require finger prick and identifies glucose variations, especially nocturnal hypoglycemia.
Objectives: Evaluate the short-term effect of acupuncture in the treatment of type 2 diabetes mellitus (DM2) using the FreeStyle libre system.
Method: In a randomized, controlled, prospective, open-label trial, we randomly assigned 20 insulin independent DM2 patients to undergo acupuncture (group 1) or in the control group (group 2). Participants should be between 20 and 75 years old, diagnosed with DM2 for at least 3 years, and with stable glycemic control (evaluated through glycated hemoglobin). Patients should not be in use of glucocorticoids or insulin, be pregnant or have record of nephrotic syndrome, hepatic insufficiency, hyperthyroidism, acromegaly or renal insufficiency. Demographic data, baseline characteristics, biochemical and metabolic profiles were analyzed before the intervention. Participants underwent continuous glucose monitoring for 14 days, period in which they did not change diet, exercise or medication. Group 1 received acupuncture 4, 8 and 12 days after installation of the monitoring system. The acupuncture treatment promotes energetic rebalance and, in this study, diabetes-specific treatment points were used in all patients (B38, IG4, R24, E36 e BP9). This trial was approved by the ethics committee (CAAE—60576616.6.0000.5572) and registered at Brazilian Registry of Clinical Trials (UTN) is U1111-1199-9630.
Results: There were no statistically significant differences in the baseline characteristics (Table 1). In group 1, mean glucose level obtained through 14 days monitoring after acupuncture treatment was 143 ± 28,8 mg/dl, whilst in group 2, who did not undergo acupuncture, the mean level was 165.8 ± 30.2 mg/dl (p-0.015) (Fig. 1).
Conclusion: In this randomized pilot trial, there was an improvement in global glycemic control during the 14 days of monitoring in the acupuncture group. Despite the small sample of this trial, there were no significant differences in baseline characteristics. Further studies with larger cohorts should be performed.
A2 A real world overview of diabetes mellitus profile and management in Brazil
António Chacra1, Denise Reis Franco2, Luis Eduardo Procopio Calliari3, Freddy Goldberg Eliaschewitz4, Graziela Ferreira5, Maurício Aguiar de Paula5, Leila Lima5, Felipe Lauand5
1Diabetes Center of Federal University of São Paulo, Brazil and Diabetes Center at the Sírio-Libanês Hospital, São Paulo, Brazil; 2CPClin Clinical Research Center, São Paulo, Brazil; 3Pediatric Endocrinology Unit, Pediatric Department, Santa Casa de São Paulo School of Medicine, São Paulo, Brazil; 4Hospital Israelita Albert Einstein-São Paulo Brazil and CPClin Clinical Research Center, São Paulo, Brazil; 5Sanofi, São Paulo, Brazil
Correspondence: António Chacra
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A2
Introduction: Real-world data on diabetes mellitus (DM) in Brazil is scarce. Given the complexity of current DM management, an understanding of the disease profile is essential to inform clinical and public health decisions.
Objective: We aimed to describe the proportion of T1DM and T2DM patients with HbA1c < 7.0%, the socio demographic and clinical characteristics of DM patients and the therapeutic strategies adopted in Brazil.
Methods: This was an observational, cross-sectional study, conducted between January and June 2016 in 250 public and private healthcare centers, randomly selected across Brazil.
Results: Overall, 2590 patients (51.8% male) were included, of which 244 (9.4%) had T1DM and 2 346 (90.6%) had T2DM. Most T1DM patients (43.4%) were in the 18-30 age group and most T2DM patients (51.5%) were in the 5170 age group. BMI ≥ 30 kg/m2 was found for 14.6% of T1DM patients and 36.6% of T2DM patients. Mean age at diagnosis was 25.1 (SD 15.8) years for T1DM and 50.8 (SD 12.6) years for T2DM. Most patients (76.9%) are followed in the private healthcare sector. The most frequent comorbidity was dyslipidemia (46.7%; n = 1209), both for T1DM patients (20.1%; n = 49) and T2DM patients (49.4%; n = 1160). HbA1C < 7.0% was found for 41.8% (95% CI [34.7%; 49.0%]) of T1DM patients and for 52.3% (95% CI [50.1%; 54.5%]) of T2DM patients. Among T2DM patients, 14.4% (n = 338) were insulin-treated, of which 55.6% (n = 188) with NPH, 23.7% (n = 80) with fast-acting insulin analogues, 22.8% (n = 77) with long-acting insulin analogues, 13.6% (n = 46) with regular insulin and 3.6% (n = 12) with premixed insulin. The oral antidiabetics most commonly used by T2DM patients were metformin (n = 1538; 65.6%), followed by DDP-4 inhibitors (n = 774; 33.0%) and sulfonylureas (n = 644; 27.5%). On average, patients attend 3.7 appointments per year for diabetes management (T1DM: 4.3; T2DM: 3.6).
Conclusion: A high proportion of patients in this cohort did not meet the glycemic control target of HbA1C < 7.0%, even though most were under pharmacological treatment. Given the risk of diabetic complications posed by uncontrolled disease, further action should be taken to address this issue. Globally, this study offers valuable insight into DM’s epidemiology and management in Brazil. Funding: This study was funded by Sanofi.
A3 A restropective epidemiological study of the disability benefits caused by diabetes mellitus
Daniela Vieira e Silva Vítor1, Luciano Resende Ferreira1, Viviane Aparecida Sotto Bazalia Capeli1, Luciana Avila Furtado Cardillo1, Renan Vieira de Brito1, Cláudio A Baptista2, Priscila I Scardovelli2, Vinícius B Rodrigues2
1Unifae-Centro Universitário das Faculdades Associadas de Ensino, São João da Boa Vista, Brazil; 2UNIFAE, São João da Boa Vista, Brazil
Correspondence: Daniela Vieira e Silva Vítor
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A3
Introduction: Diabetes mellitus (DM) is a disease that has a high prevalence around the world. In 2014, the World Health Organization estimated that 422 million adults had the disease, worldwide. The DM is one of the main causes of disability, which can negatively affect productivity in active workers. In Brazil, the National Institute of Social Security (INSS) is responsible for granting benefits and salaries in cases of absenteeism due to illness.
Objective: The objective of this study was to evaluate the epidemiological profile of INSS beneficiares receiving disability benefits due to DM.
Methods: A retrospective study based on analysis of 184 patients who requested disability benefits due to diabetes mellitus from the INSS, in a city located in the south of Minas Gerais- Brazil. The analyzed data were characterized by age, gender and employment situation through the ICD-10 (E10, E11 and E14) from January 2014 to February 2016.
Results: The results showed that diabetes mellitus represented 34.2% of all disability benefits requests associated with endocrine diseases (n = 538). Considering just the diabetes ICDs, Insulin-dependent diabetes mellitus (E10) represented 63.6%, followed by non-insulin-dependent Diabetes (E11) with 24.4% and unspecified diabetes mellitus (E14) with 12%. The majority of beneficiaries were male (71.7%), associated with urban jobs (53.3%) especially administrative posts, ranging from 50 to 64 years old (63%).
Conclusion: The profile of workers who have requested benefits due to diabetes mellitus showed that the majority of beneficiaries were male adults, working in urban jobs ranging from 50 to 64 years old, mainly affected by Insulin-dependent diabetes mellitus disease. In addition, these beneficiaries can be more susceptible to workplace thermal conditions, stress and other issues inherent to the disease, such as hypo or hyperglycemia. These data should help in the implementation of strategies and measures to prevent the work disability caused by diabetes involving Brazilian workers. As consequence, it is expected that there will be a reduction in costs related to the absence of these workers.
A4 Ability of the pedersen method to stratify hypoglycemia awareness and assess the risk of hypoglicemia
Ticiana Paes Batista da Silva1, Luiz Clemente Rolim1, Celso Sallum Filho1, Sergio Atala Dib1
1UNIFESP, São Paulo; Brazil
Correspondence: Ticiana Paes Batista da Silva
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A4
Introduction: The Perdersen method is a simple method to assess impairment of hypoglycemia awareness, which is a major risk factor for severe hypoglycemia.
Objective: To assess hypoglycemia awareness in consecutive type 1 diabetes patients using the Pedersen method and evaluate their glycemic profile and frequency of hypoglycemia.
Method: The Pedersen consists in confronting patients with the question: “Do you recognize symptoms, when you have a hypoglycemia?” and gives the possibility of one of four answers: (1) “Always”; (2) “Usually”; (3) “Occasionally”; (4) “Never”. The population is then stratified in three groups: Normal awareness of hypoglycemia (NAH)—patients who answered “always”; Impaired awareness (IAH)—patients who answered “usually”; Unawareness of hypoglycemia (UAH)—patients who answered “occasionally” or “never”. For all subjects, glycemic profile and hypoglycemia frequency were prospectively evaluated in detail in a 1 month period.
Results: In total, 98 patients with a mean age of 26 years and 13 years of diabetes duration were classified as UAH = 28.6%, IAH = 22.4%, and NAH = 49%. Patients with hypoglycemia unawareness (UAH) were older and had longer diabetes duration. The proportion of patients who reported at least one episode of severe hypoglycemia in the last year was significantly lower in patients with NAH (p < 0.001). When asked what level of blood glucose triggered their symptoms of hypoglycemia, significantly more patients with UAH reported levels < 40 mg/L (NAH = 4.2%, IAH = 4.5%, UAH = 57.0%, p < 0.001). In the analyses of the 4 weeks period of prospective data collection we observed a progressive increase in the average number of episodes of hypoglycemia as hypoglycemia perception decreased (NAH = 6.5 ± 5.3, IAH = 8.8 ± 4.4, UAH = 11.5 ± 8.4; p = 0.004). The proportion of patients with at least one episode of hypoglycemia with no warning symptoms (i.e. no symptoms and capillary glucose < 52 mg/L) was highest in those with UAH (p < 0.001 vs. NAH and p = 0.011 vs. IAH). On univariable analysis, age (OR = 1.07; p = 0.002), diabetes duration (OR = 1.07; p = 0.027), and creatinine clearance (OR = 0.81; p = 0.014) were associated with unawareness of hypoglycemia. On multivariable analysis, there was no factor independently associated with unawareness of hypoglycemia.
Conclusion: The Pedersen method is a simple and feasible clinical tool that correctly identified patients with high risk for severe hypoglycemia.
A5 Accession to medicinal therapeutics of patients with diabetes mellitus
Tayse Tâmara da Paixão Duarte, Ana Carla de Macedo Mesquita, Camila Leal Cardoso, Márcia Cristina da Silva Magro
UNB, Brasília, Brazil
Correspondence: Tayse Tâmara da Paixão Duarte
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A5
Introduction: Diabetes Mellitus is a chronic non-communicable disease that occurs due to hereditary and/or environmental factors. Adherence to drug therapy is essential to avoid complications.
Objective: To identify adherence and drug therapy and the difficulty that these individuals with type 2 DM have in relation to treatment adherence through the Morisky-Green Test (MGT) and Brief Medication Questionnaire (BMQ).
Method: Quantitative, descriptive, exploratory cross-sectional study. Study conducted with patients diagnosed with Type II Diabetes Mellitus. The results were analyzed by the Statistical Package for the Social Science (SPSS) 17, using Chi square tests and Fisher‘s exact test, was considered significant p < 0.05. All participants signed the informed consent form—TCLE. This research was approved by the Research Ethics Committee of the Health Sciences Teaching and Research Foundation of the health secretariat—FEPECS/SES, CAAE 45288915.6.0000.5553.
Results: Among the 99 patients interviewed, the majority were female (71.7%), aged 60.4 ± 1.0 years, married (54.5%), household 36 (36.4%), whose family income was constituted up to a minimum wage (34.3%). Regarding adherence to medication therapy, it was found to be moderate for both sexes, 48% (Female) and 50% (Male), through the MGT evaluation. The BMQ showed women with a likely adherence to treatment (55%) with a higher incidence and men focused on a low adherence rate (36%). Regarding the limitations for adherence, 45.5% of the individuals reported having difficulty reading what is written on the medication packages and 24.2% reported having difficulty remembering the time to take the medications.
Conclusion: Through MGT there was similar adherence to medication therapy between men and women, whereas in the BMQ women showed a more likely adherence to higher incidence. The limitation in reading what is written on the packages and remembering the timetables for their ingestion were some of the difficulties to adherence to drug therapy referred by the patients (Figs. 1, 2, 3, 4, 5).
A6 Achievement of HBA1C targets in the diabetes unmet need with basal insulin evaluation (dune) real-world study
Luigi Meneghini1,2, Didac Mauricio3, Emanuela Orsi4, Nebojsa Lalic5, Anna Cali6, Jukka Westerbacka6, Peter Stella6, Christophe Candelas6, Valerie Pilorget6, Riccardo Perfetti6, Kamlesh Khunti7
1University of Texas Southwestern Medical Center, Dallas, TX, USA; 2Parkland Health & Hospital System, Dallas, TX, USA; 3Hospital Universitari Germans Trias i Pujol, Barcelona, Spain; 4Endocrine and Metabolic Diseases Unit, Fondazione Ca‘Granda IRCCS, Milan, Italy; 5Clinic for Endocrinology, CCS Faculty of Medicine, University of Belgrade, Serbia; 6Sanofi, Paris, France; 7Diabetes Research Centre, University of Leicester, Leicester, UK
Correspondence: Luigi Meneghini
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A6
The association between achievement of individualized glycemic targets and hypoglycemia risk in the real-world setting is unknown. DUNE was a 12-week, prospective, observational, multinational, real-world study (conducted Feb 2015–Jul 2016) in adults with T2DM newly (at time of enrollment) or recently (< 12 months) initiated on basal insulin (BI) therapy. The study aimed to assess individualized HbA1c target achievement and its association with symptomatic hypoglycemia (occurrence/frequency). Of 3139 evaluable participants, 99.7% were set individual HbA1c targets by their physicians (57% set at 7.0–7.4%). At week 12 both insulin-naïve and prior BI participants showed a mean HbA1c decrease from baseline with limited up-titration of insulin dose (Table); only 28 and 27%, respectively, achieved individual HbA1c targets (Table), with an average insulin dose of 0.31 U/kg/day at week 12. Overall, symptomatic hypoglycemia was reported by 16% of participants. Univariate logistic regression analysis showed a positive association between the occurrence and frequency of symptomatic hypoglycemia and HbA1c target achievement (Table). To conclude, results from this real-world study show that while HbA1c levels fell substantially, most participants did not achieve individual HbA1c targets; participants who reached target were more likely to experience symptomatic hypoglycemia. Study code: OBS13780. This is an ENCORE abstract previously presented at ADA2017. Funding and editorial support provided by Sanofi (Fig. 1).
A7 Action ear acupuncture on glycemic control in people with type 2 diabetes mellitus: systematic review
João Batista Moreira1, Lidiane Aparecida Monteiro2, BIANCA BACELAR DE ASSIS1, THAILA OLIVEIRA ZATITI BRASILEIRO1, Jefferson Felipe Ribeiro1, Denise Hollanda Iunes1, Érika de Cássia Lopes Chaves1
1UNIFAL, Alfenas, Brazil; 2USP Ribeirão Preto, Ribeirão Preto, Brazil
Correspondence: João Batista Moreira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A7
Introduction: Diabetes Mellitus (DM) is a global health problem of the century. It is observed that 90 to 95% of DM cases are of people with Type 2 Diabetes Mellitus (DM2). Complications resulting from this morbidity can be systemic as peripheral. Therapeutic resources such as ear acupuncture have been used for the purpose of maintaining physiological balance and reducing the risks of complications from Diabetes.
Objective: To evaluate the evidence found in the literature on the action ear acupuncture on glycemic control in people with T2DM.
Methods: Systematic review in the databases: PubMed, Web of Science, Cinahl, Cochrane, Scoppus, PEDRo, Science Direct, with keywords: Type 2 Diabetes Mellitus · Auriculotherapy/Type 2 Diabetes Mellitus · Acupressure/Type 2 Diabetes Mellitus · Ear acupuncture; adapted to each base, with the inclusion criteria: experimental works published in the last 10 years.
Results: 79 articles found. After reading the title, 22 articles composed the sample for analysis in its entirety. In the final sample, five studies answered the guiding question and presented the inclusion criteria. These showed ear acupuncture as an effective intervention for glycemic control. Despite this diversity, auriculotherapy can be applied by means of seed techniques (3 studies), with manual stimulation and electrical stimulation in the auricular pavilion (2 studies), both with variable number of sessions.
Conclusion: Treatment protocol varied from and there is no consensus among the experts on the number of sessions, duration of treatment and the points applied.
A8 Action planning and coping planning strategies to improve adherence to oral antidiabetics: a secondary analysis of a randomized controlled trial
Danilo Donizetti Trevisan1, Flávia Helena Pereira2, Thaís Moreira São João1, Marilia Estêvam Cornélio1, Fernanda Freire Jannuzzi3, Roberta Cunha Matheus Rodrigues1, Maria Helena de Melo Lima1
1Universidade Estadual de Campinas, Campinas; Brazil; 2Instituto Federal do Sul de Minas Gerais, Minas Gerais, Brazil; 3Colégio Técnico de Campinas, Campinas, Brazil
Correspondence: Danilo Donizetti Trevisan
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A8
Background: Discontinuation of drug treatment may be considered a common problem in patients with type 2 diabetes mellitus (T2DM) and, consequently, contribute to inadequate glycemic control. A systematic approach to improving adherence consists of: assessing adherence, removing barriers to overcoming them, and finally establishing follow-up plans that confirm the change in planned treatment and the evaluation of their goals.
Aim: To describe action plans related to the behavior of adherence to oral antidiabetic drugs (OADs), developed by patients with type 2 diabetes mellitus in primary care, as well as to identify the perceived barriers and respective coping strategies to effect this behavior.
Method: A cross-sectional study derived from a randomized controlled trial. Individuals (n = 44) who used oral antidiabetics and who had the ability to read and write in Brazilian Portuguese, composed the sample and were invited to elaborate behavioral strategies to improve OADs adherence. Ethics Approval: The study was approved by the University of Campinas’ Ethics Board, approval number 1.278.099/2016, 1.408.883/2016 and 1.528.738/2016 and conducted according to the recommendations of the Declaration of Helsinki.
Results: It was evidenced that 97.7% of the action plans were associated with taking OADs after meals, 36.4% of the participants chose to take OADs in the room, and 45.4% associated them with activities of daily living such as preparing breakfast, brushing teeth and bathing. In daily activities, forgetfulness (21.4%), presence of adverse events (59.1%) and absence of routine (6.1%) were the most prevalent barriers raised by patients. The preparation of daily coping plans, such as leaving the tablets in an easily accessible place (17.3%), eating every three hours (14.3%), drinking 2 L or more of water per day (7.2%) and standardized mealtimes (6.1%) were the coping strategies that were most related to overcome the behavioral failure gap.
Conclusion: Most of the action plans were associated with taking OADs to temporal markers or the wake/sleep cycle. The development of coping planning including day-to-day activities were the strategies that most related to overcoming the behavioral failure gap. These findings provide support for the application of these strategies to promote adherence to drug therapy among patients with T2DM.
A9 Acute coronary syndromes with and without elevation of the st segment in diabetic patients type 2: a 5-year follow-up analysis
Tatiana Siqueira Capucci1, Lais de Oliveira Hernandes1, Mariana Accioly Carrazedo1, Wimbles Pires2, Alihene Barros Colombo Aguilera3, Amanda Bissoli Lopes3, Ariella Gimenes Maschio3, Alex Sandro Souza Almeida3, Caroline Alves Machado3, Felipe Emmanuel Jakymiu3, Ricardo Emidio Navarrete de Toledo4
1Beneficência Portuguesa de São Paulo, São Paulo; Brazil; 2FMU, São Paulo, Brazil; 3IEFAP, UNINGÁ, Maringá, Brazil; 4Beneficência Portuguesa de São Paulo, IEFAP, UNINGÁ, Maringá; Brazil
Correspondence: Tatiana Siqueira Capucci
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A9
Introduction: Acute coronary syndromes (ACS) are associated with increased risk of disability, hospitalization and death in populations, especially in diabetic patients. Type 2 diabetes mellitus (DM2) accounts for 90–95% of all cases of diabetes. It usually occurs in obese individuals and is older than 40 years. Approximately 70–80% of patients with T2DM have a set of factors that implies a high cardiovascular risk (abdominal obesity, dyslipidemia, glucose intolerance or diabetes and arterial hypertension), thus denominating the metabolic syndrome (MS). The dyslipidemia found in patients with MS is highly atherogenic, considerably increasing the cardiovascular risk of these patients, since the combination of these multiple risk factors makes this population a group of patients highly susceptible to cardiovascular diseases (CVD), with a risk up to 3× greater for the event cardiovascular, up to 4x for death by CAD and up to 2.4× for death from any cause. The more components of MS the patient has, the greater the risk of CVD and the presence of MS in patients with pre-existing CVD increases the risk of a new event in these people.
Objective: The objective of this study was to compare the clinical differences, the impact and the characteristics of hospitalizations for Acute Coronary Syndrome (ACS), either acute myocardial infarction without ST-segment elevation (STEMI) or acute myocardial infarction with ST-segment elevation IAMCSST) in type 2 diabetic patients.
Methodology: Retrospective study from the charts of diabetic patients followed up by the Endocrinology Team who were diagnosed with ACS (IAMSSST and IAMCSST) between March/2012 and March/2017. Clinical data included sex, age, main cause of admission, comorbidities, and mean length of hospital stay. Patients hospitalized with other macrovascular causes (cerebrovascular disease and peripheral arterial insufficiency) were excluded. Data are presented in absolute numbers and percentages.
Result: Of the 446 admissions due to macrovascular causes, 86% were due to ACS (n = 384, 73% male and mean age 62.5 ± 12.4 years). The main age group was between 61 and 70 years (59%). The main diagnoses at hospital discharge were: 34% AMI (with/without SST), 57% AI and 9% noncardiac chest pain. The mean hospital stay was 16.8 ± 2.6 days. Overall mortality occurred in 3% (n = 6), occurring only in patients with AMI/AI.
Conclusion: Our data reaffirm the diabetic condition as an independent risk factor for cardiovascular events, being 2 to 3 times greater in males, which are more prone to the development of coronary diseases, being the main cause of hospitalization in this population. These results reinforce the need for a simultaneous intervention between glycemic control and the traditional cardiovascular risk factors, in order to weaken the central determinants involved in the genesis of atherosclerosis.
A10 Acute lowering of circulating fatty acids does not improve the incretin effect in patients with type 2 diabetes
Valeria B Chueire1, Brenno D Astiarraga2, Ricardo Pereira Moreira1, Aglecio L Souza1, Sylka Rodovalho3, Sarah Monte Alegre1, Andrea Tura4, Andrea Mari4, Ele Ferrannini5, Elza Muscelli1
1Unicamp, Campinas, Brazil; 2University of Pisa, Pisa, Italy; 3PUC-Campinas, Campinas, Brazil; 4CNR Institute of Neuroscience, Padua, Italy; 5CNR Institute of Clinical Physiology, Pisa, Italy
Correspondence: Valeria B Chueire
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A10
Background and aims: Plasma glucose is the main stimulus for insulin secretion (IS), but non-esterified fatty acids (NEFA) and the incretin hormones (GLP-1 and GIP) also are important modulators of IS. The incretin effect (IE) accounts for the ~40–80% higher IS after oral ingestion compared to intravenous glucose. Palmitate impairs IE by downregulating GLP-1 receptor signaling in beta-cell lines and isolated mouse islets. Insulin resistance and defective IE are common in T2DM. Thus, increased NEFA levels could impact beta-cell function through an impairment of IE. Our aim was to test whether an acute NEFA reduction induced by acipimox (ACP, a potent inhibitor of lipolysis) improves IE in T2DM.
Materials and Methods: 13 patients (10F/3 M; 54.8 ± 7.6 years, mean ± SD; BMI = 32.8 ± 5.6 kg/m2; HbA1c = 7.24 ± 0.48%) received a 3 h OGTT (75 g) and a 3 h isoglycaemic glucose infusion (IV) on separate days. Both tests were repeated after ACP ingestion (200 mg 2 h before and 1 h after starting glucose). C-peptide deconvolution was used to calculate IS rates; mathematical model to quantitate ß-cell function and IE. Main parameters: insulin secretion rate (ISR); glucose sensitivity (ßGS), i.e., the slope of the IS/glucose dose–response curve; glucose-induced potentiation (PGLU), a time-dependent modulation of the dose–response; incretin-induced potentiation (PINCR) calculated as the fold IS increment during OGTT compared to IV glucose.
Results: On the OGTT, ACP decreased NEFA OGTT-area-under-curve (AUC) by 55 ± 14% (64 ± 28 vs 27 ± 9 mol L−1 h−1, p < 0.01). Fasting glycaemia, OGTT and IV glucose AUCs were similar before and after ACP, while ACP decreased incremental OGTT-glucose AUC (744 ± 163 vs 902 ± 262 mol L−1 3 h−1, p < 0.05). ISR was lower during IV than OGTT both in the control (58 ± 19 vs 70 ± 23 nmol m−2; p < 0.01) and ACP studies (53 ± 15 vs 64 ± 20 nmol m−2; p < 0.01). ACP reduced ISR (64 ± 20 vs 70 ± 23 nmol m−2, p < 0.05) and did not change ßGS (32 ± 11 vs 26 ± 9 pmol min−1 m−2 mM−1), PINCR (1.17 ± 0.14 vs 1.12 ± 0.19 fold), PGLU, plasma glucagon and GIP (all p = ns). In contrast, ACP improved insulin sensitivity, estimated as the oral glucose sensitivity index, OGIS (326 ± 44 vs 291 ± 60 ml min−1 m−2, p < 0.05). Changes in ISR were directly related to changes in NEFA (rho = 0.62, p = 0.03) and inversely related to OGIS (rho = −0.73, p = 0.01).
Conclusion: In patients with type 2 diabetes, acute pharmacological NEFA reduction lowers glycaemia and enhances insulin sensitivity but does not improve the incretin effect.
A11 Acute omega-3 (3) consumption protect mice from visceral adiposity and hyperphagy
Susana Castelo Branco Ramos Nakandakari1, Patricia Brito Rodrigues1, Marcella Ramos Sant‘Ana1, Rafael Calais Gaspar1, Vitor Rosetto Muñoz1, Camilla Bertuzzo Veiga1, Adelino Sanchez Ramos da Silva2, Eduardo Rochete Ropelle1, Leandro Pereira Moura1, José Rodrigo Pauli1, Dennys Esper Cintra1
1UNICAMP, Campinas, Brazil; 2USP, São Paulo, Brazil
Correspondence: Susana Castelo Branco Ramos Nakandakari
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A11
Introduction: The short-term consumption of saturated or unsaturated fatty acids it is enough to change the metabolism. The adipose tissue hypertrophy and dysfunction induced by saturated fatty acids consumption represent strong markers to cardiometabolic risk. On the other hand, omega-3 food sources seems to protect from excess of adiposity, inflammation and hyperphagy.
Objective: The aim of this study was to test the short effects of flaxseed oil, riches in 3, against high-fat diet disturbances in adipose visceral tissues.
Materials and methods: Animals C57BL6 J, 4 weeks old, were distributed in 3 groups (N = 6 each), maintained during 3 days under specific diets: control diet (CTL—4% soy oil), High-fat diet (HFD—35% lard), and High-fat diet with 10% of flaxseed oil in substitution of lard (FS—25% from lard). It was carried out food intake, fasting glucose, body weight gain, metabolic and physiological parameters, lipidomics and histopathological analysis.
Results: On the 1st., the food intake significantly increased in the HFD group compared to CTL (P < 0.05) while in the last day (3rd day), there was a significant increase in the HFD group, compared to FS (P < 0.05). FS diet did not protected mice from weight gain in comparison to HFD group. However, surprisingly, the total fat depots in mesenteric adipose tissue from FS group was smaller than HFD group (P < 0.05), and the difference between HFD and CTL group on mesenteric, epididymal and retroperitoneal tissues was extremely significant (P < 0.001). Interestingly, the 3 fatty acid (C18:3 α-linolenic) bioavailability was confirmed by lipidomics, through its incorporation into adipose tissues from FS group in comparison to HFD group (P < 0.001). In addition, FS oil replaced diet was able to restore 6:3 balance (5:1), even under high fat conditions, when compared to HFD group (14:1).
Conclusion: Therefore, acutely high-fat diet consumption was able to impair several metabolic parameters, while 3 fatty acid sources can protect against these damages. We believe that the sporadic imbalances on diet is not a risk for metabolic diseases. However, changes in the food pattern influenced by western diet, and the continuous consume of high-fat meals con be harmful and determinant to the dysmetabolism (Fig. 1).
A12 Acute response to high intensity intermittent exercise in children and adolescents with type 1 diabetes
Andreia Araújo Porchat de Leão1, Valderi Abreu de Lima1, Juliana Pereira Décimo1, Camilla Kapp Fritz1, Marcia Regina Messaggi Gomes Dias1, Neiva Leite1, Suzana Nesi França1, Luis Paulo Mascarenhas2
1Universidade Federal do Paraná, Paraná, Brazil; 2Universidade Estadual do Centro-oeste, Paraná, Brazil
Correspondence: Andreia Araújo Porchat de Leão
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A12
Introduction: The risk of hypoglycemia during and after exercise is a limiting factor to regular exercise in patients with type 1 diabetes. Studies related to intermittent exercise, characteristic of most sports and games, present contradictory results regarding glycemic responses and the risk of hypoglycemia induced by exercise.
Objective: The objective of this study was to evaluate the influence of intermittent high intensity exercise on the glucose response of children and adolescents with type 1 diabetes, related to the insulin application schedule.
Materials and Methods: Participated in the study 30 patients with type 1 diabetes mellitus, Z score of BMI 0.13 ± 0.93; Chronological age 13.09 ± 1.90; duration of disease 6.47 ± 3.77; Concentration of HbA1c 9.69 ± 1.56%. The patients had a standardized meal and insulin application was performed in the clinic (mean basal insulin 25.75 ± 8.47 U/kg/d and fast acting insulin 17.31 ± 11.35 U/kg/d). Two tests were performed in cycle ergometer, intensity of 60% VO2max, interspersed by five high-intensity sprints every 5 min, tests were performed one and 2 h after the application of insulin (T1 h and T2 h). Blood glucose was assessed at the beginning and at the end of the tests and for 8 h after the end of the tests using the continuous glucose monitor (MCG).
Results: Pre-and post-test glycemic variation was higher in T2 h (−30.66 mg/dl) than in T1 h (−19.78 mg/dl, p = 0.007). There was a significant difference between the mean number of occurrences of hypoglycemia in the 8 h following the tests (p = 0.017). The hypoglycemic odds ratio showed a higher odds ratio for hypoglycaemia after exercise and up to 8 h after insulin administration (OR: 37.94% CI 9.30–15.75).
Conclusion: According to the results of this study, the practice of intermittent high-intensity exercises performed 1 h after insulin and feeding showed a lower risk of hypoglycemia in the following 8 h compared to the exercises performed 2 h later. Ethics Approval The study was approved by Ethics Committee on Human Research at Hospital de Clínicas, UFPR, CAAE 44193214.7.0000.0096 with opinion number 1,101.60. (Fig. 1).
A13 Adhesion to the autocare for patients with diabetes mellitus in a public hospital
Patrícia Veras Tavares, Lilian Barros de Sousa Moreira Reis
Hospital Regional da Asa Norte-Hran, Brasília, Brazil
Correspondence: Patrícia Veras Tavares
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A13
Introduction: The evaluation of the autocare in patients with diabetes mellitus has as checking finality if the patients put in practice the directions that they receive of the health professionals to reach a better control glicêmico and lipídico, to maintain the appropriate weight and to obstruct or to delay complications resulting from the disease.
Objective: This study aimed to value the autocare of the patient at the next dimensions: general food, specific food, physical activity, monitorização of the glicemia, care with the feet, use of the medication and the practice of the tobaccoism.
Method: Cross study carried out in a public hospital of Brasilia, DF—in the period from 12th of January till 21st of May of 2016. The sample was composed by 100 patients with DM1 and DM2, both sexes, ages between 18 and 64 years attended in the outpatient department of endocrinologia of this hospital more than a year ago. A validated questionnaire was applied, QAD—Questionnaire of Activity of Autocare with Diabetes.
Resulted: The care with to the food was satisfactory with reduced consumption of sweets and fats in the diet; the practice of physical activity between the participants of this sample was low. The use of prescribed medicines and direction as for the care they was with the feet that they had bigger adhesion as the patients. Regarding tobaccoism practice, 41% of the interviewed ones said to have smoked in some phase of the life, nevertheless, in the moment of the inquiry, only 6% maintains the habit.
Conclusion: This study reinforces the importance of the autocare for control and prevention of the complications of diabetes mellitus (Fig. 1).
A14 Adverse perinatal outcomes of diabetic pregnant women treated with metformin in a tertiary hospital between 2009 and 2016
Tabita Furukita Thomazini, Penelope Tabatinga Castro, Adriano Roberto Manoel Radin, Juliana Rodrigues de Paula, Beatriz Graciano Sant‘anna, Claudio Capuano, Wagner Rodrigo Brida Gonçalves, Ji Hoon Yang, Daniela Yone Veiga Iguchi, Leila Guastapaglia
HSPM, São Paulo, Brazil
Correspondence: Tabita Furukita Thomazini
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A14
Background: Diabetes mellitus (DM) is the main endocrinopathy in pregnancy and its treatment aims to reach an adequate maternal glycemic control and reduce the adverse perinatal outcomes. The classic treatment is diet (D), physical activity (PA) and insulin (I), the last one associated to hypoglycemia and weight gain. On the other hand, metformin (MTF) does not lead to hypoglycemia neither weight gain. However, there are limited data regarding the use of metformin during pregnancy.
Goals: The aim of the study was to retrospectively analyze the impact of the glycemic control on perinatal outcomes of the diabetic pregnant women who received MTF, alone or associated with insulin, and to compare the results with those on conventional treatment.
Methods: We analyzed the medical records of the diabetic pregnant women who were attended at the Endocrinology Clinic of Hospital do Servidor Público Municipal between 2009 and 2016. The incidence of fetal macrosomia, prematurity, respiratory distress, hospitalization in intensive care unit and abortion were analyzed and correlated to the glycemic control. Good glycemic control was defined by the presence of at least 80% of capillary blood glucose within the following range: pre-prandial < 90 mg/dL, 1 h postprandial < 140 mg/dL, 2 h postprandial < 120 mg/dL
Results: 98 pregnant women were evaluated and divided into four groups: D + PA (n = 27), D + PA + I (n = 33); D + PA + MTF (n = 12); and D + PA + MTF + I (n = 26). The mean age of the patients was 34.9 years old, which was similar between the four groups. In the group D + PA, 3/27 women had adverse outcomes. Two (67%) of them had poor glycemic control. In the group D + PA + I, 8/33 pregnant women presented adverse perinatal outcomes. Of these, three (37.5%) were poorly controlled. In the D + PA + MTF group, 5/12 pregnant women had adverse outcomes, of which four (80%) had poor glycemic controls. Finally, in the group who received D + PA + MTF + I, 9/26 had adverse outcomes and of these, eight (89%), had inadequate glycemic control (Fig. 1).
A15 Air pollution participates in the genesis of obesity through the activation of hypotalamic TLR4
Clara Machado Campolim1, Clílton Kraüss de Oliveira Ferreira1, Vitor Ferreira Boico1, Olívia Pizetta Zordão1, Daisuke Hayashi Neto1, Mariana Matera Veras2, Patricia Oliveira Prada1
1UNICAMP, Campinas, Brazil; 2USP, São Paulo, Brazil
Correspondence: Clara Machado Campolim
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A15
Background: Exposure to air pollution has unfavorable cardiometabolic effects. Particulate matter 2.5 (PM2.5) is associated with the induction of chronic inflammation in many tissues. Leptin signaling in the hypothalamus participates in the maintenance of energy homeostasis. Leptin resistance may occur due to hypothalamic low grade inflammation in obese models. One of the mechanisms that triggers the low grade inflammation is the activation of toll-like receptor 4 (TLR4) pathway by lipopolysaccharide (LPS), which is one of the components of MP2.5.
Objectives: Therefore, the aims of the present study are to investigate: 1) TLR4 gene expression in the hypothalamus of C57BL/6 J mice (C57) exposed to PM2.5 (polluted) compared to C57 exposed to filtered air (FA); 2) the changes in weight gain, energy intake and energy expenditure (respirometry), glucose tolerance (GTT) and insulin tolerance (ITT) in TLR4- knockout mice (TLR4KO) exposed to PM2.5 or FA.
Materials and methods: 6 weeks-old male mice were exposed to PM2.5/FA in the Harvard Ambient Fine Particles Concentrator at University of Sao Paulo during 3 months. All mice received standard diet (Nuvilab®) and potable water ad libtum. After this period, part of these mice was submitted to intraperitoneal leptin sensitivity protocol, which consisted of daily injections of leptin for 2 days followed by saline injections for 3 days. During this protocol, body weight and food intake were measured daily. Another part of the mice underwent to glucose and insulin tolerance tests (GTT and ITT) made in different weeks. At the end of all in vivo experiments, mice were killed for tissues dissections after intraperitoneal leptin or saline stimulation. Hypothalamus and epididymal adipose tissue were collected and kept under −80 °C.
Results: As a result, it was observed that the polluted C57 mice had increased body weight, adipose mass and serum insulin concentration. The GTT and ITT were altered in the polluted C57 compared to C57 FA. There was no difference on food intake between groups; however, the oxygen consumption was significantly lower in polluted C57 compared to FA mice, suggesting lower energy expenditure in this group. Leptin resistance in the hypothalamus was observed in the polluted C57 mice compared to FA mice, because body weight and food intake in response to leptin only decrease in the FA C57 mice. TLR4 gene expression levels were elevated in the hypothalamus of polluted C57 mice. The TLR4KO exposed to MP2.5 did not present changes in body weight or adipose mass and hypothalamic leptin sensitivity was similar to FA C57 mice. In addition, GTT and ITT were similar between polluted TLRKO and FA C57 mice.
Conclusion: Together, the data suggest that the air pollution participates in the genesis of obesity, insulin resistance and glucose intolerance. The increase of adiposity was due, at least in part, to the reduction of energy expenditure. Hypothalamic inflammatory pathways may be involved in leptin resistance induced by air pollution, because the TLR4 deletion protected the animal from obesity, insulin resistance and glucose intolerance.
A16 Albuminuria reduction after high dose of vitamin D in patients with type 1 diabetes mellitus: a pilot study
João Soares Felício1, João Felício Abrahão Neto2, Manuela Nascimento de Lemos1, Fabrício de Souza Resende1, Lorena Margalho Sousa1, Fernando Costa Araújo1, Luciana Marques da Costa1, Lorena Regina Velasco Guimarães Silva1, Ana Carolina Contente Braga de Souza1, Franciane Trindade Cunha de Melo1, Marcia Costa dos Santos1, Amanda Soares Peixoto1, Alana Ferreira de Oliveira1, Natércia Neves Marques de Queiroz1, Luísa Corrêa Janaú2, Isabela Imbelloni Farias de Franco1, Karem Miléo Felício1
1Universidade Federal do Pará, Pará, Brazil; 2Universidade do Estado do Pará, Pará, Brazil
Correspondence: João Soares Felício
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A16
Background: Some studies suggest an association between diabetic kidney disease (DKD) and vitamin D (VD), but there is no data about the effect of high dose of VD on DKD in type 1 diabetes mellitus (T1DM). Our pilot study aims to evaluate albuminuria reduction in patients with T1DM supplemented with high dose of VD.
Methods: 22 patients received doses of 4000 and 10000 IU/day of cholecalciferol for 12 weeks according to patient’s previous VD levels. They were submitted to continuous glucose monitoring system (CGMS), 24-h ABPM and urine albumin-to-creatinine ratio (UACR) before and after VD supplementation.
Results: There was a reduction of DKD prevalence at the end of the study (68 vs 32%; p = 0.05), with no changes on insulin doses, HbA1c, glycemic variability (GV) and blood pressure (BP) values. A correlation between percentage variation of VD levels (∆VD) and albuminuria at the end of the study was presented (r = −0.5; p < 0.05). Among T1DM patients with DKD at the beginning of the study, 8/13 (62%) had their DKD stage improved, while the other five ones (38%) showed no changes (p < 0.05).
Conclusions: Our pilot study suggests an association between VD high dose supplementation, lower prevalence and improvement in stages of DKD in T1DM.
A17 Allergy to insulin: case report
Jessica Tatiana Mendoza Peña, Davi Francisco Machado, Janaina Petenuci, Egle Bastos Targino Puppim, Karen Viviana ivasiuten Gorejko, Patricia Borges, Diego Santos Rocha, Thais Braga Meira, Mara Barbosa Gayoso, Rosane Kupfer
IEDE-Instituto Estadual de Diabetes e Endocrinologia, Rio de Janeiro, Brazil
Correspondence: Jessica Tatiana Mendoza Peña
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A17
Introduction: Allergy to human insulin or its analogues is rare. No effective strategy has been found yet. The incidence is estimated between 1 and 2.4% on insulin-treated patients. Reactions range from local signs to anaphylaxis. Individuals may be allergic to the insulin molecule itself or to pharmaceutical excipients such as protamine, zinc or metacresol. A defective injection technique (intradermal application) facilitates the development of such reactions. The underlying mechanisms of allergy may be type I (IgE-mediated), type III (IgGmediated immune complex) and type IV (T cell-mediated late-type hypersensitivity). Epidermal Langerhans cells carry a foreign antigen to T lymphocytes and perform a key role on the beggining of cutaneous immune responses and responses to chemical allergens found on the surface of the skin.
Case report: Patient 55 years old, fem, DM2 for 4 years, in the use of 2 sulfonylureas (SUs)at the same time and NPH insulin, came to our hospital. She denied allergies. SUs were suspended. Metformin was introduced and adjusted to be used with insulin. Ten days later she returned presenting erythema and pruritus at the site of insulin application, that had no improvement with antihistamine drugs nor taking off technique application error and there was an itchy maculopapular rash after 10 min around the injection spot, the same being observed after switching to another Insulin (Detemir). IgE antibody specific for insulin was positive. Insulin was suspended and started SGLT2 inhibitor together with DDP4 inhibitor, and submitted to desensitization protocol according to scheme Pföhler et al. In a new insulin test 3 months later, the skin reaction was again presented.
Discussion: The frequency of allergic reactions to insulin has decreased significantly since the introduction of the recombinant human form and it´s analogues. The hypersensitivity reactions are now generally due to the presence of various additives of pharmaceutical formulas. Treatments go from the use of antihistamines drugs to desensitization therapy. Systemic corticosteroids can be used as long as attention is paid to glycemic control. Changing Insulin could be effective because of little differences in amino acid sequences and their antigenicities. Initially, the patient presented with a good response to desensitization, although presented recurrence before the end of the protocol. The availability of oral treatments allowed the control without the use of insulin at this time.
Informed consent to publish had been obtained from the patient.
A18 Analysis of anthropometric parameters in patients with type 2 diabetes at a university hospital in Belém, PA
Aline da Silva Cota, Adrielle Aguiar de Carvalho, Elenilce Pereira de Carvalho, Fernanda Oliveira Serrão, Naiza Nayla Bandeira de Sá, Ana Beatriz Praia Ribeiro, Letícia Ribeiro das Chaves
UFPA, Pará, Brazil
Correspondence: Aline da Silva Cota
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A18
Introduction: Diabetes mellitus (DM) is considered a progressive metabolic disease. Several factors may contribute to the aggravation of this disease, such as overweight and visceral fat accumulation. It is well known that some visceral fat assessment methods could be complex and expensive. But, since waist circumference (WC) correlates directly with the amount of visceral fat, it can be used as a useful alternative method of measurement. Besides that, when WC results are compared to the body mass index (BMI) ones, a better evaluation of metabolic and cardiovascular risk is performed.
Objective: To analyze the nutritional status of diabetic patients by using anthropometric measurements.
Methods: A cross-sectional, quantitative and descriptive study was carried out with type 2 diabetic patients hospitalized in a university hospital, located in the city of Belém, State of Pará, Brazil, in a period of April to July 2016. Patients were asked about socioeconomic issues and were performed some anthropometric assessments (BMI and WC). Optimal WC cut-offs were 80 cm and 94 cm, in men and women. While for BMI the cut off used was 18.5 to less than 25 kg/m2. All the patients understood and accepted the Informed Consent Term (ICT).
Results: Fifty-five patients with type 2 DM were interviewed. Most of them were females (54.55%) with ages ranging from 32 to 78 years (mean: 61 ± 9.75 years). The mean time of diagnosis was 15 ± 10 years. Regarding the level of education, it was noted that most of the diabetic patients had only incomplete elementary schooling (81.81%). This might contributed to a low adherence to treatment. In the present study, it was found that the frequency of overweight (BMI ≥ 25 kg/m2) was high (41.8%), often resulting from a sedentary lifestyle and a high consumption of processed foods. Waist circumference analyzes showed an elevated risk of metabolic alterations in both women (93.33%) and men (52%), demonstrating the impact of this measurement on the occurrence and progression of diabetes.
Conclusion: Most of the patients had elevated WC and almost half had overweight. This condition of body fat accumulation in patients with type 2 DM is cause of concern, since it is a factor that impairs the metabolic control. This contributes to the appearance of chronic complications of diabetes. The role of nutritional therapy aims to introduce and sensitize the patient to having healthy living habits that provide a better quality of life.
A19 Analysis of brazilian videos about diabetic neuropathy shared on youtube
Gabriela de Araújo Nominato, Grayce Kelly Cristina Costa dos Santos, Lucas Gabriel de Siqueira, Ana Paula Nunes Nogueira, Edson da Silva
UFVJM, Minas Gerais, Brazil
Correspondence: Gabriela de Araújo Nominato
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A19
Background: There are numerous tools, social networking platforms and sites that share information. Studies highlight the importance of YouTube as a source of useful information about some diseases, including Diabetes Mellitus (DM). However, no study has evaluated YouTube‘s use in Brazil as a source of information on diabetic neuropathy. This term is used to describe a group of manifestations characterized by the presence of symptoms and/or signs of peripheral and autonomic nerve dysfunction in people with DM after the exclusion of other causes.
Objective: In this study, our aim was to research the source and audience of videos on YouTube Brazil regarding diabetic neuropathy.
Materials and methods: The Web site (www.youtube.com) was searched on May 16, 2017, for the associated terms “diabetic neuropathy,” “neuropathy treatment,” and “neuropathy complications.” The videos of greater than 30-min duration, without audio, not recorded in Brazilian Portuguese language and those not related to the focus were excluded. Were included the videos associated with the terms and available on the rst 10 pages (200 videos) of search results. The videos were analyzed independently by G.N. and G.S. Were recorded the following parameters for all videos: the upload date, number of views, duration, “likes,” “dislikes”, and comments. The video sources were categorized into 4 groups: organizational, professional, personal and advertisement. Approval by the ethics committee was not required, since YouTube search is not directly involved with humans using public domain material.
Results: Our search resulted in a total of 346 videos, of which 200 were pre-selected, and 34 analyzed. The 34 videos analyzed were published between 2007 and 2016, and presented the following metrics: 308,693 views; 1,464 “likes”; 93 “dislikes”; 46 comments; and total duration of 4 h, 33 min and 56 s. The video source revealed the following classification: organizational, n = 19; professional, n = 10; personal, n = 5; and advertisement, n = 0.
Conclusion: It was evidenced that YouTube in Brazil is little used in both the availability and the search for information about diabetic neuropathy. So, we should admit its educational potential to be explored. There was greater contribution of health organizations and health professionals in the elaboration of the videos. However, videos not related to the theme predominated, which could to appoint, a risk of sharing inaccurate or misleading information about the diabetic neuropathy. Studies will be needed to analyze the quality of content about diabetic neuropathy presented on YouTube videos in Brazil. The authors are grateful to the CNPq, FAPEMIG and UFVJM for the support.
A20 Analysis of the blue friday campaign elaborated in a diabetes education social network
Edson da Silva1, Gabriela de Araújo Nominato1, Elenice dos Santos Paula1, Marileila Marques Toledo1, Yara Gomes Pena1, Lorena Kelly Babetto Amaral1, Jéssica Samara Oliveira Tolomeu2, Lucas Gabriel de Siqueira1, Luciana de Freitas Campos1
1UFVJM, Minas Gerais; Brazil; 2Secretaria Municipal de Saúde de Diamantina, Minas Gerais; Brazil
Correspondence: Edson da Silva
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A20
Background: The Blue Friday initiative was created by Cherise Shockley after being diagnosed with Diabetes Mellitus (DM). Nowadays, Blue Friday is a campaign of the International Diabetes Federation (IDF) with support from several institutions, including the Brazilian Society of Diabetes. Its purpose is to make people aware of the importance of bringing everyone together for the prevention and control of DM.
Objectives: This research aimed to analyze actions of the Blue Friday Campaign conducted in the Fanpage Diabetes Diamantina (FDD) during the year 2016.
Materials and methods: This study analyzed the number of individuals reached by a Blue Friday Campaign. The Diabetes Study Group of the Federal University of the Jequitinhonha and Mucuri Valleys (UFVJM) promoted the campaign during 30 weeks, between April and November 2016. Photographs from 26 Brazilian States and the Federal District were captured with a Sony Digital Camera. Thirty digital images of tourist spots in the Brazilian States containing some reference in the blue color were selected and edited using the software Microsoft Office PowerPoint®. Thus, all digital images received the slogan of World Diabetes Day 2016: ‘Eyes on Diabetes’. The slogan was originally written in English and translated into Portuguese. Messages were complemented by several descriptions about DM in Portuguese, English and Spanish to be posted online in the FDD. To identify general data with publication metrics, two researchers accessed the Facebook database. Numbers of ‘likes’, ‘shares’ and ‘total reach’ of people who saw the publications during all campaign time were analyzed.
Results: The data revealed an expressive virtual public involvement throughout the campaign. The total reach, numbers of ‘like” and ‘share’ publications increased over the months. At the end of the Blue Friday Campaign 2016 the postings reached 73,722 views in Brazil and in others more than 40 countries; 3,520 likes and 2,197 shares.
Conclusion: The total range of people who shared the images in FDD was high. The content possibly informed and/or sensitized many people around the world about the great importance of DM nowadays. In addition, the use of Brazilian tourist spots images attracted the virtual interaction of the people each other and an involvement with the campaign theme. Thus, the use of this social network as a complementary tool for educational actions in favor of DM was relevant in this research. However, future studies are needed, in order to understand the impact of this kind of virtual campaign about DM education.
Acknowledgements: The authors are grateful to the CNPq, FAPEMIG and Proexc/UFVJM for the support.
A21 Analysis of the ophthalmoscopy examination in people with diabetes mellitus from a program of health promotion in the amazon
Jéssica Gomes da Silva, Francineide Pereira da Silva Pena, Rafael Pinto da Silva, Maria Silvia da Costa Silva, Sônia Silva Alves, Gabriela de Souza Amanajás, Jessica Monteiro Cunha, Ediene Stherfany Marques Vale, Adriane Stefanny Rocha Ribeiro, Danielle Cardoso Portilho, Amiraldo Dias Gama, Tallitha Barbosa da Luz, Emanuel de Jesus Vaz Bittencourt, Diego Quaresma Ferreira, Angel Tamna Souza de Souza
UNIFAP, Amapá, Brazil
Correspondence: Jéssica Gomes da Silva
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A21
Introduction: Retinopathy is the third cause of blindness in adults in Brazil, and it is the major one among people of productive age (16–64 years). It is also one of the most common complications of Diabetes Mellitus (DM) being found after 20 years of DM analysis, 90% of diagnosis being type 1 and 50–80% type 2 and the growth of life expectancy of the patients is greatly increasing the incidences (Aragon, 2013).
Objective: Evaluate eye health of participants of a health promotion program for people with Diabetes Mellitus in the Amazon.
Method: Descriptive study of quantitative approach. The data gathering was made through analysis of fundoscopy results. Participation in the program was the inclusion criterion used for the development of the study. The study was approved by the Ethics and Research Committee (Comitê de Ética e Pesquisa) (CEP) of the Federal University of Amapá (Universidade Federal do Amapá), under Postal Code/CEP: 900.066/2015.
Results: Twenty-one (21) clinical examinations were analyzed, the majority of participants were female (76.1%); male (23.8%) (Table 1). Description of the results analysis: MACULA: brightness, 15 people (71.4%), low brightness, 2 people (9.5%) and no brightness 1 person (4.76%) and with no evaluation of the macula 2 people (9.5%). OPTIC DISC WITH CUPPING: 0.2 (19%), 0.3 (19%), 0.4 (23.8%), physiological (14.2%) and no result (23.8%). VESSELS: normal (61.9%), slight tortuous (4.7%), tortuous (4.7%), no vessel evaluation (23.8%). CONTOUR: preserved (42.8%), regular (19%), no result (38%). DIAGNOSES: Glaucoma, 1 person (4.7%), Cataract, 5 people (23.8%); Diabetic Retinopathy: mild, 1 person (4.7%), severe 1 person (4.7%); Hypertensive retinopathy, 1 person (4.7%), Asteroid Hyalitis, 1 person (4.7%); Pterygium 1 person (4.7%) (Table 2)
Conclusion: The analysis of the data showed that most of the participants presented good ocular health; it may be related to the satisfactory adherence to the DM treatment, stimulated by the health actions developed in the Program for the Promotion of Diabetic Health in the Amazon (Programa de Promoção à Saúde dos Diabéticos na Amazônia). However, programmed assessment of visual function for the detection of ophthalmological changes and early diagnosis of visual complications in the diabetic population is important for the prevention of major diseases, especially blindness. For Nursing, it provides the elaboration of a plan of care that adapts to the lifestyle and limitations of the patient, in order to provide a better quality of life and active participation in their own care (Fig. 1).
A22 Analysis of the profile, indication and metabolic and social impact of the use of continuous insulin infusion system in young patients, with type 1 diabetes mellitus
Nathalia Liberatoscioli Menezes de Andrade1, Jesselina Haber1, Rafael S A Haber2, Victor Cabral2, Heloisa Cerqueira Cesar Villar1
1FAMEMA, Marília, Brazil; 2UNIMAR, Marília, Brazil
Correspondence: Nathalia Liberatoscioli Menezes de Andrade
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A22
Introduction: Severe hypoglycemia, multiple admissions, glycemic variability and poor adherence to treatment are some of the problems that young patients with type 1 diabetes mellitus (DM1) face during disease progression. The continuous system of insulin infusion (CSII), when indicated, becomes a technological allied helping to obtain glycemic control and reduction of complications in young people, who often face the diagnosis in early childhood.
Objective: To evaluate the profile, indication and the metabolic and social impact of CSII use in young patients with DM1.
Method: Retrospective cohort of patients with DM1, attended at the Diabetes Mellitus outpatient clinic of the Hospital das Clínicas, Faculdade de Medicina de Marília, CSII users.
Results: 22 patients (64% male, 82% white), with 15.5 ± 7.3 years; 10.3 ± 6.77 years of disease evolution; started using CSII with 11.9 ± 6.55 and 6.91 ± 5.2 years diagnostic time. The pump used by all patients was Medtronic® and 13.63% associated with continuous monitoring. Hypoglycemia was the indication in 72.72%, followed by other causes: pregnancy, depression (18.18%), frequent diabetic ketoacidoses (4.54%). The average glycosylated hemoglobin (HBA1c) before and after the pump was 8.86 and 8.06%, respectively. There was a reduction in the frequency of severe hypoglycemia of 50% in the pre-use period of CSII to 13.6% after use. Prior to the use of the pump, we found 22.7% of hypoglycemic convulsions and 22.7% of diabetic ketoacidosis. No episodes with CSII were observed. The percentage of the basal insulin dose was 71% pre-pump and 49% post-pump. The mean total insulin dose at multiple doses was 1.05 Ui/kg/day and after CSII; 0.89 Ui/Kg/day. The improvement in the quality of life was reported in 100% of the patients.
Conclusion: All patients presented improvement in quality of life, reduced frequency of severe hypoglycaemia and/or diabetic ketoacidosis. There was a better distribution of the infused insulin, with an improvement in the ratio between basal insulin and bolus, associated with a slight reduction in the average total insulin dose. However, there was no significant reduction in HbA1C levels. Data suggest that even with the difficulty in glycemic control, it is possible to improve patients adherence to therapy and reduce serious health damage, as well as expenses with prolonged hospitalizations. Informed consent to publish has been obtained from this patients or family.
A23 Ancestry and health-related quality of life in type 1 diabetes: a nationwide study in Brazil
Deborah Conte Santos, Marcela Haas Pizarro, Bianca Senger Vasconcelos Barros, Laura Gomes Nunes de Melo, Marilia Brito Gomes
UERJ, Rio de Janeiro, Brazil
Correspondence: Deborah Conte Santos
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A23
Type 1 diabetes patients have reduced Health-related Quality of Life (HRQoL) compared with general population. Recent study in an aging population of a small city in Brazil showed influence of African ancestry in self-reported health status. The aim of the present study was to evaluate the relationship between self-reported color/race and genomic ancestry with HRQoL of patients with type 1 diabetes in a highly admixed population. This was a nationwide, cross-sectional study conducted with 1,760 patients with type 1 diabetes from 2011 to 2014 at public clinics in all five Brazilian geographical regions. Information on HRQoL was obtained from two self-completed questionnaires: Short Form-6 Dimensions (SF-6D) and EuroQol-5 Dimensions (EQ-5D) with a visual analogue scale (EQ-VAS). Genomic ancestry was assessed using a Multiplex PCR methodology. Utility scores generated from the questionnaires were analyzed with multivariate logistic regression models. We included 1,698 patients. Those patients who self-reported as black had lower EQ-VAS scores compared to the patients who self-reported as white, (67.46 ± 18.45; 72.37 ± 16.44, respectively, p = 0.02). In a linear regression model, each 1% increase in African ancestry resulted in a 9.5 point decrease in EQ-VAS score (p < 0.001). In a multivariate logistic regression, after adjusting for demographic, socioeconomic status and diabetes-related variables, African ancestry remained associated with lower EQ-VAS scores. Other variables responsible for a decrease in EQ-VAS values were: female gender, higher economic status, higher HbA1c, presence of microvascular complication, sedentary lifestyle and overweight/obesity status. In conclusion, this was the first study to demonstrate that ancestry influenced HRQoL in patients with type 1 diabetes. A higher level of African ancestry implicates on lower quality of life even after adjustments for sociodemographic and diabetes-related data. This highlights the importance of social aspects such as ethnicity in diabetes management and highlights the need for psychosocial and economic actions to mitigate those differences and improve the quality of life of patients.
A24 Ankle-arm index related to the diabetes mellitus diagnosis time
Jessica Monteiro Cunha, Sônia Silva Alves, Francineide Pereira da Silva Pena, Rafael Pinto da Silva, Jessica Gomes da Silva, Danielle Cardoso Portilho, Gabriela de Souza Amanajás, Tallitha Barbosa da Luz, Diego Quaresma Ferreira, Emanuel de Jesus Vaz Bittencourt, Amiraldo Dias Gama, Maria Silvia da Costa Silva, Angel Tamna Souza de Souza, Ediene Stherfany Marques Vale, Adriane Stefanny Rocha Ribeiro
UNIFAP, Amapá, Brazil
Correspondence: Jessica Monteiro Cunha
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A24
Introduction: Type 2 diabetes mellitus (DM2) causes degenerative complications that generate human, social and economic repercussions, resulting in a major public health problem. Among the complications are the lesions in target organs, such as retinopathy, nephropathy, acceleration of atherosclerosis along with increased risk of myocardial infarction, or stroke, and those affecting the feet, which are more frequent (Junior et al. 2014).
Objective: To verify the relation of the index values in Ankle-Arm (ITB) with the time of diagnosis of DM II, with patients from a group of chronic diseases.
Method: A cross-sectional, descriptive study of a quantitative approach, carried out with participants of a Health Promotion Program for People with Diabetes Mellitus in the Amazon, from March to June 2017. The data was collected from the patients‘records between the years 2015 and 2017, with 29 patients. The Ethics and Research Committee (Comitê de Ética e Pesquisa) (CEP) approved the study of the Federal University of Amapá (Universidade Federal do Amapá), with Postal Code/CEP number: 518.389/2013.
Results: It was found that (89.7%) of the patients were female and (10.3%) were male (Table 1). In relation to ITB and MD II diagnosis time, (27.6%) were diagnosed at less than five years and had a mean ITB value of 1.04 mmHg in the lower right limb (MID) and 1,02 mmHg in the left lower limb (MIE); (37.9%) had a diagnosis of five to ten years and presented a mean ABI value of 1.07 mmHg in the MID and 1.00 mmHg in the MIE; and (34.5%) had more than 10 years of diagnosis and had a mean ABI of 0.91 mmHg in the MID and 0.94 mmHg in the MIE (Table 2).
Conclusion: It was found that all people with DM had the results indicating ITB within the values considered normal in the literature (0.91–1.30 mmHg), even with the variation of the diagnosis time of DM 2. Thus, that indicates ITB is an indicative as a method of early diagnosis of cardiovascular events and in the diagnosis of Peripheral Arterial Disease (PAD), which are frequent events in people with diabetes and directly related to the time of diagnosis of the disease. We also stress the importance of health promotion measures focused on this population, such as this program, which stimulates self-care, increase the practice of physical activities and the adoption of healthy eating habits is emphasized in this research. Starting from educational practices that can intervene in a satisfactory and continuous way in the course of the disease, seeking to minimize the complications and promoting the quality of life of this population (Fig. 1).
A25 Anti‐gad positive syndrome (stiff‐man): a 9‐years‐case report of treatment, evolution and a review
José Francisco de Camargo Carmello1, Acary Souza Bulle Oliveira2
1Hospital Alemão Osvaldo Cruz, São Paulo, Brazil; 2UNIFESP, São Paulo, Brazil
Correspondence: José Francisco de Camargo Carmello
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A25
Case: 66 years, male, white, engineer, type 1 DM (T1D)‐LADA (24 years ago) + AntiGAD neurological syndrome (Stiff-man-SPS) 9 years 4 months, all time Anti‐GAD +> 60 U/mL, progressive psychomotor agitation, cognitive loss (recent‐memory‐language) (Fig. 1). Firstly he used orally: aminotriptyline 75 mg/d‐bd, gabapentin 600 mg/d‐bd, hydantal 200 mg/d‐bd, diazepan 40 mg/d/4x, flurazepan 30 mg and muscle‐relaxant baclofen 30 mg/day/3x. IV Infusion/month: cyclophosphamide 14.29 mg/kg (3 cycles), IV‐immunoglobulin 2 g/kg‐w/m2 (30 cycles). Later, he used smaller doses by interval/dose adjustments: Nowadays(cycle60) use IV‐immunoglobulin 0.68 g/kg/3 m hospitalized. Oral drug was decreased with clinical improvement, Diazepan and Baclofen has equal dosis. Glycated hemoglobin (HBG) was < 6.5% up to 7 years evolution, despite dexamethasone use (Fig. 2). After presenting progressive psychomotor‐agitation and cognitive‐impairment antidepressants and antipsychotics were prescribed. After HBG = 12 he used 24 h nursing for T1D control.
Discussion: Stiff‐person (SPS) is a rare neurological disease (1:1,000,000–1:2,000,000 ihb/year) fistly described in 1956.Pubmed‐search as cognitive deficit + SPS = 10 articles, 5 case‐reports, one patient had all the AntiGAD‐stiff-person spectrum disorders described (SPSD).Epitopes recognized by SPSD‐anti‐GAD65 differ from T1D. It’s been described T‐lymphocyte‐infiltration in the medulla. In T1D‐LADA freq 1:10,000. In Central Nervous System (CNS), anti‐GAD65 blocks inhibitory GABAergic‐neurons. This deficit has been related to tetanus‐toxin‐sign, schizophrenia, and tetany of SPS, the agitation‐cognitive alteration of SPSD, confused as psychiatric. One article revises the treatment of SPS‐SPSD, maintaining the IV‐immunoglobulins (Dalakas MC validated A‐1‐double blind), stimulating‐GABA‐neurons: Benzodiazepines and Baclofen as an improved treatment. Two review the physiology of SPSD:in rats with infusion of antibodies from patients,and a case‐control‐study suggests cognitive loss in anti‐GAD65/non‐carriers, needing increased sample. Recently Dalakas MC`Trial doesn’t demonstrate statistical difference rituximab/placebo. We have already published another patient case study with lethal outcome without treatment and described this patient when the treatment was successful. Unfortunately, the patient had a cognitive loss without circulatory or immuno‐neurological disease only SPSD.
Final Comments: Our review confirm the best treatment for SPSD, despite this unexpected 9‐year‐evolution.
Informed consent to publish had been obtained from the patient.
A26 Assesment of food intake of patients with congenital generalized lipodystrophy in relation to the guidelines of brazilian diabetes society
Natasha Vasconcelos Albuquerque, Synara Cavalcante Lopes, Roberta Freitas Celedônio, Mônica de Oliveira Maia, Priscila Macêdo Fernandes, Lia Beatriz de Azevedo Souza Karbage, Izabella Tamira Galdino Farias Vasconcelos, Ana Paula Dias Rangel Montenegro, Virgínia Oliveira Fernandes, Renan Magalhães Montenegro Júnior
UFC, Ceará, Brazil
Correspondence: Natasha Vasconcelos Albuquerque
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A26
Background and Aims: Generalized Congenital Lipodystrophy (LGG) is a rare autosomal recessive disorder characterized by the difficulty of storing adipose tissue and metabolic abnormalities such as insulin resistance (IR), diabetes mellitus (DM), dyslipidemia and hyperphagia. The nutritional orientation in these patients contributes to the control of these comorbidities and represents one of the main treatment lines in force in Brazil. The aim of this work was to evaluate the dietary intake of patients with LGC at a center of reference in Ceará.
Metodology: A quantitative descriptive study performed at a hospital of reference in this disease in the state of Ceará, from November 2014 to February 2015. Eleven patients with a genetic diagnosis of LGC were evaluated. Food consumption was obtained through three 24-h recall (R24 h) collected on different days. The interviewers were trained and followed the automated multi-step method consisting of a five-step guided interview. The results of the R24 h analysis were grouped in means and standard deviation and compared to the values of energy, macronutrients and fibers recommended by the Brazilian Society of Diabetes (SBD).
Results: The mean age of the patients was 11.18 ± 9.26 years, ranging from 2 to 31 years. Eight patients were female. The average energy consumption was 1990.09 ± 483.09 kcal. There were inadequate intakes of protein, saturated fatty acids, total fat and fiber in 100% (11), 90.9% (10), 72.8% (8) and 45.6% (5) of the patients, respectively. While 90.9% (10), 90.9% (10) and 81.8% (9) of the subjects presented adequate intake of carbohydrates, polyunsaturated fatty acids and monounsaturated fatty acids, according to SBD recommendations, respectively.
Conclusions: The dietary intake of the patients was characterized by the inadequacy of proteins, saturated fatty acids, total fats and fibers. Considering the importance of nutritional management for the treatment of this group of patients, nutrient adjustment becomes essential.
A27 Assessment of emotional suffering and attitudes in relation to type 1 diabetes of users admitted in a public diabetes center in Belo Horizonte
Janice Sepúlveda Reis, Paula Lamego de Moura, Sônia Maria do Carmo Maulais, Karima Fernanda Rosa Simão Martins, Rodrigo Antônio Andrade Moura
IEP SANTA CASA BH, Bahia, Brazil
Correspondence: Janice Sepúlveda Reis
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A27
Background: The identification of the attitudes and emotional state of people with diabetes in relation to coping with the disease can facilitate more personalized interventions that help to obtain better results in self-management of the treatment.
Objective: To evaluate the level of emotional stress and attitudes towards diabetes in patients with type 1 diabetes (T1DM) admitted to a Reference Diabetes Center of the Unified Health System in Belo Horizonte, Minas Gerais.
Methods: This was a crosssectional study with evaluation of patients admitted from January 2015 to July 2017. Patients with cognitive limitations which impaired understanding of the instruments were excluded from the evaluation. Two instruments adapted and validated for Brazilian culture were applied: self-administered B-PAID for the measurement of emotional distress related to daily diabetes coping (a score above or equal to 40 points indicates a high level of emotional distress) and ATT-19, a self-administered questionnaire that assesses the attitude of the person with diabetes to the disease (above 70 points indicates a positive attitude towards the disease).
Results: Thirty-eight individuals with T1DM met the inclusion criteria. The median age was 34 years (10-79), with a diagnosis time of 8 years (1-26), female predominance (57.9%) and complete primary education (52.6%). Regarding instrument scores, the average score for B-PAID was 36.82 (1.25–80), which indicates a low stress index, with 39.4% of participants with a high diabetesrelated stress index (> 40 points). Regarding the sub-dimensions of B-PAID, it is observed that the predominance of stress responses was related to emotional, followed by feeding, treatment and social support (Table 1). In ATT-19, 73.6% of the people showed negative attitudes related to dealing with diabetes (score < 70), with an average score of 62.56 (36-81).
Conclusion: The study indicated the need for evaluations to be carried out from diagnosis and periodically, to guide interdisciplinary interventions and specific education programs for people with greater diabetes negative attitudes towards diabetes (Fig. 1) .
A28 Assessment of health-related quality of life of patients with type 1 diabetes (DM1) using continuous insulin infusion system (CSII) or multiple doses of insulin (MDI): what is the scenario of an outpatient reference clinic in SUS-DF?
Isabela Silveira de Oliveira Carballal1, Juliana Costa Lobato1, Andreia Zapalla Abdalla1, Raissa Pereira Fernandes1, Leonardo Garcia Miranda2, Hermelinda Cordeiro Pedrosa1, Ronan Araujo Garcia1, Denise Linhares Pereira Gottsch1, Juliana Costa Lobato1
1HRT, Brasília, Brazil; 2HR5, Brasília, Brazil
Correspondence: Isabela Silveira de Oliveira Carballal
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A28
Introduction: Fear of bad glycemic control association to diabetic complications might affect quality of life among DM1 patients. Moreover, the psychosocial impact on health-related quality of life (HRQoL) has not been widely evaluated yet in the Brazilian Unified Health System (SUS).
Objective: To compare the HRQoL of DM1 patients treated by CSII, MDI and fixed dose of insulin (FDI).
Methods: Cross-sectional, observational study for the evaluation of HRQoL of DM1 patients > 18 years of age followed at the CSII reference outpatient clinic in the Federal District SUS. PAID Scale (Problem Area in Diabetes) validated in Brazil (B-PAID) was applied to quantify the stress. B-PAID comprises 20 questions in four subdivisions of related emotional problems (DM, treatment, diet, social support); score ranges 0–100 and score ≥ 40 indicates high emotional distress. Glycemic control was verified with HbA1c. Statistical analysis: non-parametric tests and Dagun distribution (Mathematica software).
Results: Sample comprised 85 patients, 58.8% female, age 30.39 ± 10.53 years, age at diagnosis 16.54 ± 8.9 and DM duration 14.27 ± 8.17 years. Patients education level showed academic degree completed/in progress among 57.6 and 40% in high school, denoting good schooling. Patients were divided into three groups: CSII (25 patients), MDI and FDI 30 patients each. Mean HbA1c was 7.82% ± 2.13, highest value found in FDI group (9.05% ± 2.13) and lowest in CSII patients (7.29% ± 1.98) and MDI (7.19% ± 1.73). No correlation was found between HRQoL and glucose control, age, DM duration and age a diagnosis. Score B-PAID ≥ 40 was found in 57.6% of whole sample and CSII and FDI showed the highest frequency: 68 and 57%, respectively, while 50% in MDI. Overall median score was 44.64 ± 21.42, there were no statistical differences between groups (CSII 47.9, p = 0.41; MDI 38.1, p = 0.72; and FDI 50.0, p = 0.24). Emotional subdivision scores were: 1.99 ± 1.45; treatment 1.4 ± 1.48; diet 1.76 ± 1,32; social support 1.19 ± 1.60; and the highest scores were: “Worrying about the future and the possibility of serious complications” (2.91 ± 1.09) and “Feeling guilty or anxious when you stop taking care of your diabetes” (2,81 ± 1.14).
Conclusion: There was a high level of stress among DM1 patients, higher in the FDI group and lower with SICI and MDI, who showed better HbA1c. Fear of future complications represents the greatest stressful concern. Outpatient psychological support was canceled some time ago and this gap might have contributed to reduce HRQoL, despite high-level insulin therapy availability, and addresses the lack of an integrative psychosocial approach faced by patients with DM1 in the SUS.
A30 Assessment of insulin resistance in patients with diabetes mellitus type 1 between 7 and 22 years old
Susane da Silva Reis, Isabela Rolim Adriano, Maria Cláudia Schmitt Lobe
Universidade Regional de Blumenau, Blumenau, Brazil
Correspondence: Susane da Silva Reis
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A30
Introduction: The prevalence of overweight and obesity seems to follow the worldwide trends of weight gain in type 1 diabetes mellitus (DM1), with obesity being the most common cause of insulin resistance (IR) in children and adolescents. In recent years, there has been an increase in the number of children and adolescents with a mixture of both types of diabetes, these being obese and/or presenting signs of insulin resistance and autoimmune markers for beta cells. Romualdo, Nóbrega and Escrivão, conducted a retrospective study with children and adolescents from 5 to 14 years of age. It was observed that those who were resistant to insulin had higher values of body mass index, waist circumference, triglycerides and HDL-C reduction. The possibility of a relationship between insulin resistance in young patients with DM1 has not yet been clarified and it is what this paper intends to verify as well as its relation with z-BMI score, insulin dose used by the patient and time of disease.
Methods: A quantitative cross-sectional study based on the retrospective analysis of medical records of the pediatric endocrinology clinic at the University Polyclinic was performed. Patients with a diagnosis of DM1, aged between 7 and 22, who signed the Free and Informed Consent Term were included. The following variables were evaluated: gender, chronological age (CA) at diagnosis, CA at the time of the test, weight and height at the exam and time of disease (TD). Laboratory tests: glycemia and fasting insulin, glycated hemoglobin (HbA1c), exogenous slow insulin dose and microalbuminuria value. IR was calculated using the Homeostasis Model Assessment-Insulin Resistance (HOMA-IR). Values of statistical significance were considered when p < 0.05. Data analysis was performed by Microsoft Excel 2013 and SPSS version 13. The study was approved by the Regional University of Blumenau Ethic’s Committee, approval number: 57640416.2.0000.5370.
Results: Thirty-five medical records were evaluated. Three patients did not have IR. The 32 patients with IR were 21 females (60%), with averages of CA at diagnosis: 6.07 years, CA at the examination: 13.38 years, TD: 7.3 years, HbA1c: 9.1% and 8 patients (22%) presented altered values of microalbuminuria. There was no correlation between HOMA-IR with z-BMI score, insulin dose and TD in this sample.
Conclusion: Insulin resistance could not be related to any of the variables studied in this sample. Thus, HOMA-IR has not been shown to be a good parameter for assessing the quality of treatment in pediatric patients with DM1 (Figs. 1, 2, 3, 4).
A31 Assessment of knowledge and the practice of insulin application in patients with type 1 diabetes mellitus
João Henrique Del Grandi Spontão, Martha Camillo Jordão, Daniele Iop de Oliveira Caldoncelli, Caio Villaça Carneiro, Camila Gagliardi Walter, Ariane Cantarella, Ravena Machado Massucatto, Thais Picelli Pescarolo, Alexandre Eduardo Franzin Vieira, Maria Teresa Verrone Quilici, Carla Sanchez Bergamin Rizzetto
PUC-SP, São Paulo, Brazil
Correspondence: João Henrique Del Grandi Spontão
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A31
Introduction: Good control of Type 1 Diabetes Mellitus (DM1) consists of several educational and psychosocial factors, emphasizing the knowledge and technique of insulin application. The lack of theoretical and practical knowledge about insulin application techniques may result in worsening glycemic control, resulting in possible acute and chronic complications of the disease.
Objective: To analyze the knowledge and practice of insulin application in patients with DM1.
Methods: This was a cross-sectional study, conducted in a clinic of Sorocaba–SP, from January to July, 2017, through a questionnaire, with questions about the technique of insulin application, degree of schooling, duration of illness and participation in education groups about DM1 and insulin application.
Results: Among the 75 DM1 patients evaluated, 60% were female, with a mean age of 28.4 ± 11.3 years, 1.4% of whom were not literate, 24.7% with elementary education, 54.8% with high school, 13.7% with higher education. Regarding disease time, 8% had up to 5 years of diagnosis, while 28% had 5 to 10 years and 64% had more than 10 years of illness. Regarding the time of outpatient follow‐up, 32.4% of the patients were followed for more than 10 years, 96% of whom reported receiving adequate guidelines from health professionals about insulin application techniques and 62.6% were regularly attending the education group in diabetes. It was found that 54.6% of the patients reused needles, mainly due to economic reasons. Only 12% of the patients had knowledge about lipodystrophy. When asked about skin fold, 70.6% performed it correctly; 93.3% of the patients reported site rotation, but when asked about the interval of days to return to the same site, 85.3% had intervals of less than 10 days and only 4% between 10 and 14 days. Most patients (58.6%) waited 10 s or longer to withdraw the needle after application.
Conclusion: After analyzing the questionnaires applied to DM1 patients, it was possible to conclude that regardless of the level of education, adequate knowledge about insulin application techniques and regular participation in the multidisciplinary group, adherence to diabetes education practices was not observed. These results showed the need for multi-professional commitment to institute educational strategies to face the challenges of lack of adherence.
A32 Assessment of knowledge, self-care, and attitudes of diabetes type 2 individuals enrolled in a health education program
Maria Isabella Luiz da Silva1, Alícia Siqueira Emerich2, Emylle Costa Bartuli1, Gyslaine de Oliveira Saez1, Caroline Fernandes-Santos1
1UFF, Sociedade União Beneficente Humanitária dos Operários, Rio de Janeiro, Brazil; 2UNESA, Sociedade União Beneficente Humanitária dos Operários, Rio de Janeiro, Brazil
Correspondence: Maria Isabella Luiz da Silva
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A32
Introduction: There are several ways to improve the care of diabetic patients, such as the investment in new treatments and diets, support groups, global actions and health education.
Objective: Evaluate if a health education program changes the knowledge, self-care, and attitudes of subjects with type 2 diabetes attended by a philanthropic Institution in Nova Friburgo, RJ, Brazil.
Method: The study was approved by the Universidade Federal Fluminense Ethics Board (CAAE 51508915.0.0000.5626). Eleven participants with type 2 diabetes were followed up for 4 weeks. They attended health education lectures approaching diabetes physiopathology and complications and, glucose, cholesterol and triglycerides metabolism. A multiple choice questionnaire evaluated knowledge before and after lectures. Self-care and attitudes toward diabetes were assessed before and after lectures as well by the Summary of Diabetes Self-Care Activities questionnaire (SDSCA) and by the Diabetes Attitudes (ATT-19) questionnaire. Anthropometric measurements, random blood glucose and blood pressure (BP) were also evaluated before and after lectures. Data were analyzed by GraphPad Prism 6.0 and a P < 0.05 was considered significant.
Results: Data are presented as mean ± S.D. or percentage, and paired t-test assessed differences. The sample consisted of 11 participants, where 36.4% were male and 64.6% female with 58.5 ± 8.7 years old. Random blood glucose was 134.8 ± 44.8 mg/dL, systolic BP 124.8 ± 18.2 mmHg and diastolic BP 75.4 ± 8.8 mmHg before lectures, with no change after lectures. All anthropometric variables evaluated were not influenced by health education, but the waist-to-hip ratio showed a trend to decrease (0.96 ± 0.05 cm vs. 0.95 ± 0.04 cm, P = 0.08). Regarding knowledge, global questionnaire grade increased from 53.8 ± 23.3% to 65.1 ± 23.6% (P = 0.005), but the health education program did not improve the knowledge about glucose and cholesterol metabolism. Surprisingly, self-care score (SDSCA, 0-105 points) did not change after lectures (60.4 ± 18.1% before vs. 61.9 ± 13.7% after, P = 0.7) and diabetes attitude score (ATT-19, 19–95 points) decreased from 51.6 ± 10.5 to 45.9 ± 11.5 points after attending the lectures (P = 0.015).
Conclusion: Enrollment in a Health Education Program increased the knowledge of subjects with type 2 diabetes about their condition. However, lectures did not improve self-care, and their attitude toward their disease worsened. Informed consent to publish has been obtained from patients.
A33 Associated factors with the control of type 1 diabetes mellitus
Martha Camillo Jordão, João Henrique Del Grandi Spontão, Daniele Iop de Oliveira Caldoncelli, Caio Villaça Carneiro, Camila Gagliardi Valter, Ariane Cantarella, Thais Picelli Pescarolo, Ravena Machado Massucatto, Alexandre Eduardo Franzin Vieira, Maria Teresa Verrone Quilici, Carla Sanchez Bergamin Rizzetto
PUC-SP, São Paulo, Brazil
Correspondence: Martha Camillo Jordão
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A33
Introduction: Type 1 Diabetes Mellitus (DM1) is a chronic disease that should receive intensive treatment aimed at preventing complications. Good glycemic control depends on patient adherence to therapy and multidisciplinary follow‐up.
Objective: To identify factors associated with the quality of glycemic control in DM1 patients.
Methods: A cross‐sectional study through medical records review, of 66 DM1 patients on insulin-based basal‐bolus regimen, on a regular follow‐up. Were avaluated: gender, age, degree of schooling, illness time, follow‐up time, body mass index (BMI), and frequency in the multidisciplinary diabetes education group (GMED) in relation to glycemic control by glycated hemoglobin (HbA1c). Patients were divided in two groups: best glycemic control with HbA1c less than or equal to 7.5% and poor glycemic control with HbA1c greater than 7.5%.
Results: Of the 66 patients, 22.7% were in the best control group: mean HbA1c was 6.6 ± 0.9%; 53.9% female, age 28.3 ± 6.5 years (6.6% between 15 and 20 years old). Illness time was 15.9 ± 8.6 years, 30.8% between 5 and 10 years, and 69.2% longer than 10 years. Regarding follow‐up time, 53.9% had less than 5 years and 46.1% regularly participated in the GMED. Half of this group was eutrophic and 16.7% obese. On the degree of schooling, 46.2% finished high school. In the poor control group, mean HbA1c was 9.8 ± 1.9%, 60% female; mean age 27.9 ± 12.6 years, with 35.3% being aged between 15 and 20 years. Illness time was 15.5 ± 9.8 years, 5% of patients had the disease for less than 5 years and 60% for more than 10 years. Regarding follow‐up time, 60% had more than 5 years and 55% were assiduous to GMED. Evaluating the BMI, 57.9% were eutrophic and 21.1% obese. And about degree of schooling, 50% finished high school. Comparing the variables, a difference was observed between the age of the two groups: 35.3% of the patients in the group of the poor control group vs. 6.7% of the best control group were aged between 15 and 20 years (p = 0.014).
Conclusion: Glycemic control did not correlate with disease time, outpatient follow-up, participation in the GMED and educational level. The group with the poor glycemic control presented a younger age group compared to the group with the best control. The results show the difficulty of identifying variables associated and the need for attention regarding the biopsychosocial factors involved in disease control.
A34 Association between dietary fatty acid composition and diabetes kidney disease: a systematic review a systematic review and meta-analysis of observational studies
Cristina Pavinatto, Igor de Oliveira, Maicon Falavigna, Themis Zelmanovitz
UFRGS, Rio Grande do Sul, Brazil
Correspondence: Cristina Pavinatto
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A34
Introduction: Some studies have shown the deleterious and beneficial effects of saturated fatty acids (SFA) and polyunsaturated fatty acids (PUFA), respectively on chronic kidney disease in patients with diabetes. However, so far these results have not been sufficient to establish a base of dietary recommendations for these nutrients specifically.
Objective: To make a systematic review of the observational studies that analyzed the association between the intake of SFA, monounsaturated FA (MUFA) and PUFA and diabetic kidney disease (DKD).
Methods: A systematic review and meta-analysis of observational studies published until February 2017 were performed, researching the following bases: PubMed, LILACS, Cochrane and EMBASE. Manual search in the cited references in previous review articles was also made. There was no restriction for language or period in the search strategy. Observational studies that evaluated the intake and serum composition of fatty acids and the presence of DKD in diabetic patients were included. The data were extracted independently and duplicated by two researches, including the year in which the studies were performed and published, their design, size, type of population and mean and standard deviation of the content in the diet or in the blood of SFA, MUFA and PUFA, or confidence intervals at the lowest and highest percentile.
Results: 4933 articles were found in a systematic and manual search. After the duplicates were removed, 4016 abstracts and titles were read by the reviewers, and 66 articles were selected for complete reading. Finally, seven articles were included in the systematic review and five were included in the meta-analysis. To analyze the dietary PUFA, two studies were evaluated (339 participants). The dietary PUFA were inversely associated with DKD (mean difference:—1.95% of energy [95% CI −3.57 to − 0.32]; P = 0.02 [I2 = 85.6%; P = 0.009]). Two studies (748 participants) were included to analyze the serum PUFA. An inverse association was also observed between the presence of DKD and the proportion of serum PUFA (mean difference:− 0.63% of total FA [95% CI − 0.85 to − 0.40], P = 0.0001 [I2 = 0%, P 0.368]). In order to analyze the MUFA in the diet, two studies were evaluated (339 participants). The MUFA presented an inverse, but not statistically significant association with the DKD (mean difference: − 0.69% of energy [95% CI − 1.50 to 0.12]; P = 0.09 [I2 = 0.0%; P = 0.4794]). Analyzing the dietary SFA, no association with DKD was observed.
Conclusion: In the present review, the lower intake of PUFA appears to be associated with the presence of DKD. However, the small number of studies and great heterogeneity among them are limiting factors for this conclusion. Further studies are needed to evaluate the association between the intake of fatty acids and their possible effects on kidney function in diabetic patients.
A35 Association between glycaemic control over a decade and the chronic complications of type 1 diabetes
Larissa Carolina Garcia Franco da Rosa, Joana Dantas Rodrigues Vezzani, Marcus Miranda, Debora Baptista Araújo, Lenita Zajdenverg, Melanie Rodacki
UFRJ, Rio de Janeiro, Brazil
Correspondence: Larissa Carolina Garcia Franco da Rosa
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A35
Introduction: It is not known any further study in Brazil that has evaluated the glycaemic control for a long period and microvascular complications, wich is well demonstrated in Caucasian population with findings from DCCT/EDIC. AIM: We have evaluated the association between the mean of HbA1c over 10 years (m-HbA1c) and glycaemic variability assessed by standard-deviation of HbA1c (SD-mHbA1c) with microvascular complications and it has been attempted to identify HbA1c patterns over time and their relation to complications.
Methodology: Patients with ≥ 10 years of T1D with medical appointments in 2014 at the Federal University of Rio de Janeiro and at least 7 yrs. of HbA1c mean (≥ 1 HbA1c measurement of certified NGSP methods/year) were selected. The Diabetic Retinopathy was evaluated by indirect fundoscopy, Albuminuria by a single urine sample (> 17 mg/L or 30 mg/g) or 24 h urine (30 mg/24 h), eGFR (calculated by CKD-EPI, considered reduced if < 60 mL/min/1.73m2) and Cardiac Autonomic Neuropathy (CAN), assessed by heart rate variability tests. The 10-year HbA1c graphics of all patients have been evaluated.
Results: The sample consisted of 172 patients with mean age and T1D duration of 28.7 and 18 years respectively. The frequency of DR, IUAE, eGFR < 60 mL/min/1.73m2 and CAN were respectively 12.6% (15/119), 18.9% (22/119), 6% (8/134) and 33.9% (20/59). The m-HbA1c was higher in patients with DR (9.8 ± 1.7% vs. 7.9 ± 1.2%; p = 0.001); Albuminuria (9 ± 1.6% vs. 7.9 ± 1.1%; p = 0.009); eGFR < 60 mL/min/1.73m2 (9.5 ± 1.8% vs. 8.3 ± 1.4%; p = 0.032) and CAN (9.3 ± 1.3% vs. 7.5 ± 1%; p = 0.001). SD-mHbA1c was associated with DR and CAN, being higher in these groups (1.6 ± 1.1% vs. 1 ± 0.6%; p = 0.011) and (1.3 ± 0.7% vs. 0.9 ± 0.6%; p = 0.026). Some HbA1c patterns were identified over time: (a) stable, (b) improvement, (c) worsening, (d) in “i”, (e) in “u”, (f) “2 peak” and (g) anarchic and 55% patients with Albuminuria presented anarchical pattern while most of patients without albuminuria exhibited a stable pattern (p = 0.005).
Conclusion: This study found an association between DR, reduced eGFR, IUAE and CAN with higher HbA1c mean over 10 years. in a Brazilian sample and higher SD-mHbA1c with DR and CAN. These findings show the importance of establishing not only an adequate glycaemic control, but also the need to seek this, avoiding large glycaemic fluctuations, showing the importance of the concept of metabolic memory in the development of complications even in our population (Figs. 1, 2).
A36 Association between low bone density with type 1 diabetes mellitus and celiac disease
Thamires Yasmin Gomes de Souza, Lucia Henriques Alves da Silva, Rosane Kupfer
IEDE, Rio de Janeiro, Brazil
Correspondence: Thamires Yasmin Gomes de Souza
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A36
Case report: A 27-year-old male with a previous history of type 1 diabetes mellitus since the age of 19 and an irregular disease control in this period. He was diagnosed with celiac disease and diabetic distal polyneuropathy at the age of 27. At the same time, a dual energy X-ray absorptiometry (DXA) revealed femur Z-score of -5.09 and lumbar spine Z-score -3.62. Bisphosphonate and colecalciferol were promptly administered and combined to a gluten free diet. After 1 year, bisphosphonate was discontinued and the patient remains in regular medical care.
Discussion: The association between type 1 diabetes mellitus with autoimmune diseases such as celiac disease is not uncommon. It is well established that both diseases can lead to bone metabolism disfunction, which seems to be related to an imbalance of the immune system and not only due to a nutritional or endocrine disorder.
Conclusions: The association between type 1 diabetes mellitus with autoimmune diseases, such as Celiac Disease, seems to worse bone loss. It suggests a synergistic negative effect of hyperglycemia and autoimmunity on bone mineral density. Specific therapies to control this immunoregulatory imbalance and consequently bone reabsorption inhibition are still not available.
Informed consent to publish had been obtained from the patient.
A37 Association between nutritional status and dyslipidemia in children and adolescents with diabetes mellitus type 1 in a pediatric university hospital of Rio de Janeiro
Raquel Nascimento Chanca Silvério1, Elisa Maria de Aquino Lacerda1, Carolina Felizardo de Moraes da Silva1, Ana Isa Ramos de Lourenço1, Laura Maria Silva Porto1, Géssica Castor Fontes de Lima1, Júlia Maria Cabral Relvas Jacome Bertoldi1, Jorge Luiz Luescher2, Luiza Berganins Scancetti1, Fernanda Bispo dos Santos1, Roberta Ferreira Fortins1, Patrícia de Carvalho Padilha1
1UFRJ, Rio de Janeiro, Brazil; 2IPPMG/UFRJ, Rio de Janeiro, Brazil
Correspondence: Raquel Nascimento Chanca Silvério
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A37
Introduction: Children and adolescents with type 1 diabetes mellitus type 1 (DM1) have a higher prevalence of cardiovascular risk factors, among them dyslipidemia [1, 2].
Objective: To evaluate the association between nutritional status and lipid profile of children and adolescents with DM1.
Method: This was a cross-sectional study carried out at the Diabetes Service of a Pediatric University Hospital of Rio de Janeiro from May 2016 to June 2017. The eligibility criteria were: age between 7 and 16 years, diagnosis of DM1 for at least 1 year and absence of other autoimmune diseases. The dependent variables were: total cholesterol, HDL, LDL, triglycerides and nutritional status, evaluated by body mass index by age (BMI/age). The independent variables were: age, family income, place of residence, sanitation conditions, parental level of education, diabetes diagnosis time, insulin regimen, dietary method used (traditional or carbohydrate counting method) and glycated hemoglobin (HbA1c). All variables were obtained by means of medical records. Statistical analysis included simple descriptive analysis (means and frequencies), Chi square test for comparison of categorical variables and ANOVA for comparison of means. The statistical program SPSS version 23.0 was used, and the significance level adopted was 5% (p < 0.05).
Results: A total of 105 patients with a mean age of 11.6 (± 2.9) years were included in the study, of which 47.6% (n = 50) were males. High levels of total cholesterol, LDL cholesterol and triglycerides were observed in 74.3% (n = 78), 42.9% (n = 45), 15.2% (n = 16), respectively. Approximately 12.4% (n = 13) had inadequate HDL values. The mean HbA1c was 8.27% (± 1.41). No significant differences were found in serum lipid averages in relation to the age of the child, time of diagnosis of DM1, insulin regimen and ethical diet method. There was an association between triglyceride levels and inadequate glycemic control (p = 0.032).
Conclusion: The results showed a high frequency of dyslipidemia, representing an important cardiovascular risk factor for this population. It is suggested the adoption of healthy eating habits and lifestyle practices regardless of anthropometric nutritional status, in order to prevent cardiovascular diseases.
American Diabetes Association. Standards of medical care in diabetes. The journal of clinical and applied research and education, 2017; 40(1):s1-114.
Bulut T, Demirel F, Metin A. The prevalence of dyslipidemia and associated factors in children and adolescents with type 1 diabetes. J Pediatr Endocrinol Metab. 2016; 30(2):181–7.
A38 Association between reduced vitamin d levels and glomerular filtration rate estimated by CKD-EPI equation and measured by a reference method
Angélica Dall‘Agnol, Eduardo Guimarães Camargo, Letícia Almeida Brondani, Sofia Michele Dick, Vítor da Agostim Cancelier, Sandra Pinho Silveiro
UFRGS, Rio Grande do Sul, Brazil
Correspondence: Angélica Dall‘Agnol
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A38
Introduction: Diabetes kidney disease (DKD) is the leading cause of end-stage renal disease and current treatment is not able to fully control disease progression. New therapeutic alternatives have been investigated and some evidence points to 25 (OH) vitamin D deficiency as a possible factor related to the onset and/or progression of DKD.
Objective: The objective of this study was to evaluate the relationship between 25 (OH) vitamin D levels and degree of renal damage in patients with type 2 DM.
Methods: Cross-sectional study, type 2 DM subjects. The glomerular filtration rate (GFR) was estimated by the Chronic Kidney Disease Epidemiology (CKDEPI) equation and measured by the 51Cr-EDTA technique. Urinary albumin excretion albumin (UAE) was assessed by immunoturbidimetry and 25 (OH) vitamin D by the chemiluminescence technique. ROC curve and multiple logistic regression were employed to evaluate the relationship between vitamin D levels and renal damage.
Results: A total of 87 individuals with type 2 DM with a mean age of 61 ± 10 years were included, of which 46 were female (53%), with DM duration of 12 ± 6 years and self-reported white ethnicity at 81%, GFR had to be ≥ 60 mL/min/1.73 m2. Figure 1 shows the vitamin D values according to GFR, both measured and estimated by equation, categorized in levels ≥ vs. < 90 mL/min/1.73 m2, demonstrating that using measured GFR, lower vitamin D values were found inthe lower GFR group. However, no difference was observed in vitamin D levelswhen GFR was calculated with the equation. Figure 2 shows ROC curves of the two methods of GFR, and again a relationship between reduced GFR and lower levels of vitamin D was only observed with measured GFR.
Conclusion: The CKD-EPI equation is not able to identify the phenomenon ofvitamin D reduction with mild loss of renal function, which is clearly detectedwith the measured GFR (Fig. 1).
A39 Association between trans fatty acids from natural and industrial sources of diet and cardiovascular risk factors and endothelial function of patients with type 2 diabetes mellitus
Claudia Kirst, Ana Luiza Teixeira dos Santos, Tanara Weiss, Igor de Oliveira, Carolina Bassoto, Themis Zelmanovitz
UFRGS, Rio Grande do Sul, Brazil
Correspondence: Claudia Kirst
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A39
Introduction: In human nutrition the 3 main sources of trans fatty acids (TFA) are: transformation of polyunsaturated fatty acid (FA) in the rumen of animals, partial hydrogenation of vegetal oils and process of frying foods. Several studies investigate the difference of the impact that industrial TFA (I-TFA) and those from ruminants exert on cardiovascular disease (CVD), finding conflicting results. Considering the importance of the reversion of modifiable risk factors to prevent CVD in patients with type 2 DM, it is very important to study the association between the different sources of intake of TFA and CV risk factors and endothelial function in these patients.
Objective: To evaluate the relationship between the dietary TFA from ruminant (R-TFA) sources and industrial sources, with CV risk factor and endothelial function of patients with type 2 DM.
Methodology: Patients with type 2 DM followed in the Diabetes Outpatient Clinic at Hospital de Clinicas de Porto Alegre were evaluated. The clinical evaluation consisted of glycemic control, lipid profile, blood pressure and detection of chronic complications of DM. The endothelial function was determined by the Doppler study of the brachial artery to determine its diameter and the flow-mediated dilatation (FMD). The patients made 3-day weighed food records and the diet was calculated using the Nutribase Clinical Nutritional Manager software. A spreadsheet was constructed to calculate the TFA with data from the Brazilian Table of Food Composition (TACO - Tabela Brasileira de Composição dos Alimentos) and the American table (USDA). The anthropometric evaluation consisted of measures of weight, stature and abdominal circumference (AC).
Results: 186 patients were analyzed (44% men’s; mean age: 63 years and mean body mass index: 29.4 kg/m2). It was observed that the intake of R-TFA was associated with the AC of higher risk CV (dependent variable) [Risk Ratio: 2.45 (95% CI 1.11—5.38); P = 0.026], adjusted for sex and age. Also, the intake of R-TFA was associated with the greater diameter of the brachial artery [Risk Ratio: 1.93 (95% CI 1.01—3.69); P = 0.047], adjusted for age, hypertension and AC. No association was found between the I-TFA sources and the CV risk factors and parameters of endothelial function.
Conclusion: The present study suggests that the greater consumption of R-TFA sources in patients with type 2 DM is related to the greater AC and worse endothelial function.
A40 Association of anemia in diabetic obeses
Larissa Pessoa Vila Nova1, Rafael Augusto Batista de Medeiros2, Marinaldo Freire Lustosa2, Camila Lima Chagas2, Regina de Deus Lira Benevides2
1UPE, Pernambuco, Brazil; 2UFPE, Pernambuco, Brazil
Correspondence: Larissa Pessoa Vila Nova
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A40
Introduction: In Brazil, the nutritional transition presents a simultaneous aggravation of two opposing issues: a nutritional deficiency (anemia) and a typical condition of overeating, obesity. Few studies have evaluated this epidemiological paradox in the prevalence of diabetes mellitus and other chronic diseases.
Objective: Evaluate the association of anemia in obese, diabetic and cardiomyopathy patients.
Methods: A retrospective cross-sectional study was carried out to verify the admission data of overweight, diabetic and cardiac patients hospitalized at a cardiology reference center in Pernambuco. Overweight was considered according to the World Health Organization criteria (WHO, 1995) for adults (IMC ≥ 25 kg/m2) and from the cut-off point established for the elderly (BMI > 27 kg/m2) by Lipschitiz in 1994. Anemia was considered when serum haemoglobin results were < 13 m/dl for men and < 12 mg/dl for women. The study was approved by the Ethics and Research Committee of the University of Pernambuco hospital under the protocol number 656.800/2014. Statistical analyzes were performed in the software SPSS, v. 13.0, adopting statistical significance when p < 0.05.
Results: From the sixty patients evaluated, the mean age was estimated at 60.7 (±10.5) years, and 53.4% were female. The prevalence of anemia in diabetic patients with overweight was 41%, similar in both sexes (p = 0.846) and in adults and elderly (p = 0.951).
Conclusions: The high prevalence of anemia in diabetic patients with overweight highlights the need for an investigation, monitoring and prevention of this condition, regardless the nutritional condition of the individual. In addition, it is important to study other issues related to diabetes that may contribute to anemia, favoring its prevention.
A41 Association of maternal outcomes in pregnant women with diabetes mellitus and users of the unified health system who had their deliveries in a university hospital of the south of Brazil
Clarice dos Santos Mottecy1, Júlia Mottecy Piovezan2, Raquel Montagner Rossi2, Patrícia Molz3, Samantha Bernardo Nascimento2, Aloma Jacobi Dalla Lana2, Thais de Oliveira Flores2, Daniel Prá3, Sílvia Isabel Rech Franke3
1HUSM/EBSERH—UFSM, Rio Grande do Sul, Brazil; 2UFSM, Rio Grande do Sul, Brazil; 3UNISC, Rio Grande do Sul, Brazil
Correspondence: Clarice dos Santos Mottecy
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A41
Background: Gestational Diabetes Mellitus (GDM) is the most prevalent metabolic change in pregnancy. The impact of their screening on maternal and perinatal morbidity and mortality for women treated in the Basic Health Care is questioned. The Ministry of Health (MH) recommends universal screening at the first prenatal visit through fasting glycemia (FG) and clinical risk factors for GDM. The prenatal diagnosis of GDM is fundamental and its approach improves the prognosis of gestation.
Objectives: To verify the association between GDM screening (according to what MH advocates) and the repercussions on maternal outcomes in women who underwent prenatal care in the basic health care in the central region of Rio Grande do Sul, and had their births at the University Hospital of Santa Maria-RS (HUSM).
Methods: This descriptive-transversal study evaluated 283 puerperal women who underwent their prenatal care in the basic health care system through an interview, analysis of medical records and the Pregnant Woman‘s Card, and had their deliveries in HUSM between January and April 2015. Informed consent to publish has been obtained from patients. The study was approved by University of Santa Cruz do Sul Institutution‘s Ethics Board, approval number 37290714700005343.
Results: Data collected were allocated to the Statistical Package for Social Sciences (SPSS) version 20.0, with a descriptive statistical analysis and a Chi square test with significance of 0.05. In this sample, 53% of women were overweight according the Body Mass Index (BMI), being the most observed risk factor for GDM. 27.9% of the puerperal women were overweight and 25.1% were obese. Among the puerperal women, 14.5% did not undergo GDM screening through FG. The prevalence of positive screening in this sample was 86.4%. The most frequent maternal outcomes were preterm labor (12.4%), maternal tocotraumatism and lacerations (5.3%), preeclampsia in various degrees (3.9%) and premature amniorrexis (2.1%). Placental abruption occurred in two cases. There was a significant association of pregnant women with positive screening only with preeclampsia outcome.
Conclusion: Many of the maternal and fetal outcomes are known to be preventable. For this, the identification of DMG through adequate screening and early control of its risk factors is essential in the application of prenatal care actions by the health team of the basic network in the region studied in order to minimize them.
A42 Association of the phase angle with hospital hyperglycemia in surgical patients
Natalia Fenner Pena, Ariene Carmo Silva, Nayhara Castro Coury, Simone de Vasconcelos Generoso
UFMG, Minas Gerais, Brazil
Correspondence: Natalia Fenner Pena
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A42
Introduction: Phase Angle (PA) has been related to the integrity of cell membranes, as a good prognostic indicator, with the general health and nutritional status of the patients. The hyperglycemia can be triggered by adverse and characteristics of the hospital routine; the metabolic stress is one of the main causes. It has already been shown that hyperglycemia is a common outcome observed in hospitalized patients; capable of causing cellular glycotoxicity. In addition it is considered marker of poor prognosis for serious patients, both clinical and surgical.
Objective: To evaluate the prevalence of hyperglycemia and its association with PA in hospitalized surgical patients.
Methods: A prospective longitudinal study was performed at Clinical Hospital in Belo Horizonte, Brazil. Patients PA was calculated by electrical bioimpedance in three moments: before, postoperative and hospital discharge moments. Blood glucose was also collected before and postprandial capillary glycemia and the average values were considered. Results above 140 mg/dL were classified as hyperglycemia. To compare the glycemic averages, according to the categorization of the PA; the Ancova Test was used. For all analyzes a significance level of 5% was adopted.
Results: Fifty patients were analyzed, and 33.3% presented hyperglycemia. The mean glucose levels observed were 120 ± 33 mg/dL, 135 ± 37 mg/dL and 125 ± 37 mg/dL at the before, postoperative and hospital discharge moments, respectively. In the paired analysis, hyperglycemia was observed with significantly higher postoperative values (135.35 ± 37.57 mg/dL) in relation to hospital discharge (125.68 ± 37.21);(p = 0.031). There was a higher frequency of noninfectious complications among diabetic individuals (50.0% vs. 24.8%, p = 0.23). Ancova test showed a significant difference between the glycemic groups, according to the categorization of PA, and patients with nutritional risk showed higher blood glucose levels in relation to patients without nutritional risk: (133.11 ± 8.7 vs. 115, 99 ± 4.6 p = 0.089).
Conclusion: The importance of glycemic evaluation in hospitalized patients before and after surgical intervention is highlighted, in order to verify if there are significant alterations in relation to moments, outcomes and if this, and to date, this study was the first to evaluate the association between PA and hyperglycemia in the hospital. Future studies are necessary to verify the depth of this association.
A43 Bacterial endocarditis in a patient with type 2 diabetes mellitus: case report
Jacqueline Akemi Nishio Juhasz, Ieside Arruda Valadares Chamon, Ana Cristina Pithon Curi, Luis Fernando Aguiar de Paula Filho, Luis Mauricio Batalin Junior, Emanuelle Barbara Dias Tomaz, Alcinda Aranha Nigri, Fernando de Oliveira Barros
PUC-SP, São Paulo, Brazil
Correspondence: Jacqueline Akemi Nishio Juhasz
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A43
Case report: a 54-year-old female was admitted with a medical history of type 2 diabetes mellitus (T2D), hypertension, non-dialysis dependent chronic kidney disease, and lower extremity ulcers. For the treatment of the ulcers the patient underwent debridement and received antibiotics (ATB). Subsequently, the patient sought a hospital with chief complaint of dyspnea and was diagnosed with pneumonia (sic) and treated with use of ATB. Then, she presented with anasarca and fever. There was no leukocytosis probably due to the use of ATB. On the physical examination, mitral murmur was found. On the echocardiogram the patient showed mitral and tricuspid insufficiency and vegetation in the mitral valve, indicating infective endocarditis. At the time of admission, the patient presented pleural effusion, high serum urea levels (142 mg/dl), hyperglycemia (256 mg/dL of serum glucose), and low serum albumin levels (2.6 g/dL). After 6 days, the mitral valve was replaced by a bioprosthetic valve, and a tricuspid valve cerclage was performed. Postoperative blood transfusions were required. She went into cardiac arrest and a cardiopulmonary resuscitation was performed successfully. Ten day later she presented with arrhythmia, cardiopulmonary arrest, sepsis and then she died.
Discussion: Infective endocarditis is a microbial infection of the endocardial surface of the heart. It mainly affects heart valves, most commonly the mitral valve. Common etiologies are: use of injectable drugs, oral infection, long-term hemodialysis, and diabetes mellitus. The Duke Criteria was used for the diagnosis of infective endocarditis. In this case report we present a case of a patient with type 2 diabetes who evolved with an infective endocarditis. The patient’s uncontrolled glycemia led to worsening of endocarditis
Final comments: Adequate management of T2D can prevent complications such as lower extremity ulcers, consequently avoiding hematogenic dissemination and infective endocarditis. We must consider the previous antibiotic use when analyzing the patient‘s white blood cell count.
Informed consent to publish had been obtained from the patient.
A44 Banana skin: wound healing analysis in patients with diabetics
Lucas Marassi Theodoro Sousa Oliveira, Dênia Amélia Novato Castelli Von Atzingen, João Victor Braga Mendes, Marcos Mesquita Filho, Adriana Rodrigues dos Anjos Mendonça
UNIVÁS Pouso Alegre-MG, Minas Gerais, Brazil
Correspondence: Lucas Marassi Theodoro Sousa Oliveira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A44
Diabetes mellitus is a public health problem which assails millions of people around the world, and its cause can have not only hereditary factors but also environmental. The biggest worry for the health system is in relation to the lack of control of the disease by the sufferers, what can lead to a big number of consequences that can be disabling or even fatal. An important fact of the chronic phase of the disease allied to the lack of control is the appearance of skin lesions, as ulcers, which can be a simple injured or cut and progress to skin cavities formation. For the treatment of these wounds it was proposed the analysis of these wound healing through the use of a gel made from the green banana skin per 10%. This study took place in NAEENF (Nursery Assistance and Teaching Center) in the city of Pouso Alegre-MG and it was composed by 30 patients who used the gel from the green banana skin per 10% for 1 month. The protocol was approved by the Ethics Comitee of UNIVÁS (Vale do Sapucaí University) with the CAAE 48017915.6.0000.5102 and the Approval Report number 1.575.890.The results were the complete healing in 9 patient s. The initial average of the wounds was 32.89 mm2 and it finished in the eighth collection representing 22.45 mm2. The average was 19.94 mm2 for 10.30 mm2. By making the central tendencies measures there was significance in the obtained general results of the whole group (p < 0.001). We can conclude that the gel made from the green banana skin per 10% has a healing action in chronic ulcers presented by patients with diabetes.
A45 Beneficial effects of dapaglifozin in patients with diabetes mellitus type 1
Aline Andrade de Lucena, Paula Seixas V. Dias da Silva, João Marcelo Sampaio Santana, Luana Machado Figuerêdo, Gabriel Oliveira do Carmo, Ana Cláudia Rebouças Ramalho
UFBA, Bahia, Brazil
Correspondence: Aline Andrade de Lucena
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A45
Introduction: The effects of dapaglifozin inducing glycosuria, reducing hyperglycemia optimizing weight control and declining of pressure level is already well known in patients with diabetes type 2, however there are still a few studies abouts its use in patients with diabetes mellitus type 1 (DM1). As the phenotype of patients with diabetes mellitus type 1 have been modified with 25% showing metabolic syndrome, becames necessary the use of supplementary therapies to insulin.
Purpose: Assess the potential benefits and adverse effects of Dapaglifozin in a population with DM1 followed in particular offices in Salvador/BA city.
Methods: Observational and retrospective study in which they were analysed the medical recordo f patients with DM1 who made use of this medication in dose of 10 mg/day through 3-6 months.
Results: Twelve patients with DM1 were assessed, 10 females with average rate of 37.5 years. The average weight was 68.3 kg and 65.3 kg before and after therapy with dapaglifozin respectively (p = 0.002). The average BMI decreased from 26.1 to 25.4 kg/m2 after treatment (p = 0.002). There was a significant decrease in glicated hemoglobina (HbA1c) after therapy with Dapaglifozin (p = 0.002). There was a tendency to decrease of total colesterol, LDL and triglycerides (p = 0.260). Systolic blood pressure (SBP) decreased from a median of 120 mmHg to a mediano f 115 mmHg befora and after therapy with Dapaglifozin respectively (p = 0.02). With regard to dyastolic blood pressure a decrease in median values were noticed, however without statistic relevance (p = 0.059). Correlation among the use of Dapaglifozin and decreasing of basal insulin was found (p = 0.012). Values of creatinina did not change after us of adjuvante therapy (p = 0.207). With regard to adverse effects, 8.3% of patients presented urinary tract infection (UTI), 33.3% pain or pruritus on genital region and 8.3% ketoacidosis.
Conclusion: The presente study describes the uso of dapaglifozin and its beneficial and adverse effects in a population with DM1. Statistic significant decrease of Hba1C, body weight and BMI, in addition to tendency of increasing lipid profile were observed. Other studies are needed to ratify possible benefits and safety of this class of medication in patients with DM1.
A46 Beneficial effects of recreational soccer training on health profile of untrained postmenopausal women with type 2 diabetes mellitus
Maysa Vieira de Sousa, Rosa Fukui, Maria Elizabeth Rossi da Silva
FMUSP, São Paulo, Brazil
Correspondence: Maysa Vieira de Sousa
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A46
Background and aims: Postmenopausal is linked to modifications in blood hormone level and a progressive decrease in physical activity contributing to changes in metabolism and overweight, leading to an inflammatory status. This aging process and Diabetes Mellitus are strongly correlated with many chronic diseases and in this context, women warrant special attention. Lifestyle changes may modulate these disturbances among postmenopausal women. Therefore, we aimed to investigate the impact of recreational soccer combined with a calorie restricted diet on metabolic and hormonal responses of untrained postmenopausal women with T2DM vs. diet alone.
Materials and methods: Twenty-one (n = 21) untrained postmenopausal women with T2DM aged 48-74 years were randomized into a soccer + diet group (SDG; n = 9) and a diet group (DG; n = 12). Training sessions were held for 40 min, 3 times per week for 12 weeks. Dual-energy X-ray, treadmill testing, and fasting blood samplings were performed before and post 12 weeks.
Results: Maximal oxygen uptake increased only in the SDG (P < 0.05) while a decrease (P < 0.05) was observed in DG after 12 weeks. HBA1c decreased (P < 0.05) by ~ 10% in both SDG and DG after 12 weeks. In all groups, bone mineral density increased (P < 0.05) by ~ 0.03 g/cm2, fat mass decreased (P < 0.05) by ~ 3 kg, and lean body mass was not altered ~ 46 kg (P > 0.05). Baseline triglycerides and VLDL-cholesterol were reduced (P < 0.05) by 23.9% (35.0 ± 1.6 mg/dL) and 23.5% (6.9 ± 0.4 mg/dL), respectively, while HDL-cholesterol was increased (P < 0.05) by 8.1% (3.7 ± 1.1 mg/dL) in the SDG. Total cholesterol and LDL-cholesterol was unaltered (P > 0.05) in both groups. Luteinizing hormone (LH) levels decreased (P < 0.05) in SDG after 12 weeks intervention (Pre: 25.0 ± 3.1 vs. Post: 20.3 ± 3.8 IU/L), whereas the diet group alone did not alter (Fig. 1) .
Conclusion: Soccer training improved lipids profile in postmenopausal women probably related to increased fat oxidation rate post-training due to the multiple intense actions, stimulating musculoskeletal and cardiovascular adaptations. Lower LH levels may be associated with reduced risk in the prevalence of breast cancer in postmenopausal women, suggesting a potential mechanism of the favorable effect produced by regular training and weight reduction on neoplastic prevention. Thus, recreational soccer training plus diet resulted in large benefits on health profile of T2DM, decreasing risk factors associated with cardiovascular disease and cancer better than diet alone.
A47 Blog as a digital pedagogical tool in diabetes education
Hugo dos Santos Silva Júnior, Lucas Gabriel de Siqueira, Paulo Henrique Lopes, Elenice dos Santos Paula, Mayara Dumont Cunha, Daniela Pereira De Castro, Fernando Gonçalves dos Santos, Marileila Marques Toledo, Gabriela de Araujo Nominato, Ana Paula Nogueira Nunes, Luciana de Freitas Campos, Edson da Silva
UFVJM, Minas Gerais, Brazil
Correspondence: Hugo dos Santos Silva Júnior
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A47
Background: Social media are spaces that favor interaction between people, irrespective of social level and geographical position. Blogs and social networks are examples of social media used daily by a large part of the population, including as a means of creating content that promotes connection between people with common interests.
Objective: The objective of this study was to report the experience with the first year use of the Blog Diabetes Diamantina as a diabetes education tool.
Materials and methods: The Blog Diabetes Diamantina (www.diabetesdiamantina.blogspot.com.br) was created in March 2016 and became active in May of the same year (Fig. 1). Publications covered content produced by students and university professors or, in some cases, were publications adapted of national and/or international organizations of diabetes. The Blog database was accessed monthly from its creation until July 8, 2017 for analysis. Posts have been sorted into 7 categories. Subsequently, the total number of publications, content visualizations and readers‘countries of origin were identified. The data were analyzed and described. Results Sixty publications in the Portuguese language were produced, including texts, videos and images (Fig. 2). The subjects were classified as: complications of diabetes (n = 9), nutrition (n = 6), therapeutics/clinical aspects (n = 12), cell biology (n = 3), obesity (= 4), exercise (n = 2) and education (n = 24). The Blog received 67,546 views by national and international readers until the month of July. Currently, in October 2017 the number increased to almost 70 thousand views (Figs. 1 and 4). The United States was the main country from origin of the readers, followed by Brazil, Portugal, the United Kingdom, Chile, Mexico, France, Argentina, Spain and Russia (Fig. 3). Some Blog posts have been shared on Fanpage Diabetes Diamantina, a social network of diabetes education that publishes in the Portuguese, English and Spanish languages, which possibly justifies the origin of international access to the Blog.
Conclusion: The Blog proved to be a favorable tool for sharing information about diabetes mellitus, since its access reached Brazil and other countries. The Blog reinforced the integration relations between the use of technology, the University and the Society. This tool has renewed awareness and encouraged social participation among people interested in updates on diabetes. In addition, it provided innovative experiences to students involved in the use of the social media in diabetes education actions with bidirectional interaction between different social agents interconnected in this type of online health education. The authors are grateful to the CNPq, FAPEMIG and UFVJM for the support (Fig. 4).
A48 Brazilian young-onset type 2 diabetes in comparison to type 1 diabetes in adults and type 2 diabetes
Renata Midori Hirosawa, Sergio Atala Dib
UNIFESP, São Paulo, Brazil
Correspondence: Renata Midori Hirosawa
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A48
Introduction: There is an increasing prevalence of young-onset diabetes, especially in developing areas. Also, there is increasing recognition that the phenotype of YT2DM is more severe than type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) in older adults, with a lower response to metformin, a more rapid evolution for insulin dependence. Further, the youth may be more susceptible to the development of some complications. At the moment there are no data on YT2DM in Brazil.
Objective: To evaluate long-term clinical outcomes in a brazilian YT2DM group compared to T1DM and T2DM.
Patients and Methods: YT2DM was defined as age between 18 and 39 years at the diagnosis, T1DM and DM2 according to the criteria of the SBD and ADA. We abstracted clinical data from electronic medical, laboratory records.
Results: The age at diagnosis of YT2DM (n = 61), T1DM (n = 26) and T2DM (n = 39) groups were, respectively: 29.8 ± 5.1, 25.8 ± 6.0 and 50.5 ± 8.4 years. The duration of diabetes was 22.3 ± 12.1 years (YT2DM), 13.5 ± 7.5 (T1DM), 17.3 ± 6.4 (T2DM). The BMI of YT2DM, T1DM and T2DM was 31.9 ± 5.5, 23.7 ± 3.3 and 29 ± 4.8 kg/m2. HbA1c (%) was 9.1 ± 1.9 (YT2DM), 8.8 ± 1.5 (T1DM) and 8.8 ± 1.6 (T2DM). YT2DM compared to T1DM showed a higher percentage of retinopathy (55.7 vs 26.9%, p 0.018), nephropathy (55.7 vs 30.8%, p 0.019) and neuropathy (62.3 vs 19.2% p 0.0002). Cardiovascular events showed superiority trend in YT2DM group (27.9 vs 11.5% p = 0.09) compared to T1DM. The percentage of complications, either micro (retinopathy (55.7 s 51.3% p 0.68), nephropathy (55.7 vs 53.8%, p < 1.0), neuropathy (62.3 vs 51.3%, p < 0.21) as macro (27.9 vs 33%, p = 0.66) were not significant, when compared YT2DM to T2DM.
Conclusions: YT2DM compared to T1DM with a similar age of onset, duration of diabetes and similar glycemic control was more aggressive in relation to microangiopathy. In relation to T2DM, YT2DM was similar. Glycemic control and screening of microangiopathy should be intensified in YT2DM.
A49 Brittle diabetes in a patient with polyglandular autoimmune syndrome type 2 (schmidt’s syndrome), neurogenic bladder and psycho-familial distress: a case report
Fátima Salomão Machado, Levimar Rocha Araújo
HUCM, Minas Gerais, Brazil
Correspondence: Fátima Salomão Machado
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A49
Introduction: Brittle diabetes occurs in a small group of patients with type 1 diabetes and is characterized by a severe instability of glycaemic levels, with frequent and unpredictable episodes of hypo or hyperglycaemia. The individuals with brittle diabetes are predominately young women and they use twice as much insulin than usual. The causes of the instability are varied and the prevalence of psychosocial distress is high in these patients. The type 1 diabetes is one of the components of Schmidt’s syndrome, a rare autoimmune syndrome.
Objective: To report a case of brittle diabetes in a patient with Schmidt’s syndrome and neurogenic bladder, as well as psycho-familial distress.
Case report: R.A.S, 28 years old, woman, single, presented with a picture of urinary retention in 2002, which was then characterized as neurogenic bladder. She has always used catheterization procedure for bladder drainage thereafter. In the following months of the initial presentation, the patient had a ketoacidosis episode and was diagnosed with type 1 diabetes. From the beginning, the glycaemic levels control has proved to be extremely difficult, even after trying different types of high dose insulin. In addition, the patient was diagnosed with hyperthyroidism in 2013, and after treatment with radioactive iodine, she developed renal insufficiency. After 7 months of haemodialysis, her renal function was unexpectedly recovered. In 2015, she started using a pump for continuous subcutaneous insulin infusion, which contributed for the attenuation of glycaemic instability and improved her quality of life. In 2016, the patient developed adrenal insufficiency, which together with type 1 diabetes and thyroid dysfunction characterizes Schmidt’s syndrome. Regarding the psycho-familial distress, she has had traumas in her childhood, she lives by her own since she was 14 years old and she does not have any family support. The medicines used by this patient includes prednisone, levothyroxine and ultra-fast insulin. The patient is assisted by a multidisciplinary team.
Conclusion: Brittle diabetes is a severe condition that requires constant vigilance from the patient as well as from the professionals involved. In addition to the other endocrine dysfunctions that this patient presents, there is the poor family support and consequent negative psychological impact. This psycho-familial aspect possibly plays an important role in the genesis and maintenance of the glycaemic instability.
Informed consent to publish had been obtained from the patient.
A50 Bruns-garland and parsonage-turner syndrome as a differential diagnosis of diabetic neuropathy: 2 case reports
Julia Martins de Oliveira, Priscila Rodrigues Leite Oyama, Filipe Dias de Souza, Gustavo Ivani de Paula, Clícia Santos de Moura Fé, Sergio Atala Dib, Luiz Clemente de Souza Pereira Rolim
UNIFESP, São Paulo, Brazil
Correspondence: Julia Martins de Oliveira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A50
Case 1: A 45-year-old male with type 2 diabetes mellitus (T2DM) and 6 years of diabetes duration (DD) presented with a complaint of severe lumbar pain (Verbal Numeric Rating Scale ‚VNRS‚ 10 out of 10) since the last 2 months. The characteristics of pain were paroxysmal, with nocturnal worsening, and irradiated to the left thigh. One month after the pain, this was associated with quadriceps weakness, which was initially asymmetrical and progressing to bilateral. Three weeks later, the patient presented crural paraplegia and could not walk. Physical examination (PE) revealed severe quadriceps wasting and bilateral patellar areflexia. Electroneuromyography showed asymmetric polyneuropathy and axonal degeneration, suggestive of Bruns-Garland (BG) syndrome. Consequently, the patient was started with prednisone (60 mg/day). After 30 days, he recovered the quadriceps strength, improved the sleep pattern and returned to walking. The pain was successfully managed with the combination of pregabalin and duloxetine (VNRS of 4 out of 10).
Case 2: A 68-year-old male with T2DM and 7 years of DD presented with a six-month history of intense burning pain in his right shoulder (VNRS 8 out of 10), with irradiation to the entire arm. 15 days after began the symptoms, deltoid weakness was observed. On PE, there was a right deltoid atrophy; therefore, a Parsonage-Turner (PT) syndrome was diagnosed. Although the patient had had a good response to pain after 12 months (VNRS of 0 out of 10) with the combination of pregabalin and imipramine, he developed severe depression. Discussion: BG and PT are diabetic radiculoplexus neuropathies (DRN) and can develop serious complications as paraplegia, chronic pain, insomnia, and depression. By contrast with the more common diabetic polyneuropathy, DRN usually manifests as an intense and acute or subacute focal pain that progresses to muscle weakness. Since DRN is an immune-mediated condition, the use of corticoids or intravenous immune globulin has been used in patients with onset of symptoms in the preceding 30-60 days. Improvement of pain, muscle weakness, and quality of life (QOL) has been reported following corticoid immunosuppression.
Conclusions: DRN is an overlooked condition that requires both a high level of suspicion and a careful clinical examination. An early diagnosis is essential to the success of immunotherapy, which can reverse this syndrome improving plegia, pain, insomnia, and quality of life of these patients.
Informed consent to publish had been obtained from the patient.
A51a Cardiovascular autonomic neuropathy (CAN) is frequent in type 2 diabetic patients with painful polyneuropathy, even inthe absence of known autonomic dysfunction or signs or symptoms of can
Maria Regina Calsolari1, Alisson Verissimo1, Pedro Weslley Rosario1, Luis Fernando Faria Oliveira2, Adriana Aparecida Bosco1
1Santa Casa de Belo Horizonte, Minas Gerais, Brazil; 2Fundacao Universidade Itauna, Minas Gerais, Brazil
Correspondence: Maria Regina Calsolari
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A51a
Background: The 10-g monofilament test is widely used in clinical practice for the detection of neuropathic impairment. Alterations in this test reflect the involvement of large fibers, which occurs late in DM. Neuropathic pain reflects the involvement of small fibers, which occurs early in diabetes mellitus (DM) . Cardiovascular autonomic neuropathy (CAN), which is a serious complication even if subclinical, also results from the involvement of small fibers . It is therefore possible that neuropathic pain is more related to the presence of CAN and the early stage of this condition.
Objective: This study evaluated the frequency of CAN in type 2 diabetic patients with painful polyneuropathy (PNP), but without known autonomic dysfunction, or signs or symptoms of CAN. Materials and Methods: Type 2 diabetic patients with PNP (based on signs and symptoms of neuropathic impairment), who reported no exercise intolerance and who had no known autonomic dysfunction (e.g., gastroparesis, neurogenic bladder) and no postural hypotension or resting tachycardia, were selected. Patients with conditions that can also cause neuropathy or interfere with the evaluation proposed were excluded. A control group without DM, which was similar in terms of sex, age and BMI, was studied. Tests evaluating heart rate variability (HRV) during deep breathing, Valsalva maneuvers and orthostatism, and spectral analysis of HRV (spectral amplitude in the three bands: very low-frequency, low-frequency, and high-frequency)  were performed.
Results: Thirty patients (22 women and 8 men) aged ≥ 40 years (mean 63 years), with a mean BMI of 28.6 kg/m2 and diagnosed with DM2 at least 3 years ago (mean 15.4 years) were included. The mean value of the last HbA1c was 8.8%. Eleven patients (36.6%) had a definite diagnosis of CAN (≥ 3 altered tests ) and 3 patients had 1 altered test. None of the subjects of the control group had any altered test (100% specificity). (Fig. 1)
Conclusion: In patients with DM2 and PNP, but without known autonomic dysfunction, or signs or symptoms of CAN, HRV tests detected subclinical CAN in 36.6%, with 100% specificity. Compliance with Ethical Standards The study was approved by the Research Ethics Committee of our institution. Informed consent was obtained from all individual participants included in the study.
Hoeijmakers JG, Faber CG, Lauria G, Merkies IS, Waxman SG. Small-fibre neuropathies—advances in diagnosis, pathophysiology and management. Nat Rev Neurol. 2012; 8:369-379.
Spallone V, Ziegler D, Freeman R, et al.; Toronto Consensus Panel on Diabetic Neuropathy. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metab Res Rev. 2011; 27:639-653.
A51b Cardiovascular autonomic neuropathy (CAN) may even be present in type 2 diabetic patients without sensorimotor polyneuropathy, known autonomic dysfunction, or signs or symptoms of can
Maria Regina Calsolari1, Alisson Verissimo1, Pedro Weslley Rosario1, Luis Fernando Faria Oliveira2, Adriana Aparecida Bosco1
1Santa Casa de Belo Horizonte, Minas Gerais, Brazil; 2Fundacao Universidade Itauna, Minas Gerais, Brazil
Correspondence: Maria Regina Calsolari
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A51b
Background: Symmetrical sensorimotor polyneuropathy (PN) is a known complication of diabetes mellitus (DM). Cardiovascular autonomic neuropathy (CAN) is another possible complication of the involvement of nerve fibers in DM. It is therefore reasonable to imagine the CAN is present in patients with PN.
Objective: This study evaluated the frequency of subclinical CAN in patients with DM2, but without PN, known autonomic dysfunction, or signs or symptoms of CAN.
Materials and methods: Type 2 diabetic patients without PN (based on signs and symptoms of neuropathic impairment), who reported no exercise intolerance and who had no known autonomic dysfunction (e.g., gastroparesis, neurogenic bladder) and no postural hypotension or resting tachycardia, were selected. Patients with conditions that can also cause neuropathy or interfere with the evaluation proposed were excluded. A control group without DM, which was similar in terms of sex, age and BMI, was studied. Tests evaluating heart rate variability (HRV) during deep breathing, Valsalva maneuvers and orthostatism, and spectral analysis of HRV (spectral amplitude in the three bands: very low-frequency, low-frequency, and high-frequency) [1, 2] were performed.
Results: Twenty-four patients (17 women and 7 men) aged ≥ 40 years (mean 63 years), with a mean BMI of 27 kg/m2 and diagnosed with DM2 at least 3 years ago (mean 9.5 years) were included. The mean value of the last HbA1c was 7%. Four patients (16.6%) had a diagnosis of CAN, which was incipient in 3 (≥ 2 altered tests [1, 2]) and definite in 1 (3 altered tests [1,2]). None of the subjects of the control group had any altered test (100% specificity).
Conclusion: In patients with DM2, but without PN, known autonomic dysfunction, or signs or symptoms of CAN, HRV tests detected subclinical CAN in 16.6%, with 100% specificity. The study was approved by the Research Ethics Committee of our institution. Informed consent was obtained from all individual participants included in the study (Fig. 1).
Vinik et al. Circulation 2007;
Spallone et al. Diabetes Metab Res Rev. 2011. Compliance with Ethical Standards
A52 Cardiovascular risk assessment by coronary calcium score in brazilian subjects with GCK- and HNF1A-mody
Luciana F. Franco1, Renata P. Dotto2, Gilberto Szarf3, Sergio A. Dib1, Regina CS Moises1, Magnus Regious Dias-da-Silva2, Fernando M A Giuffrida4, Andre Fernandes Reis1
1Centro de Diabetes, Universidade Federal de São Paulo, São Paulo, Brazil; 2Laboratório de Endocrinologia Molecular a Translacional,Universidade Federal de São Paulo, São Paulo, Brazil; 3Disciplina de Radiologia Universidade Federal de São Paulo, São Paulo, Brazil; 4Universidade do Estado da Bahia –UNEB, Bahia, Brazil
Correspondence: Luciana F. Franco
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A52
Introduction: Monogenic diabetes due to glucokinase (GCK-MODY) and hepatocyte nuclear factor-1 homeobox A (HNF1A-MODY) mutations are the most common forms of MODY. Little is known about cardiovascular (CV) risk profile of subjects with these forms of diabetes. Together with clinical and biochemical data and some scores as Framingham, coronary artery calcium (CAC) score has shown good predictive value for coronary artery disease (CAD).
Objectives: assess CV risk by CAC score in GCK-MODY (GCK) and HNF1A-MODY(HNF1A).
Methods: Ninety-one individuals without CAD have been assessed for CV risk factors by clinical and laboratory data using high-sensitivity C-reactive protein (hs-CRP), Framingham Risk Score, Metabolic Syndrome (IDF), and CAC score with multi-slice computed tomography (Agatston score). We considered CAC > 10U as marker of subclinical atherosclerosis: 27 individuals with GCK-MODY(GCK) from 15 families and 8 individuals with HNF1A-MODY(HNF1A) from 4 families, 24 with type 2 diabetes (T2D), and 28 normoglycemic controls (C) (age-BMI-matched spouses or non-affected relatives of MODY patients),statistics by ANOVA and Kruskal–Wallis, significance P < 0.05,
Results: See Table 1.
Conclusions: Our data suggest GCK-MODY subjects to have lower CV risk than other common forms of DM such as T2D, with CV risk similar to control individuals and bearing a low long-term risk despite lifelong hyperglycemia. HNF1A subjects, conversely, have high CV risk comparable to T2DM and this has to be taken into account in the clinical follow-up of these individuals (Fig. 1).
A53 Cardiovascular risk profile and reach of LDL targets in diabetic patients type 2 attended in the diabetes ambulatory
Michelle Gentile Cherit, Daniele Maieron, Cátia Cristina Silva Sousa Vergara Palma, Roselee Pozzan, Raquel De Carvalho Abi-Abib, João Erni Vidal Scarparo Sorio, Aneliza Arantes Zanette
UERJ, Rio de Janeiro, Brazil
Correspondence: Michelle Gentile Cherit
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A53
Introduction: Identifying asymptomatic patients with increased cardiovascular risk (CVR) is fundamental for the implementation of therapeutic strategies aiming to more rigid risk factor control goals.
Objectives: To evaluate the CVR profile and the achievement of LDLc targets in type 2 diabetic patients treated at diabetes outpatient clinic.
Methods: Cross-sectional study with electronic data collection of patients treated in July 2017 for the following variables: age, sex, duration of diabetes, total cholesterol, HDLc, HbA1C systolic BP,history of hypertension treatment, smoking, coronary artery disease, stoke, peripheral vascular disease, atrial fibrillation(AF) and statin use and doses. The Framingham calculator (Wilson 2008) was used to evaluate CVR in patients aged 30-74 years and without history of previous events. The consensus of the AACE 2017 was used as a reference to define the lipid goals according to the degree of risk. The percentage of patients that were within the proposed goal were evaluated. Data were described as mean ± SD (min–max) and frequencies.
Results: 127 patients were evaluated, of which 33 (26%) had previous history of at least one cardiovascular event. The mean age was 62.9 ± 10.9 (28-91) years, and the duration of diabetes was 16.5 ± 10.7 (1-56) years. The following frequencies were found for the evaluated variables: female 61.4%, hypertension 93.7%, AF 1.6%, smoking 9.4%. The CVR was calculated in 84 patients: 61.9% were classified as high risk, 29.8% as intermediate risk and 8.3% as low risk. The percentage of patients with established cardiovascular disease (CVD) who presented LDLc below 70 mg/dl, according to the goal, was only 39.4%. Among the patients without CVD, 55.3% presented LDL-c below 100 mg/dl according to the goal. Statin use was observed in 109 (85.8%) and none of the patients were using the maximum dose.
Conclusion: Although the patients ‘profile was high in CVR, the proportion with LDL-c outside the goals established by the AACE consensus was high, pointing to the need for improvement in statin therapy. The prescription of more potent statins and in higher doses is often hampered by the financial difficulties of the patients attended in public clinics.
A54 Case report: rare form of diabetes mellitus type 1 in adolescent patient
Beatriz da Camara Fernandes, Lucio Henrique Rocha Vieira, Elisa Borges Schmidt, Daniel Luis Schueftan Gilban, Lívia Vianna Ferreira
HFB, Rio de Janeiro, Brazil
Correspondence: Beatriz da Camara Fernandes
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A54
Background: Being a rare form of presentation of Diabetes Mellitus type 1 (DM1), Mauriac Syndrome (MS) is characterized by the symptomatology of hepatomegaly, growth retardation and diabetes with poor metabolic control of long evolution. It is reversible with improved metabolic control of the patient.
Case presentation: A 15-year-old male patient, during the 6-year diagnosis of DM1, presented a history of poor glycemic control, growth retardation and development, hepatomegaly, and dyslipidemia. Makes continuous use of insulin, enalapril, simvastatin and gabapentin, for neuropathic pain. Also presents Arterial Hypertension with investigation of normal secondary causes (renal ultrasound (US) and normal metanephrines). During an investigation of low weight gain with occasional abdominal pain, he had no antibodies or clinical history compatible with celiac disease. Laboratory screening revealed a significant increase in transaminases, with viral and autoimmune markers that did not justify liver injury. US liver suggestive of enlarged liver with diffusely high density. Normal proteins lectrophoresis. In spite of 3 years of insulin therapy, his weight-height curve was reduced to values lower than the percentile 3, which is maintained until now. No delay in psychomotor development, with good school performance. Tanner G1P1 classification (pubertal delay). Last hospitalization at age 14 was scheduled to evaluate adherence to treatment and dose adjustment, as A1c reached 18.2%. After this measure, with the intervention of a team composed of endocrinologists, psychologist, social worker, nurses and educators in diabetes, it returns to adequate metabolic control and after one year there was a reduction of A1c to 7.1%. Patient is now conscientious and adherent to treatment and with good response in weight gain and height (Fig. 1).
Conclusions: The diagnosis of MS is clinical and should be early. The prognosis is reserved, although the treatment is the same as in the traditional forms of DM1. Hepatic growth is a sign of inadequate glycemic control, in the exclusion of other secondary causes. Adequate patient therapy accelerated the growth curve and pubertal development. MS is a rare complication of poorly controlled DM1, the attending physician should be attentive to perform differential diagnoses, and thus, be able to perform timely interventions.
Informed consent to publish has been obtained from the parent of this patient.
A55 Case report: cardiovascular autonomic neuropathy associated with type 1 diabetes—evolution after myocardial revascularization
Denise Linhares Pereira Gottsch, Raissa Pereira Fernandes, Ronan Araujo Garcia, Hermelinda C Pedrosa, Cejana de Souza Hamu Aguiar
Hospital Regional de Taguatinga, Distrito Federal, Brazil
Correspondence: Denise Linhares Pereira Gottsch
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A55
Case report: Female patient, 43 years old, DM1 for 35 years, compensated hypothyroidism, grade 1 central obesity, SOAS, former smoker (aged > 20 years), current treatment (CIIS) and OAD (metformin; iSGT2, offlabel), mean HbA1c 8.0%. MI positive Family history (father died at age of 44 years). Painful diabetic polyneuropathy (PDPN) screening was absent and Installed cardiac autonomic neuropathy (ICAN) presente with high heart rate (HR, 95 bpm). Beta-blocker and thioctic acid HR 600 mg were initiated and she was referred to a cardiologista. Angiotomography could not be performed due to bronchospasm and further catheterization showed severe lesion in anterior descending artery (AD) and pharmacological stent was implanted. Reevaluation 8 months later showed CAN change to Incipient rather than Installed and HR reduced to 75 bpm.
Discussion: CAN is a DM frequent complication and considered a cardiovascular risk marker due to its association with silent infarctions, arrhythmias, sudden death. CAN is evaluated through cardiovascular autonomic reflex tests (CARTS) and cardiac frequency spectral analysis (CARTS and HR; Ewing DJ, 1986), respectively. CAN: Absent (0-1 abnormal test: sensitivity 99%); Incipient (2 abnormal tests: specificity 98%); Installed (3 abnormal tests, specificity 99%); Severe (3 abnormal tests and systolic hypotension). CARTS are non-invasive, have high sensitivity, specificity, reproducibility, easy to perform (time 20-30 min) and are golden standard for CAN. Overt changes indicate 56% mortality in 5 years (Vinik A, 2007). Screening should be performed after 5 year duration of DM1 independently of clinical symptoms (rest tachycardia, syncope, palpitation or weakness). Patient has never been investigated either for CAN or coronary heart disease.
Final comments: CAN is a strong predictor of CVR, early diagnosis and treatment increase survival and quality of life. However, CARTS have not been performed into the endocrinological or cardiologic clinical routine. This poor approach contribute to subdiagnosis, higher risk of sudden death and may explain the lack of studies of CAN following myocardial revascularization.
Informed consent to publish had been obtained from the patient.
A56 Case report: painful diabetic polyneuropathy and cardiovascular autonomic neuropathy associated with type 1 diabetes—evolution after myocardial revascularization
Denise Linhares Pereira Gottsch, Ronan Araujo Garcia, Raissa Pereira Fernandes, Cejana de Souza Hamu Aguiar, Hermelinda C Pedrosa
Hospital Regional de Taguatinga, Distrito Federal, Brazil
Correspondence: Denise Linhares Pereira Gottsch
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A56
Case presentation: Female patient, 56 years old, DM1 since 10 years of age, no smoker. Current treatment: insuline glargine + ultra fast acting insulin. Screening: severe diabetic polyneuropathy (DPN) and installed cardiovascular autonomic neuropathy (CAN). Angiotomography and coronary artery calcium score (CAC): diffuse calcification in anterior descending artery (AD), circumflex, marginal and right coronary arteries without possibility of determining stenosis due to intensity of calcification. Immediate catheterization was performed as AD showed 70% occlusion requesting a drug-eluting stent implantation.
Discussion: DPN and CAN are frequently associated DM complications. CAN is considered a marker of cardiovascular risk (CVR) and it is associated with silent infarctions, arrhythmias, sudden death. DPN and CAN were evaluated by validated protocols (Abbot C, 2011; Gomes MB, 2012 and Ewing DJ, 1986): Neuropathy Disability Score (NDS), cardiovascular autonomic reflex tests (CARTS) and heart rate, respectively. Painful DPN presente (PDPN) if score of signs ≥ 3 and symptoms ≥ 5; CAN: Absent (0-1 abnormal test: sensitivity 99%); Incipient (2 abnormal tests: specificity 98%); Installed (3 abnormal tests, specificity 99%); Severe (3 abnormal tests and systolic hypotension). CARTS are non-invasive, have good sensitivity, specificity, reproducibility and are easily performed (20-30 min), thus are considered gold standard. Abnormalities indicate 56% mortality in 5 years (Vinik A, 2007) and screening must be performed after 5 years of DM1 diagnosis. Patient had never been investigated for CAN neither for coronary heart disease. Strong relationship between PDPN and CAN as a result of small nervous fiber (pain and autonomic innervation, Testfaye S, 2010). ACCORD STUDY (2010) showed that CAN + DPN were the greatest predictors of cardiovascular death; and DCCT/EDIC (2013) the association of DM duration, age at DM diagnosis and CVR alluding a “metabolic memory” effect which influenced the lower incidence. Finally, Vinik A and Ziegler D (2007) points out CAN as a vector of the CVR.
Conclusion: Coexistence of CAN + DPN increases CVR, but are still underdiagnosed and subtreated. CAC with our without scan is not routinely used to screen CVR. The presente case is a clear example of lack of proper approach 2 and reinforces the need of screening, early diagnosis and prompt treatment of cardiovascular complications among DM1 patients.
Informed consent to publish had been obtained from the patient.
A57 Challenges in the management of type 1 diabetes with suspected hyporreninemic hypoaldosteronism
Caio Villaça Carneiro1, Martha Camillo Jordão1, Rafael Buck Giorgi1, João Henrique Del Grandi Spontão1, Daniele Iop de Oliveira Caldoncelli1, Camila Gagliardi Walter1, Ravena Machado Massucatto1, Thaís Picelli Pescarolo1, Ariane Cantarella1, Alexandre Eduardo Franzin Vieira1, Maria Teresa Verrone Quilici1, Carla Sanchez Bergamin Rizetto1, Luiz Clemente2
1PUC-SP, São Paulo, Brazil; 2UNIFESP, São Paulo, Brazil
Correspondence: Caio Villaça Carneiro
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A57
Case presentation: A 24-year-old male, diagnosed with type 1 diabetes mellitus (DM1) for 12 years, presented progressive of walking difficulties 5 years ago, associated with dizziness, weakness, and tachycardia at rest with hypotension. The patient had a history of poor glycemic control, with no evidence of nephropathy, retinopathy, and serum potassium levels within normal limits. Neuropathy Disability Score (NDS) was carried out, presenting 10 out of 10 points, classified as severe impairment. Because of an extremely significant clinical condition, with no evidence of microvascular compromise, hyporeninemic hypoaldosteronism (HH) was investigated. He was submitted to the posture test, with aldosterone dosage and renin plasma activity, without a significant increase in his values. Subsequently, the patient was exposed to the exogenous ACTH test, with the administration of ACTH 250mcg intravenous and dosages of serum cortisol and aldosterone at times 0‘, 30‘, 60‘. There was an elevation of serum cortisol to levels above the limit of normality (18 mcg/dL), discarding primary adrenal insufficiency, and aldosterone levels at the lower limit of normal (attached tables). Even tests without confirmation, the use of fludrocortisone 0.2 mg/day was started as a therapeutic test. The patient progressed with an improvement of the blood pressure (BP) and dizziness.
Discussion: HH is an uncommon condition, often associated with DM1, and such diagnosis is considered a challenge to the endocrinologist. Pathophysiology is supported by two main factors: reduction of aldosterone and renin production, secondary to autonomic neuropathy of the juxtaglomerular cells. HH has the effect of reducing angiotensin II, leading to hydro electrolytic disorders such as hyperkalemia, as well as BP deregulation. Recent studies showing this association are scarce due to the difficulty in diagnosis and lack of knowledge of this complication.
Final comments: The patient described presents an unusual clinical condition, incompatible with a standard laboratory HH picture, which may be justified by the probable autonomic neuropathy, triggered by denervation of the glomerular zone, with subtle elevations in aldosterone levels, without suppression of plasma renin. In conclusion, HH is a group of diseases that are difficult to diagnose and may manifest in atypical forms. Therefore, the dedication of the medical team should be expanded to avoid underdiagnosis of this condition. Informed consent to publish had been obtained from the patient (Fig. 1).
A58 Changes in intestinal tlrs gene expression after 3 months of roux-en-y gastric bypass (RYGB) in type 2 diabetes mellitus (T2DM) obese patients
Beatriz de Azevedo Muner Ferreira, Danielle Cristina Fonseca, Raquel Susana Matos de Miranda Torrinhas, Natasha Mendonça Machado, Robson Kiyoshi Ishida, Marco Aurélio Santo, Eduardo Guimarães Hourneaux de Moura, Paulo Sakai, Ismael Francisco Mota Siqueira Guarda, Dan Linetzky Waitzberg, Priscila Sala1
FMUSP, São Paulo, Brazil
Correspondence: Beatriz de Azevedo Muner Ferreira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A58
Background: Toll-like receptors (TLRs) are immune receptors involved in inflammation and are mostly activated by fatty acids and endotoxins. TLRs are present in inflammatory states such as obesity and metabolic syndrome. TLR4 and TLR7 receptors, for example, have been associated with chronic inflammation, impaired immune function and type 1 and type 2 diabetes mellitus (T2DM), while TLR10 is an anti-inflammatory pattern recognition receptor. Following Roux-en-Y Gastric Bypass (RYGB), patients may present changes in intestinal TLRs gene expression, decreased inflammation, and rapid improvement in glycemic control.
Objective: Examine selected TLRs in intestinal tissue within 3 months after RYGB.
Methods: Intestinal biopsies (duodenum, jejunum and ileum) were obtained from 20 obese women with T2DM (age, 46.9 ± 6.2 years, body mass index [BMI], 46.5 ± 5.3 kg/m2) before and 3 months after RYGB (BMI, 38.2 ± 4.2 kg/m2), and submitted to transcriptomic analysis by microarray technique and RT-qPCR. Markers of glycemic homeostasis were measured in the blood. After 1 year of RYGB, patients were classified as responsive (R) and nonresponsive (NR) to total remission of type T2DM.
Results: Three months after RYGB, TLR-encoding gene expression had significantly reduced TLR4 and TLR7 in the jejunum of patients responsive to remission of T2DM (p < 0.05).
Conclusion: RYGB and weight loss induce change in intestinal expression of TLRs mainly in the jejunum of R group. Modulation of TLRs in the gastrointestinal tract could mediate mechanisms of attachment to remission of T2DM after RYGB.
A59 Characterization of care of patients with foot diabetic in a public ambulatory in Sao Paulo‘s interior
Sandra Maria Batista Grossi, Ligia Nogueira Manso de Oliveira, Nancy Bueno Figueiredo
AME BAURU, São Paulo, Brazil
Correspondence: Sandra Maria Batista Grossi
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A59
Introduction: Diabetic foot is considered a complication of diabetes mellitus and it is the major cause of lower limb amputations. Avoiding its appearance, there is a need for guidelines on preventive measures and self-care.
Objective: Performing the matriciament of patients ‘wounds with diabetic foot, propose therapeutic actions to treat the lesions and emphasize the importance of self-care and prevention of complications related to diabetic foot.
Methods: Data were collected from February 2016 to July 2017, through an evaluation form of wounds. This is a descriptive and quantitative study with a sample of 24 patients who were followed up in nursing consultations.
Results: Data revealed a prevalence of males, aged average 59, predominance of type 2 diabetes, with neuropathic etiology and mean disease duration of 16 years. It was verified that 30% of patients presented amputation, five had osteomyelitis and three had progressed to amputation. Regard to the use of shoes, it was observed the use of inappropriate footwear in all patients‘therapeutic for 71% of the cases. Among 24 patients, 79% participated in multidisciplinary guidance on foot care. 17% of patients are under treatment, 46% wound healing, 21% were against referral to the primary service and 17% were referred to tertiary service, due to the complexity of the lesion.
Conclusion: This study revealed the need for educational, mainly in relation to preventive measures and, therefore, required education and self-care in order to prevent complications. Nurses play a key role in the evaluation and prescription of dressing, guidance and injury prevention. A multi professional action may potentiate as guidelines and increase adherence to treatment.
A60 Circulating microparticles are associated with type 2 diabetes mellitus and correlate with fasting glucose levels
Kathryna Fontana Rodrigues1, Nathalia Teixeira Pietrani1, Adriana Aparecida Bosco2, Ana Paula Fernandes1, Fernanda Magalhães Freire Campos1, Karina Braga Gomes Borges1
1UFMG, Minas Gerais, Brazil; 2Instituto de Ensino e Pesquisa da Santa Casa, Minas Gerais, Brazil
Correspondence: Kathryna Fontana Rodrigues
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A60
Introduction: Type 2 diabetes mellitus (T2DM) is associated with a chronic and subclinical inflammatory state. Microparticles (MPs) are extracelular microvesicles released during apoptose and cellular activation. MPs express pro-coagulant and -inflammatory activities, contributing to endothelial dysfunction observed in T2DM.
Objective: This study aimed to evaluate the circulating MPs profile in T2DM patients and to correlate it with fasting glucose levels in this group.
Methods: Sixty-nine subjects were selected, of whom 39 patients with clinical and laboratorial diagnosis of T2DM and diabetic kidney disease, and 30 gender and body mass index -matched non-diabetic control. Circulating MPs from platelets (PMPs; CD41 +), leukocytes (LMPs; CD45 +), endothelial cells (EMPs; CD51/61 +), and that express tissue factor (TFMPs; CD142 +) were measured by flow cytometry. Fasting glucose levels were measured in serum samples, after 8 h of fasting, using a commercial kit by enzyme-colorimetric method. Statistical analysis were performed with SPSS (version 17.0) using Mann–Whitney and Spearman’s correlation tests. The data were presented as “median (interquartile range)”. A pvalue < 0.05 was considered statistically significant. This study was approved by Federal University of Minas Gerais Ethical Committee and an informed consent was obtained from the individuals.
Results: We observed higher total levels of circulating MPs in T2DM [153.40 (142.15) MPs/μL] than in control group [85.33 (76.08) MPs/μL; p < 0.0001]. Moreover, higher levels of circulating PMPs [T2DM 167.53 (206.73) MPs/μL; control 113.83 (97.05) MPs/μL], LMPs [T2DM 119.13 (86.27) MPs/μL; control 53.80 (44.42) MPs/μL], EMPs [T2DM 157.53 (131.53) MPs/μL; control 86.50 (71.65) MPs/μL], and TFMPs [T2DM 169.93 (213.47) MPs/μL; control 99.60 (87.53) MPs/μL] were observed in T2DM patients when compared with control subjects (p < 0.0001 for all). Considering all the subjects, fasting glucose levels showed a significant positive correlation with PMPs (r = 0.286, p = 0.017), LMPs (r = 0.549, p < 0.0001), EMPs (r = 0.462, p < 0.0001), and TFMPs (r = 0.343, p = 0.004) levels.
Conclusion: These results suggested that higher circulating MPs levels are associated with T2DM and they correlate with glycemic levels. Therefore, MPs are promising biomarkers for assessment of inflammatory and pro-coagulant status in T2DM patients with diabetic kidney disease.
A61 Clinical and epidemiological profile of patients with post-transplant diabetes mellitus of liver in a center of reference of the state of Ceará
Naiara Castelo Branco Dantas, Leticia de Sousa Guerin, Caio Viana Botelho, Luma Maria Tavares de Sousa, Marcelo Kervin Reis Frota, Manoela Montenegro Dias de Carvalho, Daniel Duarte Gadelha, Cyntia Ferreira Gomes Viana, Elodie Bomfim Hyppolito, José Huygens Parente Garcia, Karla Brandão Pereira, Gustavo Rêgo Coelho, Tarciso Daniel Santos Rocha, Virgínia de Oliveira Fernandes, Renan Magalhães Montenegro Junior
HUWC, Ceará, Brazil
Correspondence: Naiara Castelo Branco Dantas
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A61
Introdution: Liver transplantation is becoming one of the most important therapeutic options in the liver failuretreatment. One of the complications of the transplantation is the developing of post-transplant diabetes mellitus (PTDM), due to the presence of multiple risk factors such as the use of immunosuppressive agents that increase the risk of developing PTDM by 74%. PTDM is associated with adverse outcomes such as an increasing mortality, a reduction of graft survival, a risk of sepsis and microvascular complications when compared to patients without PTDM.
Objective: To evaluate the clinicalepidemiological profile of patients with PTDM and to identify the potential risk factors for PTDM present in this population.
Methods: A cross-sectional, retrospective and descriptive study that occurred in a Hospital in the State of Ceará, Brazil, a national reference in liver transplantation, with patients who were followed up in an specialized center in PTDM between 2009 and 2015. The data were collected from medical charts. Demographic and clinical features were collected, including an evaluation of comorbidities, body mass index (BMI), glycated hemoglobin (HbA1c) and immunosuppressive therapy.
Results: From 2009 to 2015, 868 patients underwent liver transplantation, 5.3% (46/868) had diabetes before the transplant. Of those 822 who were not diabetic before surgery, 8.2% (67/822) were diagnosed with PTDM. The average age at diagnosis was 58.63 ± 10.5 years old and 77.8% (n = 52) were men. Arterial hypertension was present in 41.8% (28/67), dyslipidemia in 6% (4/67) and overweight/obesity in 65.7% (n = 44/67). The glycated hemoglobin at diagnosis was 7.06 ± 2.3%. Family history of diabetes was positive in 29.8% (20/67). The immunosuppressive treatment were done with 2 to 3 drugs, mainly tacrolimus, prednisone and mycophenolate mofetil.
Discussion: The subjects who developed with PTDM presented risk factors such as mean age greater than 40 years, metabolic syndrome, overweight/obesity, and family history of diabetes. This could suggest that patients who will undergo liver transplantation and present these features should be followed more closely after surgery and should be encouraged to reduce modifiable risk factors prior to surgery, because of the increased risk of developing diabetes. This may be a strategy to prevent PTDM in this population and the adverse outcomes associated with this condition.
A62 Clinical and sociodemographic variables associated with chronic complications in diabetic patients type 2 during ambulatory follow-up
Laís de Oliveira Hernandes1, Tatiana Siqueira Capucci2, Mariana Accioly Carrazedo3, Wimbler Pires4, Jucelia Candido5, Josafá Fabricio dos Santos5, Joelma Aguilera Dias Magalhães5, Ricardo Emidio Navarrete de Toledo3,5
1Santa Casa de São José dos Campos, São Paulo, Brazil; 2Instituto Policlin de Ensino e Pesquisa, São José dos Campos, São Paulo, Brazil; 3Beneficência Portuguesa de São Paulo, São Paulo, Brazil; 4FMU (Faculdades Metropolitanas Unidas), São Paulo, Brazil; 5IEFAP/Uningá, Paraná, Brazil
Correspondence: Laís de Oliveira Hernandes
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A62
Introduction: Type 2 diabetes mellitus (DM2) is one of the main public health problems today, with alarming rates of morbidity and mortality. The production of information on the prevalence and sociodemographic variables associated with complications increases the knowledge about the health of people with DM2 and favors the formulation of feasible policies and strategies for the prevention and treatment of this condition.
Objectives: To evaluate the interrelationships between chronic complications and clinical and sociodemographic variables of patients with DM2.
Materials/Methods: A cross-sectional study between October and December/2016, based on the medical records of 278 DM2 patients followed up at the Endocrinology Outpatient Clinic. Forty-two patients were excluded from the analysis by incomplete data, totaling 236 patients. The following variables were analyzed: age, gender, weight, height, body mass index (BMI), presence or absence of systemic arterial hypertension (HAS), and the presence of chronic microvascular and macrovascular complications. The data were organized in Excel 2010® worksheet and a descriptive analysis was performed.
Results: Among Multiple linear regression analysis identified that DM2 correlated positively with age (96% with age > 40 years had DM2, r = 0.61, p < 0.01), sex (prevalence 64% (p < 0.01), BMI (100% of DM2 had BMI > 30 kg/m2) and presence of hypertension (84.87%). With regard to complications, 52.56% had some micro or macrovascular complications. There was a reciprocal relationship between hypertension and BMI (76.69% of hypertensive patients had BMI > 25 kg/m2, while 77.77% of hypertensive obese patients had hypertension).
Conclusion: Our results reinforce the main clinical and sociodemographic variables associated with the phenotype of the metabolic syndrome, which corroborate the development of DM2.
Acknowledgments: No funding was obtained from pharmaceutical companies to carry out this study. All authors were involved in the data collection and analysis. DISCLOSURE: The authors declare no conflict of interest.
A63 Clinical evaluation of methodology based on variability of cardiac frequency for early diagnosis of autonomic neuropathy in individuals with type 1 diabetes
Ana Paula Franco Pacheco, Simone Van de Sande Lee, Jefferson Luiz Brum Marques, Cristina Schreiber Oliveira
UFSC, Santa Catarina, Brazil
Correspondence: Ana Paula Franco Pacheco
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A63
Background: Autonomic neuropathy (AN) is a serious diabetes complication, which affects the autonomic nervous system. This system has the function of controlling the autonomous body’s organs, it is sensitive to changes caused by the lack of control of type 1 diabetes mellitus (T1DM) and can cause cardiovascular autonomic neuropathy (CAN). One way to detect AN is by examining the heart rate variability (HRV) that corresponds to fluctuations in the intervals between consecutive heartbeats, using signal processing techniques.
Objectives: To evaluate the clinical utility of the method referred to diagnose CAN still in subclinical stage; evaluate its predictive validity as an indicator of prognosis; to determine which set of parameters and clinical characteristics best discriminates between stages of CAN; to evaluate influence on clinical status of individuals who participated in a structured education program (SEP).
Methods: In this cohort study, a spectral analysis of HRV was performed through a system that captures ECG signals, and this methodology was refined by comparison with conventional tests O’Brien and BRS for the detection of CAN in individuals with T1DM with different degrees (No CAN, Subclinical CAN and Established CAN). Analysis of clinical and physical examination of peripheral neuropathy (PN) and follow-up of individuals who participated in the SEP.
Results: The analysis of these results showed the efficacy of the methodology applied for the early detection of CAN, as well as to discriminate characteristics between the different stages, and determined parameters calculated to identify these groups of individuals. The sample size was 66; the mean age was 31.35 ± 9.97 years; The mean time of DM1 diagnosis was 16.03 ± 9.22 years; The mean HbA1c was 8.65% ± 1.94 or 71.05 mmol/mol ± 21.22; Of the total number of individuals, 25 (37.88%) had previously participated in SEP and 18 (27.27%) had a diagnosis of retinopathy. In the O‘Brien test, 16 (24.24%) individuals presented a diagnosis of subclinical CAN and 11 (16.67%) of established CAN, whereas by the HRV test, 35 (53.85%) were diagnosed with subclinical CAN and 12 (18.46%) with established CAN. The HRV parameters HF, LF, SD2, SDNN, RMSSD and TP showed a difference between groups and CSI values for subclinical CAN were higher than for individuals No CAN (p < 0.05). SEP participants maintained ideal HbA1c values.
Conclusion: It was possible to affirm that the model adopted by the study diagnoses in a simple and efficient way, through some specific parameters, the subclinical CAN in individuals with T1DM with its predictive value and high indices of specificity and sensitivity. In addition, it was understood that SEP has influence on the process of avoiding and/or retarding CAN. It is expected that the study may contribute to scientific, technological and innovation development with emphasis on diabetes, treatment and complications (Fig. 1).
A64 Clinical evolution of patients with type 1 diabetes mellitus followed in a secondary care reference center of Minas Gerais
Agma Leozina Viana Souza, Aleida Nazareth Soares, Alexandra Dias, Janice Sepulveda Reis, Tatiane Gea Horta
Instituto de Ensino e Pesquisa Santa Casa BH, Minas Gerais, Brazil
Correspondence: Agma Leozina Viana Souza
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A64
Background: Diabetes mellitus is a serious public health problem worldwide. Because it is a chronic condition of high prevalence, regular follow-up is important to prevent complications due to the disease.
Objective: To evaluate the clinical evolution of patients with type 1 diabetes mellitus (T1DM) attended in a secondary care reference center of Minas Gerais.
Methods: This is a longitudinal study with 174 people with T1DM followed up by a multidisciplinary team, all of them referred from primary care from 2010 to 2015. Clinical evolution was based on annual mean levels of glycated hemoglobin (A1c) and LDL cholesterol. Paired T-test and McNemar test were used for the annual comparisons of A1c and LDL-c. In every test a significance level of less than 5% was considered.
Results: The sample was constituted by a majority of men (55.1%), single (60.9%), self-referred as brown (47.1%), formal workers (47.1%), with full high school or college education (47.2%), income between 1 and 2 minimum wages (69.6%), average age of 34 ± 14 years old, having diabetes for 15.35 ± 10.3 years and 49.5% of people living in Belo Horizonte. All patients were undergoing intensive treatment of diabetes, with 10 patients (5.7%) in a continuous system of insulin infusion. Of those in multiple daily applications, the majority were in NPH use (61.5%), followed by glargine (32.8%), with 83.3% in ultrafast insulin use. Less than half of the study group, 87 subjects (47.1%), used statins. The study showed that 63.21% of patients (n = 110) started the accomplishment at the health service with A1c values above 8%, of which 47 (27.01%) were above 10%. At the end of the first year of follow-up, that percentage was reduced to 49.99%, with the higher reduction in the ones with A1c levels over 9% (Table 1). In this period, there was a significant reduction in the A1c means (9.01 ± 2.46 in 2010 and 8.2 ± 1.74 in 2011; p < 0.001), remaining unchanged in the following years, but with a concentration of patients in the category of 7–8%, below the national average. Regarding LDL-c, it was observed a significant reduction throughout the follow-up period (p < 0.005) (Table 2).
Conclusion: The multidisciplinary assistance to patients with TIDM in a secondary care service has contributed to the improvement of metabolic parameters since the first year of follow-up (Fig. 1).
A65 Clinical impact of treatment intensification in patients with T2D uncontrolled with basal insulin
Erin Buysman1, Tao Fan2, Cori Blauer-Peterson1, Lesley-Ann Miller2
1Optum, INC., Eden Prairie, MN, USA; 2Sanofi US, INC., Bridgewater, NJ, USA
Correspondence: Erin Buysman
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A65
Despite the availability of several antidiabetes agents, treatment intensification (TI) may not be promptly implemented in cases of suboptimal glycemic control. This study compared clinical outcomes for patients (pts) with T2D uncontrolled after ≥ 6 months of treatment with basal insulin (BI) who underwent TI or no TI (NTI). TI included adding a GLP-1 receptor agonist (RA), bolus insulin or SGLT2 inhibitor, switching to premixed insulin or increasing BI dose. Data on eligible pts undergoing TI within 6 months of the first A1c ≥ 7.0% measure (index date) were collected from the Optum administrative claims database between January 1, 2009 and August 31, 2015. A1c change from the index date and hypoglycemia incidence were determined 12 months after TI (randomly selected date for the NTI cohort). Bivariate comparisons were made between the two cohorts. A total of 10.425/16,140 (65%) adults uncontrolled with BI underwent TI. Pts in the TI cohort were slightly younger than in the NTI cohort (61 vs. 62 years) and had higher index A1c (8.94% vs. 8.60%; P < 0.001). A greater A1c reduction (− 0.30% vs. − 0.04%; P < 0.001) and higher hypoglycemia rate (6.94% vs. 5.76%; P = 0.004) were seen for TI pts at follow-up. Pts adding a GLP-1 RA and bolus insulin showed greater A1c changes vs. those increasing BI dose (GLP-1 RA, − 0.62%; bolus insulin, − 0.61%; BI, − 0.23%; P ≤ 0.002 for both agents vs. BI), and severe hypoglycemia was less frequent with GLP-1 RA-containing vs. insulin-only regimens (GLP-1 RA, 0.43%; bolus insulin, 3.13%; BI, 2.52%; P < 0.05 for GLP-1 RA vs. insulin). Clinical inertia is still widespread in clinical practice. Timely TI improves A1c levels but is associated with more frequent hypoglycemia, primarily driven by basal-bolus insulin and BI titration. Injectable agents are more effective than BI dose increases for pts uncontrolled after ≥ 6 months on BI; GLP-1 RAs show the lowest hypoglycemia rate. Our data highlight a need for new and improved agents that effectively manage glycemia while reducing hypoglycemia risk. This is an ENCORE abstract previously presented at ADA2017. Funding and editorial support provided by Sanofi.
A66 Clinical inertia in primary health care: can a game change the game?
Leandro Arthur Diehl, Bárbara Jacob Vieira, Cláudio Augusto da Silva Júnior, Douglas Henrique Katayama de Souza, Emanuelle Roberto Trevisani
Universidade Estadual de Londrina (UEL), Paraná, Brazil
Correspondence: Leandro Arthur Diehl
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A66
Background: Only 24% of patients with diabetes mellitus (DM) present good glycemic control. This is partly due to clinical inertia (failure to adjust therapy when needed), especially related to insulin initiation.
Objective: To assess if playing a digital serious game for medical education on insulin therapy (InsuOnline) is associated with changes in the practice of primary care physicians (PCPs) related to insulin initiation.
Methods: A noncontrolled experimental study was performed with PCPs working in primary healthcare units (UBSs) in Londrina and Cambé (Paraná). All of them played InsuOnline. We identified the patients for whom those PCPs initiated insulin in their UBSs in 2 time points: up to 6 months before, and up to 6 months after playing the game. Then we collected from their charts: demographic data, time between the first indication for insulin and the first prescription of insulin, and glycemic control indicators. Data were stored and analyzed in Epi-Info 7. Research protocol was previously approved by an institutional review board and local health authorities.
Results: 23 PCPs were included (4 from Cambé and 19 from Londrina). They initiated insulin in 56 patients in the period (22 before, and 34 after the game; P = 0.09). Patients were most female (32/56), with mean age 59 ± 12. Mean duration of DM when insulin was initiated was 5.4 ± 5.3 years. Time between the first indication for insulin and the first prescription of insulin by the PCP was 70 days (median; IQ 0–393). When insulin was initiated, mean A1c was 10.2 ± 1.8% and mean plasma glucose was 268 ± 89 mg/dL. After insulin initiation, A1c and glucose decreased to 9 ± 1.5% and 193 ± 72 mg/dL, respectively; 59% of patients presented improved glycemic control after insulin initiation. No difference was found when the time points (before and after the game) were compared. The small sample and the lack of data in charts were limitations to this study. It is possible that additional interventions are required to improve the actual care of DM patients in primary health care.
Conclusion: There was a nonsignificant trend to more frequent insulin initiation by PCPs after playing the game InsuOnline.
A67 Clinical perspectives from the begin and edition longer-acting insulin programs: trial-level meta-analyses outcomes with either degludec (IDEG) or glargine 300 μ/ml (GLA-300) vs. glargine 100 μ/ml (GLA-100) in T2DM
Julio Rosenstock1, Robert A. Ritzel2, Soazig Chevalier3, Beverley Balkau4, Ronan Roussel5
1Dallas Diabetes and Endocrine Center at Medical City, Dallas, TX, USA; 2Klinikum Schwabing, Städtisches Klinikum München GmbH, Munich, Germany; 3Sanofi, Paris, France; 4INSERM U1018, Center for Research in Epidemiology and Population Health, UPS-UVSQ, Villejuif, France; 5Assistance Publique Hôpitaux de Paris, Bichat Hospital, Paris, France
Correspondence: Julio Rosenstock
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A67
Efficacy and safety of IDeg and Gla-300 were compared with Gla-100 in the BEGIN and EDITION programs, respectively. HbA1c, FPG and hypoglycemia incidence with IDeg or Gla-300 vs Gla-100 were explored in 2 trial-level meta-analyses of clinical trials in T2DM (Fig). FPG reduction was significantly more pronounced with IDeg vs Gla-100 but HbA1c reduction was significantly greater for Gla-100. HbA1c reduction was comparable with Gla-300 and Gla-100 whereas FPG reduction was significantly greater with Gla-100 in the fixed but not random effect model. Risk of ≥ 1 confirmed (< 56 mg/dL) or severe hypoglycemic event was lower with IDeg vs Gla-100 at night (00:01-05:59 h) but comparable at any time (24 h). Risk of ≥ 1 confirmed (< 54 mg/dL) or severe hypoglycemic event was lower with Gla-300 vs Gla-100 at night (00:00–05:59 h) and also at any time (24 h). Risk of ≥ 1 severe hypoglycemic event was comparable with IDeg or Gla-300 vs Gla-100. Summary, in trial-level meta-analyses in T2DM, Gla-100 reduced HbA1c more than IDeg despite IDeg having a greater FPG-lowering effect. Hypoglycemia risk was lower with IDeg vs Gla-100 for nocturnal but not anytime events. Gla-300 provided comparable glycemic control to Gla-100 with lower risk of anytime and nocturnal hypoglycemia. Head-to-head trials of IDeg vs Gla-300 are needed. Study codes: NCT01499082, NCT01499095, NCT01676220. This is an ENCORE abstract previously presented at ADA2016. Funding and editorial support provided by Sanofi (Fig. 1).
A68 Clinical profile of patients with diabetes mellitus and liver transplantation and results after a multidisciplinary team intervention
Cinthia Minatel Riguetto, Ticiane Gonçalez Bovi, Adriana Russo Fiore, Luciana Teixeira Lot, Elaine Cristina de Ataíde, Arnaldo Moura Neto, Ilka de Fátima Ferreira Santana Boin
Universidade Estadual de Campinas, São Paulo, Brazil
Correspondence: Cinthia Minatel Riguetto
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A68
Background and aims: Over the years, survival after liver transplantation (LT) has increased and metabolic complications are becoming more common, contributing to patients’ morbidity and mortality. The objectives of this study were to describe a population of patients with hepatic transplantation and diabetes mellitus (DM), evaluate the frequency of metabolic complications and assess the impact of a multidisciplinary team on DM management.
Materials and Methods: This was a retrospective study involving interview and medical record analysis of 46 consecutive patients followed at the Diabetes Mellitus and Liver Transplantation Unit of a tertiary university hospital, all evaluated by a multidisciplinary team. In twenty-nine of these patients anthropometric measures of nutritional status were evaluated including body mass index (BMI), triceps skinfold (TSF), arm circumference (AC), arm muscle circumference (AMC) and fat area (FA).
Results: Off all patients, 76.1% were men, with median age of 60 years old (IQR 56–65 years) and LT time of 5 years (0.6–9 years). The most frequent etiology of cirrhosis leading to LT was hepatitis C virus (69.6%), followed by alcohol abuse (19.6%). Hypertension, hypercholesterolemia, hypertriglyceridemia, alcoholism and smoking were present in 47.8, 34.8, 23.9, 34.8 and 30.4% of the patients, respectively. Regarding the evaluation of nutritional status, 11 patients (37.9%) were classified as overweight according to BMI (median 26.27 kg/m2) and 12 (41.2%) according to the TSF. Nineteen (66.5%), 21 (72.4%) and 13 (44.8%) patients were classified as eutrophic according to AC, AMC, and FA, respectively. The diagnosis of DM was made after LT in 65.2% of cases, with a median time of 1.5 years (0.5-5.5). The most frequent immunosuppressant in use were tacrolimus (71.1%) and mycophenolate (48.9%). The median HbA1c and weight before and after intervention of the multidisciplinary team were, respectively, 7.6% (5.7%–8.8%;) vs. 6.5% (5.7%–7.7%); p = 0.022 and 70.5 kg (64.7–82.0 kg) vs 71.6 kg (65.0–85.0 kg); p = 0.18.
Conclusions: There was a high frequency hepatitis C virus and users of tacrolimus in patients with DM. Hypertension and dyslipidemia are common in transplanted patients with DM. Intervention of the multidisciplinary team resulted in a significant improvement in HbA1c without significant weight gain. This study showed that a multidisciplinary team approach in the management of DM in LT patients is helpful.
A69 Clinical, demographic and laboratorial parameters in a population of type 1 diabetic patients with metabolic syndrome
Bianca Senger Vasconcelos Barros, Deborah Conte Santos, Marcela Haas Pizarro, Laura Gomes Nunes de Melo, Marilia Brito Gomes
UERJ, Rio de Janeiro, Brazil
Correspondence: Bianca Senger Vasconcelos Barros
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A69
Introduction: Obesity has become a concern worldwide, even in patients with type 1 diabetes. It has been associated with musculoskeletal disorders, cancer and metabolic syndrome (MS), which is known to enhance cardiovascular risk.
Objective: To investigate the prevalence of MS in a type 1 diabetic population and to determine which parameters are associated with this diagnosis.
Methods: We evaluated 1,760 patients from all geographical regions of Brazil, in this cross-sectional multicenter study. Patients were classified according to the International Diabetes Federation criteria for metabolic syndrome (MS).
Results: From a total of 1678 (95.3%) patients with complete data, 28.4% (n = 477) were classified as having MS. Mean age (35.3 ± 11.9 vs. 28.0 ± 11.4) and diabetes duration (18.7 ± 9.8 vs. 14.1 ± 8.8) were higher and use of metformin (25.4 vs. 7.1%), statin (34.4 vs. 16.7%), fibrate (1.7 vs. 0.4%) and renin-angiotensin system inhibitor (44.4 vs. 20.6%) was more frequent in patients with MS in comparison to those without MS (p < 0.05 for all the analysis). There was no difference between the two groups regarding HbA1c levels (8.9 ± 1.9 vs. 9.0 ± 2.2). Female gender was also more prevalent in the group with MS (68.6 vs 50.0%), as well as family history for type 2 diabetes (33.8 vs 21.9%) and obesity (29.6 vs. 21.2%), p < 0.001 for all the analysis. Patients with MS also showed significantly higher levels of ALT, AST, C-reactive protein and uric acid.
Conclusions: MS affects approximately one-third of patients with type 1 diabetes. Female patients, with higher disease duration, higher age, positive family history of type 2 diabetes and/or obesity should bring attention to the risk of MS. Patients with MS exhibit higher levels of ALT, AST, C-reactive protein and uric acid, which might be related to an increase cardiovascular risk and also to an increase risk of non-alcoholic liver disease. Further studies are necessary to determine which complications are more frequent in type 1 diabetic patients with MS and how these patients should be managed.
A70 Combination of behavioral strategies to improve adherence to oral antidiabetics: a randomized controlled trial
Danilo Donizetti Trevisan1, Flávia Helena Pereira2, Thaís Moreira São João1, Marilia Estêvam Cornélio1, Fernanda Freire Jannuzzi3, Roberta Cunha Matheus Rodrigues1, Maria Helena de Melo Lima1
1Universidade Estadual de Campinas, São Paulo, Brazil; 2Instituto Federal do Sul de Minas Gerais, Minas Gerais, Brazil; 3Colégio Técnico de Campinas, São Paulo, Brazil
Correspondence: Danilo Donizetti Trevisan
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A70
Background: Through psychosocial theories such as the Theory of Planned Behavior (TPB), it becomes possible to apply theoretical models with a view to improving the adherence of patients with T2DM to oral antidiabetics and, consequently, to improve glycemic control.
Aim: The aim of this study was to evaluate the effect of the combination of the intervention strategies “Action Planning” and “Coping Planning” on the medication adherence of oral antidiabetics among patients with T2DM.
Methods: A randomized clinical trial involving outpatients with T2DM attended in a primary service care in Brazil was conducted. At the baseline, participants were randomized into two groups (intervention—IG and control—CG) and were followed for a 15-week period. The IG received a combination of strategies to promote adherence to oral antidiabetics based on face-to-face meetings and telephone calls. The CG received usual care from the health service. Drug adherence behavior, Global Adherence assessment and Glycated hemoglobin (HbA1c) were evaluated as primary outcomes. Generalized estimating equations models were applied to compare groups throughout the follow-up.
Results: Of the 90 participants, 88 completed the follow-up (IG = 44, CG = 44). The regression analysis showed better scores for the adherence behavior (p = 0.028), global adherence (p < 0.0001) and percentage of adherence (p < 0.0001) for IG when compared to CG. At follow-up, it was evidenced that the chance of IG being more adherent corresponds to 18.31 times the CG chance (CI 95%: 4.58–73.10, p < 0.001).
Conclusion: The findings of the present study allow us to conclude that the combination of behavioral strategies was effective in improving drug adherence behavior, promoting compliance to oral antidiabetic drugs and reducing HbA1c levels. Keywords: Diabetes Mellitus, Type 2; Hypoglycemic Agents; Medication Adherence; Nursing; Clinical Trial Trial registration: Brazilian Registry of Clinical Trials (RBR-439f77). Consent to publish: Informed consent to publish has been obtained from this patient.
Ethics approval: The study was approved by the University of Campinas’ Ethics Board, approval number 1.278.099/2016, 1.408.883/2016 and 1.528.738/2016 and conducted according to the recommendations of the Declaration of Helsinki.
A71 Comparable glycemic control, greater weight loss, and lower hypoglycemia with once weekly dulaglutide versus insulin glargine, both combined with lispro, in type 2 diabetes and moderate to severe chronic kidney disease (AWARD-7)
Katherine R. Tuttle1, Mark C. Lakshmanan2, Jorge L. Gross3, Brian Rayner4, Robert S. Busch5, D. Bradley Woodward2, Alan G. Zimmermann2, Aline Rejane Muller Gerent2, Fady T. Botros2,
1Providence Health Care, University of Washington, Spokane, WA, USA; 2Eli Lilly and Company, Indianapolis, IN, USA; 3Centro de Pesquisas em Diabetes, Porto Alegre, Rio Grande do Sul Brazil; 4Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa; 5Albany Medical Center Division of Community Endocrinology, Albany, NY, USA
Correspondence: Katherine R. Tuttle
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A71
Introduction/objective: The objective was to demonstrate dulaglutide (DU) noninferiority for HbA1c change after 26 weeks.
Methods: This phase 3 study compared once weekly DU to titrated daily insulin glargine, both combined with insulin lispro, in people with type 2 diabetes (T2D) and chronic kidney disease (CKD) stages 3–4. Participants were randomized (1:1:1) to DU 1.5 mg or DU 0.75 mg or titrated insulin glargine.
Results: Baseline characteristics (N = 576) included: [mean ± SD] age 64.6 ± 8.6 years, HbA1c 8.6 ± 1.0%, eGFR 38.3 ± 12.8 mL/min/1.73m2, BMI 32.5 ± 5.2 kg/m2, daily insulin dose 58.2 ± 31.8 U. DU was non-inferior to insulin glargine for HbA1c change (table). Body weight decreased with DU, whereas it increased with insulin glargine. The hypoglycemia rate (≤ 70 mg/dL) was lower for DU 1.5 mg and 0.75 mg vs insulin glargine (5.5, 7.8 and 17.1 events/participant/year; p < 0.001). Nausea, vomiting and diarrhea were more common with DU 1.5 mg (19.8, 12.0, 15.6%) and DU 0.75 mg (11.1, 5.8, 13.7%) vs insulin glargine (2.6, 3.1, 3.1%).
Conclusions: DU produced comparable glycemic control, greater weight loss, and lower hypoglycemia rate vs insulin glargine in people with T2D and CKD stage 3–4 (Fig. 1).
A72 Comparation of different intensities physical exercise on capillary glucose of type 2 diabets
Emmerson Cristyan Ferreira Dantas1, Jonathan Nícolas dos Santos Ribeiro2, Cláudio Barnabé dos Santos Cavalcanti1, Denise Maria Martins Vancea1
1UPE, Pernambuco, Brazil; 2UFPE, Pernambuco, Brazil
Correspondence: Emmerson Cristyan Ferreira Dantas
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A72
Introduction: Physical exercise has been advocated as a beneficial activity in the treatment of diabetes mellitus, improving glycemic control, contributing to weight loss and improving quality of life.
Objective: To compare different physical exercise intensities on capillary glycemia of type 2 diabetics.
Method: The study included 19 type 2 diabetics, of both sexes, with a mean age of 65 years. They were divided into two training groups according to intensity, moderate intensity training (n = 10) and high intensity training (n = 09). They performed the training three times a week in the morning, totaling 18 training sessions. The capillary glycemia was collected from diabetics before and after each training session, using glucoside. The training protocol was composed of aerobic and resistance training. For statistical analysis, the Wilcoxon test and the Kruscal-Wallis non-parametric test were used, adopting a significance level of p < 0.05.
Results: The frequency of diabetics in training was 65%. A significant decrease in glycemia in moderate intensity training (182.8 mg/dL ± 41.5 mg/dL vs. 139.2 mg/dL ± 47.2 mg/dL p = 0.00) was observed and in training (169.7 mg/dL ± 43.8 mg/dL vs. 129.2 mg/dL ± 38.9 mg/dL p = 0.00).
Conclusion: The training of different intensities, moderate and high intensity, were effective in reducing capillary glycemia of type 2 diabetics, but in the intergroup evaluation there was no significant difference. Keywords
A73 Comparative analysis between 2 studies conducted in a public health care center with 10-year interval regarding the selfblood glucose monitoring habits and level of understanding in a population of type 1 diabetic patients
Igor Torres Dias1, Cristina Figueiredo Sampaio Façanha2, Adriana Costa Forti3, João Augusto Lima Bisneto1, Gabriel Melo Ferraz Pessoa1, Joana Cysne Frota Vieira1, Gisele Ferreira Camara1, Isabele Moreno de Alencar1, Isabele Fontenele de Santiago Campos1, Kaik Brendon dos Santos Gomes1, Guilherme Leite Barboza Gonçalves1, Kenya Vitoria de Aguiar Queiroz1, George Sales de Arruda1
1Unichristus, Ceará, Brazil; 2Unichristus e Centro Integrado de Diabetes e Hipertensão do Estado do Ceará, Ceará; Brazil; 3Centro Integrado de Diabetes e Hipertensão do Estado do Ceará, Ceará, Brazil
Correspondence: Igor Torres Dias
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A73
Introduction: Self-monitoring blood glucose (SMBG) is essential for proper treatment of Type 1 Diabetes(DM1). It requires knowledge and skills to understand the tests results and make proper adjustments of the therapy. Therefore, educating the patient with diabetes to use the method has been a constant concern since the regulation of Federal Law No. 11.347, which conditioned patient education to the distribution of glucometers and supplies for the treatment of DM1. In 2007 we evaluated the ability of our patients to use SMBG and adjust the treatment, in order to direct educational actions. After 10 years of the program on a public health care setting, we evaluated another group of patients in our service.
Objectives: To compare the abilities of DM1 patient to use SMBG data to adjust their treatment at the beginning of the program and after 10 years of its implementation.
Methods: A comparative study between the data from the evaluation done in 2007 and 2017 at the same outpatient referral center about the knowledge of DM1 patients on SMBG. For statistical analysis EpiInfo version 3.5.2 was used.
Results: In 2006, we evaluated 108 DM1 patients, with a mean age of 16.6 years, 59% female, mean disease time of 6.6 years. In 2017: 95 DM1 patients, mean age: 17.03 years, 60.22% female, 40.22% with diabetes > 1 year and ≤ 5 years. In 2007 we observed that 41% monitored blood glucose 1x/day and only 11% ≥ 4×/day. Currently, 48.81% monitor ≥ 4×/day and only 2.38% 1×/day. Regarding the understanding of the test results, in 2007, 88.9% believed they knew the glycemic target, and of these 82.4% correctly answered the fasting value and 57.4% postprandial. In 2017, 91.4% answered to be aware of the glycemic target, of these, 80.0% correctly answered the fasting target and 47.37% the postprandial target. The test result was used to adjust treatment by 54.6% of the patients who monitored blood glucose levels in 2007, and currently only 65.22% of the users self-adjust the dose based on tests result.
Conclusion: We observed that in our current scenario, where the availability of supplies for SMBG is improving, our patients are monitoring more frequently throughout the day, and although we see improvement in patient skills on interpreting the test results, we still need to focus on the development of an educational program that promotes patient’s empowerment to obtain the full benefit of the procedure.
A74 Comparison between methods for evaluation of renal function among diabetic patients
Mariana Carneiro da Silva1, Maiara Uchôa Fonseca2, Juliana Claro Peloso2, Gilson Fernandes Ruivo2, Rayssa Neves Salles de Carvalho1, Wanessa de Lourdes Pinto1, Camila Uchôa Fonseca2, André Luis Moreira Duarte1
1PUC Campinas, São Paulo, Brazil; 2Universidade de Taubaté, São Paulo; Bazil
Correspondence: Mariana Carneiro da Silva
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A74
Introduction: Chronic kidney disease (CKD) consists of progressive and irreversible renal damage. According to the Brazilian Society of Nephrology, Diabetes Mellitus (MD) is the leading cause of kidney failure in the world. The best way to measure renal function is glomerular filtration rate (GFR). Currently, to calculate this, we use 24-h urine creatinine clearance (ClCr), and some formulas that estimate it: Cockcroft-Gault (CG), MDRD and CKDEPI.
Objectives: The main objective is to perform a comparative analysis between the formulas and the creatinine clearance in the diabetic population, in order to determine between the different groups the closest approach to creatinine clearance in the 24-h urine.
Methods: It represents a cross-sectional observational study using a population sample of 149 type 2 diabetic patients treated at the nephrology outpatient clinic during 2014 and 2015. Patients were stratified by sex, age, and insulin use. The data were analyzed statistically with the aid of the SPSS and Bioestat program. The parameters of the descriptive statistics were used, with the use of measures of central tendency and dispersion, besides the calculation of the relative frequency and the Kolmogorov–Smirnov test.
Results: Patients were stratified by demographic variables of race (black or non-black), sex and age, showing a white (95%), female (69%) and over 50 years (96.6%) prevalence. When the formulas of estimates of renal function compared to each other, we noticed that the CKD-EPI formula behaves statistically different from the others (p < 0.05), suggesting that it would be underestimating the value of the GFR. When considering classification by CKD stages, any of the methodologies can be used, although CKD-EPI has a particular pattern in relation to others, all of them have a significant correlation with CKr. No significant differences were found between the formulas and CrCl when compared to age, sex and insulin use or not.
Conclusion: It is concluded that the use of equations developed for the calculation of GFR in diabetic patients is a precise way of evaluation of renal function. It should be routinely used for early diagnosis and control of its progression and delay of renal replacement therapy (Fig. 1).
A75 Comparison of cardiovascular risk calculators in type 2 diabetic patients attended in tertiary health unit
Bruna Nogueira Würdig, Bruna Duarte Berdun Silva, Luciana Müller Bagatini, Rebeca Bandeira de Melo Cavalcante, Bruna Braga Dias, Roselee Pozzan, Raquel de Carvalho Abi-Abib, Cátia Cristina Silva Sousa Vergara Palma
UERJ, Rio de Janeiro, Brazil
Correspondence: Bruna Nogueira Würdig
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A75
Introduction: Diabetes is often considered a “cardiovascular risk equivalent” despite representing a heterogeneous group of patients with different risks. In order to estimate cardiovascular risk (CVR), numerous formulas were developed differing to the population of origin, age group and the analyzed outcomes.
Objective: Compare the results of Framingham risk calculator (D‘Agostino, Circulation 2008) and ACC/AHA risk calculator(Circulation 2013) in type 2 diabetic patients.
Methodology: Cross-sectional study with data collection from electronic medical records: age, total cholesterol, HDL-c, systolic BP, treatment for hypertension, DM, smoking and history of coronary, cerebrovascular or peripheral arterial disease. Patients aged 40 to 74 attended in July 2017 were included. Those with coronary, cerebrovascular or peripheral vascular disease were excluded. Values above 20% in FRS and 7.5% in ACC/AHA were considered high risk. The percentage of agreement between the two calculators was evaluated.
Results: 82 patients, mean age 60.29 ± 7.6 years, mean DM duration of 14.9 ± 9.4 years, 64.6% female, 11% with smoking history and 92.7% with hypertension were evaluated. There were 52 (63.41%) patients classified as high risk by FRS and 67 (81.7%) by ACC/AHA. All those classified as high risk by FRS had the same classification by ACC/AHA. However, 14 out of 25 patients (56%) at moderate risk for FRS were classified as high risk by ACC/AHA, and 1 in 5 patients (20%) with low risk from FRS were at high risk by ACC/AHA.
Conclusion: Although the FRS, described by D‘Agostino 2008, assesses risk of more cardiovascular outcomes than the ACC/AHA 2013 calculator, the latter calculates more patients as being at high risk. There is disagreement mainly in the moderate risk groups of FRS, which may benefit from more intensive preventive measures or other risk assessment exams.
A76 Comparison of neuropathy disability score (NDS) with michigan neuropathy screening instrument (MNSI): peripheral polyneuropathy screening in grade II and III obese and diabetics patients
Lisiane Stefani Dias1, Otto Henrique Nienov1, Camila Perlin Ramos1, Fernanda Dapper Machado1, Emilian Rejane Marcon2, Daiane Rodrigues1, Helena Schmid1
1UFRGS, Rio Grande do Sul, Brazil; 2HCPA, Rio Grande do Sul, Brazil
Correspondence: Lisiane Stefani Dias
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A76
Introduction: In the DCCT/EDIC study cohort, the Michigan Neuropathy Screening Instrument (MNSI) was validated for screening of signs and symptoms of peripheral polyneuropathy (PNP) in diabetics’ patients, presenting a sensitivity and specificity of 61% and 79%, respectively, for a cutoff point of ≥ 2.5. Neuropathy Disability Score (NDS) has also been used in epidemiological studies to screening PNP in diabetic patients.
Objective: To evaluate PNP prevalence through MNSI and NDS instruments in grade II and III obese and diabetic patients, and to assess the sensitivity and specificity of NDS (cutoff point of ≥ 3) in relation to the gold standard MNSI.
Methods: A cross-sectional study was conducted in 291 patients with grade II and III obesity and 276 diabetic patients, where the prevalence of PNP was assessed by MNSI and NDS. For sensitivity and specificity evaluation, ROC curves were constructed.
Results: We found PNP prevalence of 5.5 and 16.0% with NDS and 27.5 and 32.6% with MNSI, in the grade II and III obese and diabetics’ patients, respectively. Among the grade II and III obese patients with positive NDS, all presented mild neuropathic signs. The diabetic patients presented mild, moderate and severe symptoms (9.1, 5.1 and 1.8%, respectively). In grade II and III obese and diabetic patients, respectively, the areas calculated below the ROC curves were 0.841 (95% CI 0.790–0.892) (Fig. 1) and 0.770 (95% CI: 0.704–0.836) (Fig. 2) and, for the same cutoff point (1.5), a sensitivity of 51.3 and 60% and a specificity of 11.8 and 11.3% were found.
Conclusion: For screening PNP, NDS shows acceptable performance when compared to the MNSI.
A77 Competence for the self-care in diabetic patients
Izabel Cristina Ribeiro da Silva Saccomann, Melissa Aparecida Brandi Passaro, Flávia Pereti Schonfelder
PUC/SP, São Paulo, Brazil
Correspondence: Izabel Cristina Ribeiro da Silva Saccomann
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A77
Introduction: The appearance of complications in diabetic patients have worried some health professionals. Great part of this complications make the person unable to realize some common activities affecting the self-care and consequently his life quality.
Objective: Evaluate the competences for the self-care of patients with diabetics and the factors associated, and realize an educative action based on the shortfall self-care.
Method: Was realized an exploratory study of quantitative nature in 25 patients monitored in the Integral Attention to Adult Health Program from Family Health Unity, inside the São Paulo state. To collect the data was used the Identification of the Competence of the Diabetic for Self-care (ECDAC in Portuguese).
Result: In cognitive competence 51% of the patients presented shortfall of self-care in relation to knowledge about diabetes, signals and symptoms, and treatment. In physics and emotional competence, the patients didn’t show any shortfall. From this results realized an educative action based on the shortfall of self-care in the cognitive competence. Has some increase in the scores of the subscales cognitive competence with significant difference (p < 0.001), indicating the decrease of the shortfall of self-care in this competence.
Conclusion: The knowledge of the competence for the self-care of this population made possible the educational action that show yourself as effective, offering subsidies for the patient be the author of your own care. It’s believed that this study sensitized this population for like healthy habits that will contribute in the reduction of events considered preventable.
A78 Consistent outcomes across dose ranges with titratable lixilan, insulin glargine/lixisenatide fixed-ratio combination, in the lixilan-o trial
Robert R. Henry1, Bo Ahrén2, Melanie Davies3, Yujun Wu4, Yehuda Handelsman5, Elisabeth Souhami6, Elisabeth Niemoeller7, Julio Rosenstock8, Lixilan-O Trial Investigators
1UC San Diego and Veterans Affairs San Diego Healthcare System, Center for Metabolic Research, San Diego, CA, USA; 2Lund University, Lund, Sweden; 3Diabetes Research Centre, University of Leicester, Leicester, UK; 4Biostatistics and Programming, Sanofi-Aventis US, Bridgewater, NJ, USA; 5Metabolic Institute of America, Tarzana, CA, USA; 6Diabetes Division, Sanofi, Paris, France; 7Diabetes Division, Sanofi, Frankfurt, Germany; 8Dallas Diabetes and Endocrine Center at Medical City, Dallas, TX, USA
Correspondence: Robert R. Henry
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A78
Efficacy and safety of LixiLan, a novel titratable fixed-ratio combination of insulin glargine (Gla-100) with lixisenatide, was compared with Gla-100 alone and lixisenatide alone in T2DM inadequately controlled on metformin (MET) ± a second oral glucose-lowering drug. Participants (n = 1170) were randomized (2:2:1) to once-daily LixiLan, Gla-100 (max 60 U/day), or lixisenatide (20 μg maintenance dose) plus MET for 30 wks. LixiLan provided statistically superior glycemic control compared with Gla-100 and lixisenatide alone. In this exploratory analysis, efficacy and safety were evaluated for LixiLan based on Gla-100 and lixisenatide doses at study end. Reduction in HbA1c and percentages achieving HbA1c < 7% with LixiLan were consistent across Gla-100 and lixisenatide dose categories at wk 30. Across all LixiLan doses, the body weight increase seen with insulin alone was mitigated. With LixiLan, incidence of documented symptomatic hypoglycemia (BG ≤ 70 mg/dL) was similar across final dose categories of insulin and lixisenatide (Table). Incidence of nausea/vomiting was low (Table), related to the slow titration of lixisenatide in the combination. In conclusion, LixiLan efficacy and safety, with a low frequency of nausea and vomiting, was consistent across all final dose categories of its Gla-100 and lixisenatide components. Study code: NCT02058147. This is an ENCORE abstract previously presented at ADA2016. Funding and editorial support provided by Sanofi (Fig. 1).
A79 Contraception habits and knowledge assessment in diabetic women of reproductive age
Arthur Sampaio Façanha, Filipe Lins Linhares de Sousa, João Augusto Lima Bisneto, Lara Justi Silva Nogueira, Leonardo Siqueira Albuquerque, Ana Kamila Paiva de Souza, Matheus Pontes Parente Travassos, Valeria Silva Bezerra, Sabrina Gomes Aguiar, Marcela Sobreira Kubrusly, Cristina Figueredo Sampaio Façanha
Unichristus, Ceará, Brazil
Correspondence: Arthur Sampaio Façanha
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A79
Introduction: Pregnancy in women with Diabetes Mellitus (DM) is becoming more frequent and proper planning of pregnancy is especially important in this group to prevent adverse maternal and fetal outcomes related to hyperglycemia in early pregnancy. The education of these patients in family planning is critical, but given the complexity of diabetes treatment, it is often neglected by the health staff. The choice of the proper contraceptive method (CM) for the patient with diabetes is not always simple, since some are related to increased risk of vascular complications and worsening metabolic control.
Objectives: To evaluate the knowledge and practices of DM patients of childbearing age on contraception.
Methods: This is a descriptive, cross-sectional study with the application of a structured questionnaire in 66 women with diabetes, of childbearing age attending an outpatient practice on a referral service in the public health care system in Ceará, Brazil. For statistical analysis EpiInfo version 3.5.2 was used.
Results: The sample was 66 women, with a mean age of 36.5 years, 48% did not complete high school and 68% referred a stable marital status. 63% had type 1 DM, average years of disease of 11.4. 26% were nulliparous, and 29.1% had a history of previous abortion. 71.2% of the patients already used some CM, 39% used oral contraception (OC), 16.6% condoms and 18% injectable or subdermal implants and 4% IUDs. Behavioral methods were used by one patient. Among OC patients, 72.3% were unaware about any interference of the method on glycemic control and as only 51% of them used the OC with medical prescription, 8.9% were guided by friends or relatives. Among the existing CMs, it was observed that 97.0% knew the Male Condom, OC: 89.4%, IUD-Cu: 81.8% and 77.3 tubal sterilization. Behavioral methods such as the rhythmic method were known by 69.7%, Coitus Interruptus: 39.4% Cervical mucus: 7.6% and Spermicide: 7.6% and Basal Temperature, 6.1%.
Conclusions: Data show that in a high-risk population where family planning is critical, the issue is poorly discussed during medical care, and half the diabetic women of that sample were using hormonal contraception without medical advice. This situation certainly contributes to the high unplanned pregnancy rate in women with Diabetes. We also observed that behavioral methods are little used by these patients.
A80 Correlation between adiponectin levels and homa-ir index in children and adolescents with overweight and obesity
Carlos Alberto Menezes, Paulo Roberto Santana de Melo, Gabriela Correia Matos de Oliveira, Luís Jesuíno de Oliveira Andrade
UESC, Bahia, Brazil
Correspondence: Carlos Alberto Menezes
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A80
Background: Adiponectin is a major adipokine with insulin-sensitizing function, being an important mediator of insulin resistance (IR).
Objective: The purpose of this study is to study the correlation between IR and adiponectin concentrations in overweight and obese children and adolescents.
Materials and methods: It is a cross-sectional study involving overweight and obese children and adolescents. Anthropometric indices and laboratory evaluation were performed, including insulin, glucose, adiponectin, and IR by HOMA-IR determination. The mean adiponectin was 3.53 ± 5.86 mcg/mL. The HOMA-IR was elevated in 33.3% of overweight and 58.8% of obese. Adiponectin levels were higher in 16.7% overweight compared to 5.9% of obese subjects. The correlation between HOMA-IR elevation and adiponectin levels was statistically significant (P 0.0001).
Conclusion: Levels lower of adiponectin may be a biomarker for the presence of IR in overweight and obese children and adolescents, and constitute another predictive factor for the metabolic syndrome.
A81 Correlation between leptin concentrations and insulin resistance by homa-ir in children and adolescents with overweight and obesity
Carlos Alberto Menezes, Paulo Roberto Santana de Melo, Gabriela Correia Matos de Oliveira, Luis Jesuíno de Oliveira Andrade
UESC, Bahia, Brazil
Correspondence: Carlos Alberto Menezes
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A81
Background: The leptin have as function main the regulation of energy balance as well as regulation of glucose homeostasis and insulin sensitivity.
Objective: The purpose of this study is to study the correlation between leptin concentrations and insulin resistance (IR) by HOMA-IR in children and adolescents with overweight and obesity.
Materials and methods: It is a cross-sectional study involving overweight and obese children and adolescents. Anthropometric indices and laboratory evaluation were performed, including insulin, glucose, leptin, and IR by HOMA-IR determination.
Results: Forty-one subjects participated of study, 25 men and 16 women, mean age 11.68 (6 to 17) years, 24 with overweight (58.5%) and 17 obese (41.5%), 23 with normal HOMAIR (56.1%) and 18 with high HOMA-IR (43.9%). The mean leptin was 26.06 ± 11.025 ng/mL (48.8% normal and 51.2% high). The HOMA-IR was elevated in 33.3% of overweight subjects and in 58.8% of obese subjects. The leptin was elevated in 58.3% of overweight subjects and in 41.8% of obese subjects. The correlation between HOMA-IR elevation and leptin levels was not statistically significant.
Conclusion: High concentrations of leptin and IR are present in children and adolescents with overweight and obesity. The presence of hyperleptinemia without hyperinsulinemia suggests a likely inherent genetic basis for increased leptin resistance.
A82 Correlation between neuropathic symptoms and sensitivity tests in the evaluation of diabetic neuropathy
Júlia Scaravelli Mario, Marília Klein Reis, Mari Cassol Ferreira
Unochapeco, Santa Catarina, Brazil
Correspondence: Júlia Scaravelli Mario
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A82
Introduction: Diabetic foot is a chronic complication of diabetes mellitus (DM) that may manifest as neuropathy, vasculopathy, osteoarticular involvement and infection. Neuropathy initially affects small nerve fibers, responsible for the thermic and pain sensitivity; later, the large nerve fibers are affected leading to changes in proprioception, vibration sensitivity and monofilament test. Nerve damage contributes to the development of lower limb areas with abnormal pressure favoring callosities, local trauma and consequently ulcer and amputation.
Objective: Evaluate the prevalence of neuropathic symptoms and clinical manifestations of peripheral neuropathy in DM patients in primary and secondary care.
Method: Cross-sectional analytic study evaluated 550 individuals with DM type 1 and 2, assisted in the public health service, 212 in primary and 338 in secondary care, with informed consent. The protocol applied was: Screening and early assessment of risk factors and prevention of diabetic foot. The study was approved by UNOCHAPECÓ’s Ethic Board, approval number 162/14.
Results: Samples evaluated showed that diabetes duration average was 11.2 ± 8.4 years; glycated hemoglobin (HbA1c) average was 8.7 ± 2.2%, and 74.6% of individuals had a value above 7%. It was found that 32% of the patients presented loss of protective sensitivity (LPS) and 24.9% showed peripheral arterial disease (PAD). The most prevalent clinical findings were dry skin, cracks or fissures (68.4%), callosities (36.5%) and nail mycosis (35.3%). Neuropathic symptoms (burning, tingling, fatigue or pain) were reported by 74.5% of the individuals; this finding correlated with the involvement of nerve fibers observed by clinical examination (p < 0.001). Patients with LPS had a longer duration of DM (p < 0.001), but individuals with suggestive manifestations of only small fibers damage had a shorter time of disease than those who also had large fibers affected (p < 0.001). Most of the individuals (53.1%) were classified as risk zero (without LPS ± PAD) although some showed neuropathic symptoms, 17.5% as risk 1 (LPS ± deformity), 18.5% as risk 2 (PAD ± LPS) and 10.9% as risk 3 (previous ulcer/amputation).
Conclusion: Data confirms that there was a high prevalence of loss of protective sensibility, but the presence of neuropathic symptoms was higher than the alteration in the sensitivity tests, which highlights the importance of verification of these symptoms as an early sign of diabetic neuropathy.
A83 Correlation of distal diabetic polyneuropathy signs and symptoms with balance and strength of type 2 diabetic patients under insulin therapy: pilot study
Camilla Rodrigues de Souza Silva, André dos Santos Costa, Diogo Arruda Martins de Lima, Tamires do Nascimento, Sandro Gonçalves de Lima, Jhonnatan Vasconcelos Pereira Santos, Paulo Daywson Lopes da Silva, César Augusto Melo de Souza, Sílvia Regina Arruda de Moraes
UFPE, Pernambuco, Brazil
Correspondence: Camilla Rodrigues de Souza Silva
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A83
Introduction: the distal diabetic polyneuropathy (DDP) is one of the main complications of Diabetes mellitus type 2 (DM2) and it contributes to atrophy and muscular weakness, bone deformations, impairment of foot mechanics, resulting in balance deficits and increased risk of falls in this population.
Objective: correlate the DDP signs and symptoms scores with strength and balance of DM2 patients under insulin therapy.
Methods: transversal study, with 6 type 2 diabetic patients (3 women e 3 men; 59 ± 4,7 years; 68,1 ± 4,9 kg; 160.8 ± 5,4 cm; 21,8 ± 9,2 years of DM2 diagnostic) under insulin therapy and DDP diagnosed by the DDP diagnostic scale (DDPDS). The DDPDS provided the Neuropathy Symptom Score (NSS) and the Neuropathy Disability Score (NDS) of each individual. The balance and risk of falls assessment was performed by Biodex Balance System (BBS) (Biodex Balance System, New York, USA) before and after the training period, by means of the modalities: Fall Risk Test (using the general instability index for the assessment of risk of falls), Limits of Stability Test (using the general limits of stability index and test duration to assess dynamic stability) and Postural Stability Test (using the general instability index, the anterior/posterior stability index and medial/lateral stability index for the assessment of static stability). The strength evaluation was performed by the 1 repetition maximum tests (1-RM), using the bench press and leg press machines to assess upper limb and lower limb, respectively. After the Kolmogorov–Smirnov normality test, the Pearson correlation index was calculated to describe the relation between the DDP scores and the balance and strength findings.
Results: The NDS showed negative correlations with the lower limbs ( − 840; p = 0.03) and with the general limits of stability index ( − 933; p < 0.01), while the NSS showed negative correlation with test duration on the dynamic stability assessment ( − 864; p = 0.02). The balance, risk of falls and upper limb strength parameters did not show a significant correlation.
Conclusion: The increase of the signs caused by DDP are related to less lower limb strength and the increase of both signs and symptoms are related to with dynamic balance deficits of type 2 diabetic patients under insulin therapy.
A84 Cost-effectiveness of a clinical-educational intervention in patients with diabetic retinopathy
Maurício Aguiar de Paula, Maria Helena Senger, Flávio Morgado
Pontifícia Universidade Católica de São Paulo, São Paulo, Brazil
Correspondence: Maurício Aguiar de Paula
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A84
Introduction: Diabetic retinopathy (DR) is related to inadequate metabolic and blood pressure control. Diabetics treated in primary care in Sorocaba and region are referral to Hospital Oftalmológico de Sorocaba (HOS) already in advanced stage of the DR, which requires ophthalmologic intervention. To perform these procedures, there is a need for clinical adjustment that occurs in the primary care, generating delay, low resolution and social, economic and individual losses.
Objectives: To offer a program of intensive clinical-educational adjustment to patients with DR attended at HOS; Evaluate changes in the level of understanding and metabolic control of this population; Evaluate the performance of the proposed procedures compared to a similar population that did not undergo the intervention; Analyze the costs of the alternative of clinicaleducational adjustment. Material and
Methods: The program had four weekly individual medical visits with educational support. The adjustments were based on the clinical evaluation and analysis of glycemic monitoring with seven measures of 3-day intercalated that preceded care. One group underwent clinical-educational intervention (n = 24) and for the other (n = 24) only the medical records were evaluated. The intervention group was evaluated before and after regarding knowledge about DM, adherence to treatment and attitudes in coping with the disease. The evolution of the ophthalmologic picture in the two groups was compared with the performance of the indicated procedures and costs involved in the activities of each clinical adjustment process: usual and proposed by the study. The activities of each clinical adjustment process were mapped, their unit costs defined and the alternatives compared using the cost-effectiveness method.
Results: A significant difference was observed in the intervention group with improved glycemic control, a higher rate of scheduled procedures (96 vs 48%, p = 0.00), shorter performance time (1.2 months vs 5 months), and Cost-effectiveness ratio. There was a significant increase in knowledge about the disease, adherence to treatment and improvement of the attitude towards the disease.
Discussion: Intensive clinical-educational adjustment program for advanced-stage DR patients offered in specialized service as an alternative to that currently practiced in primary care has a better cost-effectiveness, occurs in a shorter time and can minimize personal, social and institutional losses resulting from evolution of DR. Funding: There was no funding to the study. Sanofi provided editorial support through the hiring of a third part—Eurotrials.
Ethics approval: The project was submitted and approved by the Research Ethics Committee of Hospital Oftalmológico de Sorocaba/SP (CAAE 32784014.7.0000.0088) Consent to publish: Informed consent to publish has been obtained from these patients
A85 Cost-effectiveness of insulin glargine 300 units/ml (GLA-300) vs insulin degludec 100 units/ml (IDEG) in t2d
Daniel R. Murphy1, Xueting Yu1, Marie Fournier2, Timothy M. Klein1, Tao Fan3, Sinem Perk1, Ron Preblick3, Fang Liz Zhou3
1Medical Decision Modeling Inc., Indianapolis, IN, USA; 2Sanofi, Chilly-Mazarin, France; 3Sanofi, Bridgewater, NJ, USA
Correspondence: Daniel R. Murphy
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A85
Objective: A new generation of basal insulins has been developed in recent years to reduce hypoglycemic risk and provide steadier glycemic control in T2D. This study evaluated cost-effectiveness for two of these basal insulins, Gla-300 and IDeg, from a US payer perspective.
Methods: This modelling analysis simulated a cohort representing patients in the EDITION 2 and 3 trials using the IMS Core Diabetes Model with a time horizon of 50 years (lifetime) for 1,000,000 patients starting at 62 years old. Treatment efficacy parameters, measured as A1C reduction and hypoglycemia event (HE) rates, were estimated using a network meta-analysis: for Gla-300 vs IDeg, the A1C reduction over 24 weeks was 1.00 vs 0.98%; HE rates were estimated as 2.5 vs 4.0 severe HEs and 446 vs 555 non-severe HEs (NSHEs) per 100 patient years, respectively. The cost/unit of Gla-300 was set to $0.22 to maintain dose-adjusted price parity with insulin glargine using data from the EDITION trials. The cost/unit of IDeg was set to $0.296 from its US Wholesale Acquisition Cost. The treatment cost was $1,561 per SHE and $13.65 per NSHE (2015 $). Utilities to estimate quality-adjusted life years (QALYs) for multiple comorbidities were applied using the minimum utility approach. A disutility of -0.0118 was applied for SHE, and method of diminishing marginal disutility for NSHE.
Results: Compared with IDeg, Gla-300 provided a total cost reduction per patient of $8,998 ($162,288 vs $171,286) and a QALYs gain of 0.035 (7.677 vs 7.642) for lifetime in base-case analysis. One-way sensitivity analysis showed that 10% change in A1C, SHE/NSHE rates, and treatment costs did not change the incremental cost-effectiveness ratio (ICER) dominance for Gla-300. Probabilistic sensitivity analysis found that Gla-300 was less costly in 95.4% of cases and more effective in 60.1% of cases vs IDeg.
Conclusion: Gla-300 provides a dominant cost-effectiveness profile over IDeg, though real-world data needs to confirm this finding. This is an ENCORE abstract previously presented at ADA2017. Funding and editorial support provided by Sanofi.
A86 Critical evaluation of the food factor in a group of patients with type 1 diabetes of different age groups using continuous subcutaneous insulin infusion and inadequate glycemic control
Monica A L Gabbay1, VAnessa Montanari1, Carolina Sallorenzo1, Paula Pascali1, Maria Gabriela Cavicchioli1, Willian Komatsu1, Erika HernandesOliveira2, Vanessa Fujimoro Galves3, Paula Cristina Augusto Costa1, Tarcila Ferraz Campos1, Beatriz F Bernardo1, Marcio Alex Santos1, Priscila F Gonçalves Pecoli1, Sergio Atala Dib1
1unifesp, São Paulo, Brazil; 2meditronic, São Paulo, Brazil; 3Roche, São Paulo, Brazil
Correspondence: Monica A L Gabbay
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A86
Introduction: At present, insulin replacement with the continuous subcutaneous insulin infusion (CSII) is considered to be the therapeutic option closest to the physiological one for patients with type 1 diabetes (T1D) because it allows greater food flexibility and rapid corrections of hyperglycemia. However, a significant percentage of these patients remain outside the targets of good metabolic control (glycemia and lipids). One of the factors may be related to an inadequate distribution among the three main food groups.
Objective: Evaluate the intake of carbohydrate, proteins and fats in relation to the standard diet in a group of patients with T1D of different age groups using CSII and inadequate glycemic control.
Methods: 53 patients with T1D, using CSII, were divided into 3 groups (PPGpre-pubertal: < 9 years), (PG-pubertal: 10–18 years) and (AG-adult: 19–35 years), BMI (kg/m2), CSII use time (years), A1c (%), total cholesterol (TC) and fractions, triglycerides (TG), and the relative percentage of carbohydrates, in relation to the standard diet.
Results: A1c was similar between the 3 groups (PPG: 8.1 ± 0.5%, PG: 9.3 ± 1.3% and AG-8.2 ± 1.1%). Carbohydrate intake below recommended age showed an inverse relationship with age (PPG < 63%, PG < 93% and AG < 100% p = 0.00). However, the type of carbohydrate was inadequate, being above recommended in relation to processed juices at 100% (PPG), 66% (PG) and 25% (AG), fastfood at 21% (PPG), 46% (PG) and AG (66%) and in sweet 81% (PPG), 73% (PG) and 33% (AG). Protein (milk) intake was adequate in 80% (PPG) PG and 33% in AG, while fat intake was above 40% in the 3 groups studied. Alcohol was present in ¼ PG and 62% AG, but in an adequate amount. The values of CT and TG were adequate in the 3 groups.
Conclusion: Patients with T1D using CSII had a carbohydrate intake below the recommended level and with an inverse relationship to age, but with inadequate content. The amount of fat was above the expected and protein within the recommended. The study emphasizes the need for a better orientation of the type of carbohydrate and the amount of fat for T1D patients using CSII. These aspects should be considered during optimization of the results obtained with this high cost therapy for T1D patients.
James Ml, Green L, Amiel SA, Chourdhary P. Evaluation of the effect of carbohydrate intake on postprandial glucose in patients with type1 diabetes treated with insulin pumps. J Diab Sci Tech 2016:1-7.
A87 Curatella americana treatment during pregnancy of rats with mild diabetes: fetal repercussions
Bruno Stephano Ferreira da Silva1, Gabriel Gomes Araujo1, Larissa Lopes da Cruz1, Thais Leal Silva1, Verônyca Gonçalves Paula1, Rafaianne Queiroz de Moraes Souza1, Maysa Rocha de Souza1, Débora Cristina Damasceno2, Gustavo Tadeu Volpato1
1UFMT, Mato Grosso, Brazil; 2UNESP, São Paulo, Brazil
Correspondence: Bruno Stephano Ferreira da Silva
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A87
Introduction: During pregnancy, hyperglycemia can lead to maternal and fetal complications, leading to reproductive changes and fetal impairment. considered to treat diabetes and prevent its complications, and one of these alternatives is the use of medicinal plants, such as Curatella americana. However, there is no scientific evidence on the safety of the plant use during gestation and its effects on fetuses.
Objective: To evaluate the effects of treatment with Curatella americana during pregnancy on the fetuses of rats with hyperglycemia of mild intensity.
Method: Diabetes was induced in newborn female Wistar rats, at 24 h after birth, by subcutaneous injection of Streptozotocin at a single dose of 100 mg/kg. At 110 days of age (adulthood), oral glucose tolerance test (OGTT) was performed to confirm the mild diabetes model. After confirmation of the diabetes, the rats were mated and distributed into 4 experimental groups (n = 12 animals/group): Control: Non-diabetic rats treated with water; Control Treated: Non-diabetic rats treated with the plant; Diabetic: Diabetic rats treated with water; Diabetic Treated: Diabetic rats treated with the plant. The administration of the Curatella americana leaves aqueous extract, at dose of 300 mg/kg, was done daily, by gavage, throughout pregnancy. On the morning of the 21st day of pregnancy, the rats were anesthetized and the uterus was removed. Fetuses and placentas were weighed and fetuses were analyzed for the presence of external, skeletal and visceral anomalies.
Results: There was no difference among the experimental groups in the ossification sites, placental efficiency and in the frequencies of fetal abnormalities (external, skeletal and visceral). However, the Control Treated group present lower fetal and placental weight, with an increase of fetuses classified as small for pregnancy age.
Conclusion: Treatment with Curatella americana caused intrauterine growth restriction in nondiabetic animals at the dose tested, but this weight loss did not translate into changes in skeletal development and anomalies. Therefore, more studies are needed to prove the safety of the use of this plant for the fetus.
A88 Dapaglifozin in loss and maintenance of weight over 3 years in a diabetic patient
Nara Nóbrega Crispim Carvalho1, Rômulo Bagano Meneses2, Lucas Sampaio Lustosa Neves3, Mariana Oliveira do Amaral3, Maria Alayde Miranda de Oliveira Neta3, Vivianne Almeida da Nóbrega4, Felícia Nóbrega Crispim Ribeiro5, Patrícia Fontes da Costa Bagano6
1Universidade Federal da Paraíba-PB, Paraíba, Brazil; 2Hospital Geral Ernesto Simões Filho-CE, Ceará, Brazil; 3Faculdade de Ciências Médicas da Paraíba-PB, Paraíba, Brazil; 4Centro Universitário de João Pessoa-UNIPÊ-PB, Paraíba, Brazil; 5Hospital Regional de Patos Janduhy Carneiro-PB, Paraíba, Brazil; 6Hospital Português-CE, Ceará, Brazil
Correspondence: Nara Nóbrega Crispim Carvalho
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A88
Introduction: SGLT2 inhibitors are oral antidiabetic agents capable of altering independent cardiovascular risk factors, such as: blood glucose, blood pressure, weight, intrarenal hemodynamic and albuminuria.
Objective: To describe a clinical case in which the use of dapaglifozin (DAPA) was effective in inducing and maintaining weight loss over 3 years.
Case report: M.G.G.A, female, 65 years old, caucasian, married, sought an endocrinologist in 2014 due to the diagnosis of type 2 diabetes mellitus 3 years ago, she used glimeperide 4 mg/day and metformin (MTF) 1 g/day. She was hypertensive and dyslipidemic, already under treatment, and reported difficulty in losing and maintaining weight for several years. She denied physical activity (PA) practice for 1 month (before walking 3x/week) and in a 24-hour diet reminder there was an excess of simple carbohydrate (SC) intake and saturated fat (SF). The physical examination showed: arterial pressure (AP):130x80 mmHg, weight (W):78.6 kg, height:1.54 m, BMI:33.14 kg/m2 and abdominal circumference (AC):108 cm. The patient was oriented to change her lifestyle and it was also requested exams. After 1 month: fasting glycemia (FG):169 mg/dl, postprandial glycemia (PPG):145 mg/dl, Hb1Ac:7.1%, total cholesterol (TC):253 mg/dl, HDL:55 mg/dl, LDL:129 mg/dl, triglycerides (TG):156 mg/dl, 25-hydroxy vitamin D(25-OHD):23 ng/dl, creatinine:0.6 mg/dl, glomerular filtration rate (GFR): > 60 ml/min/1.73 m2 (MDRD), microalbuminuria, and the rest of the serum tests normal. At this time, due financial limitation, she was directed to maintain medications, prescribed vitamin D3 14,000 IU/week and stimulated lifestyle change (LC). She returned after 4 months with unchanged physical examination measures, HbA1c:7.8%, FG:166 mg/dl, PPG:163 mg/dl, being chosen to exchange oral antidiabetic regimen for DAPA 10 mg/day and MTF 1 g/day, with maintenance of the other guidelines for LC. After 9 months: W:69.9 kg, AC:98 cm, BMI:29.47 kg/m2, and she reduced the consumption of SC and SF, but maintained the sedentary lifestyle. Exams: Hb1Ac:7.0%, FG:118 mg/dl, PPG:152 mg/dl, TC:242 mg/dl, LDL: 139 mg/dl, TG:127 mg/dl and irregularly using rosuvastatin 10 mg, guided regular use of medications. During 3 years of follow-up, patient maintained controlled HbA1c (around 6.8%) and W:69 kg, but she still did not perform PA.
Conclusion: DAPA associated with MTF improved the glycemic levels, and it also helped in the weight loss and the weight maintenance of the pacient over these 3 years. Informed consent to publish has been obtained from this patient.
A89 Day-to-day variability of fasting self-measured plasma glucose (SMPG) correlates with risk of hypoglycemia in adults with type 1 (T1D) and type 2 diabetes (T2D)
Timothy S Bailey1, Anuj Bhargawa2, Hans de Vries3, Gregg Gevery4, Januz Gumprecht5, Wendy Lane6, Carol Wysham7, Athena Philis-Tsimikas8, Monica Palmanhani9, Bak Ba10, Nielsen E Rachmann10
1AMCR Institute, San Diego, CA, USA; 2Iowa Diabetes and Endocrinology Research Center, Des Moines, IA, USA; 3University of Amsterdam, Amsterdam, Netherlands; 4Albany Medical Center, Albany, NY, USA; 5Medical University of Silesia,Zabrze,Poland; 6Mountain Diabetes and Endocrine Center, Asheville, NC, USA; 7Rockwood Clinic, Spokane, WA, USA; 8Scripps Whittier Diabetes Institute, San Diego, CA, USA; 9Novo Nordisk, São Paulo, Brazil; 10Novo Nordisk, Bagsværd, Denmark
Correspondence: Timothy S Bailey
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A89
Background: The relationship between hypoglycemia and day-to-day variability of glycemic control has not been well established.
Aim: A post hoc analysis was performed correlating day-to-day variability of fasting SMPG with hypoglycemia in two double-blind, treat-to-target, crossover trials that compared insulin degludec once daily (OD) with insulin glargine U100 OD in adults with T1D (SWITCH 1, n = 501) or insulin-experienced adults with T2D (SWITCH 2, n = 721)
Methods: Available SMPG measurements were used to determine a weekly variance for each patient, using the log SMPG values to allow for relative comparisons. For each patient and treatment, the geometric mean of the weekly variance was calculated and these values were categorized into low, medium and high tertiles as a measure for day-to-day variability. The effect of having low or high variability compared with medium variability was analyzed in relation to overall symptomatic (severe or blood glucose [< 56 mg/dL] confirmed), nocturnal symptomatic (00:01–05:59), and severe (requiring third-party assistance and confirmed by a blinded adjudication committee) hypoglycemia.
Results: Day-to-day SMPG variability was a significant predictor for the risk of overall and nocturnal hypoglycemia in T1D and T2D, and severe hypoglycemia in T1D (Table).
Conclusion: Day-to-day glycemic variability relates to hypoglycemia risk.
Informed consent to publish had been obtained from the patient (Fig. 1).
A90 DDP4 inhibitor activity in partial family lipodystrophy- case report
Alessandra Muto, Fernanda Padua, Olga Simone Nebel First
Hospital Ipiranga, São Paulo, Brazil
Correspondence: Alessandra Muto
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A90
Dunnigan type partial lipodystrophy is a rare autosomal dominant disease. In its classic form, it is resulting from a heterozygous missense mutation in the LMNA gene, which encodes the nuclear protein called A/C lamina(1). Changes begin at puberty, with enlargement of the labia majora, chin and face, as well as disappearance of subcutaneous tissue in upper and lower limbs. Affected women are particularly predisposed to insulin resistance and its complications, including signs of polycystic ovary syndrome. Case report: 35-year-old female diabetic, hypertensive, diagnosed with Kobbeling Dunningan syndrome after the first gestation in 2001, began treatment with a plastic surgery team for changes in the classic fat distribution of her disease, with rhytidectomy and initiated follow-up in the team of endocrinology for diabetes control in the use of insulin therapy with poor glycemic control, after the initiation of DDP4 inhibitor initiated improvement of glycemic levels with maintenance of control.
Informed consent to publish had been obtained from the patient.
A91 Depression, anxiety and stress in people with diabetes mellitus type2
Rafael Pinto da Silva, Francineide Pereira da Silva Pena, Jessica Gomes da Silva, Jessica Monteiro Cunha, Sônia Silva Alves, Danielle Cardoso Portilho, Gabriela de Souza Amanajás, Tallitha Barbosa da Luz, Diego Quaresma Ferreira, Emanuel de Jesus Vaz Bittencourt, Amiraldo Dias Gama, Maria Silvia da Costa Silva, Adriane Stefanny Rocha Ribeiro
UNIFAP, Amapá, Brazil
Correspondence: Rafael Pinto da Silva
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A91
The evidence of symptoms of depression, anxiety, and stress in the person with Diabetes Mellitus can relate to difficulties in modifying eating habits, suitability for therapeutic regimens and diabetic’s quality of life. This study aimed to identify levels of anxiety, depression and stress of participants in a Health Promotion program for people with Diabetes Mellitus, performed in the city of Macapá, AP, Brazil. This is a descriptive study with a quantitative approach, carried out in November 2016 with 38 people participating in the program who accepted to answer the questionings of the Depression, Anxiety and Stress Scale—Short Form (DASS-21) involving a theoretical model which evidences the symptoms of depression, anxiety and stress, not always differentiated by other scales or instruments. The study, approved by the Ethics and Research Committee (Comitê de Ética e Pesquisa) (CEP) of the Federal University of Amapá (Universidade Federal do Amapá), opinion number: 861.456/2014. Of the participants, the majority (78.9%) were females with average age of 63 and males (21.1%) with average age of 47.5 years (Table 1). In relation to the DASS-21 scale of evidence of identified symptoms, (28.9%) presented changes in the depression symptoms, (10.5%) presented moderate symptoms, (7.9%) severe symptoms and (10.5%) very severe symptoms. For anxiety (52.5%) presented alterations, where (18.4%) presented moderate symptoms, (10.5%) severe symptoms and (23.6%) very severe symptoms. For stress, (34.0%) presented changes in symptoms, (13.1%) moderate symptoms, (7.8%) severe symptoms and (13.1%) very severe symptoms (Table 2). It was also identified in (23.6%) of participants alterations for depression, anxiety and stress concomitantly symptoms, (7.8%) for anxiety and stress, (5.2%) for stress and depression and (2.6%) depression and anxiety (Table 3). In addition, it was observed that (18.4%) of the patients had altered symptoms specifically for anxiety, while those with modified symptoms of depression or stress always had other aspects simultaneously, and (42, 1%) did not present alterations in the symptoms evaluated. Anxiety is the problem to be overcome by the participants, a factor that will be related to a worse glycemic control, an increase and a greater severity of the clinical complications, being also necessary to potentiate through non-pharmacological treatments the symptoms of depression and stress that add up and interfere with social, economic and educational aspects (Fig. 1).
A92 Design of an application for the evaluation of people‘s feet with diabetes mellitus
João Batista Moreira, Eliene Sousa Muro, Ismael David de Oliveira Muro, Lidiane Aparecida Monteiro, Denise Hollanda Iunes, Érika de Cássia Lopes Chaves, Juliana Bassalobre Carvalho Borges
UNIFAL, Minas Gerais, Brazil
Correspondence: João Batista Moreira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A92
Introduction: Diabetes Mellitus is a challenge for Health, with a high potential for morbidity and mortality. Among its main complications is the diabetic foot, defined as a series of alterations that occur in the lower limbs, associated to the high amputation index, which affects the productivity and independence of the person. Proper examination of the feet is able to diagnose the problem early and prevent injuries and hospitalizations. However, the evaluation for prevention of diabetic foot is insipient and not fully incorporated in the health services. However, it is necessary to develop innovative tools that facilitate foot examination in order to save time and standardize evaluation.
Objective: To develop an application to evaluate the risk of diabetic foot, based on the Diabetic Foot Manual of the Brazilian Ministry of Health.
Methods: Methodological, descriptive, quantitative and multidisciplinary study that allowed the development of an application on the Android platform, with based on the evaluation of the feet of the person with Diabetes Mellitus advocated by the diabetic foot manual of the Ministry of Health. Java language was used for programming. For interaction between the researchers was used the Extreme Programming method that consisted of a cyclical process: select user stories; divide stories into tasks; plan release; develop/integrate/test; release version and evaluate the application, returning through the steps until it was suitable for foot evaluation.
Results: “Foot Care” application was developed with 19 main screens that contain icons for access to photos and help and videos that demonstrate the procedure of sensitivity and reflex tests. Screens are thus arranged: presentation screen with information about the application and instructions for use; screen with features of registration, data export and the list of people evaluated; screens of the assessment itself, which include the skin and attachment domains, sensitivity assessment, vascular assessment and evaluation of foot deformities. Finally, the screen that presents the risk classification of the diabetic foot; the change that suggested such a risk; the recommendations, the evaluation frequency and the behaviors that should be taken by the health professional.
Conclusion: It is concluded that the application made in this study is an innovative tool and is an important tool to prevent early diabetic foot.
A93 Detection of strongyloides stercoralis by PCR in stool samples among diabetes type 2 patients
Marcia Carolina Mazzaro1, Émelin Alves dos Santos1, Géssica Baptista de Melo2, Priscila Duarte Marques2, Laura Vilela Souza1, Jefferson Elias1, Bruna Campos da Silva1, Fabiana Martins de Paula2, Fernanda de Mello Malta2, Ronaldo César Borges Gryschek2
1UFG, Goiás, Brazil; 2USP, São Paulo, Brazil
Correspondence: Marcia Carolina Mazzaro
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A93
Introduction: Strongyloides stercoralis is an intestinal nematode that infects approximately 100 million people worldwide, mainly in tropical and subtropical regions. Most S. stercoralis carriers are asymptomatic or oligosymptomatic, which does not mean absence of pathogenic action. Extra-intestinal manifestations can lead to severe and life-threatening conditions, especially in immunocompromised patients. The medical literature has case reports of disseminated strongyloidiasis in diabetic patients, but no studies have determined the relationship between diabetes and strongyloidiasis.
Objective: The aim of this study was to evaluate the parasitological and molecular profile of strongyloidiasis in patients with type 2 diabetes mellitus (DM2) and to analyze their value in the detection of chronic asymptomatic infection in these patients.
Method: The study population were patients seen in the Diabetes Education and Control Program Jataí—GO and other non—diabetic individuals living in the city. A total of 149 individuals were collected from three fecal samples on alternate days, these were characterized in two groups: Group I (97) patients with DM2, Group II (52) individuals not carrying DM2. The fecal samples provided were submitted to parasitological methods of Hoffman, Rugai and agar plate culture, and subsequently, to molecular analysis by Polymerase Chain Reaction (PCR), and all positive samples were confirmed by DNA sequencing. Data were analyzed using Chi square and logistic regression tests.
Results: The overall positivity of S. stercoralis by parasitological techniques was 2.6% (4/149), and only one DM2 patient was positive for the infection. With PCR, the positivity was 16.1% (24/149), being 9.3% (9/97) in the group I, and 28.8% (15/52) in the group II. DM2 showed to be a protective factor for strongyloidiasis (OR 0.252 IC95% 0.101 a 0.628 p = 0.003). There was no agreement between the parasitological methods and PCR in the detection of S. stercoralis.
Conclusion: The PCR technique using primer species-specific for S. stercoralis showed a superior ability to detect infection in asymptomatic diabetic and non-diabetic patients.
A94 Determinants to weight loss in outpatients with obesity
Mônica Maurer Sost, Vanice Low Wagner, Anize von Frankenberg, Jussara Carnevale de Almeida
UFRGS, Rio Grande do Sul, Brazil
Correspondence: Mônica Maurer Sost
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A94
Several strategies can be used to obesity treatment by the multidisciplinary team: diet, physical activity, behavioral therapy, medications and surgery. The dietary adherence has been associated with weight loss, however determinants to weight loss in the individual approach of treatment with nutritionist are not clarified yet. To know these determinants can support the strategies adoption in clinical practice. In this way, the aim of this retrospective cohort is to evaluate the factor determinants to weight loss of outpatients with obesity follow by nutritionist. Obese outpatients who were follow out dietary counselling by registered nutritionist from the Endocrinology Division of HCPA, Porto Alegre-RS were select consecutively. All procedures involving patients were approved by the Hospital Ethics Committee (nº15.0138) according to Declaration of Helsinki. The protocol were five visits: anamnesis (clinical, lifestyle, and anthropometric evaluation); diet visit with delivered a prudent diet with calorie restriction; and three bimonthly visits (described as visit one, two and three) to dietary approaches. The dietary adherence was ranked (0-100%). Patients were grouped into those who achieved the goal of at least weight 3% loss from initial weight in 6 months (achieved the goal) and those who cannot achieved the weight loss goal and their characteristics were compared using appropriate tests. Poisson regression models were performed to evaluate the possible association between determinants and weight loss. One hundred and forty-seven patients were included and 47 patients (26%) achieved the weight loss goal [Δ weight—5.9(−21.5 to −2.3)kg]. A higher proportion of patients which achieved the goal also attended the visit one (83% vs. 66%, p = 0.040) and visit two (83% vs. 56%, p = 0.001) as compared to patients without weight loss. Dietary adherence was not different between groups, as well as the other characteristics (social,clinical and medications use). The attendance in the visit two was associated with more chance of weight loss when comparing with those who did not go to the visit: OR 4.44 (95% IC 1.6112.25); p = 0.004) after adjust to physical activity, drugs use and dietary adherence. In conclusion, the patients who achieved the weight goal were more assiduous than the other patients. The visit absence maybe a negative determinant to weight loss. The reasons for that need to be investigated.
A95 Development and cultural adequacy of a tool to evaluate the level of knowledge from users of continuous insulin infusion system (CIIS-Brazil)
Maria Eugênia Silva Hitchon1, Carla Ferraz de Oliveira Borges1, Débora Bohnen Guimarães1, Luciana Valadares Ferreira1, Adriana Silvina Pagano2, Ilka Afonso Reis2, Aleida Nazareth Soares1, Janice Sepúlveda Reis1
1Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte., Minas Gerais, Brazil; 2UFMG, Minas Gerais, Brazil
Correspondence: Maria Eugênia Silva Hitchon
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A95
Background: The Continuous Insulin Infusion System (CIIS) is increasingly being used in Brazil, with trained professionals actively involved in the initiation and monitoring of diabetes treatment. However, there are not any tools that have been adapted to measure the level of knowledge of diabetes patients using CIIS. The elaboration of reliable tools that make possible to measure effects of the teaching-andlearning process, before and after an intervention, can only be useful and able to present scientific results when those tools have valid psychometric qualities in order to not implicate the quality of acquired data.
Objective: To elaborate and to adequate culturally a tool to evaluate the knowledge from users of CIIS.
Methods: Methodological study, comprising two steps: 1) Elaboration of the tool, based on both national and international diabetes guidelines, followed by evaluation by a committee of experts, including endocrinologist, nutritionist, nurses and statistician, to generate the first version (V1); 2) V1 was sent via the e-surv platform to a committee of judges, comprising endocrinologists with experience in therapy, certified instructors employed by the companies that sell the CIIS in Brazil, and linguists from different regions of the country, who evaluated the tool for clarity and relevance. Based on this evaluation, the Content Validity Index (CVI) and the judges’ percentage score for the adequacy of the tool’s components were calculated, with changes which generate a second version (V2). After each of these phases, there was discussion of the Expert Committee to evaluate suggestions, to identify problems and pertinent changes.
Results: V1 of the tool was highly scored by the judges’ committee with respect to clarity and relevance, with a CVI of 0.97, from which V2 was generated, comprising 17 questions (Table 1).
Conclusion: The tool CIIS-Brazil is considered culturally adequate to evaluate the knowledge from its users. This tool proceeds to the validation process (Fig. 1).
A96 Diabetes care center in the municipality of Blumenau—SC
Luiz Carlos Pereira Junior, Maytê Alves de Andrade Possamai, Thyara Becker, Fulvio Clemo Santos Thomazelli
NAD (Núcleo de Atenção em Diabetes da Prefeitura de Blumenau—SC), Santa Catarina, Brazil
Correspondence: Luiz Carlos Pereira Junior
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A96
Introduction: In the region of Blumenau, the prevalence of Diabetes Mellitus (DM) is approximately 25,000 people, of which 3,249 are insulinized and are enrolled in the program of distribution of inputs for the treatment of the disease by SUS. In 2012, the Coordination of the Adult Health Policy and the Management of the Health Department of the Municipality of Blumenau elaborated the implementation of a Diabetes Care Center (NAD).
Objective: To describe the actions performed by the NAD team, whose main objective is to provide specialized interdisciplinary care to people with decompensated DM.
Methodology: This is a descriptive study about the experience of professionals working at the Diabetes Care Center of the Municipality of Blumenau. The reporting period is from the year of its implementation to date.
Results: In the implementation of the NAD in 2012, the activities started with a team with a minimum structure, however, with the increase in the demand of patients, it was necessary to hire more professionals and the construction of a new headquarters, with a bigger physical structure. Today 2,688 users are already registered with NAD. A total of 320 consultations in endocrinology, 80 nutrition consultations, 60 consultations in psychology and 40 nursing consultations are carried out per month for foot evaluation, insulinization and acquisition of special footwear for free. To ensure psychological support, meetings of therapeutic groups are also held. Since its implementation, it has been established as an Assistence Teaching Unit and serves as a research field for scholarship recipients and health course volunteers, who work in the FURB PET-HEALTH GRADUASUS group. Online marriages in endocrinology and training for network professionals are conducted through an event entitled Debates Mellitus. In November, actions related to the Municipal Diabetes Prevention Week are carried out, among them: Seminars, background work, preventive actions in squares with capillary glycemia tests, and, finally, the “Blue Walk”.
Conclusions: We believe that through a policy of care the person with DM develops educational, preventive and diagnostic actions, that guarantees the free supply of medicines and supplies for self-control and that makes the user aware of their co-responsibility in the treatment through of Supported Self-Care, it is possible to minimize the complications of DM and improve the quality of life of users.
A97 Diabetes flatbush: from cetoacidose and full insulinotherapy to anti-diabetes oral and diet
Erick Augusto Ferreira Coutinho, Giovana Mahamed Daher, Fernanda Vasconcelos de Carvalho
Conjunto Hospitalar do Mandaqui (CHM), São Paulo, Brazil
Correspondence: Erick Augusto Ferreira Coutinho
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A97
A 42-year-old male patient with obesity and hypertension was brought to the emergency department of Hospital Conjunto do Mandaqui in São Paulo with adinamy, weight loss, polyphagia, polydipsia and polyuria 3 weeks ago. On physical examination, the patient had sleepinees, dehydration (3 +/4 +), ketone breath, tachycardia 136 BPM, hypotension, 75 × 50 mmHg, oxygen saturation of 99% and respiratory rate of 20/min. The initial laboratory tests indicated high capillary blood glucose, leukocytosis of 18,400 (neutrophilia of 90%), haemoglobin level of 15.1 g/dl, hematocrit of 49.9%, urea of 173 creatinine of 3,36 sodium of 146 potassium of 5,1. The arterial gasometry showed a significant metabolic acidosis. The urinalysis was marked by glycosuria (2 +) and leukocyturia (176,000). The diagnosis of diabetic ketoacidosis was made, and the patient was treated with venous hydration and continuous intravenous insulin infusion. The patient showed a satisfactory response to treatment, with good control of the dehydration and blood pressure. An hyposodic and diabetic diet was introduced, and the patient showed an increase in appetite. Normal values of the C—4,6 peptide were obtained and indicated no pancreatic injury. Two consecutive tests were negative for the autoantibodies against GAD, islet cells, insulin and IA2. The pacient was discharged from the hospital with full insulin therapy. During the follow-up, the insulin dose was gradually reduced due to few episodes of hypoglycemia. After 2 months the patient had good glycemic control, and reported adequate lifestyle and dietary habits. metformin use XR 1500 mg/day establishing as most likely diagnosis flatbush diabetes. Flatbush diabetes is one of the several variations of the type 2 DM, and is also refered to as idiopathic type 2 DM and ketosis-prone type 2 DM. Here, a misleading diagnosis of DM 1 is common, due to the total autoimmune destruction of the T cell-mediated pancreatic beta cells, without antibodies associated with the type 1 DM. In DM flatbush, diabetic ketoacidosis, but in this case it is possible the weaning of insulin therapy and the drug adoption proposed for DM 2, in addition to the non-medicament measures, since it was observed that preservation and recovery of pancreatic function is possible. The case report aimed to raise awareness of this rare condition and avoid misdiagnosis and unecessary treatments.
Informed consent to publish had been obtained from the patient.
A98 Diabetes patients’ adherence who went through education group in a clinical program from a private institution in São Paulo
Marcela Alves Teixeira Furtado, Camila Yumi Senaga, Pedro Gabriel Melo Barros e Silva, Viviane Aparecida Fernandes, Valter Furlan
Amil-Total Care SP, São Paulo, Brazil
Correspondence: Marcela Alves Teixeira Furtado
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A98
Introdution: Diabetes Mellitus (DM) is a chronic, complex, not transmissible disease that requires continuous medical care and strategies to decrease multifactorial risks besides glycemic control; to improve patients’ treatment and prevent possible complications. From1980 s diabetes’ treatment has becoming even more complex with incorporation of new medications and technology within reach of patients being part of their daily lives. From the beginning of the diagnosis, patients and their relatives must get knowledge about the disease and develop necessary skills for patients’ self-care. It is called, education in diabetes. The process that develops these skills incorporates tools that reach results in each stage of the treatment. Therefore, education in diabetes is the main tool to guarantee patient’s self-care,leading them to self-control. The present study aims to describe the importance of promoting education for type 1 and type 2 diabetic patients for the purpose to promote treatment adherence and encourage self-monitoring.
Study population: Patients from Diabetes Clinical Program in a Private Outpatient Institution (POI) in São Paulo (TOTAL CARE) who passed through education in comparison to diabetic patients who did not pass through diabetes education (N = 1673). The average age is mainly between 41 and 80 years old, 50% both sexes; in the two groups, 50% with more than 20 years of diagnosis.
Methods: The Patients from Diabetes Clinical Program—Total Care (N = 2152) were evaluated regarding adherence to multi-professional intervention (nutrition, eye examination, foot examination, dentist consultation). Patients who were seen by the diabetes Educator were compared with those who did not pass through this developing process as a stage of their treatment.
Results: Among evaluated patients the best adherence was found in the group who passed through Diabetes Education process (Fig. 1).
A99 Diabetes with ketosis tendency (flatbush diabetes) in Brazil: clinical features and evolution
Luana Aparecida de Lima Ramaldes de Oliveira1, Patricia Medici Dualib1, Mônica Andrade Lima Gabbay1, João Roberto Sá2, Sérgio Atala Dib2
1Unifesp, São Paulo, Brazil; 2Unifesp- Escola Paulista de Medicina, São Paulo, Brazil
Correspondence: Luana Aparecida de Lima Ramaldes de Oliveira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A99
Introduction: Until now it is known that diabetes presenting as ketoacidosis (DKA), in the absence of a detectable precipitating factor, may correspond to a heterogeneous group of pathologies, especially when it occurs in adults. Among these pathologies we have ketosis-prone diabetes (KPD), initially described by Banerji et al. 1994 in African Americans. KPD is a rare form of Diabetes Mellitus (DM) which presents with DKA and after initial glycemic compensation may evolve into insulin exogenous independence. In recent years, cases of KPD have been reported in Africa, Japan, Spain, China and Pakistan, suggesting a global distribution. In Brazil, there is only one case report in the literature.
Patients: Here we report a prospective study of 4 cases of Brazilian KPD. The diagnosis of KPD was based on the occurrence of spontaneous DKA after the age of 30 years in individuals with newly diagnosed DM and not classifiable according to the classic types. The data during the presentation and follow-up of the KPD are summarized in the table Discussion The patient diagnosis age during the 4th and 5th decade of life is compatible with the studies described in the literature. The mean BMI of the group was 31.23 kg/m2, comparable to previous studies (28.9 kg/m2 reported by Banerji, 37 kg/m2 by Umpierrez, 30.3 kg/m2 by Maldonado). The presence of family history of DM2 was 80% higher than that seen by other groups (Chihaoui (56%), Banerji (67%) and Mauvais Jarvis (67.6%). Significant recovery of beta cell function and time of insulin dependence in the group was reported to be close to 1 year, consistent with studies reporting a period of 1 to 2 years.
Conclusion: This is the first series of cases of KPD described in Brazil being characterized by DKA at diagnosis, absence of autoimmunity, recovery of beta cell function and evolution to insulin independence. Further studies are needed to verify the true prevalence of KPD in our population. The diagnosis of KPD should be considered in patients who, despite having the first manifestation in DKA and requiring a period of insulin therapy to resolve the glycotoxicity, may evolve to treatment with oral hypoglycemic agents (Fig. 1).
A100 Diabetes without borders: insertion of digital media into diabetes education actions developed within the state of Minas Gerais
Elenice dos Santos Paula1, Mayara Dumont Cunha1, Daniela Pereira De Castro1, Fernando Gonçalves dos Santos1, Gabriela de Araujo Nominato1, Hugo dos Santos Silva Júnior1, Lucas Gabriel de Siqueira1, Paulo Henrique Lopes1, Marileila Marques Toledo1, Jéssica Samara Oliveira Tolomeu2, Juliana Sales Rodrigues Costa1, Grayce Kelly Cristina Costa dos Santos1, Érica Cristina Santos Rodrigues1, Ana Cláudia Chaves1, Franciele Angelo de Deus1, Eduardo Augusto Barbosa Figueiredo1, Noêmia de Fátima Silva Lopes3, Luciana de Freitas Campos1, Milena Campos Silva1, Lorena Kelly Babetto Amaral1, Edson da Silva1
1UFVJM, Minas Gerais, Brazil; 2Secretaria Municipal de Saúde de Diamantina, Minas Gerais, Brazil; 3UNIMONTES, Minas Gerais, Brazil
Correspondence: Elenice dos Santos Paula
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A100
Background: Diabetes Mellitus (DM) is a chronic disease with increasing worldwide prevalence. Therefore, it is relevant to use digital media resources in diabetes education, especially to educate people living in the interior regions of the country, in which patients deal with limitations of access to health services
Objective: In this study, our aim was to report the insertion of digital media in diabetes education actions developed in a project of University extension.
Materials and methods: The project was developed by the Diabetes Study Group of the Federal University of Jequitinhonha and Mucuri Valleys (UFVJM) with the support of the Campus Radio (99.7 FM). The main educational actions were developed through the creation of the radio program entitled “Em sintonia com o diabetes” (In tune with diabetes). Between May 2016 and February 2017, different programs with about 90 s of duration, were transmitted 6 times a day, 6 programs unpublished every fortnight. The programs were written and recorded by students (undergraduate and postgraduate) under the supervision of UFVJM professors. After each fortnight of transmission the programs were converted into podcasts for posting on Diabetes Diamantina websites (SoundCloud, Facebook, Blogger and Google +). The Fanpage Diabetes Diamantina (FDD) was widely used as an online education strategy, in which various educational contents about DM were published or shared (Figs. 1 and 2).
Results: Our search identified a total of 128 unpublished radio programs that were produced and broadcast, reaching about 100,000 people from Diamantina and 10 other municipalities in the region. The FDD received more than 1,500 likes/followers and its publications reached 375,647 views in Brazil and in 44 other countries (Figs. 1 to 4). Diabetes Diamantina on SoundCloud shared 25 podcasts, which were reproduced online 1,196 times, and received 37 likes. The Diabetes Diamantina Blog hosted 42 posts about DM, with weekly frequency and the total of 49,040 views by people from Brazil and other 9 countries. In addition, 25 educational games were developed from the texts used in the radio programs.
Conclusion: The University extension actions of the project have been a high social relevance, given the scope of the sharing of educational content and the use of digital media. There was an admirable contribution to the academic formation and greater integration among those involved in this proposal for online diabetes education. The authors are grateful to the CNPq, FAPEMIG, Rádio 99.7 FM and UFVJM for the support.
A101 Diabetes mellitus evolution in two brothers with berardinelli-seip congenital lipodystrophy (BSCL), one R
Enzo Loandos Oliveira, Luiz Brandão Dantas Costa Junior, Thays Marchi, Thiago Almeida Gomes Moura, Aline Andrade de Lucena, Gabriel Oliveira do Carmo, Gisele de Sá Mascarenhas, Luana Machado Figueredo, Leila Maria Batista Araújo
HUPES/UFBA, Bahia, Brazil
Correspondence: Enzo Loandos Oliveira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A101
Case presentation: Two brothers with neonatal diagnosis of Berardinelli-Seip Congenital Lipodystrophy (BSCL), born in Caculé-Bahia, without cases of diabetes or similar diseases in their family. Clinically, both present muscular hypertrophy and acromegaloid features. Case 1: MJFA, 17 years old, at 11 with hyperglycemia (fasting 108 mg/dL; HbA1C 6.4%), moderate hepatic steatosis and hypertriglyceridemia between 200 and 350 mg/dL. Serum leptin 1 ng/mL (reference range: 2–18). In july 2017, in use of Metformin 1.5 g, Fenofibrate 160 mg and Losartan 50 mg/day, with HbA1C 7.6% and triglyceride level of 453 mg/dL. Case 2: LJFA, 16 years old, at 10 with hyperglycemia (fasting 73 mg/dL; HbA1C 7%), left ventricle hypertrophy detected by echocardiography and hepatomegaly. Leptin 1.3 ng/mL. In 2016, HbA1C 7.8%, in use of Metformin 2 g/day, pioglitazone and vitamins E, A and D supplementation. 2017 Fibroscan revealed Hepatic Fibrosis F3. In april 2017, HbA1C 6.1% and triglyceride level 151 mg/dL. By that time, Metreleptin was initiated at a 5 mg/day dose (0.07 mg/kg/day) and Metformin was maintained. After 3 months, the patient has HbA1C 5%, triglyceride level 70 mg/dL, TGO 42 U/L and TGP 32 U/L.
Discussion: BSCL is characterized by the absence of functional adipocytes and leptin diminution. Major clinical criteria for diagnosis are: lipoatrophy (trunk, limbs and face), acromegaloid features, hepatomegaly, hypertriglyceridemia and insulin resistance. Minor criteria are: hypertrophic cardiomyopathy, psychomotor retardation, hirsutism, precocious puberty in women, bone cysts and phlebomegaly. Diagnosis is established in an individual with 3 major criteria or 2 major plus 2 or more minor criteria, and/or by detection of biallelic pathogenic variants in genes BSCL-2 and/or AGPAT-2. In the presented cases, diagnosis was established solely by clinical criteria. After 60 years of BSCL’s first description and of unsuccessful management with general use drugs, metreleptin, a recombinant leptin analog, emerged with significant impact on metabolic parameters of BSCL, notably on insulin resistance and type 2 diabetes mellitus, lipid profile and liver enzymes, as noted here in the comparison between the two brothers, one in use of Metreleptin, and the other not.
Final comments: Metreleptin has been shown as pivotal in improving diabetes mellitus status in BSCL patients, and therefore it is necessary to spread its use by this population. Informed consent to publish has been obtained from these patients.
A102 Diabetic gustatory sweating as a manifestation of diabetic autonomic neuropathy: a case report
Luiz Fellipe Carvalho Viola, Lariana Stefanello, Marcela Junqueira, Diego Rocha, Paloma Nehab Hess, Rosane Kupfer, Carolina Martins Corcino
Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione (IEDE), Rio de Janeiro, Brazil
Correspondence: Luiz Fellipe Carvalho Viola
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A102
Case report: We present a case of a 63-year old, female patient, who had been diagnosed with Type 2 Diabetes Mellitus (T2DM) 20 years ago, poorly controlled, as well as chronic kidney disease stage V. Patient has been undergoing hemodialysis for 3 years already listed for renal transplantation, with a history of diabetic retinopathy submitted to extensive photocoagulation, and also had a long-standing diagnosis of hypertension. She was referred to an endocrinology center with a seven-month complaint of profuse sweating, extending from the neck to the scalp. It was triggered by chewing any kind of food and lasting up to 20 min after ingestion without associated symptoms. She had initially been treated for Panic Disorder in another department. After evaluation and exclusion of other diagnoses (medication use, trauma, or facial surgery) as well as exclusion of another kind of diabetic neuropathy, such as sensitive or cardiac autonomic neuropathy, the hypothesis of diabetic gustatory sweating (DGS) was established. A starch-iodine test was performed, which was positive, revealing an extensive area of sweating after eating a small amount of food. In the absence of contraindications, systemic treatment with oxybutynin was proposed due to the size of sweating area and involvement of the scalp. Patient experienced an excellent response as early as week 1 of medication use, with mild side effect of xerostomia; lower intensity sweating only occurred with the ingestion of large amount of food.
Discussion: DGS is considered a type of diabetic autonomic neuropathy, usually associated with other diabetic neuropathies and/or diabetic nephropathy. It is characterized by the appearance of sweating during and/or shortly after a meal, and its intensity depends on the amount of food ingested. It usually affects the upper thorax and face and may be accompanied by erythema. DGS seems to be underdiagnosed because of different intensities of symptoms and also due to the fact that it may not be a patient’s primary complaint nor a physician’s question. It is observed, however, that patients affected by DGS have worse quality of life. Therapeutic options include oral anticholinergics (oxybutynin, glycopyrrolate, scopolamine), alpha-blockers (clonidine), topical agents (glycopyrrolate), or botulinum toxin application. The onset of treatment improves the quality of life and decreases the intensity and frequency of sweating.
Conclusion: Even though underdiagnosed, diabetic gustatory sweating is a common condition among patients with long-term T2DM, which treatment provides an extensive improvement in the quality of life of those patients. Informed consent to publish the case report has been obtained from this patient.
A103 Diabetic ketoacidosis complicated with urinary tract infection in children: case report
Jacqueline Akemi Nishio Juhasz, Ieside Arruda Valadares Chamon, Ana Cristina Pithon Curi, Alcinda Aranha Nigri, Luis Fernando Aguiar de Paula Filho, Luis Mauricio Batalin Junior, Emanuelle Barbara Dias Tomaz
PUC-SP, São Paulo, Brazil
Correspondence: Jacqueline Akemi Nishio Juhasz
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A103
Case report: A 12-year-old female, previously diagnosed with type 1 diabetes mellitus, on regular insulin use, presented with lowered level of consciousness and increasing abdominal pain which first started a week before. The patient was then referred to Hospital de Mairinque. At the admission the patient presented hyperglycemia (capillary blood glucose = 453 mg/dL), metabolic acidosis (pH 7.01) and hypokalemia (potassium = 3.4 mEq/L). It was performed administration of intravenous (IV) saline solution containing 4U of regular insulin. Subsequently, administration of saline solution with insulin 0.1 U/g/h and replacement of HCO3 were performed. She was intubated due to a decrease in the level of consciousness and bronchoaspiration. The patient was transferred to Conjunto Hospitalar de Sorocaba presenting leukocytosis (20,100/mm3). She was diagnosed with urinary tract infection (UTI) by Candida sp, and then admitted to the pediatric intensive care unit (PICU). The patient remained in the PICU for 14 days and had difficulty maintaining hydroelectrolytic and glycemic control, then she evolved with severe dehydration, acute renal failure and septic shock.
Discussion: Diabetic ketoacidosis (DKA) is characterized by dehydration, abdominal pain, Kussmaul breathing (a deep and labored breathing pattern), lowered level of consciousness, hyperglycemia (glycemia > 250 mg/dL), metabolic acidosis (arterial pH < 7.3 or plasma bicarbonate (HCO3) < 15 mEq/dL), ketosis and ketonuria. Common DKA complications are hydroelectrolytic disorders and cerebral edema (mainly in pediatric cases). In this case report we present a case of a patient with type 1 DM who presented a non-specific UTI with atypical symptoms which usually occur in children who evolved with diabetic ketocidadose. We emphasize the importance of the discussion of the case about the non-specific symptoms of UTI in children presenting with a complication which was diabetic ketoacidosis.
Final comments: It’s possible that UTI promoted increase in proinflammatory cytokines, these may cause insulin resistance which decreases the use of glucose, increases lipolysis and, consequently, increases fatty acids in plasma. The oxidation of fatty acids leads to the production of ketone bodies in the liver. The case presented several complications caused by difficulties in maintaining hydroelectrolytic and glycemic control, resulting in shock, long period of hospitalization and great risk to life.
Informed consent to publish had been obtained from the patient.
A104 Diabetic retinopathy in participants of a health promotion program in the north/Brazil region
Danielle Cardoso Portilho, Francineide Pereira da Silva Pena, Jessica Gomes da Silva, Rafael Pinto da Silva, Jessica Monteiro Cunha, Sônia Silva Alves, Gabriela de Souza Amanajás, Adriane Stefanny Rocha Ribeiro, Diego Quaresma Ferreira, Ediene Sterfany Marques Vale, Amiraldo Dias Gama, Tallitha Barbosa da Luz, Emanuel de Jesus Vaz Bittencourt, Maria Silvia da Costa Silva, Angel Tamna Souza de Souza
UNIFAP, Macapá, Brazil
Correspondence: Danielle Cardoso Portilho
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A104
Background: Diabetes Mellitus (DM) is considered a worldwide public health problem. It is estimated that there are 415 million adults with DM by 2015 and this number is estimated to increase to 642 million by 2040 (IDF, 2015). Diabetic retinopathy (RD) is one of the main complications related to DM and the main cause of blindness in people aged 20-74 years (KLEIN; KLEIN, 2000). Thus, the duration of diabetes and glycemic control are respectively the two most important factors related to the development and severity of RD (DSBM, 2016).
Objective: To evaluate the RD rate of people participating in a health promotion program for people with Diabetes Mellitus (GPSDM).
Method: A cross-sectional and descriptive study developed with 16 members of the Group of Health Promotion of People with Diabetes Mellitus (Grupo de Promoção da Saúde de pessoas com Diabetes Mellitus) (GPSDM) of the Federal University of Amapá (Universidade Federal do Amapá) (UNIFAP). The study was approved by the Ethics and Research Committee (Comitê de Ética e Pesquisa) (CEP) from UNIFAP, with Postal Code/CEP number: 39488114.6.0000.0003.
Results: Demographic and socio-economic background information: female gender predominance (56.2%), average age 58.5 (SD ± 11.7) years. CLI laboratory profile: 100% present Type 2 DM, of these, 7 (41.1%) carry the disease less than 5 years, 6 (37.5%), 5 to 10 years and 3 (18.7%) over 10 years; Hypertension is 68.7%, average Systolic Blood Pressure (SBP): 128.1 (DP ± 13.7)mmHg and Diastolic: 76.8 (DP ± 7.04)mmHg and HbA1c average 6.8% (PD ± 1.8) (Table 1).
Conclusion: After the socio-demographic and clinical-laboratory analysis of the study participants, it was verified that they did not present manifestations of microvascular complications due to DM, such as RD. This is due to the weekly monitoring and observance of their anthropometric values with intense health promotion and specialized consultations in the Health Promotion Group for people with Diabetes Mellitus. Therefore, according to the IDF (2015), good metabolic control or prevents the onset or delays the progression of its complications, especially microangiopathic ones (Fig. 1).
A105 Diagnosis of diabetes mellitus type 1 before 1 year
Dyrlanne Marcia Lopes Bastos 1, Wildlay Dos Reis Lima 2, Emanuelle Lopes Vieira Marques3, Ana Cristina de Araújo Bezerra2, Paola Cole Brugnera4, Isadora de Farias Pereira2
1Universidade De Brasília, Brasília, Brazil; 2Hospital De Base De Brasília, Brasília, Brazil; 3Hospital Regional Da Asa Norte, Brasília, Brazil; 4Hospital Da Criança De Brasília, Brasília, Brazil
Correspondence: Dyrlanne Marcia Lopes Bastos
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A105
Case report: Patient, 1 years and 2 months, Diabetes Mellitus Type 1 (DM1) diagnosed at the age of 11 months. In this case the child presented polydipsia, polyuria, vomiting and dyspnea. It was hospitalized in the ICU dehydrated in diabetic ketoacidosis. The examinations have shown metabolic acidosis with an 825 mg/dl glycemia index. In the etiological investigation, the decarboxylase antibody of the glutamic acid (anti-GAD) and the antiisland were positive. The patient has used the glargine and the ultrafast insulin, but has evolved with a huge glycemic variability. This way, he has started the therapy with the continuous infusion of insulin system and has improved the glycemic control.
Discussion: The Diabetes diagnosis in children younger than 1 year old must include the pancreas malformation and auto immune diabetes, specially during the 6 first months. Between 6 months and 1 year, the auto immune DM1 is more common. The treatment with insulin in this age group leads to hypoglycemia risks. The continuous infusion of insulin system permits a glycemic control with less glycemic variability and glycemia reduction.
Final considerations: The Diabetes and its diagnosis in children younger than 1 year old is a challenge. The continuous infusion of insulin system permits a glycemic control with less glycemic variability.
Informed consent to publish had been obtained from the patient.
A106 Differences in sedentary behavior measured by triaxial accelerometry between type 1 and type 2 diabetes patients
Bruno Pereira de Moura1, Bruna Priscila Colombo2, Marília de Brito Gomes1
1Programa de Pós-graduação em Ciências Médica–UERJ, Rio de Janeiro, Brazil; 2Residência em Medicina de Família e Comunidade–SMS Rio de Janeiro, Rio de Janeiro, Brazil
Correspondence: Bruno Pereira de Moura
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A106
Introduction: Sedentary behavior (SB) is defined as behavior that generates low energy expenditure (1.0-1.5 MET) in a sitting or reclining position during the waking time. SB has been the new focus for research in the field of “physical activity for health”. Therefore, it is necessary to establish a better understanding about SB profile among patients with type 1 (DM1) and type 2 (DM2) diabetes.
Objective: To compare SB between DM1 and DM2 groups.
Method: This is a cross-sectional study in which 100 patients DM1 and 150 DM2 were evaluated; > 19 years, both genders and at least 1 year of diabetes diagnosis. Patients with severe cardiovascular disease or functional disability were excluded. The study was approved by the local Ethics Committee. SB was measured by tri-axial accelerometers fixed with an elastic belt on the right side of the hip for 7 consecutive days, except in activities in the water or during nighttime sleep. Data were recorded at 60-s intervals and analyzed using ActiLife software version 6.13.3. Wear time validation was defined according to the following criteria: (A) 1 day was considered valid if it had at least 600 min (10 h) of use, without excessive counts (> 20,000 counts.min-1); (B) Only data that had at least 1 valid day was included in the analysis. SB was considered as time spent in activities ≤ 200 counts min−1 of vector magnitude. Data were standardized for 17 h of use. Comparisons of means between groups DM1 and DM2 were performed using t-test for independent samples through IBM SPSS software, version 24. Data are showed as mean ± SD.
Results: DM1 group: 59% were women; Age (y): 37.07 ± 12.12; Diagnostic time (y): 17.21 ± 10.25; BMI (Kg.m-2): 25.14 ± 4.78; Waking time (h): 16.80 ± 1.44; A1C (%): 8.70 ± 1.96; SB (min): 533.72 ± 103.15. DM2 group: 60.7% were women; Age: 57.54 ± 9.27; Diagnostic time: 13.14 ± 7.88; BMI: 29.97 ± 5.41; Waking time: 16.34 ± 1.47; A1C: 8.21 ± 1.68; SB: 495.02 ± 115.04. When comparing the groups, all variables above showed statistical significance (p < 0.05). However, despite presenting statistically different BMI, both are still classified as overweight/pre-obese. DM1 group presented more SB than DM2 group (p = .007). DM1 were 38.69 min (7.25%) more sedentay than DM2 group.
Conclusion: Although we already know that DM1 and DM2 have distinct etiological characteristics, this study is the first to demonstrate by objective measures that DM1 group presents more time in SB than DM2 group. Funding: CNPq and FAPERJ (Fig. 1).
A107 Dipeptidyl peptidase-4 inhibitors, pancreatic cancer and acute pancreatitis: a meta-analysis with trial sequential analysis
Lana C Pinto, Dimitris V Rados, Sabrina S Barkan, Cristiane B Leitão, Jorge L Gross
UFRGS, Rio Grande do Sul, Brazil
Correspondence: Lana C Pinto
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A107
Background: The use of dipeptidyl peptidase-4 (DPP-4) inhibitors may be associated with increased risk for pancreatic cancer and acute pancreatitis. Recent meta-analyses have reported conflicting findings. Therefore, we performed a meta-analysis to assess the risk of both pancreatic cancer and acute pancreatitis associated with the use of DPP-4 inhibitors. In addition, we investigate if the number of patients included in the trials was enough to establish definitive conclusions.
Methods: PubMed, EMBASE, Cochrane Library, and clinicaltrials.org were reviewed up to February 2017. We included randomized controlled trials, lasting 24 weeks or more, that compared DPP-4 inhibitors versus placebo or other antihyperglycemic agents. We also performed trial sequential analysis (TSA) to estimate if meta-analysis was powered for firm conclusions and a metarregression using duration of trial as a covariate to access if it interfered in the results found.
Results: A total of 59,404 patients were included. There was no relationship between the use of DPP-4 inhibitors and pancreatic cancer (Peto odds ratio 0.65; 95% CI 0.35–1.21), and the optimal sample size was reached to determine a number needed to harm (NNH) of 1000 patients. DPP-4 inhibitors were associated with increased risk for acute pancreatitis (Peto odds ratio 1.72; 95% CI 1.18–2.53), with a large NNH (one case for 1066 patients treated). Trial duration had no impact on the incidence of both outcomes.
Conclusion: In conclusion, there is no association between DPP-4 inhibitors and pancreatic cancer, and a small risk for acute pancreatitis was observed with DPP-4 inhibitors use. PROSPERO registry: CRD42016953346. Funding: Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Fundo de Incentivo à Pesquisa e Eventos – Hospital de Clínicas de Porto Alegre (FIPE-HCPA) (Fig. 1).
A108 Distribution of body fat in eutrophic diabetic individuals
Larissa Pessoa Vila Nova1, Camila Lima Chagas2, Marinaldo Freire Lustosa2, Rafael Augusto Batista de Medeiros2, Regina de Deus Lira Benevides2
1UPE, Recife, Brazil; 2UFPE, Recife, Brazil
Correspondence: Larissa Pessoa Vila Nova
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A108
Introduction: The Body Mass Index (BMI) is a widely-applied method of diagnosing the nutritional status in clinic analyses, differentiating individuals in underweight, eutrophic, overweight or obese. However, the literature has demonstrated that those considered underweight or eutrophic are not always with the adequate percentage of body fat. Considering that the accumulation of fat in the abdominal region is considered a risk factor for endocrine, metabolic and cardiovascular diseases, even if BMI is within the limits of normality, it is essential to evaluate body composition in order to reduce the risk of new coronary incidents in diabetic individuals, who are already considered high-risk cardiovascular patients.
Objective: Identify the presence of inadequate body fat distribution in eutrophic diabetic individuals.
Methods: A retrospective study of data from patients hospitalized at a cardiology hospital during the period of 2010 to 2014 was carried out. Diabetic patients under 21 years old and of both sexes were included. Healthy BMI ranged between 18.5 and 24.9 kg/m2 for adults (WHO, 1997) and 22–26.9 kg/m2 for the elderly (Lipschitiz, 1994). The variables taken into consideration were: gender, age, BMI and Abdominal Circumference (AC). Body fat distribution was assessed by CA (≥ 88 cm for women and ≥ 102 cm for men). The study was approved by the Ethics and Research Committee (protocol number 346,129/2013) of the Universidade de Pernambuco hospital. The data were analyzed in the SPSS software, v. 13.0, adopting a significant value of p < 0.05.
Results: From 49 patients with mean age of 66.4 ± 9.2 years with homogeneous distribution between genders, the prevalence of poor body fat distribution in eutrophic diabetic patients was 40.8%. It was found higher in females (p < 0.001) and similar in adults and elderly (p = 0.301).
Conclusions: Eutrophic diabetic patients exhibited an inadequate distribution of body fat, especially women, indicating that BMI should not be adopted as an isolated assessment resource. Abdominal obesity should be evaluated in diabetics since it represents an additional risk factor for cardiovascular diseases.
A109 Drug interactions in elderly adults with vestibular disorders and consequences on glycemia
Fabiane Maria Costa, Antonio Carlos Frias, Célia Aparecida Paulino
Universidade Anhanguera de São Paulo (UNIAN-SP); São Paulo; Brazil
Correspondence: Fabiane Maria Costa
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A109
Background: Aging can support a multiplicity of diseases that lead to polypharmacy and drug interactions, increasing health risks among elderly adults, including those with balance disorders and their associated comorbidities.
Objective: The aim of the study was to analyze drug interactions in elderly people with vestibular diseases and their consequences on glycemia.
Materials and methods: A retrospective study was carried out involving 131 elderly patients with a medical diagnosis of vestibular disease, at the research laboratory of a private university in São Paulo, Brazil. The study was approved by the Institution‘s Research Ethics Committee, approval number CAAE 24995713.6.0000.5493. We collected sociodemographic, clinical, and pharmacological data. The identification and classification of drugs were made according to the Anatomical, Therapeutic and Chemical Classification System (ATC code); analysis of drug interactions and their consequences were carried out using specialized software. A significance level of 5% was used for association analysis.
Results: There was a prevalence of women (86%) in the study population, and mean age was 70.5 years. Dizziness was the most frequent vestibular complaint (97%). There was concomitant use of 3–5 drugs (45%) and 6 or more drugs (27%). The most prevalent drugs were for treatment of cardiovascular (29%), nervous (23%), and digestive system disorders and metabolism disorders (14%), among others. Of the total, 71 elderly patients (54%) had some type of drug interaction, especially women and those aged 65–70 years (32%). The most frequent consequences of these interactions included hyperglycemia (13%) owing to a reduced insulin effect, and increased hyperglycemic effect of thiazides, and hypoglycemia (11%) due to an increased hypoglycemic effect, and increased risk of hypoglycemia. The Chi square test showed a significant association between concomitant use of 6 or more drugs and hyperglycemia (p < 0.001). There was no association of these consequences with the most common vestibular symptoms (dizziness, body imbalance, and tinnitus) or the occurrence of falls (p > 0.05).
Conclusions: Polypharmacy increases drug interactions and the use of 6 or more drugs may result in hyperglycemia, a serious condition associated with vestibular disorders. It is important to monitor insulin therapy and thiazide diuretics to avoid this therapeutic consequence. Glycemic control is relevant in the treatment of vestibular disorders and contributes to the control of body balance in elderly patients with vestibular complaints.
A110 Educational intervention on self care with diabetic foot: study methodology
Luciana Catunda Gomes de Menezes 1, Yara Lanne Santiago Galdino2, Nádya dos Santos Moura3, Denizielle de Jesus Moreira Moura1, Eline Saraiva Silveira Araujo2, Sherida Karanini Paz de Oliveira4
1Faculdade da Grande Fortaleza-Fametro, Fortaleza, Brazil; 2Prefeitura Municipal de Fortaleza, Fortaleza, Brazil; 3Universidade Federal do Piauí, Piauí, Brazil; 4Universidade Estadual do Ceará-UECE, Ceará, Brazil
Correspondence: Luciana Catunda Gomes de Menezes
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A110
Introduction: Among the chronic complications of diabetes mellitus (DM), there is the diabetic foot. This condition requires great investment of care and permanent educational interventions that can contribute to reduce this complication. In Nursing, there are different technologies that promote the emancipation of the people involved in the care process. In the classification of technologies highlighted in this study the construction of an educational technology, the primer type.
Objective: To describe the process of building an educational booklet on self-care to the diabetic foot.
Method: Methodological approach, in which the steps are followed: the content and type of technology selection to be built, imaging, typesetting and composition of the layout. Among the selected and addressed care in the booklet, the highlights: daily foot inspection to detect early minor trauma, care such as washing and drying the feet, particularly the interdigital spaces to avoid injury, hydration of the feet to prevent drying of the skin with moisturizer use, cutting the toenails with clippers and nail scissors with rounded tip, and others. The ethical and legal aspects of research involving human beings were respected in accordance with Resolution 466/2012 and the project was approved by the Ethics Committee of the State University of Ceará (UECE) under Opinion No. 728464/2014.
Results: The work resulted in the production of the final version of the booklet, which was entitled “Healthy Foot‘s Foot Well Care”. The construction process of the booklet was based from the items of the Accession Questionnaire Self Care Patients with Diabetic Feet (QPED) Silva (2014).
Conclusion: The feature is facilitator for the improvement of knowledge and self-care practices with diabetic foot.
A111 Educational strategies on insulin therapy for young people with diabetes mellitus: systematic review
Rebecca Ortiz La Banca1, Mariana Bueno1, Taine Costa1, Valéria de Cássia Sparapani2, Lucila Castanheira Nascimento1
1Universidade de São Paulo, São Paulo, Brazil; 2Universidade Federal de Santa Catarina, Santa Catarin, Brazil
Correspondence: Rebecca Ortiz La Banca
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A111
Introduction: Brazil is the third country with the highest number of Type 1 Diabetes (T1D) new cases per year in young people. Treatment requires the development of skills and knowledge for self-care. Among behaviors that are expected, taking medication is challenging, since insulin therapy is a highly complex subject and requires an adequate educational approach according to age group.
Objective: To identify evidence from the literature about educational strategies on insulin therapy targeted at young people with T1D.
Method: A systematic review was led in October 2016. Searches were conducted at Medline via PubMed, EMBASE, CINAHL, LILACS and ERIC databases. MeSH terms used were Insulin/therapeutic use, Patient Education as Topic, Diabetes Mellitus Type 1, Child, Infant, Adolescent and other keywords. Primary studies on educational strategies for insulin therapy targeted to young people with T1D were included. Studies regarding insulin pump therapy were excluded.
Results: 226 references were identified of which 12 met the inclusion criteria. Studies were published between 1991 and 2013. Educational strategies aimed at young people (from 8 to 24 years old) were described. These strategies were implemented in a large variety of.
Methods: One-on-one sessions, in groups, by telephone, by a text messages, through role play and diabetes camps. Studies did not focus solely on insulin therapy education, but rather on general aspects of diabetes education. Positive results were described regarding quality of life, reduction of hypoglycemia episodes and number of hospitalizations. No significant results were described in terms of the improvement of metabolic control.
Conclusions: The development of educational strategies for young people with T1D is needed. Educational strategies should be tailored by using appropriate language, and focusing specifically on insulin therapy and its complexity. The development of interventions to promote self-care behaviors related to insulin therapy contributes with teaching guidelines to young people with T1D, with promoting adherence to drug therapy, and with improving metabolic control.
A112 Alpha-linolenic acid supplementation effects on endoplasmic reticulum stress in visceral adipose tissue from morbid obese patients
Mariana Pinto Chaves, Maria Cristina Foss-Freitas
Universidade de Sao Paulo-HCRP-USP, São Paulo, Brazil
Correspondence: Mariana Pinto Chaves
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A112
Alpha-linolenic acid supplementation effects on endoplasmic reticulum stress in visceral adipose tissue from morbid obese patients. 2017. Tese (Doutorado)—Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 2017. Currently, obesity is considered a worldwide epidemic. It is associated with chronic inflammation and stress activation of the endoplasmic reticulum (ERE), related to the pathogenesis of various diseases such as type 2 diabetes mellitus, cardiovascular diseases, cancer, hypertension, among others. In this context, studies are needed to find alternatives that improve the inflammatory process. Several studies in humans and animals have already demonstrated the anti-inflammatory properties of omega-3 fatty acid. The objective of our study was to evaluate the effects of alpha-linolenic acid (ALA) supplementation on the metabolism and stress of the endoplasmic reticulum in obese patients. A prospective, randomized, placebo-controlled, double-blind study was conducted. In total, 52 patients were randomized to supplementation with 3 g/day of ALA or placebo, 27 individuals from the omega-3/ALA group and 25 from the control group. Lipid, glycidic and inflammatory profile were evaluated before and after supplementation. Visceral adipose tissue (TAV) was collected during bariatric surgery after supplementation. The fatty acid profile incorporated in the TAV was evaluated by gas chromatography. Genes were evaluated by real-time PCR. There was no change in serum levels of IL-6 (p = 0.2201), TNF-α (0.7703) and CRP (p = 0.57) after supplementation with ALA, but we observed a decrease in serum Leptin levels (P = 0.0154) and IP-10 (p = 0.0410), inflammatory cytokines, and increase in IL-4 (p = 0.0211), anti-inflammatory cytokine. Significant incorporation of ALA (p = 0.0002), EPA (p < 0.0001) and DHA (p = 0.0005) into the TAV was observed. Molecular evaluation showed an increase in the gene expression of XBP1 (p = 0.0013), sXBP1 (p < 0.0001), EIF2-α (p = 0.0063), GADD34 (p = 0.0117) and CCT4 chaperone (p = 0.0001), decrease in the gene expression of leptin (p = 0.0410) and ATF-6 (p = 0.0305) and a tendency to decrease the gene expression of CHOP. We can conclude that ALA can modulate ERE through the IRE1/XBP, PERK and ATF-6 pathways, leading to increased chaperones (CCT4), which may demonstrate a therapeutic potential of ALA in obese patients.
A113 Effect of dapagliflozin in energetic and glycemic homeostasis in the brain and hypothalamic functionality in humans
Leticia da Silva Pires1, Ana Carolina Junqueira Vasques1, Andrea Tura2, Brunno de Campos1, Licio Augusto Velloso1, Bruno Geloneze1
1UNICAMP, São Paulo, Brazil; 2CNR Institute of Neuroscience, Padova, Italy
Correspondence: Leticia da Silva Pires
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A113
Background: In type 2 diabetes mellitus, sodium-glucose co-transporter inhibitors type 2 (iSGLT-2) reduce the renal glucose reabsorption threshold, resulting in glycosuria, lower glycotoxicity and insulin resistance, improved beta-cell function, loss of body weight and consequent improvement of glycemic control. Glucose is the main source of energy for the brain and, in the hypothalamus where the mechanisms of hunger and satiety are regulated, the expression of SGLTs may be important in the detection of glucose and a possible therapeutic target for obesity. So, the aim of this study was to evaluate the effect of SGLT-2 inhibitor (dapagliflozin) on glycemic and energetic homeostasis and the hypothalamic functionality of healthy people.
Methods: Twenty healthy and non-diabetic women (19–37 years old) were evaluated at baseline and 7 days after dapagliflozin (10 mg/day), maintaining their regular lifestyle. Body mass index (BMI), sagittal abdominal diameter, body composition by electrical bioimpedance and energy expenditure of resting and oxidation of energetic substrates in fasting by indirect calorimetry were analyzed. Functional magnetic resonance imaging detected the activation of brain areas against the stimulation of glucose and dapagliflozin. From the oral glucose tolerance test (TTOG), insulin sensitivity, hepatic insulin extraction and beta-cell function were assessed by mathematical modeling. Moreover, glucose, insulin, peptide C, glucacon, glycated hemoglobin, adiponectin and free fatty acids were measured.
Results: After the intervention, there was no reduction in BMI (21.7 ± 2.0 vs. 21.5 ± 2.0 kg/m2, p = 0.05), sagittal abdominal diameter (15.1 ± 1.1 vs. 14, (p = 0.05) and fat percentage (28.4 ± 6.3 vs. 27.6 ± 4.0%, p = 0.46). Calorimetry did not identify significant changes in energy expenditure and respiratory quotient. There was a reduction in glycemia (75 ± 7 vs. 71 ± 7 mg/dL, p = 0.02), a trend to reduce insulinemia (5.7 ± 3.6 vs. 3.9 ± 3.5 mU/mL, p = 0.05) and increased adiponectin levels (3.2 ± 1.4 vs. 5.7 ± 3.3 μg/mL, p = 0.02) and free fatty acids (0.6 ± 0.2 vs. 0.3 mmol/L, p = 0.02). In TTOG, after intervention, there was better efficiency in the glycemic curve decay (p = 0.028) without accompanied changes in the curves of insulin, peptide C and glucagon. Also, there was an increase in insulin sensitivity index with oral glucose-OGIS (p = 0.048), reduction of beta-cell sensitivity to glucose, greater efficiency in the first phase of insulin secretion and reduction in the rate of insulin secretion to a glycemia of 90 mg/dL. Functional magnetic resonance imaging examined correlation and connectivity among the hypothalamus and other brain regions, such as insula and primary gustatory cortex, suggesting that the use of dapagliflozin may alter these connections.
Conclusions: The intervention with dapaglifozin in healthy women did not alter energetic homeostasis and provided a set of metabolic adaptations to maintain normal glycemic levels and to prevent hypoglycemia against the glycosuric effect of the drug. The use of dapagliflozin may alter the connections among the hypothalamus and specific regions of the brain, which are related to food intake. Thus, dapagliflozin can act similarly to glucose and play a possible role in hunger control.
A114 Effect of insulin on renal maximum glucose transport capacity in healthy volunteers and patients with type 2 diabetes
Ricardo Pereira Moreira1, Marta Seghiere2, Brenno D. Astiarraga2, Aglecio L Souza1, Valeria B Chueire1, Anna Solini2, Ele Ferrannini3, Elza Muscelli1
1Unicamp, São Paulo, Brazil; 2University of Pisa, Pisa, Italy; 3CNR Institute of Clinical Physiology, Pisa, Italy
Correspondence: Ricardo Pereira Moreira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A114
Background: Most studies, though not all, indicate that the maximum glucose transport capacity of the proximal tubule (TmG) is increased in patients with type 2 diabetes (T2D). Furthermore, one study from 1951 suggested that insulinization may reduce TmG. In contrast, in human embryonic kidney 293T cells insulin increases the activity of transfected human SGLT2. To assess these issues de novo, we examined the effect of physiological hyperinsulinaemia on TmG and urinary glucose excretion (UGE) in healthy subjects (NGT) and T2D patients under steady-state conditions of plasma glucose and insulin concentrations. Subjects and.
Methods: 13 T2D (7F/6 M; 54 ± 6 years, mean ± SD; BMI = 29.5 ± 5.0 kg/m2; HbA1c = 7.6 ± 0.6%) and 12 NGT (6F/6 M; 36 ± 10 years; 24.2 ± 3.0 kg/m2) received a IV 7-h constant somatostatin (400 µg/h) and a variable glucose infusion to achieve steady-state glycaemias of ~ 22 mmol/L in 1 h and to maintain this level for the next 3 h (CT period). Then, a constant insulin infusion (1 mU min−1 kg−1) was started and maintained for additional 3 h (INS period) while clamping glycaemia at CT levels with the use of an ad hoc algorithm. Urines were collected separately for the two study periods for the measurement of glucose and creatinine.
Results: Plasma glucose plateaus were similar across group and study periods. Exogenous glucose infusion rate (GIR) was similar in T2D and NGT during the CT period (26 ± 12 vs 36 ± 16 µmol kg MM−1 min−1; p = ns); during the INS period, GIR rose much higher in NGT than T2D (157 ± 46 vs 71 ± 47 µmol kg MM−1 min−1, p < 0.0001). Creatinine clearance was similar between groups and study periods. During the CT period, UGE was significantly lower in T2D than in NGT (490 vs 690  µmol min−1, median and [IQR], p = 0.03) whereas fractional glucose excretion (FEG) tendede to change (17 ± 6 and 20 ± 5%, respectively; p = 0.0502). During the INS period, both UGE and FEG rose above CT levels in NGT (to 770  µmol min−1 and 24 ± 3%, respectively, p < 0.005 for both vs CT), whereas UGE tended to change in T2D (530 µmol min−1; p = 0.0546) and FEG was unchanged (17 ± 7%, p = ns). In the pooled data of T2D and NGT participants, FEG was positively associated with GIR during the INS period (Rho = 0.462, p = 0.0008).
Conclusions: Acute physiological hyperinsulinaemia during steady-state hyperglycaemia increases urinary glucose excretion in NGT subjects. This insulin effect is impaired in patients with type 2 diabetes, and may be related to insulin resistance.
A115 Effect of sglt-2 inhibition by dapagliflozin on mice hypothalamus
Letícia da Silva Pires, Thiago Matos Ferreira de Araújo, Daniela Soares Razolli, Albina de Fatima Silva Ramalho, Ana Carolina Junqueira Vasques, Lício Augusto Velloso, Bruno Geloneze Neto
UNICAMP, São Paulo, Brazil
Correspondence: Letícia da Silva Pires
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A115
Background: The balance between eating behavior and energy expenditure is coordinate by specialized neurons in hypothalamic nuclei. In the arcuate nucleus, NPY/AgRP and POMC/CART neurons respond to peripheral signals regarding energetic status. Variations in blood glucose levels generate a hypothalamic response that is still poorly understood, however the transporters GLUT and SGLT play an important role in this process. The sodium-glucose co-transporter type 2 (SGLT-2) is expressed in the kidney and brain and its inhibition leads to glycosuria and caloric loss concomitantly with a decrease in body weight and an apparent increase in food intake. Thus the aims of this study were to evaluate (i) the effect of SGLT-2 inhibition by dapagliflozin in the hypothalamus of mice; (ii) the potential effect of dapagliflozin on body weight, food intake and glycemic homeostasis; (iii) to characterize the hypothalamic expression of neurotransmitters involved on the regulation of food intake and energy expenditure.
Methods: C57BL/6 mice received vehicle or dapagliflozin (1, 5 or 10 mg/kg) by gavage once a day for 2 weeks. Body weight and food intake were evaluated at treatment times 0, 7 and 14 days. At the end of the treatment, glucose tolerance was evaluated by ipGTT as well as epididymal adipose tissue weight and neurotransmitters by immunofluorescence.
Results: SGLT-2 is expressed in the arcuate nucleus and colocalizes with POMC and NPY neurons. The treatment with dapagliflozin did not alter food intake significantly, although there was a decrease in body weight gain (mean = 0.56 ± 1.1 g, p < 0.05) and a trend to reduce epididymal adipose mass (mean = 0.15 ± 0.02 g, p = 0.13). There was increased glycosuria (mean = 307.2 mg/dL, min = 30 mg/dL, max = 1221 mg/dL, p < 0.05), improved fasting glycemia (mean = 165.6 ± 28.8 mg/dL, p < 0.05) and reduction in the area under glucose curve during the glucose tolerance test (mean = 28,078 ± 5623.5 arbitrary units, p < 0.05).
Conclusions: SGLT-2 is expressed in the hypothalamic arcuate nuclei and colocalizes with neurons that control energetic homeostases. The treatment with dapagliflozin for 2 weeks improved fasting glycemia and glucose tolerance, promoted glycosuria and reduced body weight gain without altering food intake. Understanding the mechanisms involved in body weight control promoted by dapagliflozin could guide strategies to enhance weight loss in obesity concomitantly with diabetes treatment.
A116 Effect of weight loss induced by bariatric surgery on male gonadal function
Giovanni Faccina Brolo, Fernanda Augustini Rigon, Marisa Helena Cesar Coral, Simone van de Sande-Lee, Alexandre Hohl, Marcelo Fernando Ronsoni, Beatriz Marquardt Leite, Manuella de Lucca Michels, Priscila Nobre Dantas Mattje, Camila Sartor Spivakoski
UFSC, Santa Catarina, Brazil
Correspondence: Giovanni Faccina Brolo
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A116
Functional hypogonadism in obese male patients is considerably higher if compared with the general population, fact that is widely reported in literature. One of the ways to study this condition is to analyze gonadal hormonal changes after the weight loss resulting from bariatric surgery, being this approach employed in this study. The present work comprises a longitudinal and observational investigation of 27 men, aged between 30 and 64 years, body mass index (BMI) greater than 35, that underwent to bariatric surgery (Roux-en-Y gastric bypass and the sleeve gastrectomy). The clinical data were recorded, for all subjects, before and after 6 months of the surgical procedures. After 6 months of the surgery, a substantial weight loss from 158.5 ± 25.8 to 119.4 ± 20.8 kg (p < 0.0001 for both) was verified. The BMI and total testosterone (TT) level ranged from 51.9 ± 6.6 to 39.2 ± 5.6 (p < 0.0001) and 225.5 ± 96.9 ng/dl to 394.4 ± 160.9 ng/dl (p < 0.001), respectively. The hypogonadism (TT ≤ 300 ng/dl), verified in 85% of the subjects before the surgery, persisted in only 26% of these patients after 6 months. There were no statistical differences in hypogonadism neither between the two surgical techniques, nor between the patient groups with and without diabetes. The results point out that the weight loss induced by bariatric surgery leads to an important recovery of the gonadal function in a significant number of male patients.
A117 Effect on the reproductive performance of Curatella americana treatment during the pregnancy of rats with mild diabetes
Bruno Stephano Ferreira da Silva1, Gabriel Gomes Araujo1, Larissa Lopes da Cruz1, Thais Leal Silva1, Verônyca Gonçalves Paula1, Rafaianne Queiroz de Moraes Souza1, Cristielly Maria Barros Barbosa1, Kleber Eduardo de Campos1, Débora Cristina Damasceno2, Gustavo Tadeu Volpato1
1UFMT, Mato Grosso, Brazil; 2UNESP, São Paulo, Brazil
Correspondence: Bruno Stephano Ferreira da Silva
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A117
Introduction: During pregnancy, hyperglycemia can lead to maternal and fetal complications, causing reproductive changes. Alternatives are considered to treat diabetes and prevent its complications, and one of these alternatives is the use of medicinal plants, such as Curatella americana. However, there is no scientific evidence on the safety of this plant effect during gestation.
Objective: To evaluate the effects of the aqueous extract of Curatella americana in the reproductive performance of pregnant rats with mild intensity hyperglycemia.
Methods: Diabetes was induced in newborn female Wistar rats, at 24 h after birth, by subcutaneous injection of Streptozotocin at a single dose of 100 mg/kg. At 110 days of age (adulthood), oral glucose tolerance test (OGTT) was performed to confirm the mild diabetes model. After confirmation of the diabetes, the rats were mated and distributed into 4 experimental groups (n = 12 animals/group): Control: Non-diabetic rats treated with water; Control Treated: Nondiabetic rats treated with the plant; Diabetic: Diabetic rats treated with water; Diabetic Treated: Diabetic rats treated with the plant. The administration of the Curatella americana leaves aqueous extract, at dose of 300 mg/kg, was done daily, by gavage, throughout pregnancy. The maternal weight was verified at the beginning and end of pregnancy. On the morning of the 21st day of pregnancy, the rats were anesthetized and the uterus was removed. Pre- and post-implantation loss rates were calculated.
Results: Both diabetic groups exhibited higher pre-implantation loss rates and lower maternal weight gain. The treatment with the plant change no others reproductive parameters.
Conclusion: The reproductive alterations showed in the present study were caused by hyperglycemia, and treatment with Curatella americana did not cause any maternal impairment at this dose.
A118 Effectiveness of gestational diabetes mellitus screening in the central region of Rio Grande do Sul
Clarice dos Santos Mottecy1, Júlia Mottecy Piovezan2, Raquel Montagner Rossi2, Patricia Molz3, Julia Thies Baladão2, Kátia Biasuz Trevisan1, Laura Hélen Mercado Vargas2, Sílvia Isabel Rech Franke3
1HUSM/EBSERH - UFSM, Rio Grande do Sul, Brazil; 2UFSM, Rio Grande do Sul, Brazil; 3UNISC, Rio Grande do Sul, Brazil
Correspondence: Clarice dos Santos Mottecy
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A118
Background: One of the most observed pathologies in pregnancy is Diabetes Mellitus (DM). When Gestational Diabetes Mellitus (GDM) is not identified and treated can lead to complications during gestation and/or delivery, besides woman with GDM may develop Type 2 DM in the future, and their children can become obese and have DM as adults. In Brazil, according to the Ministry of Health (MH), the screening should be universal with assessment of risk factors and fasting glycemia (FG) at the first prenatal visit, ideally in the first trimester. If negative, FG should be repeated in the second trimester. If positive, oral glucose tolerance test (OGTT) should be requested. The cut-off point of normal glycemia in pregnancy of 4.72 mmol/L was standardized by a Brazilian multicenter study using parameters from the World Health Organization with sensitivity of 94%.
Objective: The aim of this study was to evaluate the effectiveness of GDM screening according to the MH guideline, using FG criteria in postpartum women in the public health care who had their deliveries at the University Hospital of Santa Maria-RS.
Methods: In a cross-sectional study, postpartum women over 18 years of age who underwent prenatal care at the health units and had the pregnant woman‘s card at the time of the interview were included. Data were collected through interviews, analysis of the pregnant women’s card and evaluation of medical charts between January and April of 2015. Informed consent to publish has been obtained from patients. The study was approved by University of Santa Cruz do Sul Institutution‘s Ethics Board, approval number 37290714700005343.
Results: Of the total of 283 postpartum women studied 85.5% performed a FG, 14.5% did not perform the test. Negative screening was observed in 74.8% of postpartum women, while 25.2% had positive test. Of the postpartum women with negative screening, only 50.3% continued research. Of the women with positive screening who should progress in the investigation performing the OGTT, only 37.7% did it.
Conclusion: In this group was observed that GDM screening process, through FG was not performed effectively in 59.7% of the women, as recommended by MH. Therefore, it is necessary to identify the factors responsible for ineffectiveness and promote awareness and training of the health team in the basic care to improve the screening and diagnosis of this pathology, aiming to reduce maternal–fetal morbidity and mortality and its future consequences.
A119 Effects of acute elevation of plasma NEFA on incretin-stimulated insulin secretion
Benno D Astiarraga1, Elza Muscelli2, Stefania Camastra1, Ricardo Pereira Moreira2, Valéria B Chueire2, Simona Baldi1, Andrea Tura3, Andrea Mari3, Ele Ferrannini4
1University of Pisa, Pisa, Italy; 2Unicamp, São Paulo, Brazil; 3CNR Institute of Neurosciences, Padua, Italy; 4CNR Institute of Clinical Physiology, Pisa, Italy
Correspondence: Benno D Astiarraga
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A119
Background: Plasma nonesterified fatty acids (NEFA) are an important source of energy during fasting and postprandial periods but their excess could have an inhibitory effect on insulin secretion (IS). Information on in vivo effects of NEFA on incretin-stimulated IS is lacking.
Aim: Assess the effects of acute hyperlipidaemia on incretin-stimulated IS in healthy subjects (HS).
Methods: 10 HS, 34 ± 3 years, BMI 24 ± 2 kg/m2 were studied in 2 sets of experiments. First, each subject received a 75-g oral glucose tolerance test (CT-OGTT) and, a week later, an isoglycaemic intravenous glucose infusion (CT-IIGT) matching glycaemic profile from CT-OGTT. Both tests were repeated during a 20% Intralipid infusion (60 mL/h) plus a primed continuous heparin infusion started 2 h before either test (L-OGTT and L-IIGT). The dynamics of IS were assessed by mathematical model of glucose and C-peptide responses.
Main parameters: insulin secretion rate (ISR); glucose sensitivity (ßGS—the mean slope of the IS/plasma glucose dose–response curve); glucose-induced potentiation (PGLU), a time-dependent modulation of the dose–response during IIGI; incretin-induced potentiation (PINCR), which quantifies the time-course of the incretin effect, IE. The IE was also indexed as the oral-to-IV ratio of IS. Results NEFA rose from 0.19 ± 0.03 to 3.55 ± 0.53 mmol/L on the L-OGTT, and from 0.23 ± 0.03 to 3.77 ± 0.45 mmol/L on the L-IIGT (p ˂ 0.005 for both). Plasma triglycerides increased from 0.7 ± 0.1 to 3.2 ± 0.6 mmol/L on L-OGTT and from 0.6 ± 0.1 to 3.2 ± 0.5 mmol/l on L-IIGT (p ˂ 0.005 for both). While lipid infusion raised glycemia only marginally (p = ns), it increased total ISR from 61  to 78  nmol m−2, median [IQR] on the OGTT (p = 0.005), and from 29  to 57  nmol m−2 on the IIGT (p = 0.02). While neither ßGS nor PGLU was significantly affected (p = ns), PINCR decreased from 1.6 [1.1] to 1.3 [0.2] units, p = 0.05. Moreover, during Intralipid infusion IE was significantly decreased between 0 and 90 min (p = 0.001). The time-courses of GLP-1 and GIP did not change significantly, while the plasma ghrelin response to the OGTT declined from 12.3 ± 2.6 to 8.2 ± 1.2 ng/mL, p = 0.005. Lipid infusion also induced mild insulin resistance during the OGTT (as the oral insulin sensitivity index [OGIS] decreased from 402 ± 22 to 355 ± 28 mL min−1 m−2 p = 0.05).
Conclusion: An acute increment in plasma lipids stimulates total insulin secretion but selectively impairs incretin-stimulated insulin secretion.
A120 Effects of Bisphenol-A consumption on insulin secretion in ovariectomized female mice fed with hyperlipidic diet
Kênia Moreno de Oliveira, Letícia de Souza Figueiredo, Vanessa Kiil Rios, Juliana do Nascimento da Silva, Helene Nara Henriques Blanc, Rosane Aparecida Ribeiro
UFRJ, Rio de Janeiro, Brazil
Correspondence: Kênia Moreno de Oliveira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A120
Introduction: Bisphenol-A (BPA) is used as a raw material in the production of everyday utensils, but there is evidence that it may have estrogenic, antiestrogenic and antiandrogenic actions related to increased adiposity and type 2 diabetes.
Objective: The effects of BPA on the development of obesity and glucose homeostasis in ovariectomized (OVX) and high fat diet (HFD) female mice.
Methods: Female Swiss mice with 80–100 days of life were OVX, after 2 weeks females in anestrous were distributed in the control groups (CTL): fed with normolipid diet and water containing 0.01% ethanol (vehicle); BPA control (CBPA): normolipid diet and water containing 0.01% ethanol and 1 μg/mL BPA; HFD: diet containing 36 g% fat and vehicle; and (HBPA): HFD and BPA. After 3 months, glucose tolerance test (GTT) and islet isolation for insulin secretion were performed (CEUA UFRJ-Macaé: MAC035 approval). Data were analyzed for the distribution of normality (Shapiro–Wilk), followed by analysis of variances: parametric (ANOVA followed by Newman–Keuls) or non-parametric (Kruskal–Wallis followed by Dunns; P < 0.05).
Results: HFD females had higher body weight (BW, 57.3 ± 2.3 g) when compared to female CTL (47.8 ± 1.8 g). The HBPA group had higher CP (63.4 ± 2.1 g) when compared to HFD. During the GTT, HFD females presented hyperglycemia at 15 and 30 min of the test (444 ± 13 and 453 ± 23 mg/dL) in relation to CTL (332 ± 19 and 361 ± 24 mg/dL, respectively). HBPA female presented hyperglycemia similar to the HFD group (427 ± 17 and 450 ± 22 mg/dL) at 15 and 30 min of GTT. AUC area in GTT was higher in HFD females (33,049 ± 2931 mg/dL min−1) than in CTL females (21,658 ± 1910 mg/dL min−1). However, HBPA females had AUC area in GTT (32,409 ± 1992 mg/dL min−1) similar to HFD and CTL. Insulin secretion in response to 2.8 and 22.2 mM glucose did not differ between HFD islets (1.2 ± 0.14 and 4.0 ± 0.7 ng/islet h) and CTL (0.88 ± 0.1 and 2.0 ± 0.3 ng/islet h). However, islets isolated from HFD females secreted more insulin compared to 11.1 mM glucose (1.0 ± 0.3 ng/ilhota h) relative to CTL islets (0.5 ± 0.2 ng/islet h). Females consuming BPA and HFD hypersecreted insulin in response to 2.8 and 11.1 mM glucose (1.8 ± 0.2 and 1.0 ± 0.3 ng/islet h).
Conclusion: Data to date demonstrate that the HFD diet causes glucose intolerance, when associated with BPA, elevates BW and generates impaired insulin secretion.
A121 Effects of educational strategy on sleep hygiene and light exposure on sleep quality, emotional stress and glycemic control in type 2 diabetes mellitus: randomized controlled trial
Flávia Helena Pereira1, Danilo Donizetti Trevisan2, Daniela Santos Lourenço3, Maria Helena de Melo Lima2
1Instituto Federal do Sul de Minas Gerais, Minas Gerais, Brazil; 2Universidade Estadual de Campinas, São Paulo, Brazil; 3Universidade Federal de Alfenas, Minas Gerais, Brazi
Correspondence: Flávia Helena Pereira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A121
Background: The relationship between type 2 diabetes mellitus (DM2) and sleep is already established and studies indicate that this relationship is bidirectional. Measures to improve sleep quality may reduce the emotional stress related to diabetes and consequently improve glycemic control.
Aim: To evaluate the effects of educational strategy of sleep hygiene and light exposure on sleep quality, emotional stress and glycemic control in people with T2DM.
Methods: Randomized Controlled Trial (RCT), unicego, involving 91 participants with DM2, attended in primary care service, in a municipality in the south of Minas Gerais, Brazil. Participants were randomized into two groups: intervention (IG), who received the educational strategy of sleep hygiene and exposure to light and control (CG), who received guidance on foot care and were followed for a period of 3 months. Both groups received face-to face counseling at 1-month intervals and telephone reinforcements each week, with the exception of the last month. The variables related to sociodemographic and clinical characterization, sleep quality, diabetes-related distress (DRD) and glycated hemoglobin (HbA1c) were performed at the baseline and at the 3rd month of follow-up. The primary endpoint was the assessment of sleep quality observed after 3 months of follow-up. The Consolidated Statement of Reporting Trials (CONSORT) was followed for randomization, masking, group tracking and data analysis. Linear mixed effects models were used to compare the variables over time and the linear regression model to correlate the variables with the primary outcome. The level of significance was set at 5%. Ethics Approval: The study was approved by the University of Campinas’ Ethics Board, approval number 1.183.930/2015 and conducted according to the recommendations of the Declaration of Helsinki.
Results: Comparison over time, between groups, showed that IG presented better sleep quality (mean of 5.02 versus 6.30 points, p = 0.0272). For the IG, over time, there was an improvement in sleep quality (p < 0.0001) and in the mean of DRD score (p = 0.0001). Through a linear regression model, it was observed that the variables of DRD, gender and type of group had influence, with significant statistical difference on sleep quality. Being male and showing improvement in DRD levels contributed significantly to sleep quality improvement (p = 0.0314 and p = 0.0202, respectively). In relation to the groups, belonging to the IG contributes to the improvement of sleep quality (p = 0.0024).
Conclusion: This study demonstrated that measures of sleep hygiene and exposure to light have a positive effect on the improvement of sleep quality, emotional stress and glycemic control in individuals with T2DM.
A122 Effects of nurse telesupport on transition between specialized and primary care in diabetic patients
Ana Marina da Silva Moreira1, Camila Bergonsi de Farias2, Roberta Marobin1, Dimitris Varvaki Rados1, Sabrina Coelli2, Bárbara Luiza Bernardi2, Thizá Massaia Londero1, Livia Almeida Faller2, Laura Ferraz dos Santos2, Ana Maria Matzenbacher2, Natan Katz2, Erno Harzheim2, Sandra Pinho Silveiro2
1HCPA, Rio Grande do Sul, Brazil; 2UFRGS, Rio Grande do Sul, Brazil
Correspondence: Ana Marina da Silva Moreira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A122
Introduction: The prevalence of diabetes mellitus type 2 (T2DM) is increasing and the primary health care (PHC) plays an important role in its management. In an attempt to improve the training of PHC team, the National Telehealth Program was created. One of the aims of this program is to stimulate the transition of care, increasing the safety of outpatient discharge from specialized services.
Objectives: To evaluate the effectiveness of a telehealth strategy in T2DM patients who were discharged from a tertiary hospital outpatient clinic.
Methods: Randomized clinical trial open-label (randomization 1:1). Were included T2DM patients on treatment at Endocrinology Service of Hospital de Clínicas de Porto Alegre, with glycated hemoglobin (HbA1c) < 8% and indication of discharge. The exclusion criteria were: glomerular filtration rate < 30 mL/min, symptomatic ischemic heart disease, severe peripheral and autonomic neuropathy. Both groups were discharged and were followed-up in PHC. The intervention group received phone-calls for education in T2DM by a trained nurse every 3 months and a free phone number (0800) for resolution of any doubt. The control group received calls without intervention. After 1 year of follow-up, both groups returned for clinic evaluation.
Results: To date, 145 patients were included in the study (target 150), with 2 follow-up losses. The sample consisted of 62.3% women, 67.2% white, with median age of 65.3 ± 11.2 years-old, BMI 31.1 ± 7.4, with a DM duration of 15.4 ± 10.8 years. Medium HbA1c (%) at discharge was 7.01 ± 0.68, fasting glucose (mg/dl) was 127.37 ± 42.33 and creatinine (mg/dl) was 0.91 ± 0.29, without differences between groups at baseline. To date, 67 patients were evaluated after 1 year. There were no differences between groups (control and intervention, respectively) in terms of HbA1c (7.6% × 6.9%, p = 0.16), systolic blood pressure (129 mmHg × 129 mmHg, p = 0, 85), diastolic blood pressure (77 mmHg × 75 mmHg, p = 0.35) and total cholesterol (161 mg/dL × 160 mg/dL, p = 0.48).
Conclusions: In a preliminary analysis of the data, after 1 year of follow up, the patients maintained a good glycemic control, with no differences between the groups. These findings need to be confirmed in the final analysis of the study.
A123 Effects of physical exercise on adiponectin transduction signal in hypothalamus of obese animals
Rafael Calais Gaspar1, Vitor Rosetto Muñoz1, Guilherme Pedron Formigari1, Barbara Moreira Crisol1, Gabriel Keine Kuga1, Susana Castelo Branco Ramos Nakandakari1, José Diego Botezelli1, Luciene Lenhare1, Adelino S.R. da Silva2, Dennys Esper Cintra1, Leandro Pereira de Moura1, Eduardo Rochete Ropelle1, José Rodrigo Pauli1
1UNICAMP, São Paulo, Brazil; 2USP, São Paulo, Brazil
Correspondence: Rafael Calais Gaspar
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A123
Introduction: Physical exercise is one of the main interventions capable of modulating energy homeostasis, but little is known about the relationship between physical exercise and adiponectin in the energy balance of regulatory mechanisms.
Objective: Verify the acute physical exercise effect on the adiponectin signaling pathway modulation in the hypothalamus of obese mice and its action on energetic homeostasis.
Methods: Swiss mice, 6 weeks old, were divided into 3 groups exposed to different diets: CTL-standard diet; OBS-hyperlipidic diet; OBEX-hyperlipidic diet and submitted to the protocol of acute physical exercise (3 sessions of 45 min at treadmill with break of 15 min between each session). Serum adiponectin, glucose tolerance, food intake and energy expenditure were analyzed. For the molecular analyzes, the animals received stimulation of intraperitoneal leptin. Signaling pathway of leptin proteins, adiponectin and PI3K-Akt in the hypothalamus and UCP1 in brown adipose tissue were analyzed.
Results: It was demonstrated that the OBEX group did not present alteration in the total body mass compared to the OBS. However, an increase in glucose tolerance and serum adiponectin of OBEX were observed compared to OBS (Fig. 1). There was a reduction in food intake in OBEX when compared to OBS, and APPL1 mRNA levels correlated negatively with food intake (Fig. 2). In addition, OBEX showed increased oxygen consumption and heat production compared to OBS. At the molecular level, OBEX presented an increase in UCP1 compared to the other groups (Fig. 3). In addition, physical exercise was not able to modulate the leptin pathway (Fig. 4). However, the exercise had a positive effect on the APPL1, key protein in the adiponectin transduction pathway. It was observed that OBS group presented reduction in the hypothalamic APPL1 in relation to the CTL group and the OBEX animals showed APPL1 increased compared to OBS (Fig. 5). The animals exercised showed increased protein content in the PI3K-Akt signaling pathway in the hypothalamus (Fig. 6). Finally, in both animal and human bioinformatics analyzes, there was a strong correlation between the levels of mRNA of APPL1 and hypothalamic PI3K (Fig. 6).
Conclusion: Physical exercise is able to increase the protein content of APPL1 in the hypothalamus of obese mice, increase energy expenditure and reduce food intake.
A124 Effects of regular physical exercise on the levels of flexibility of diabetics type 2
Cristiane Correia da Silva1, Jonathan Nícolas dos Santos Ribeiro2, Cláudio Barnabé dos Santos Cavalcanti1, Denise Maria Martins Vancea2
1UPE, Recife, Brazil; 2UPE/UFPE, Recife, Brazil
Correspondence: Cristiane Correia da Silva
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A124
Introduction: Collagen is the main protein responsible for resistance to flexibility, and in connective tissue disorders of glucose metabolism in the diabetic can produce a superglicolization of specific collagens, thus reducing levels of flexibility.
Objective: To verify the effects of regular physical exercise on the flexibility levels of type 2 diabetics.
Method: Characterized as a quasi-experimental study. The sample was non-probabilistic; 11 female subjects with type 2 diabetes, with a mean age of 66.5 ± 1.6 years, participated in the study. The training protocol was composed of resistance and aerobic training, the flexibility assessment was performed before and after the intervention that lasted 6 weeks. To assess flexibility, a Tera Flex 1.8 digital flexometer was used by Tera Science. For the comparison of the means of the variables, a variance analysis was used with repeated measures, and multiple comparisons using Fisher‘s least significant difference method and Wilcoxon‘s nonparametric test. For all tests a significance level was adopted p < 0.05.
Results: There was an increase from 87.7 ± 12.5 to 102.4 ± 14.6 (p = 0.003), in the thoracic joint amplitude of the diabetics evaluated.
Conclusion: The training protocol used in this study showed a significant increase in the levels of flexibilities of type 2 diabetics, of this sample.
A125 Effects of resistance training on signs and symptoms of distal diabetic polyneuropathy in type 2 diabetic patients: pilot study
Camilla Rodrigues de Souza Silva, André dos Santos Costa, Tamires do Nascimento, Diogo Arruda Martins de Lima, Sandro Gonçalves de Lima, Jhonnatan Vasconcelos Pereira Santos, Paulo Daywson Lopes da Silva, César Augusto Melo de Souza, Sílvia Regina Arruda de Moraes
UFPE, Pernambuco, Brazil
Correspondence: Camilla Rodrigues de Souza Silva
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A125
Introduction: The distal peripheral polyneuropathy (DPP) is one of the main Diabetes complications and physical exercise can be an alternative to minimize the signs and symptoms.
Objective: Assessment of resistance training effects on signs and symptoms of DPP on type 2 diabetic patients.
Methods: Randomized controlled trial with 10 diabetic patients (7 women and 3 men 58.8 ± 3.8 years; 71.9 ± 9.1 kg; 158 ± 5.5 cm; 15.6 ± 10.6 years of DM2 diagnostic) with DDP diagnosed by the DDP diagnostic scale (DDPDS). They were randomized in two groups, the control group (n = 4) received education sessions about diabetes, and the exercise group (n = 6) besides the education sessions, followed a moderate exercise training for upper and lower limbs 3 times a week, during 12 weeks. The DDPDS provided the Neuropathy Symptom Score (NSS) and the Neuropathy Disability Score (NDS) of each individual. The tactile sensibility was evaluated with the Semmes–Weinstein monofilament (10 g). After the Kolmogorov–Smirnov normality test, the pared t test was used for intragroup comparisons. For the intergroup comparison, the t test was used for independent samples both on pre and post intervention phases.
Results: The results showed significant improvements on the NDS, on both intragroup comparison of the exercise group (p < 0.01) and intergroup comparison on the post-intervention moment. The other parameters assessed did not show significant difference.
Conclusion: The resistance training was effective on the improvement of the Neuropathy Disability Score of type 2 diabetic patients with distal diabetic polyneuropathy.
A126 Effects of the nutritional transition in women with pregestational diabetes
Vânia Naomi Hirakata1, Maria Lúcia da Rocha Oppermann2, Janine Alessi3, Daniela Wiegand1, Angela Jacob Reichelt1
1Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; 2Hospital de Clínicas de Porto Alegre, FAMED UFRGS, Porto Alegre, Brazil; 3FAMED UFRGS, Porto Alegre, Brazil
Correspondence: Vânia Naomi Hirakata
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A126
Introduction: Pregestational diabetes is associated with adverse outcomes for the mother and the newborn. This may further depend on the epoch women were treated, due to changes in standards of care and maternal clinical characteristics. Our objective was to study characteristics of pregnant diabetic women across two periods of time.
Methods: We evaluated 220 women, 85 with type 1 diabetes (DM) and 135 with type 2 DM, attended at a specialized prenatal care. Clinical characteristics as weight, body mass index (BMI), preeclampsia, cesarean section and newborn outcomes were evaluated. Epoch of care was stratified in two periods: from 2005 until 2010 (period 1) and after 2010 (period 2). Analyses were performed applying the Student‘s t test and the Chi square test in SPSS version18.
Results: Type 1 DM was more frequent in period 1 (56.5% vs. 43.5%), but was surpassed by type 2 DM in period 2 (63.0% vs 37.0%) (p = 0.005). The Figure presents the number of patients with type 1 and type 2 diabetes taking prenatal care at each year. Previous macrosomia (8.2% vs. 20.5%, p = 0.011) and previous preeclampsia (PE) (9.2% vs 21.3%; p = 0.015), as well as pregestational BMI ≥ 25 kg/m2 (59.1% vs 78%, p = 0.003) were more frequent in period 2. There was a trend to a lower diagnosis of PE (37.0% vs 24.8%; p = 0.055) in the second period. We stratified data of the two periods according to type of diabetes: in women with type 2 diabetes, previous PE and macrosomia were more frequent and ρfamily history of diabetes, less frequent, in the second period. Conversely, women with type 1 diabetes presented higher pre-pregnancy weight and higher A1c test in the second period.
Conclusion: Nowadays, women of reproductive age are frequently diagnosed as having type 2 diabetes, in parallel to the escalating rates of obesity; even those with type 1 DM presented higher pre-gestational weight in the second period. The effects of nutritional transition are also reflected in women with pre-gestational diabetes (Fig. 1).
A127 Effects of the physical training in different intensities on the balance of elderly with type 2 diabetes
Rodrigo dos Santos Rodrigues Alves1, Jonathan Nícolas dos Santos Ribeiro2, Cláudio Barnabé dos Santos Cavalcanti1, Denise Maria Martins Vancea3
1UPE, Pernambuco, Brazil; 2UFPE, Pernambuco, Brazil; 3UPE e UFPE, Pernambuco, Brazil
Correspondence: Rodrigo dos Santos Rodrigues Alves
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A127
Introduction: In diabetes mellitus, changes in skeletal muscle, associated with age muscle mass loss, contribute to a decrease of muscle strength, balance and control.
Objective: To investigate the effects of physical training after 3 months of intervention in the balance of elderly with type 2 diabetes.
Method: Characterized as quase-experimental. Twenty-four elderly with type 2 diabetes were enrolled in a supervised physical exercise program. Two groups of moderate intensity (n = 11) and high intensity (n = 13) were organized. The physical training protocol was composed of aerobic and strength training. The strength group was divided into moderate intensity of 20–25 repetitions and high intensity of 8–15 repetitions, both with 1′ interval. The aerobic group, which used the treadmill, used the protocol with 10′ in the moderate intensity, scale 13 on the Subjective Effort Perception, and 5′ for high intensity, in the scale 15. For balance evaluation we used the sit and stand test. Multiple comparisons were made using Fisher‘s least significant difference method. Nonparametric Kruscal-Wallis test was also performed and a significance level of p < 0.05 was used for all tests.
Results: There was an improvement in the balance at moderate intensity (pre 4.9 ± 2.0 versus post 6.2 ± 2.2 p = 0.04) and at high intensity (pre 3.7 ± 2.6 vs. post 5.0 ± 2.6 p = 0.03).
Conclusion: The physical training used in this study was effective in improving the balance of elderly with type 2 diabetes.
A128 Efficacy and safety across the final dose ranges in patients with T2DM receiving insulin glargine/lixisenatide fixed-ratio combination in the LixiLan-L trial
Robert Ritzel1, Josep Vidal2, Vanita R. Aroda3, Yujun Wu4, Elisabeth Souhami5, Elisabeth Niemoeller6, Robert R. Henry7, Lixilan-L Trial Investigators
1Klinikum Schwabing, Städtisches Klinikum München GmbH, Munich, Germany; 2Department of Endocrinology and Nutrition, Hospital Clinic of Barcelona, Barcelona; Spain; 3Medstar Health Research Institute, Hyattsville, MD, USA; 4Biostatistics and Programming, Sanofi-Aventis US, Bridgewater, NJ, USA; 5Diabetes Division, Sanofi, Paris, France; 6Diabetes Division, Sanofi, Frankfurt, Germany; 7UC San Diego and Section of Diabetes, Endocrinology, and Metabolism, Veterans AWairs San Diego Healthcare System, Center for Metabolic Research, San Diego, CA, USA
Correspondence: Robert Ritzel
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A128
In the 30-week LixiLan-L trial, LixiLan, a novel titratable fixed-ratio combination of insulin glargine (Gla-100) and GLP-1RA lixisenatide, showed superior glycemic control over Gla-100 alone, both optimized to FPG 80–100 mg/dL (maximum 60 U/day), in patients with T2DM inadequately controlled on basal insulin ± ≤ 2 oral drugs. In this post hoc analysis, safety and efficacy of LixiLan were evaluated in final dose categories of Gla-100 (both groups) and lixisenatide (LixiLan group). At week 30 (study end), reductions in HbA1c and proportions of responders achieving HbA1c < 7% were similar across dose categories. Across all dose levels, LixiLan induced body weight loss or prevented weight gain. Incidence of documented symptomatic hypoglycemia (SMPG ≤ 70 mg/dL) was numerically higher in patients receiving final Gla-100 dose < 30 U vs. those receiving ≥ 30 U. This is also shown by final lixisenatide dose level. Incidence of nausea was low in the LixiLan group (Table), potentially due to slow increase of lixisenatide component in the combination. Efficacy and safety of LixiLan were generally consistent across final dose categories of its Gla-100 and lixisenatide components and consistent with overall treatment groups. These results support clinically based dose titration of a fixed-ratio combination of insulin glargine and lixisenatide. Study code: NCT02058160. This is an ENCORE abstract previously presented at ADA2016. Funding and editorial support provided by Sanofi (Fig. 1).
A129 Efficacy and safety of insulin degludec/liraglutide (IDegLira) vs basal–bolus (BB) therapy in patients with type 2 diabetes (T2D): dual VII trial
Billings LK1, Gouet D2, Oviedo A3, Rodbard H4, Tentolouris N5, Grøn R6, Halladin N6, Jodar E7, Fonseca MIH6
1NorthShore University Health System, Evanston, Illinois, USA; 2La Rochelle Hospital, Aunis, France; 3Santojanni Hospital and Cenudiab, Bueno Aires, Argentina; 4Endocrine and Metabolic Consultants, Rockville, MD, USA; 5National and Kapodistrian University of Athens, Athens, Greece; 6Novo Nordisk, Bagsværd, Denmark; 7University Hospital Quiron Salud, Madrid, Spain
Correspondence: Billings LK
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A129
Introduction: The efficacy and safety of insulin degludec/liraglutide (IDegLira) has been demonstrated in patients with type 2 diabetes uncontrolled on several treatments.
Objective: To demonstrate non-inferiority of Ideglira in A1c reduction from baseline as compared to basal-bolus insulin therapy.
Methods: 26-week open-label trial comparing Ideglira with Basal-bolus insulin therapy in type 2 diabetes.
Results: 506 patients (pts) with T2D uncontrolled on metformin and 20–50 units (U) of insulin glargine U100 (IGlar) were randomized 1:1 to IDegLira or BB therapy (IGlar + insulin aspart up to 4 times a day). Mean A1C decreased from 8.2% at baseline to 6.7% at end of trial in both arms; non-inferiority (by < 0.3%) for IDegLira was confirmed (p < 0.0001; Table). A similar proportion of pts achieved A1C targets with IDegLira vs BB (66.0% vs 67.0% for < 7%/49.6% vs 44.6% for ≤ 6.5% respectively). Total daily insulin dose was lower for IDegLira (40.4 U) vs BB (84.1 U) (p < 0.0001). Body weight decreased with IDegLira and increased with BB (p < 0.0001); the rate of hypoglycemic episodes (HEs) was lower with IDegLira vs BB (p < 0.0001). More pts achieved a triple composite endpoint (A1C < 7% with no HE in the last 12 weeks and no weight gain) with IDegLira vs BB (38.2% vs 6.4%; odds ratio 10.39 [5.76; 18.75] p < 0.0001). Mean pre- to postprandial plasma glucose increment decreased more with BB vs IDegLira (p = 0.0032). SF-36 (mental component summary) and TRIM-D (total scores) improved more with IDegLira vs BB (p = 0.0074 and p < 0.0001 respectively). Adverse event rates were similar.
Conclusion: In conclusion, in pts with A1C > 7% on metformin and IGlar, IDegLira vs BB resulted in similar A1C reductions, lower insulin dose, weight loss and lower risk of HEs (Fig. 1).
A130 Efficacy of group education for carbohydrate counting in a public diabetes center in Belo Horizonte
Alessandra de Cássia Lovato, Débora Bohnen Guimarães, Marina Moreno Wardi, Stephanie Araújo Oliveira Rezende, Luciana Valadares Ferreira, Juliana Bohnen Guimarães, Janice Sepúlveda Reis
Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Minas Gerais, Brazil
Correspondence: Alessandra de Cássia Lovato
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A130
Background: Carbohydrate counting (CC) is considered the nutritional therapy of choice for patients with type 1 diabetes (T1DM), since it allows greater food flexibility and adjustment of insulin treatment as intake. However, it is a strategy little used in the public health service because there are very few specialized team, resources and appointments times for the correct training of the therapy. Since 1970, teaching people in groups has been an effective intervention for diabetes education.
Objective: To evaluate the efficacy of nutritional education groups for the treatment of CC in patients with T1DM from a public referral service in Belo Horizonte, Minas Gerais, Brazil.
Methods: Forty-one adult patients underwent to a group nutritional education program with 3 meetings: 1st healthy eating and introduction to the CC; 2nd CC for extra snacks or substitutions; 3rd full CC (at all meals with food amount required). The evolution to this stage was made based on an evaluation of the 24-h food recall, with quantification of carbohydrate grams by nutritionists, and insulin/carbohydrate ratio prescribed by endocrinologists. In addition, this evolution was the patients’ free choice because they felt or not safe. A fourth meeting was held for patients with doubts about the progression to full CC. A 3-day food record with the quantification of carbohydrate grams per meal, together with glycemic control, was requested after beginning the therapy. The study was approved by Institution’s Ethics Board, approval number 1.064.985 and written consent was obtained from all participants.
Results: The sample consisted of 66% women, ages 39.8 ± 16.4 years old, with incomplete elementary school and complete high school education (24.4 and 36.6%, respectively). 49% of the patients evolved for the full carbohydrate counting treatment (3rd meeting), with observation in 51% of the participants not learning the therapy, or of their own choice in not counting the carbohydrates daily, maintaining fixed dose of food amount. Lower schooling (r2 = 0.34, p < 0.001) and advanced age (r2 = 0.45, p < 0.001) showed a positive correlation with non-evolution for full therapy, being independent of gender (p 0.91).
Conclusion: The carbohydrate counting groups were effective for patients with T1DM of a public service, with optimization of time and greater involvement of patients in the discussions. However, low schooling and older age are barriers to the broader choice of therapy.
A131 Elaboration and cultural adequacy of the adhesion test to healthy diet in carbohydrate counting (TAHC)
Sheyla Geralda Cordeiro Ferreira1, Débora Bohnen Guimarães2, Alessandra de Cássia Lovato2, Marina Moreno Wardi2, Heloísa de Carvalho Torres3, Adriana Silvina Pagano3, Ilka Afonso Reis3, Janice Sepúlveda Reis4
1IEP-Instituto de Pesquisa da Santa Casa de Belo Horizonte, Minas Gerais, Brazil; 2IEP - Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Minas Gerais, Brazil; 3UFMG-Universidade Federal de Minas Gerais, Minas Gerais, Brazil; 4Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Minas Gerais, Brazil
Correspondence: Sheyla Geralda Cordeiro Ferreira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A131
Background: Carbohydrate counting are indicated for patients with type 1 diabetes mellitus as an effective strategy in optimizing food intake and should be inserted in the context of healthy eating. There is a lack of instruments adapted to the Brazilian population to evaluate the adherence to healthy eating by patients who use this nutritional therapy.
Objective: To elaborate and adapt culturally the instrument of evaluation of adherence to healthy diet in carbohydrate counting (TAHC).
Methods: Methodological study, including three steps: First: Preparation of the instrument, based on national and international guidelines for diabetes and nutrition, followed by the evaluation of a committee of experts, composed of endocrinologists, nutritionists, linguists, and statisticians-Version 1 (V1). Second: The V1 was sent, via an e-survey platform, to the judges committee of nutritionists and endocrinologists experienced in carbohydrate counting, where the clarity and relevance of the questions were evaluated for each item of the instrument. Based on this evaluation, the Content Validity Index (IVC) and the percentage of acceptance of the judges were calculated in relation to the adequacy of the evaluated items, with changes generating the version (V2). Third (pre-test); With the participation of 20 individuals with type 1 diabetes with more than 12 years of age, with changes and adaptations generating version 3 (V3). After each phase described, an interdisciplinary meeting was held by researchers and the committee of experts evaluated the suggestions. At all stages, the methodology followed the recommendations established in the literature and for each problem identified, improvements were suggested, and changes were made.
Results: The V1 of the instrument presented a good agreement among the Judges Committee, with a valid content index of 0.954, being considered appropriate the value ≥ 0.78 for new instruments (Table 1).
Conclusion: It is considered that the TAHC instrument is culturally appropriate to evaluate the adherence to a healthy diet in the carbohydrate counting, which goes into the validation process. Ethics Approval The study was approved by Santa Casa of Belo Horizonte Institution’s Ethics Board, approval number 1.962.869 and consent was obtained from all participants (Fig. 1).
A132 Endogenous hyperinsulism in a patient with diabetes mellitus
Andressa Martins Oliveira, Renata Moraes Fagundes Costa, Camila Vicente Santos, Paloma Nehab Hess, Rosane Kupfer
Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione (IEDE), Rio de Janeiro, Brazil
Correspondence: Andressa Martins Oliveira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A132
M.C.F., a 56 year-old female, diagnosed with type 2 diabetes (T2DM) at 22 years old, using insulin for 22 years. Eight years ago, she started to present frequent episodes of symptomatic hypoglycemia, preferably in fasting periods. There was no cessation of the episodes even with the suspension of all insulin and antidiabetic drugs, which lead to an investigation with a prolonged fasting test (Table 1). The test confirmed endogenous hyperinsulinism (EH). Endoscopic ultrasound and abdominal magnetic resonance imaging showed no masses. She was then submitted to a selective arterial calcium stimulation test (SACST), whose results excluded insulinoma. Acarbose was prescribed 2 years ago, with no improvement. Verapamil (80 mg/day) was initiated along with dietary changes, with good response.
Discussion: In the presence of hypoglycemia and serum levels of nonsuppressed insulin/C-peptide, rare causes such as pancreatic beta (β) cell disease and autoimmune hypoglycemia should be excluded. EH is confirmed by the prolonged fasting test through the findings: glycemia < 55 mg/dL with symptoms, associated with insulinemia ≥ 3 IU/mL, peptide C ≥ 0.60 ng/mL, proinsulin ≥ 5 pmol/L. In adults, the main cause is insulinoma, but when a mass is not identified, the diagnosis of non-insulinoma pancreatogenic hypoglycemia syndrome (NIPHS) should be considered. NIPHS is a hyperfunctional pancreatic disorder characterized by the diffuse involvement of islets with nesidioblastosis. Its incidence in patients with previous T2DM is rare, with only 4 cases being documented. In these cases, T2DM can be reversed by dysfunctioning hypertrophic β cells, which is a reactive process to the destruction of β cells or existing functional failure in diabetic patients, leading to hypoglycemia and confirmed by the prolonged fasting test. The diagnosis is established by exclusion of insulinoma and histopathological and immunohistochemical findings in the pancreas. Patients with EH with inconclusive noninvasive imaging are candidates to perform SACST, which is important for the therapeutic definition. Treatment consists of dietary changes, medications and, in refractory cases, surgery. Surgical extension should be evaluated to avoid recurrence of hypoglycemia and, at the same time, the risk of exocrine and endocrine complications.
Final comments: We illustrate a rare case of EH after discontinuation of insulin therapy in a long-term T2DM patient. Verapamil blocks the β-cell membrane, inhibiting insulin secretion. The treatment improves quality of life and possibly reducts mortality. Informed consent to publish had been obtained from the patient (Fig. 1).
A133 Epidemiological profile of diabetic patients with sepsis admitted in intensive care unit
Tatiana Siqueira Capucci1, Lais Oliveira Hernandes1, Mariana Accioly Carrazedo1, Wimbler Pires2, Camila Roos3, Eduardo Gabriel Miranda Zocunelli3, Elias Pereira da Silva Junior3, Ricardo Emidio Navarrete de Toledo4
1Beneficência Portuguesa de São Paulo, São Paulo, Brazil; 2FMU, São Paulo, Brazil; 3IEFAP, UNINGÁ, Paraná, Brazil; 4Beneficência Portuguesa de São Paulo, IEFAP/Uningá, São Paulo, Brazil
Correspondence: Tatiana Siqueira Capucci
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A133
Introduction: Sepsis is the leading cause of death in critically ill patients treated in an intensive care unit (ICU). According to the new consensus of 2016, sepsis is defined as “the presence of life-threatening organic dysfunction secondary to the body‘s unregulated response to infection”. Being the infectious process—infectious agent—the main question that, in itself, is able to injure tissues and lead to death. Both inflammation and immunosuppression are present as part of the response to the microorganism.1 Around the world every 6 s a person dies as a result of diabetes or its complications, with an average of 5 million deaths a year. In 2015, in Brazil, there were 130,000 adult deaths, in the age group of 20–79 years, due to complications of DM.2 We know that infections are among the main causes of diabetes mellitus decompensation, altering the metabolic control of the diabetic patient. Once the infectious process is installed, with the possible worsening of the metabolic control we will have a patient at risk and more susceptible to sepsis. 3 While infection is suspected, cultures should be obtained in the relevant foci, since they are the most important sources of information for the investigation of hospital infection and correct and effective treatment of the etiological agent.3
Objective: To determine the epidemiological profile of infections of septic patients treated in the ICU.
Methodology: Cross-sectional study through 1623 antibiograms collected from diabetic patients admitted to ICUs that met criteria for SIRS/SEPSE between January 2014 and March 2017. Six sites were considered susceptible to infection (pulmonary, urinary, operative wound, catheter tip, blood and drained liquids), and the prevalences for each one were analyzed, as well as the registry of the most frequent microorganisms.
Results: A total of 387 patients (83.2% DM2) were studied, with an average length of hospital stay of 27 days, mean hospital infection rate of 44.8%, and mortality rate of 23.5%. Infection prevalence rates for each site were as follows: 32.5% respiratory, 27.8% urinary, 22.1% surgical wound, 7.8% catheter tip, 5.5% secretions/fluids drained, 4,3% blood.
Conclusion: The growth of microorganisms in culture does not guarantee that they have a pathogenic role, and it is fundamental to recognize the most probable pathogens that affect the diabetic population and to disseminate it periodically, since the local epidemiological profile leads to the rationalization of the use of antibiotics, avoiding excessive spectrum, which predisposes to infections caused by multiresistant germs and fungi. However, the prevalence and mortality rates found in our study were extremely high, making it essential to prevent diabetes-associated infections through adequate metabolic control and specific preventive measures for each primary site of infection (Fig. 1).
A134 Epidemiological profile of patients admitted with acute hyperglycemic crises in tertiary hospital
Guadalupe Dihe da Silva Motooka, Flavia Cristina Carvalho Tortul, Ana Carolina Wanderley Xavier, Ana Carolina Carli de Freitas, Clarissa Silva Martins
UFMS, Mato Grosso do Sul, Brazil
Correspondence: Guadalupe Dihe da Silva Motooka
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A134
Introduction: Diabetes Mellitus (DM) is a chronic syndrome characterized by hyperglycemia, due to absolute or relative insulin deficiency. It can present acute complications: diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), which are potentially fatal if not promptly treated. DKA is characterized by hyperglycemia > 250 mg/dl, ketonemia or ketonuria and metabolic acidosis. HHS is characterized by hyperglycemia > 600 mg/dl, pH > 7.3, serum osmolality > 320 mOsm/kg. The identification of triggering factors may aid in the prevention of hyperglycemic crises.
Objectives: The objective of this study was to trace the epidemiological profile of patients treated with hyperglycemic crises (DKA and HHS) in a tertiary hospital, seeking to identify the main triggering factors. Search.
Methods: Medical data records from patients admitted to the Medical Clinic Sector of a Tertiary Hospital with diagnosis of acute hyperglycemic crisis (DKA or HHS) after implantation of Endocrinology Reference Service at the same hospital from February to July 2017 Preliminary.
Results: In the first 6 months of the Endocrinology Reference Service, 13 patients with acute hyperglycemic crisis (DKA or HHS) were treated. Of the 13 patients treated, only 1 had the diagnosis of HHS and the others had DKA. The average age of the patients was 37.45 years. The HHS patient was 67 years old, while the age of patients with DKA ranged from 14 to 59 years. The patient with HHs was male. Among patients with DKA, 84% were female and 16% male. The glycated hemoglobin average (HbA1c) was 12.67%. The patient with HHS had 13.3% HbA1c while patients with DKA ranged from 8.9 to 16.9%. The HHS patient had DM type 2. Among the patients with CAD, 1/3 had the diagnosis of DM type 1, 1/3 had the diagnosis of DM2 and in 1/3 it was done presumptive diagnosis of LADA. At the time, it was not possible to dose anti-GAD for confirmation. In 11 of the 13 patients treated, an infectious cause was observed as a factor of decompensation, with pyelonephritis being the most frequent.
Conclusion: DKA can affect both DM1 and DM2 patients, but it is more common in patients with DM1. The incidence of DKA is higher than that of HHS. The main triggering factor are episodes of bacterial infection, notably urinary tract infections.
Informed consent to publish had been obtained from the patient.
A135 Epidemiological profile of patients with gestational diabetes mellitus in a tertiary care service
Luizianne Mariano Martins, Pedro Nogueira Damasceno Neto, Aurea Maila Albuquerque, Paulo Cruz de Queiroz, Ângela Delmira Nunes Mendes
UFC, Ceará, Brazil
Correspondence: Luizianne Mariano Martins
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A135
Introduction: The prevalence of Gestational Diabetes Mellitus (GDM) is associated with increased risk factors such as advanced age, overweight, obesity, excessive weight gain in pregnancy and family history of diabetes in first-degree relatives.
Objective: To characterize epidemiologically and clinically pregnant women with GDM accompanied in the Endocrinology department of a University Hospital.
Methods: Cross-sectional, observational and descriptive study with 83 pregnant women with Gestational Diabetes Mellitus (GDM) attended from February 2016 to April 2017. Data collected from charts and statistical analysis performed using Excel. Variables studied: age, gestational age at the first visit, BMI, gestational weight gain at the first visit, family and personal history of diabetes, previous and current obstetric conditions, other associated conditions and treatment.
Results: At the first visit, the mean age was 31 years; the mean gestational age 28 weeks; 35.29% were overweight and 36.76% were obese; 6.02% presented alterations in the current gestation. Associated conditions were hypothyroidism (45.16%), chronic hypertension (29.03%) and hypertensive disorder during pregnancy (16.13%). Only 36.4% had previous obstetric complications such as macrosomia and abortion; 62.7% were multiparous; 44.58% had a positive family history for Diabetes Mellitus and 2.41% had family history of GDM. The diagnostic test used was oral glucose tolerance test in 79.52% of the cases and fasting plasma glucose in 20.48%. The diagnosis of GDM was given in the first trimester in 16.87% of patients, 43.37% in the second trimester and 39.76% in the third trimester. The goals of weight gain during pregnancy were exceeded in 20.83% of overweight pregnant women at the first visit and in 11.11% of obese women. The treatment established at the first consultation and subsequent consultations was, respectively, dietary change (59.26, 40.28%), metformin (22.22; 18.06%), combination of metformin and insulin (4.94, 12.50%) and insulin alone (13.58, 29.17%).
Discussion: The population had a late arrival at the service and frequent weight changes. The most frequent initial treatment was dietary change, achieving good control in 68% of the cases.
Conclusion: The choice of monotherapy with metformin decreased throughout pregnancy, but it proved to be a good option when in combination with insulin at more advanced gestational ages due to better control of insulin resistance.
A136 Epidemiological profile of women with altered fasting glycemia in first trimester of pregnancy
Natalia Gattass Ferreira Soares Pereira, Ana Luiza de Mattos Telles, Lenita Zajdenverg
UFRJ, Rio de Janeiro, Brazil
Correspondence: Natalia Gattass Ferreira Soares Pereira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A136
Introduction: According to the IADPSG and WHO criteria, the presence of fasting glucose (FG) ≥ 92 and < 126 mg/dL at any time during pregnancy is diagnostic of gestational diabetes mellitus (GDM). However, there are few studies with pregnant women diagnosed by this method in the first trimester.
Objective: To evaluate epidemiological profile of pregnant women diagnosed with GDM by FG ≥ 92 and < 100 mg/dL in 1st trimester.
Method: Observational study, with pregnant women attended at the prenatal care of Maternidade Escola (ME) of UFRJ, between 11/2016 and 07/2017, with 1st trimester FG ≥ 92 and < 100 mg/dL (cases) or < 92 mg/dL (controls). Exclusion criteria were those with permanent DM, GDM already under treatment, multiple gestation or bariatric surgery. Those with FG ≥ 92 mg/dL performed a 2nd FG to confirm GDM. They were divided in 3 groups: 1 (2 FG ≥ 92 mg/dL-GDM confirmed), 2 (only the 1st FG ≥ 92 mg/dL-GDM not confirmed) and 3 (FG < 92 mg/dL-control). A semi-quantitative food frequency questionnaire (used in ME) and physical activity questionnaire (short IPAQ) were applied. Other data were collected in medical records. G2 and G3 pregnant women perform oral glucosetolerance test (75-g OGTT) between 24 and 28 weeks. The analysis was done in EPI INFO and p value < 0.05 was considered significant.
Results: 64 pregnant women were interviewed, with the following results [consecutively exposed by groups 1 (n = 20), 2 (n = 28) and 3 (n = 16): mean of 1st FG 95.6 (± 2,7), 94.7 (± 2.1) and 84.7 (± 3.6)mg/dL; of 2nd FG (G1 and G2 only) 97.0 (± 4.6) and 84.1 (± 5.4)mg/dL; age 29.8 (± 7.3), 27.3 (± 6.6) and 27.3 (± 6.1) years; BMI 29.6 (± 0.2), 26.1 (± 5.4) and 29.5 (± 5.2)kg/m2; median TEV 1570 (766–3986), 1620 (687–5669) and 1841 (1190–3164) kcal/day. Frequency analysis showed that 45, 54 and 37% were nonwhite; 90, 86 and 87% had > 8 years of study; 75, 82 and 75% were active or irregularly activeA; 18, 7 and 0% had history of GDM; 40, 18 and 25% were chronic hypertensive; 35, 39 and 19% had family history of DM. The OGTT was performed in 19 pregnant women from G2 and 8 from G3, with averages FG 85.7 and 78.9 mg/dL, with statistical significance (p < 0.01). The comparison of other variables did not present significance, except for the BMI between group 1 and 2 (p = 0.04).
Conclusion: No demographic differences were found between groups, except for the presence of higher BMI in Group1 (xG2). This suggests that the probability of confirming an altered FG is greater in those with a higher BMI.
A137 Epidemiological, clinical and obstetrical profile of pregnant women with diabetes at a public reference center
Angela Cristina Beuren, Lucia Henriques Alves da Silva, Rodrigo Gomes de Souza, Daniel Barretto Kendler, Rosane Kupfer
Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione (IEDE), Rio de Janeiro, Brazil
Correspondence: Angela Cristina Beuren
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A137
Introduction: Diabetes Mellitus (DM) is the most common metabolic problem of pregnancy. The most frequent presentation is gestational DM (GDM), which estimated prevalence varies between 3 and 25% of pregnancies, depending on the population and the diagnostic criteria used. The others are represented mainly by pre-gestational DM1 and DM2. Due to the importance of the issue, the screening and identification of maternal hyperglycemia, as well as the knowledge about the epidemiological profile of the patients, are fundamental for the adequate management and reduction of undesirable maternal–fetal outcomes.
Objective: The primary objective of this study was to evaluate the epidemiological, clinical and obstetric characteristics of patients diagnosed with DM accompanied at the State Institute of Diabetes and Endocrinology Luiz Capriglione (IEDE).
Methodology: It was a retrospective observational study. A sample of 100 patients from IEDE or referred by the National System of Regulation (SISREG) was analyzed. Inclusion criteria were newly or previous diagnosis of DM and, at least a prenatal and postnatal evaluation. Exclusion criteria were lost of follow-up and co morbidities that could influence at the metabolic parameters.
Results: The majority of IEDE patients had DM1, were younger, had a longer time to diagnose DM, had a higher rate of chronic microvascular complications, more previous pregnancies with fetal macrosomia, used higher doses of insulin during pregnancy and the time of delivery was earlier. Those from SISREG were mostly diagnosed with GDM and had a higher pre-gestational Body Mass Index (BMI). Both groups had mean pre-gestational hemoglobin (HgA1c) and in each trimester, but after delivery, the HgA1c of patients from the SISREG was lower than the IEDE patients (Table 1). 55% of the patients presented undesirable maternal–fetal outcomes, despite the better glycemic control during pregnancy, with preterm birth being the most frequent (Table 2). We found no correlation between pre-gestational HgA1c and throughout the trimesters with the height and weight of the newborn or gestational age at delivery.
Conclusion: Inadequate glycemic control in pregnant women with DM is a high risk factor for undesired maternal–fetal outcomes. Preventive measures and appropriate treatment before conception, both in those with risk factors for GDM, and in those diagnosed with DM, constitute the mainstay for changing this scenario (Figs. 1, 2).
A138 Errors in self-application of insulin in a youth group
Andréa Maria Alice Gallo, Augusto Pimazoni-Netto, Patrícia Zach, Sônia Couto Ramos, Maria Tereza Zanella
UNIFESP, São Paulo, Brazil
Correspondence: Andréa Maria Alice Gallo
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A138
Introduction: Misinformation about the correct techniques for self-application of insulin is a constant and the consequences are of great concern, since incorrect application results in substantial changes in the pharmacokinetics and pharmacodynamics of insulin.
Purpose: To evaluate quantitatively the various mistakes made by young people in the self-application of insulin.
Method: Observational study, performed at a reference center for diabetes care in the Unified Health System, located in Porto Alegre. The youngsters answered a specific questionnaire about self-administered insulin practices, with a practical demonstration of the aspiration and insulin self-injection technique.
Results: The sample consisted of 20 insulinized adolescents older than 6 months, of both sexes, from 6 to 20 years of age, with type 1 diabetes. A high percentage of errors were observed during aspiration of the prescribed doses of insulin with the use of and 100 UI syringes, ranging from 50 to 60% of incorrect doses. However, using 30 and 50UI syringes, a significant reduction of errors was observed, varying from 0 to 5% of correct doses. This can be explained by the fact that young people do not use 100 UI syringes in their daily lives, only having contact with this type of syringe in the study. The application rotation technique was considered inadequate in 30% of the young and 10% of them did not perform it, which can cause the development of complications in the application sites; the skin fold was not performed in 15% of the young, which increases the risk of intramuscular injection and ineffective metabolic control. The presence of lipodystrophy was found in 50% of the young.
Conclusion: Significant errors were observed, showing a very worrying situation that could compromise the success of the treatment of type 1 diabetes totally dependent on insulin, especially with the use of the 100 UI syringe for application, when the guidance on the graduation scale of material of unusual use is not realized. There is, therefore, an immediate need for implementation of effective and continuous educational strategies, which provide the young diabetic and their family the knowledge necessary to reduce the potential risks of insulin self-injection.
Ethics approval: The study was approved by UNIFESP’s Ethics Board, approval number 1698/11. Informed consent was obtained from all patients this study.
A139 Estimation of use and reimbursement for point-of-care blood glucose test strips with implementation of a hospitalar glycemic control commitee: study of costs
Alina Coutinho Rodrigues Feitosa, Carla Pereira de Oliveira, Jacqueline Araújo Teixeira Noronha, Ligia Beatriz Wanke Azevedo, Yandreson Carvalho Cavalcante, Cláudio Reis, Taiana Freitas
Hospital Santa Izabel-Santa Casa da Bahia, Bahia, Brazil
Correspondence: Alina Coutinho Rodrigues Feitosa
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A139
Background: Proper management of hyperglycemia and hypoglycemia in hospitalized patients can reduce complications and inpatient length of stay. Investments are necessary and institutional support is essential.
Aims: To estimate the consumption and reimbursement related to point-of-care blood glucose test strips (TS) after implementation of a Hospital Glycemic Control Commitee (GCC) as a form of pre-implementation planning in a hospital.
Methods: In a teaching Hospital, Salvador, Bahia, we evaluated the number of inpatient admissions between 01/2016 and 07/2017, TS performed at admission and during the first 24 h and the reimbursed blood glucose test strips. Data related to consumption of blood glucose test strips and blood glucose test results were collected from medical account department and electronic medical health records, respectively. We estimated implementation costs of a GCC only considering the monitoring of blood glucose, consumption of TS and exchange of previous glucose meters for equipments in accordance with RDC302. The estimate of use of TS considered the blood glucose tests performed in accordance with national guideline recomendations: blood glucose test in more than 90% of admitted patients, inpatient hyperglycemia prevalence of 35%, repetition of, at least, one blood glucose for confirmation and four blood glucose tests for monitoring in the first 24 h in those who tested positive at screening.
Results: The hospital has 492 beds and, in the study period, there were 37,624 hospitalizations, averaging 1985 hospitalizations per month. A total of 361,345 blood glucose tests had been performed in the study period. Glycemia screening was realized in 13,574 patients (4%) and most tests occurred within the first 24 h of hospital admission (54%). Considering the average monthly reimbursement of 21,560 test strips, the screening test would consume 842 test strips, with 469 in the first 24 h. The goal, after GCC implementation will be performing glycemia screening on admission in more than 90%, which will result, considering monthly hospital admission, in a consumption of 1786 TS for glycemia screening, 625 TS for confirmation of positive cases (prevalence of 35% of in hospital hyperglycemia) and 2500 TS for monitoring positive cases in the first 24 h (Table 1). The cost of a single previous point-of-care blood glucose test strip was R$ 0.82 and would be R$ 1.48, and the reimbursement from supplementary health system was R$ 42.50 and would be R$ 48.50. We estimated that following glycemic protocol at admission and monitoring blood glucose in the first 24 h will increase test strips consumption (21,560–26,472) and the monthly reimbursement related to test strips in 22.8%.
Conclusion: Implementation of GCC is therefore likely to increase the reimbursement and consumption of test strips in the first 24 h for the hospital (Fig. 1).
A140 Estimative of liver fibrosis in type-2 diabetic patients candidate to bariatric surgery who presented hepatic steatosis
João Henrique dos Santos Pereira1, Carolina Parente Gress do Vale1, Rafael Gomes de Olivindo1, Ana Gabriela Santana Fontana2, Giovanna Cassetti Pedotti2, Marina de Assis Melero2, Nicole Nardy Paula Razuck2, Michelle Patrocínio Rocha1
1Hospital Santa Marcelina, São Paulo, Brazil; 2Faculdade Santa Marcelina, São Paulo, Brazil
Correspondence: João Henrique dos Santos Pereira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A140
Introduction: Non-alcoholic fatty liver disease (NAFLD) has its origin related to two highly prevalent conditions in the world population: type-2 diabetes mellitus (DM-2) and obesity; it can present itself as hepatic steatosis and steatohepatitis (NASH)—which can evolve to cirrhosis and hepatocellular carcinoma. Some studies estimated that this disease will be the major cause of liver transplant in 2020.
Objective: To analyze the application of score systems that estimate liver fibrosis in diabetic patients candidate to bariatric surgery who presented hepatic steatosis in abdominal ultrasound.
Methods: This study was approved by Hospital Santa Marcelina’s Ethic Board (n. 06545/17), and was based on the review of patient files attended in Hospital Santa Marcelina’s Endocrinology service between September/2009 and April/2017. Criteria for inclusion were: type-2 diabetic individuals who presented NASH in abdominal ultrasound; and who had registered levels of HbA1c, AST, ALT, platelets and serum albumin. Anthropometric and laboratorial data were registered in our research protocol and submitted to descriptive statistical analysis. Posteriorly, each patient had their liver fibrosis levels esteemed through three scores: • BARD: Results ≥ 2 = F3–F4, with negative predictive values of 97%. • NAFLD: Results < − 1455 = Metavir F0 (no fibrosis), F1 (minimal fibrosis) or F2 (moderate fibrosis); values > 0675 = Metavir F3 (advanced fibrosis) and F4 (liver fibrosis); intermediary levels = undetermined fibrosis. • FIB-4: Values < 1.3 = F0–F1; > 2.67 = F3–F4; intermediary levels = undetermined fibrosis.
Results: 43 patients were analyzed, being 88% female; their data (mean values and stardard deviation) were: age 44 ± 10.6 years; BMI 47.4 ± 6.6 kg/m2; HbA1c: 6.45 ± 0.72%; AST: 21.7 ± 17 U/L; ALT 21.5 ± 9.1 U/L; platelets 253.326 ± 63.196; and serum albumin 4.25 ± 0.4 U/L. Mean BARD score was 2.67 ± 0.47, estimating fibrosis in all patients. Mean NAFLD was 0.56 ± 1.33, assessing advanced fibrosis in 41.8% of the sample, and 55.8% with fibrosis of indeterminate levels. Mean FIB-4 was 0.85 ± 0.53, implying 2.32% of the patients with advanced fibrosis and 6.99% with undetermined results.
Conclusion: None of the analyzed scores presented valid individual specificity or sensibility to estimate liver fibrosis in obese diabetic patients, having more value as negative predictive tests. This fact, allied with the lack of clinical-laboratorial manifestations of the disease, denote that its suspicion levels must be high when studying this group of patients—and that it must be tracked very early, even before transaminases become elevated. Informed consent to publish has been obtained from all 43 patients.
A141 Euglycemic diabetic ketoacidosis (EDKA) associated with dapaglifozin in type 2 diabetes—a case report
Maria Gabriela Pedigoni Bulisani, Paulo Rizzo Genestreti, Maria Fernanda Ozorio de Almeida, Milena Miguita Paulino, Ana Claudia Moreno, Flavia Rother Ricci
Hospital Leforte, São Paulo, Brazil
Correspondence: Maria Gabriela Pedigoni Bulisani
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A141
Dapaglifozin (Farxiga; Aztrazeneca) is a drug used to treat type 2 diabetes by inhibiting Sodium-glucose cotransporter 2 (SGLT-2), increasing urinary glucose excretion and lowering plasma glucose, which may improve the glycemic control. Some cases of eDKA have been associated with others SGLT2 s inhibitors, like empaglifozin and canaglifozin, but there are few cases reported of eDKA associated with dapaglifozin. Here, we report one of them. A 47-year-old overweight man (BMI 37.4 kg/m2) with a 9-year history of type 2 diabetes had been taking metformin (1 g/day), glyburide (10 mg/day) and vildaglipitin (100 mg/day) for 7 years. He was admitted for elective bariatric surgery and stopped his medications a day before. He did well postoperatively and started to use dapaglifozin after 5 days of surgery. Within 48 h using dapaglifozin, he was readmitted with prostration, nausea and hyperventilation. Laboratory showed glucose of 165 mg/dl,; bicarbonate, 5 mEq/L; arterial pH, 7.23 and serum sodium of 141 mmol/L. Venous lactate was normal. The endocrinology team were consulted, and started to treat him with intravenous insulin and fluids. After 24 h, new laboratory evaluation showed glucose of 185 mg/dl; bicarbonate 17.5 mEq/L and arterial pH, 7.49, meaning clinical improvement. His anti-glutamic acid decarboxylase was negative and he had a normal C-peptide (1.98 ng/ml). As eDKA has been reported in other studies with others SGLT-2 inhibitors, it is concluded to be an adverse event of this drug class. To be aware that DKA can occur in euglycemia is important to avoid this serious complication of diabetes. It is known that there are some factors that contribute for DKA, like decreasing in-carbohydrate intake, infection or reduction of insulin therapy. Therefore, in circumstances listed, patients should consider interruption of SGLT-2 inhibitors at least 24 h prior an elective surgery, like the case reported, or immediately if any extreme stress event. Also, the patient should contact an endocrinologist for better instructions or even go to an ER if there are symptoms related to DKA like nausea, vomiting, weakness, headache or hyperventilation. We would like to suggest in cases like the one reported, which there were lower carb intake beyond the surgery, to not continue the medication after this kind of surgery.
Informed consent to publish had been obtained from the patient.
A142 Evaluating the carbohydrate counting method related to blood glucose monitoring habits in type 1 diabetes mellitus patients
João Augusto Lima Bisneto, Cristina Figueiredo Sampaio Façanha, Gabriel Melo Ferraz Pessoa, Joana Cysne Frota Vieira, Guilherme Leite Barboza Gonçalves, Igor Torres Dias, Isabele Moreno de Alencar, George Sales de Arruda, Kaik Brendon dos Santos Gomes, Kenya Vitoria de Aguiar Queiroz, Isabele Fontenele de Santiago Campos, Iohanna Maria Ponte Costa, Gisele Ferreira Camara, Carol Machado Ferrer
Unichristus, Ceará, Brazil
Correspondence: João Augusto Lima Bisneto
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A142
Introduction: As a measure which consists of the pre-prandial insulin adjustment according to the amount of consumed carbohydrate, carbohydrate counting is important to the success of the nutritional therapy of type 1 diabetes mellitus treatment, due to the close correlation between carbohydrate consumption and blood glucose concentration. This method is made possible by blood glucose self-monitoring, for it allows the possibility of self adjusting the insulin dose according to the pre-prandial blood glucose values. Therefore, it is important for patient to be able to understand the information obtained in blood glucose monitoring and be capable of taking the correct action to achieve the treatment goal.
Objective: To evaluate the blood glucose monitoring habits in a group of type 1 diabetes mellitus patients attended in secondary health service.
Methods: Cross-sectional study, descriptive, with convenience sample of type 1 diabetes mellitus patients enrolled in the blood glucose monitoring program during the period of 2016 and 2017 in a secondary referral service in the state of Ceará. Data was collected by means of questionnaires applied with patients present for outpatient care during the period of the research.
Results: In the 95 type 1 diabetes mellitus patients sample, with mean age of 17 years old, 60.2% females and 67% with 1 to 5 years of diagnose, we observed that 35.1% of the patients were doing carbohydrate counting, of which 68.24% are treated with insulin analogues, in the basal-bolus scheme. Also, 98.2% of the sample were monitoring blood glucose daily, 97.3% of it were doing it in fasting, while only 16.22% were doing postprandial, 20.59% were doing more than four times a day. Furthermore, 45.5% of all patients could not tell the adequate objective of postprandial blood glucose measurement. Patients distribution according to their behavior and knowledge about the blood glucose monitoring. Patients doing carbohydrate counting 35.1% Patients monitoring blood glucose daily 98.2% Patients monitoring in fasting blood glucose daily 97.3% Patients monitoring postprandial blood glucose daily 16.22% Patients who could tell the adequate objective of postprandial blood glucose measurement 54.5%.
Conclusion: The adherence to the carbohydrate counting technique was observed in one-third of the patients evaluated. The postprandial glucose control was evaluated by the minority of the group, and some of them are not aware of the normal glucose range, which greatly compromises the efficacy of the method. Although we know that the availability of the supplies for capillary blood glucose monitoring is an important limiting factor to the method, we also consider that the ability to understand the process limits the proper use and compromises the treatment outcome. Ethics Approval: The study was approved by Centro Universitário Christus – UNICHRISTUS Institution’s Ethics Board, approval number 5049.
A143 Evaluation and prevention of injuries and amputation in diabetic patient in the nursing school—UNESC
Liliana Dimer, Karina Cardoso Gulbis Zimmermann, Paula Ioppi Zugno, Luciane Bisognin Ceretta, Leticia Klima Felipe, Zoraide Rocha
Universidade do Extremo Sul Catarinense, Santa Catarina, Brazil
Correspondence: Liliana Dimer
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A143
Introduction: This is the result of a nursing extension project at a university in the far south of the state of Santa Catarina, the main objective of this project was evaluate the lesions and amputations observed in diabetes patients registered in a self monitoring blood glucose analysis program the municipality of Criciúma/SC, this program being a partnership between the Municipal Health Department and the University. The program is performed by the nursing course at UNESC and all procedures are made by multiprofissional team.
Materials and methods: It is a qualitative and quantitative project developed at Integrated Clinics at UNESC by students, professional and nursing residents. Work followed the rules of Ethical Committee of the university and was approved by protocol: (07160612.5.0000.0119/2012). The selection of the people of Blood Glucose Selfmonitoring program randomly occurred as the criteria for inclusion: be a diabetes patient, 18 years or older, agree to participate of the study. In November 2016, a campaign was developed was a continuous evaluation are still being offered until now. Specific equipments were used to analyse the feet‘s lesions as well as monofilament, tuning fork and goniometer. Data were analysed using Student T test and considered significant when p < 0.05. Qualitative data was analysed by the content analysis method proposed by Minayo.
Discussion and results: 133 patients were evaluated, age in between 59 and 88 years-old. 91% of them were DM2 and 92% are insulin-dependent. 11% have already had ulcers and amputation. A Student T test showed significative data when the injury, cracks, calluses, nail perfusion, temperature, staining, deformities, skin turgor, moisture/hydration and plantar pressure with the risk rating was related as risks factors.
Conclusion: Considering the higher levels of comorbities in this population, it’s importante have promotions programs to prevent and evaluate risks of injury and amputation. Diabetes patients seems don’t even realize the prevention coulbb easy and be applyed in simple changes in every day life. However, it’s believe that health education can chance this cenario. The extension Project evaluated, diagnosed needs attention, sent patients to services and updates for professionals, family members and users.
A144 Evaluation and screening of diabetes mellitus in health fairs: preliminary results of healthrise vitória da conquista
Márcio Galvão Oliveira1, Danielle Souto de Medeiros1, Welma Wildes Amorim2, Kelle Oliveira1, Daniela Arruda Soares1, Vanessa Moraes Bezerra1, Matheus Cortes1, Sóstenes Mistro1, José Andrade Louzado1, Renato Morais1
1Universidade Federal da Bahia, Bahia, Brazil; 2Universidade Estadual do Sudoeste da Bahia, Bahia, Brazil
Correspondence: Márcio Galvão Oliveira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A144
Introduction: Health fairs in basic health care units can be an important strategy to enable the screening of individuals with DM (Diabetes Mellitus), as well as an assessment of previously diagnosed patients that are uncontrolled. The objective of this study was to describe the proportion of individuals without previous diagnosis or with self-reported DM, identified in health fairs with altered glycated hemoglobin (HbA1c).
Methods: This research was conducted as part of the HealthRise project. Five health fairs were held in areas with family health strategy coverage in the city of Vitória da Conquista, Bahia, from April to July 2017. Community health agents delivered invitations to patients with DM and their families. There were also announcements on local radio. At the health fairs, questionnaires with demographic data and self-reported DM diagnosis were applied, capillary blood glucose test and blood collection for glycated hemoglobin (HbA1c) measurements were performed. The latter is for individuals with capillary blood glucose > 100 mg/dL (fasting) or 140 mg/dL (non-fasting). Samples were sent to a clinical laboratory. Individuals without a DM diagnosis with HbA1c values ≥ 6.5% were later referred for another measurement and medical assessment. Uncontrolled patients were those with a diagnosis of DM and HbA1c > 7% (adults) and > 8.5% (elderly). Data was analyzed through descriptive statistics. This study was approved by the “Universidade Federal da Bahia – Instituto Multidisciplinar em Saúde” Ethics Board, approval number 1.861.073, and was funded by the Medtronic Foundation.
Results: Among the 151 patients whose HbA1c results had already been released by the laboratory, 110 (72.8%) were female and 89 (58.9%) were older adults. 36 (23.8%) of the patients had no previous diagnosis of DM, of which 6 (16.7%) presented HbA1c ≥ 6.5%. Between 115 patients with self-reported DM, 46 (40%) had uncontrolled HbA1c, according to the study criteria.
Conclusions: A high proportion of people with uncontrolled DM was found. The strategy of DM screening at health fairs proved to be a viable alternative to identify possible new cases.
A145 Evaluation nutricional and metabolic, in the gestation and four years after the childbirth, in women with DMG—association with intolerance to the glucose and DM2
Lilian Barros de Sousa Moreira Reis, Claudia Vicari Bolognani, Adriano Dias, Iracema de Mattos Paranhos Calderon
UNESP, São Paulo, Brazil
Correspondence: Lilian Barros de Sousa Moreira Reis
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A145
Introduction: The change in the way of life, including adaptation nutricional and exercise, is the key in the handling of the DMG and in the prevention of the DM2 4 years after the childbirth.
Objective: Value the profile nutricional and metabolic of women with DMG, in the gestation and 4 years after the childbirth, and to associate to risk of hiperglicemia after the childbirth.
Method: Cohort that valued 65 women with DMG at the gestation and 47 of these quatros years after the childbirth. The food consumption was valued for recordatório of 24 h and questionnaire of frequency food and qualified by the software Avanutri. Rate of Physical Mass (IMC), pleat cutaneous tricipital (PCT), muscular circumference of the arm (CMB) and levels of glicemia, of fast and 2 h—prandial, hemoglobin glicada (HbA1c), total cholesterol and fractions and triglicerídeos were valued and been associated by them to the disorders risk hiperglicêmicas 4 years after the childbirth. In the statistical analysis there was used test of the qui-square or right one of Fisher and calculation of odds ratio (OR) and interval of confidence to 95%, with p < 0.05.
Results: Most of the women presented unsuitable caloric ingestion and food consumption, in the gestation and 4 years after the childbirth. In the avalição carried out after the childbirth, there were observed bigger values IMC and PCT (p = 0.028) and, juveniles, of CMB (p < 0,001), with bigger proportion of HbA1c ≥ 6.5%, (p = 0.007) and HDL < 50 mg/dL (p < 0.001). In this period, the IMC-gestacional ≥ 25 kg/m2 showed OR of 4583 up (1189; 17,675) for Intolerance to the glucose (14.9%) and DM2 (36.2%).
Conclusion: The food inadequacy characterized the women with DMG, in the gestation and four years after the childbirth, with indicators of obesity and disorders glicêmicas and metabolic in the period after the childbirth. Nevertheless, the IMC-gestacional ≥ 25 kg/m2 was the only factor associated to the risk of hiperglicemia 4 years after the childbirth.
A146 Evaluation nutricional in women bearers of diabetes melito gestacional—relation with metabolic syndrome, control glycemic, weight of newborn baby and diagnosis of diabetes melito after the gestation
Lilian Barros de Sousa Moreira Reis, Claudia Vicari Bolognani, Adriano Dias, Iracema de Mattos Paranhos Calderon
UNESP, São Paulo, Brazil
Correspondence: Lilian Barros de Sousa Moreira Reis
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A146
Introduction: It is defined diabetes Melito Gestacional by diabetes when second was diagnosed in or thirdly terms of the gestation, with world-wide predominance from 2 to 20%. This condition has motherly repercussions and fetais, in the gestation and after, and type constitutes risk for Diabetes Melito 2, metabolic syndrome and disease cardiovascular.
Objective I: Value the profile nutricional of pregnant women with Diabetes Melito Gestacional, considering macro and microelements, in the gestation and in the period of 4 years after the childbirth, and it will connect this profile with markers of metabolic syndrome, controls glicêmico, I hurt of the newborn baby and incident of intolerance the glucose and Diabetes Melito type 2 after the gestation.
Method: Study of cohort that included 65 pregnant women with Diabetes Melitos Gestacional. Between the motherly variables, the indicators were analysed antropométricos and of markers of metabolic syndrome and control glicêmico. In the statistical analysis the next tests were employed—Qui-Square of Pearson,—paramétricos of Wilcoxon and McNemar, for the dependent samples, calculation of odds ratio (OR) and IC 95%.
Resulted: In the period gestacional more than 70% of the pregnant women presented inadequacy in the total energetic consumption and in the consumption of calcium, vitamin D and magnesium; significant associations with markers of metabolic syndrome were confirmed between unsuitable consumption of calcium and IMC ≥ 25 kg/m2 (p = 0.042); of vitamin D and HDL-Cholesterol < 50 mg/dL (p = 0.018) and of zinc and glicemia of fast ≥ 100 mg/dL (p = 0.036), besides magnesium and when were recently been born big for the age (p = 0.016); the fibers consumption, besides unsuitable in the gestation, had significant reduction in the evaluation of 4 years after the childbirth (p = 0.047). In the evaluation 4 years after the childbirth, the IMC and the measure of the cutaneous pleat tricipital were bigger (p < 0.001; p = 0.028), with reduction in the measure of the muscular circumference of the arm (p < 0.001). The fast glicemia (p = 0.008) and the levels of HbA1c (p = 0.007) increased and the values of total cholesterol, HDL-Cholesterol and triglicérides (p < 0.001) lessened in the evaluation of 4 years after the childbirth. The IMC-gestacional ≥ 25 kg/m2 showed OR of 4583 (1189; 17,675) for Intolerance to the glucose (14.9%) and DM2 (36.2%).
Conclusion: Significant associations were identified between the unsuitable consumption of macro and micronutritious of the diet and markers of metabolic syndrome and of the weight while being born, without association with markers of the control glicêmico motherly.
A147 Evaluation of 25-hydroxivitamin D levels and vitamin d receptor polymorphisms in type 2 diabetes mellitus patients
Kathryna Fontana Rodrigues1, Nathalia Teixeira Pietrani1, Adriana Aparecida Bosco2, Josianne Nicácio Silveira1, Maira Cândida Rodrigues de Sousa1, Ieda de Fátima Oliveira Silva1, Karina Braga Gomes Borges1
1UFMG, Minas Gerais, Brazil; 2Instituto de Ensino e Pesquisa da Santa Casa, Minas Gerais, Brazil
Correspondence: Kathryna Fontana Rodrigues
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A147
Introduction: Vitamin D deficiency has been associated with a variety of diseases, including type 2 diabetes mellitus (T2DM). Due to its pleiotropic action, vitamin D can regulates insulin secretion and immune-inflammatory response. Vitamin D receptor (VDR) polymorphisms are involved in the gene expression regulation and have been associated with T2DM and their microvascular complications.
Objective: This study aimed to evaluate the association between the polymorphisms ApaI (rs7975232), BsmI (rs1544410), FokI (rs10735810), and TaqI (rs 731236) in the VDR gene with T2DM, retinopathy, diabetic kidney disease occurrence, as well as 25- hydroxivitamin D levels [25(OH)D].
Methods: We evaluated 101 patients with clinical and laboratorial diagnosis of T2DM and 62 gender- and body mass index (BMI)-matched nondiabetic control. Molecular analyzes were performed by PCR–RFLP (Polymerase Chain Reaction–Restriction Fragment Length Polymorfism). 25(OH)D levels were measured by high performance liquid chromatography. Statistical analysis was performed with SPSS (version 17.0) using qui-square test with residual analysis and Mann–Whitney test. A p value < 0.05 was considered statistically significant.
Results: The 25(OH)D levels were lower in T2DM patients [17.19 (18.26) ng/mL] when compared with controls subjects [31.10 (14.97) ng/Ml—p < 0,0001]. We found no difference between genotype and allele frequencies of the VDR polymorphisms when compared T2DM and control groups (p > 0.05 for all). However, regarding microvascular complications, diabetic kidney disease was associated with the GG genotype (p = 0.048) and G allele (p = 0.015) of BsmI polymorphism.
Conclusions: These results suggest that BsmI polymorphism is associated with the development of diabetic kidney disease in T2DM patients. Besides, T2DM patients exhibited lower 25(OH)D levels, which suggest its association with the disease. Acknowledgements: CNPq and FAPEMIG. Keywords: Vitamin D,
A148 Evaluation of cardiovascular risk in individuals with type 2 diabetes mellitus according to framingham criteria
Ana Maria Parente Garcia Alencar, Natália Pinheiro Fabrício, Daniele Gomes da Silva, Eloíza Barros Luciano Rolim, Kenya Waléria de Siqueira Coelho Lisboa, Jayana Castelo Branco Cavalcante de Meneses, Sofia de Moraes Arnaldo, Gabriela Duarte dos Santos1
URCA, Ceará, Brazil
Correspondence: Ana Maria Parente Garcia Alencar
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A148
Patients with diabetes mellitus type 2 present higher risk of developing cardiovascular diseases, which are the main causes of death in the world. Thus, we recommend evaluating the cardiovascular risk of these people as an important strategy to conduct the therapeutic plan. This was a cross-sectional study developed in a secondary care service from February to June in 2016, including a sample of 81 individuals with type 2 diabetes mellitus. We aimed to characterize the study sample regarding the sociodemographic and clinic variables and to evaluate the cardiovascular risk according to Framingham score. We collected data from individuals with type 2 diabetes and without history of cardiovascular disease, using a structured form based on Framingham risk score that estimates the cardiovascular risk in the following 10 years. The first part of the instrument described the variables sex, age, race, marital status, educational level, occupation and smoking habit, which the participants had reported, and the second part contained the variables HDL-cholesterol, LDL-cholesterol and blood pressure, based on medical records. To calculate the risk of cardiovascular event, each variable had a value and, based on the sum of these points, we estimated the cardiovascular risk in low (less than 10%), medium (10 to 20%) and high (more than 20%). We analyzed data using the descriptive statistics. We found that 82.8% of the sample were female, 23.5% were aged 55-59 years, 60.5% were married, 46.9% had not completed elementary school and 69.2% were retired. 38.3% of the sample had high risk of developing cardiovascular diseases in 10 years. In the categorization of the risk by sex, 38.9% of the female population had high risk, whereas 35.7% of the male population was equally distributed into low and highrisk categories. We found that the studied population is at risk of developing cardiovascular diseases and, therefore, we have showed the importance of optimizing prevention measurements and treatment to contribute to the decrease of morbimortality in this group.
Keywords: Diabetes mellitus, type 2; Framingham score.
A149 Evaluation of hospital Santa Marcelina’s type-2 diabetic patients before and after bariatric surgery
Ana Carolina Bueno Santana1, João Henrique dos Santos Pereira2, Isabella Doria Novais1, João Victor de Morais Máximo1, Marília Souza Ramos1, Paula Felix Pessoa1, Michelle Patrocínio Rocha2
1Faculdade Santa Marcelina, São Paulo, Brazil; 2Hospital Santa Marcelina, São Paulo, Brazil
Correspondence: Ana Carolina Bueno Santana
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A149
Background: Bariatric surgery is recommended to patients with morbid obesity, and is also efficient to control and prevent associated diseases, such as diabetes mellitus type-2 (DM-2). Past studies already showed that this procedure can reduce the incidence of DM-2 in 80%, and almost 90% of diabetic patients presented short-term remission of the disease. Weight loss can lead to improvement of insulinic sensibility and beta-cell function; also, it contributes to better hormonal modulation (through incretins GLP-1 and GIP).
Objective: This study aims to analyze the efficiency of bariatric surgery in type-2 diabetic patients, and this disease’s remission after 6 months of the procedure.
Methods: This research was approved by Hospital Santa Marcelina’s Ethics Board (n. 06587/17), and was based on the comparison of two charts: diabetic patients before bariatric surgery x after surgery. The data of each chart was retrieved through revision of Hospital Santa Marcelina’s bariatric patient files, comparing the last medical appointment before and the first one after the surgery. The sample was composed by 21 individuals; weight, BMI, obesity level, HbA1C, fasting glucose, use of oral hypoglycemic agents or insulin and drugs to lose weight were studied. After the comparison between charts, the data was submitted to descriptive statistical analysis.
Results: 90.4% of the 21 patients analyzed were female. The mean age of the group was 49 ± 10.7 years. The patients had mean fasting glucose levels of 145.47 ± 41.74 mg/dL, mean glycated hemoglobin of 7.55% ± 1.27, mean weight of 114.1 ± 25.03 kg and mean BMI of 44.06 ± 6.46 kg/m2. 19 individuals used oral hypoglycemid drugs, and 8 were insulin-dependent; there was only 1 patient who used only insulin. 6 months after bariatric surgery, the mean fasting glucose levels were reduced to 117.4 ± 44.5 mg/dL; mean HbA1C was 6.34% ± 1.33, mean weight was 91.8 ± 22.5 kg and mean BMI was 33.89 ± 6.66 kg/m2. 42.1% of the 19 patients using hypoglycemic drugs had their therapy reduced, and 55.6% stopped using insulin. 19% of the patients achieved the 3 criteria for DM remission, and 19% achieved 2 of them.
Conclusion: 6 months after surgery, 4 of the 21 patients achieved all the criteria for DM remission (fasting glucose levels < 100 mg/dL, HbA1c < 5.7% and no necessity for hypoglycemic drugs); also, 4 individuals achieved 2 of said criteria. Informed consent to publish has been obtained from all 21 patients.
A150 Evaluation of insulin degludeca versus NPH intrahospital use: a retrospective study
Penelope Tabatinga Castro1, Ana Rita Gonçalves Melo2, Victoria D´Ávilla Ramirez Frota1, Daniela Yone Veiga Iguchi Perez1, Fabiana Mandel B. Cyrulnik1
1Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil; 2Hospital Universitário da Universidade Federal do Piauí, Piauí, Brazil
Correspondence: Penelope Tabatinga Castro
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A150
Introduction: In the hospital setting, diabetes increases hospitalization length, exacerbates coexisting diseases and increases mortality. Hypoglycemia, as well as hyperglycemia, is also a predictor of mortality.
Objective: Evaluate the clinical profile, incidence of hypoglycemia, including nocturnal hypoglycemia and severe hypoglycemia as well as hospitalization length on inpatient population under use of Degludeca plus Regular Insulin versus NPH plus Regular Insulin.
Methods: We conducted a retrospective, randomized study to compare the efficacy and safety of different basal insulin (Degludeca versus NPH), both on Basal-bolus insulin regimen on inpatient population with diabetes. Data were collected from the medical records, between May, 2016 until April, 2017. 8 patients were selected and randomized in each group. We established optimal glycemic control for patients with capillary glucose below 140 mg/dl in fasting and before main meals and below 180 mg/dL for 2 h after main meals. The criteria for excellent glycemic control was to achieve at least 70% within the previously established target and for acceptable glycemic control, those patients who had between 60% and 69% of the glycemia within the established target. The total number of hypoglycemia was assessed and classified as severe hypoglycemia (< 40 mg/dl) and mild hypoglycemia (< 70 mg/dl) as well as nocturnal hypoglycemia. In addition, the time required to achieve excellent or acceptable glycemic control was also analyzed.
Results: Group 1 (Degludeca) had 4 episodes of hypoglycemia during hospitalization, including 1 nocturnal episode classified as severe. Group 2 (NPH), had 13 episodes of hypoglycemia, including 2 severe and 2 nocturnal episodes. Those Patients, independently of the group, who had excellent control presented with a greater number of hypoglycemia, as well as more severe and nocturnal events. The incidence of hypoglycemia was higher in older patients, with higher number of comorbidities, lower BMI and longer time of diabetes diagnoses. Group 1 achieved excellent glycemic control in 4 days on average, while patients in group 2 took 6 days to achieved the same glycemic levels.
Conclusion: The study confirmed data already consolidated in the literature, evidencing the superiority of Degludeca insulin in the reduction of nocturnal and/or severe hypoglycemias. Keywords: Diabetes, and degludeca.
A151 Evaluation of lipid profile in different stages of development among young people with type 1 diabetes
Wimbler Pires1, Lais de Oliveira Hernandes2, Tatiana Siqueira Capucci3, Mariana Accioly Carrazedo4, Tiago José Canali5, Silvio Baena Fernandes5, Rodrigo Eiji Fujita5, Ricardo Emidio Navarrete de Toledo6
1FMU (Faculdades Metropolitanas Unidas), São Paulo, Brazil; 2Santa Casa de São José dos Campos, São Paulo, Brazil; 3Instituto Policlin de Ensino e Pesquisa, São José dos Campos, São Paulo, Brazil; 4Beneficência Portuguesa de São Paulo, São Paulo, Brazil; 5IEFAP/Uningá, Paraná, Brazil; 6Beneficência Portuguesa de São Paulo, IEFAP/Uningá, São Paulo, Brazil
Correspondence: Wimbler Pires
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A151
Introduction: As one of the most common endocrine disease and one of the most common chronic conditions in children and teenagers, type 1 diabetes (T1D) accounts for only about 5–10% of all cases of diabetes. Given the chronic nature of the disease, the atherosclerotic process starts very soon in life, even before it shows up in screening tests for micro or macrovascular complications. Puberty consists of a series of biologic transitions, and the sequence of changes in secondary sexual characteristics has been categorized by several groups. The physical measurements of development are based on external primary and secondary sex characteristics, such as the size of the breasts, genitals, testicular volume and development of pubic hair. Due to natural variation, individuals pass through the Tanner stages at different moments, being classified as children, adolescents and adults, depending justly on the timing of puberty (Fig. 1).
Objectives: To determine serum levels of lipid, cholesterol, triglycerides in 3 different stages of maturity with T1D, when compared to data from non-diabetic ones with similar maturity levels.
Methods: A case–control study was conducted on 21 T1D patients (5 prepubertal and 6 pubertal children; 10 adults) and 42 non-diabetic patients matched on age, sex, and body mass index (BMI) and pubertal stages according to Tanner‘s criteria. The lipid profile was determined and an Odds ratio (OR) was conducted with a confidence interval of 95% (95% CI), to establish a correlation between different lipid fractions and pubertal stages. A summary of the methodology is described in Table 1. Study Design—Case Control Study 21 patients with T1D 42 patients in the control group Clinical Features and Physical Examination Age Gender Body Mass Index (BMI) Pubertal Stages (Tanner’s Criteria) Laboratory findings Total Cholesterol (TC) High Density Lipoprotein cholesterol (HDL-c) Low Density Lipoprotein cholesterol (LDL-c) Triglycerides (TG) Fig. 2: Table 1. Summary of the methodology.
Results: The T1D prepubertal children showed a trend in cholesterol levels highest than those non-diabetic, however, this difference was not statistically significant (p = 0.08). Among individuals in the pubertal stages, T1D is associated with greater prevalence of dyslipidemia (71.4% vs. 21.8%, p < 0.03), with high total cholesterol levels (184.7 ± 37.6 vs. 143.8 ± 25.9 mg/dl, p = 0.01), LDL-c (123 ± 31.2 vs. 81.4 ± 21.3 mg/dl, p < 0.02) and triglycerides (168.3 ± 25.8 vs. 146.6 ± 21.4 mg/dl, p < 0.004) than those non-diabetics (Fig. 2: Table 2). In this study, no significantly differences were found for the entire adult population. Table 2. Summary of results T1D patients control group adolescents Dyslipidemia: 71.4% TC: 184.7 ± 37.6 mg/dl LDL-c:123 ± 31,2 mg/dl TG: 168.3 ± 25.8 mg/dl Adolescents Dyslipidemia: 21.8% TC: 143.8 ± 25.9 mg/dl LDL-c: 81.4 ± 21.3 mg/dl TG: 146.6 ± 21.4 mg/dl.
Conclusion: Although search for primary and secondary causes have not been made for exclude them, our data suggests that an increasing prevalence of dyslipidemia among T1D pubertal individuals. Therefore, it is necessary systematic approaches on dyslipidemia screening in younger diabetics for preventing or delaying the development of future micro or macrovascular complications of the disease.
A152 Evaluation of macrovascular complications between diabetics type 2 in a hospital of teaching of São Paulo: retrospective study of 559 cases
Laís de Oliveira Hernandes1, Mariana Accioly Carrazedo2, Tatiana Siqueira Capucci3, Wimbler Pires4, Renan Kiyoiti Fujiwara5, Monica Cristina Baiardi Mizoguti De Oliveira5, Luiz Gonzaga Teixeira Pires5, Ricardo Emidio Navarrete de Toledo6
1Santa Casa de São José dos Campos, São Paulo, Brazil; 2Beneficência Portuguesa de São Paulo, São Paulo, Brazil; 3Instituto Policlin de Ensino e Pesquisa, São José dos Campos, São Paulo, Brazil; 4FMU (Faculdades Metropolitanas Unidas), São Paulo, Brazil; 5IEFAP/Uningá, Paraná, Brazil; 6Beneficência Portuguesa de São Paulo, IEFAP/Uningá, São Paulo, Brazil
Correspondence: Laís de Oliveira Hernandes
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A152
Introduction: The development of atherosclerosis is the main complication of diabetes mellitus and includes cardio and cerebrovascular diseases in addition to peripheral arterial insufficiency. Together, they manifest themselves clinically frequently five to ten times higher in diabetics than in non-diabetics.
Objectives: To evaluate the profile of hospitalizations of type 2 diabetic patients due to macrovascular diseases in a teaching hospital in the city of São Paulo.
Methods: Retrospective study of 559 records of type 2 diabetic patients hospitalized between January/2009 and November/2016. Anamnesis data were analyzed, such as age, sex, causes and time of hospital stay. The patients were divided into three groups regarding the occurrence of macrovascular events: cardiovascular, cerebrovascular and peripheral arterial disease (PAD).
Results: Among all hospitalizations of type 2 diabetic patients, 62.40% were due to macrovascular events (n = 349). The mean age was 63 years (79–47 years). Of the macrovascular events, 78.5% were from cardiovascular diseases, 12.5% from cerebrovascular diseases and 9% from PAD. The mean length of hospital stay was 18 days. Table 1. Summary of Macrovascular complications of type 2 diabetic patients admitted to a teaching hospital in São Paulo Macrovascular complications 62.4% Cardiovascular diseases Cerebrovascular conditions Peripheral arterial disease 78.5, 12.5, 9%.
Conclusion: Diabetes mellitus was a risk factor for cardiovascular events 2 to 3 times higher in men, who are more likely to develop coronary heart disease, being the main cause of hospitalization. The data found in our study are consistent with the literature, since macrovascular diseases represented almost two-thirds of hospital admissions in this population, with cardiovascular events being the most prevalent in more than 75% of the cases (Fig. 1).
A153 An impact assessment on a health promotion and self-management project intended for people with type 2 diabetes mellitus
Wimbler Pires1, Lais de Oliveira Hernandes2, Tatiana Siqueira Capucci3, Mariana Accioly Carrazedo4, Lucilene Fagundes da Silva Martins5, Luccas Inague Rodrigues5, Junior Lima Bezerra5, Ricardo Emidio Navarrete de Toledo6
1FMU (Faculdades Metropolitanas Unidas), São Paulo, Brazil; 2Santa Casa de São José dos Campos, São Paulo, Brazil; 3Instituto Policlin de Ensino e Pesquisa, São José dos Campos, São Paulo, Brazil; 4Beneficência Portuguesa de São Paulo, São Paulo, Brazil; 5IEFAP/Uningá, Paraná, Brazil; 6Beneficência Portuguesa de São Paulo, IEFAP/Uningá, São Paulo, Brazil
Correspondence: Wimbler Pires
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A153
Introduction: Diabetes is a serious complex condition when we take into account all the complications, the changes in the habits of life of the individuals and the several classes of drugs, not always understood by the vast majority of patients. Educational actions help those affected to deal with the disease better and preventing other associated complications.
Objective: To evaluate the impact of a project exclusively directed for people with type 2 Diabetes (T2D), in the fields of education, health promotion and self-management.
Methods: From May to November 2016, patients with T2D within 10 years or less of diagnosis were recruited from the diabetes outpatient clinic of a university hospital in the city of Sao Paulo, Brazil. Inappropriate glycemic control was defined as HbA1c ≥ 8% (HPLC method). Patients who had previously participated in other educational projects were excluded. The same structured questionnaire was administered at the beginning and the end of this project to a total of 163 eligible participants (Fig. 1).
Results: As regards the replies to the questionnaire, the average scores at the first and second time were 31.45 and 43.86 out of 56, respectively. The patients started the clinical study with an average HbA1c levels of 10.3 ± 1.4%, having two consecutive decreased statistically significant since educational program has started (p < 0.05).
Discussion: Several studies have demonstrated the intensive treatment of diabetes with medical and multidisciplinary team visits in shortest intervals focusing on the education about complications and self-management are effective strategies that improving glycemic control and reducing the symptoms or long-term endpoints of the diabetes.
Conclusion: The model of diabetes self-management and patient education, with a view to reducing the modifiable risk factors such as sedentary lifestyle, high blood pressure, obesity and smoking, is extremely important in order to achieve the glycemic control in T2D patients. The data collected using the proposed methodology may be used when drawing up the actions for improvement of critical points which may be identified. Although our data was collected using a nonrandomized and non-controlled design study, it seems clear the contribution of these new forms of education aiming the improvement of assistance quality to diabetic people, especially with regard to the self-management of diabetes (Fig. 1).
Informed consent to publish had been obtained from the patients.
A154 An impact assessment on a health promotion and self-management project intended for people with type 2 diabetes mellitus
Yehuda Handelsman1, Christina Chovanes2, Terry Dex3, Francesco Giorgino4, Neil Skolnik2, Elisabeth Souhami5, William Stager3, Juan Pablo Frias6
1Metabolic Institute of America, Tarzana, CA, USA; 2Abington Memorial Hospital, Abington, PA, USA; 3Sanofi Us, Inc., Bridgewater, NJ, USA; 4University of Bari Aldo Moro, Bari, Italy; 5Sanofi, Paris, France; 6National Research Institute, Los Angeles, CA, USA
Correspondence: Yehuda Handelsman
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A154
Introduction: The importance of a tight glycemic control in pre and gestational diabetes mellitus in maternal–fetal binomial is well known. Sometimes, the adequate glycemic goal is hard to be reached in public hospitals in development countries. However, the impact of this clinic inertia in this binomial could be heterogeneous and depends on the diabetes type.
Aim: To evaluate the relationship between the gestational age of the first antenatal visit and the maternal–fetal prognosis in the pregnancy of 3 main types of diabetes mellitus.
Methods: 642 pregnant women [470 Gestational Diabetes(GDM), 100 Type 1 Diabetes Mellitus(T1D) e 74 type 2 Diabetes Mellitus (T2D)] of a public university diabetes center were evaluated in respect of the gestational age of the first antenatal visit and fetal outcomes (jaundice, hypoglycaemia, respiratory distress, admission in intensive care unit (ICU), malformations) and maternal outcomes (preeclampsia, pregnancy specific hypertensive disease and oligoamnium). Estatistics were performed in SPSS: ANOVA and QUI square tests.
Results: The patients wih GDM, T1D and T2D had age, body mass index (BMI), gestational age of the first antenatal visit and HbA1c respectively: 33.8 + 5.3, 24.6 + 6.3 and 33.4 + 6.1 years; 30.2 + 6.1, 23.4 + 3.7 and 29.8 + 7.4 kg/m2; 25.6 + 7.1, 13.6 + 6.6 and 15.3 + 7.3 gestational weeks and 5.9 + 1.5, 8.4 +1.6 and 7.1 +1.9%. The cesarean cession was predominant in all groups: 80.6% GDM, 76.5% T1D e 73% T2D. The newborns birth weight (in kilograms) were: GDM: 3,16 +0,55; T1D: 2,74 +0,95 and T2D: 3,04 +0,72, with 8,1% of LGA (large for gestational age) in the GDM, 16,3% in T1D and 12,9% in T2D. The newborns of the patients with 1DM and 2DM had significantly higher rates of hypoglycaemia (p:0,000 in both groups), jaundice (p:0,002 and p:0,001), respiratory distress (p:0,007 and p:0,033) and admission in ICU (p:0,000 in both groups) compared to then with GDM. The malformation rate was higher in the newborns of the 1DM mothers compared to them with GDM (p:0,008). There were no significantly difference the maternal outcomes between the groups.
Conclusion: The gestational age of the first visit has higher influence in newborns than in maternal outcomes and in patients with pre gestational diabetes (Fig. 1).
A155 Evaluation of materno-fetal prognosis according to initial gestational age of first antenatal visit and metabolic-clinic parameters in type 1, type 2 and gestational diabetes mellitus in a public hospital
Patricia Medici Dualib, Rosiane Mattar, Bianca A Pititto, Sérgio Atala Dib
UNIFESP, São Paulo, Brazil
Correspondence: Patricia Medici Dualib
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A155
Introduction: The importance of a tight glycemic control in pre and gestational diabetes mellitus in maternal–fetal binomial is well known. Sometimes, the adequate glycemic goal is hard to be reached in public hospitals in development countries. However, the impact of this clinic inertia in this binomial could be heterogeneous and depends on the diabetes type.
Aim: To evaluate the relation between the gestational age of the first antenatal visit and the maternal–fetal prognosis in the 3 main types of diabetes mellitus during pregnancy.
Methods: 642 pregnant women [470 Gestational Diabetes(GDM), 100 Type 1 Diabetes Mellitus(1DM) e 74 type 2 Diabetes Mellitus(2DM)] of a public university diabetes center were evaluated in respect of the gestational age of the first antenatal visit and fetal outcomes (jaundice, hypoglycaemia, respiratory distress, admission in intensive care unit (ICU), malformations) and maternal outcomes (preeclampsia, pregnancy specific hypertensive disease and oligoamnium).Estatistics were performed in SPSS: ANOVA and QUI square tests.
Results: The patients wih GDM, 1DM and 2DM had age, body mass index (BMI), gestational age of the first antenatal visit and HbA1c respectively: 33.8 +5.3, 24.6 +6.3 and 33.4 +6.1 years; 30.2 + 6.1, 23.4 + 3.7 and 29.8 + 7.4 kg/m2; 25.6 + 7.1, 13.6 +6.6 and 15.3 +7.3 weeks and 5.9 +1.5, 8.4 +1.6 and 7.1 + 1.9%. The C cession was predominant in all groups: 80.6% GDM, 76.5% 1DM e 73% 2DM. The newborns birth weight (in kilograms) were: GDM: 3.16 + 0.55; 1DM: 2.74 +0.95 and 2DM: 3.04 + 0.72, with 8.1% of LGA (large for gestational age) in the GDM, 16.3%in 1DM and 12.9% in 2DM. The newborns of the patients with 1DM and 2DM had significantly higher rates of hypoglycaemia (p: 0.000 in both groups), jaundice (p: 0.002 and p: 0.001), respiratory distress (p: 0.007 and p: 0.033) and admission in ICU (p: 0.000 in both groups) compared to then with GDM. The malformation rate was higher in the newborns of the 1DM mothers compared to them with GDM (p: 0.008). There were no significantly difference the maternal outcomes between the groups.
Conclusion: The gestational age of the first visit has higher influence in newborns than in maternal outcomes and in patients with pre gestational diabetes (1DM and 2DM).
A156 Evaluation of precious hospital replacement after high of patients with type 2 diabetes
Laís de Oliveira Hernandes1, Mariana Accioly Carrazedo2, Tatiana Siqueira Capucci3, Wimbler Pires4, Lucilene Fagundes Da Silva Martins5, Luccas Inague Rodrigues5, Junior Lima Bezerra5, Ricardo Emidio Navarrete de Toledo6
1Santa Casa de São José dos Campos, São Paulo, Brazil; 2Beneficência Portuguesa de São Paulo, São Paulo, Brazil; 3Instituto Policlin de Ensino e Pesquisa, São José dos Campos, São Paulo, Brazil; 4FMU (Faculdades Metropolitanas Unidas), São Paulo, Brazil; 5IEFAP/Uningá, Parané, Brazil; 6Beneficência Portuguesa de São Paulo, IEFAP/Uningá, São Paulo, Brazil
Correspondence: Laís de Oliveira Hernandes
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A156
Introduction: Hospital readmission is an important indicator of care received during hospitalization. It is crucial to review the factors that lead to readmission, since it has high costs for the individual, for the health system, and is associated with higher morbidity and mortality.
Objectives: To evaluate the rate of readmission and the main associated causes among type 2 diabetic patients in a large hospital, São Paulo/SP.
Methods: A retrospective study was carried out between September 2014 and May 2017 with type 2 diabetic patients followed by the Endocrinology team for more than 48 h and readmitted within 30 days after hospital discharge. The percentage of readmissions was evaluated in relation to the total number of hospitalizations and their main causes.
Results: A total of 362 patients were studied, with a mean age of 64.5 years (43–86 years) and mean duration of diabetes 12.7 ± 9.3 years. The overall readmission rate was 11.8%. Among them, the majority were male (68%) and 78% had been hospitalized in the last 30 days with the same diagnosis. The main causes of readmission were cardiovascular diseases 56%, cancer 19.5%, respiratory 12.2%, genitourinary 7.3% and gastrointestinal 5.0% (Fig. 1: Table 1). The main adjuvant comorbidities to the diagnosis of DM and those mentioned above were (Fig. 1: Table 2): hypertension (39%), acute coronary syndromes (16%), decompensated heart failure (15%), renal failure (17%) and decompensation of chronic obstructive pulmonary disease (16%). Among those readmitted, the mortality rate was 9.7%. Table 1. Main causes of hospital readmissions in patients with DM Cardiovascular diseases 56% Oncological diseases 19.5% Respiratory diseases 12.2% Genitourinary diseases 7,3% Gastrointestinal disorders 5% Table 2. Resumo das principais comorbidades adjuvantes ao diagnóstico de DM Systemic arterial hypertension 39% Acute coronary syndrome 16% Decompensated heart failure 15% Renal insufficiency 17% Chronic obstructive pulmonary disease 16%.
Conclusion: Our data are in accordance with the literature, which indicates readmission rates varying from 2 to 16%. The profile of the main comorbidities found refers to the specialties known to the general public and, in the case of a highly complex hospital, exposes patients’ chronicity and severity. The epidemiological profile can help identify those with greater potential for rehospitalization and the implementation of strategies for better follow-up, with a substantial reduction in the morbimortality of the diabetic population.
A157 Evaluation of return rate with ogtt postpartum of patients accompanied in gestational diabetes ambulatory at UERJ
Paula da Silva Rocha, Thaysa Fernandes Lacerda Rocha Costa, Jéssika Vieira Marques, Aline Sales Nunes Santos, Ana Luiza Alves Ferreira de Carvalho Schröder, Caroline Alessandra Garcia de Mello, Raquel Abib, Fernanda Braga, carolina cabizuca, Marilia Brito Gomes
UERJ, Rio de Janeiro, Brazil
Correspondence: Paula da Silva Rocha
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A157
Gestational diabetes mellitus (GDM) is an important risk factor for the future development of type 2 diabetes (T2DM). The American Diabetes Association (ADA) recommends screening for T2DM through the oral glucose tolerance test (OGTT) at 6 to 12 weeks postpartum and every 3 years throughout life. However, studies show that even with proper guidelines, the postpartum rate of return is low, between 20 and 64%. The objective of the study was to evaluate the rate of return with the OGTT result 6–12 weeks after delivery in women with previous gestational diabetes as well as the factors implicated in the greater adherence to the test. A retrospective study was conducted with a cohort of women with gestational diabetes, with prenatal care and delivery in a tertiary university center, from January 2013 to April 2017. The diagnosis of gestational diabetes was based on IADPSG criteria (fasting ≥ 92 mg/dl 1 h ≥ 180 mg/dl and/or 2 h ≥ 153 mg/dl) and the diagnosis of type 2 diabetes and glucose intolerance were made using the ADA criteria of 2016 (fasting and 2 h post-glucose load ≥ 126 mg/dl and/or ≥ 200 mg/dl and 100–125 mg/dl and/or 140 mg/dl and 199 mg/dl, respectively). All women were instructed to perform a OGTT 6–12 weeks postpartum. Statistical analysis was performed using the SPSS program version 17.0. The t test and Mann–Whitney test were used for the analysis of continuous variables and ×2 for categorical variables. Of the 152 patients analyzed, 21 (13.8%) returned with the OGTT results. There was a statistically significant difference in the frequency of insulin use during pregnancy (76.2% vs 38.9%, respectively for the group that performed the OGTT and the non-adherent to the screening, p value = 0.001). There was no statistically significant difference between the 2 groups regarding age, family income, schooling, pre gestational BMI, parity, gestational age at the first visit, smoking, family history of T2DM, diagnosis of GDM before the third trimester, previous GDM and race. Among the patients who returned with the OGTT, 9 (45%) had the diagnosis of pre-diabetes and none of T2DM, and there was no difference between these 2 subgroups in the characteristics mentioned above. Measures are needed to improve adherence such as active patient search, earlier implementation of OGTT (48 h postpartum) and identification of patients at increased risk of developing T2DM.
A158 Evaluation of risk factors associated with the presence of ulceration in carriers of diabetes mellitus type 2 in a university hospital in Rio de Janeiro
Elias Srur Filho, Thais Improta Valle, Diana Weil Pessoa Ramos, Samila Ferrari Salles, Simone Medeiros Carvalho Shuvarin, Juliana Andressa Gomes, Márcia Helena Soares Costa, Emanuelle Duarte Oliveira de Almeida, Flávia Regina Pinho Barbosa, Juliana Nesi Cardoso Migliano Porto, Déborah Maria Brito Sírio, Raphael Nobrega Soliani
UNIRIO, Rio de Janeiro, Brazil
Correspondence: Elias Srur Filho
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A158
Introduction: Distal peripheral neuropathy (DPN), seen in more than 50% of diabetic’s patients, and obstructive peripheral arterial disease (OPAD) are the main risk factors for ulceration. Foot ulcer affects 15% of patients with type 2 diabetes (T2DM), preceding 80% of amputations. The prevalence of DPN is 15% and 42%, after 10 and 20 years of disease, respectively; there are other minor factors associated with ulceration. In this work, we analyzed risk factors for ulceration in 30 patients from the outpatient endocrinology clinic of the Federal University of State in Rio de Janeiro.
Methods: A questionnaire was applied evaluating the risk factors for ulceration, from March 2016 to July 2017, in 30 patients of both genders, varied ethnicity, socioeconomic level, with T2DM, followed by neurological examination of the feet and tibial brachial index.
Results: In the evaluated patients, 56.7% presented neuropathy, 46.6% had OPAD and the prevalence of retinopathy and nephropathy was 73.3 and 43.3% respectively. Additionally, 60% of patients had more than 10 years of illness; 73.3% were elderly; 13.3% had psychosocial factors, 46.7% had inadequate glycemic control, 36.7% were obese, 43.3% were dyslipidemic, 63.3% had hypertension, 60% used inadequate footwear, 37.5% had structural deformities, 63.3% had calluses and none has developed Charcot‘s osteoarthropathy. In our patients, 16.7% presented ulceration.
Conclusion: In the descriptive analysis of this casuistry, the data show that our results follow the prevalence of neuropathy, OPAD and ulceration in patients with T2DM, based on the current literature as well as other risk factors. We observed the need to establish an improvement in the glycemic control of these patients in order to prevent long-term micro and macrovascular complications in the case of neuropathy and ulceration, performing the screening annually through the neurological test of the feet followed by self-care guidelines in diabetic patients.
A159 Evaluation of socio-economic, clinical, and food frequency characteristics in relation to the control of patients with diabetes mellitus type 2
Wagner Gabriel Faustin Szeremeta, Gianna Carla Alberti Schrut, Ana Cláudia Garabeli Cavalli Kluthcovsky, Jefferson Matsuiti Okamoto, Matheo Augusto Morandi Stumpf
UEPG, Paraná, Brazil
Correspondence: Wagner Gabriel Faustin Szeremeta
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A159
Background: Type 2 diabetes mellitus is a disease of high prevalence and it is believed that changes in dietary patterns in the last decades may be associated with a large increase in the number of cases.
Objectives: To evaluate the socioeconomic, clinical and food frequency characteristics regarding the control of diabetes mellitus in patients attending a university hospital in the South of Brazil.
Methods: Descriptive cross-sectional and quantitative study. Socioeconomic and clinical data were collected and the Food Frequency Questionnaire was applied in 60 type 2 diabetic patients. Comparisons were made between the controlled (HbA1c ≤ 7%) and uncontrolled (HbA1c > 7%) patients, using the Chi square test and Fisher‘s Exact, with a significance level of 5%.
Results: Diagnosis time of 5 years or more (p < 0.01), insulin use (p < 0.001), frequent diet in foods rich in simple carbohydrates (p < 0.001), milk and derivatives (p < 0.01) and oils and fats (p < 0.001) were associated with worse glycemic control (HbA1c > 7%). Frequent diet in vegetables (p < 0.001), fruits (p < 0.001) and meat and eggs (p < 0.01) were associated with better glycemic control (HbA1c ≤ 7%).
A160 Evaluation of the frequency of diabetes mellitus and pre-diabetes in patients with acromegaly at diagnosis and evolution with treatment
Larissa Lima, Cintia Pereira de Souza, Mariana do Amaral Freitas, Fabiana Saldanha, Leandro Kasuki
Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
Correspondence: Larissa Lima
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A160
Introduction: Acromegaly results from increased production of growth hormone (GH) and insulin-like growth factor type I (IGF-I). Insulin resistance is one of the characteristics complications, and may result in glucose intolerance or diabetes mellitus (DM).
Objective: To identify the frequency of glycemic changes in patients with acromegaly followed in a reference service, as well as their evolution with the treatment of the pathology.
Methods: A review of medical records was carried out, and demographic, tumor and biochemical data were collected, as well as its evolution with the various forms of treatment. Numerical variables were compared using the Mann–Whitney test and categorical variables using the Chi square test.
Results: Thirty-five patients (69% women), with a median age at diagnosis of 42 years (2067) were included. Twenty-four of 29 tumors (83%) were macroadenomas. GH and IGF-I levels at diagnosis were 9.7 μg/L (1.1–80.0) and 721 ng/mL (321–1757), respectively. The glucose level at diagnosis was 109 mg/dL (82–597) and glycated hemoglobin (HbA1c) was 8.5% (6.0–10.0), with 10 patients (29%) diagnosed with DM and 8 patients (23%) with pre-DM. The frequency of DM at diagnosis was not different between genders (p = 0.440), between micro or macroadenomas (p = 0.616), nor among those with a positive family history for DM or not (p = 1.000). There was no difference in GH or IGF-I levels among patients diagnosed with DM or not at diagnosis (p = 0.075 and p = 0.357, respectively). The age at diagnosis was higher in patients with DM than in those without DM, with a tendency to statistical significance [50 years (24–67) and 38 years (20–63), respectively, p = 0.056]. The median follow-up of the patients was 60 months (1–303) and 29 patients (83%) underwent surgery. Treatment with somatostatin analogues was used in 27 patients (77%). The median glucose level at the last visit was 97 mg/dL (64–309) and there was a reduction of HbA1c to 6.1% (5.0–11.0). At the last visit, 11 patients (31%) had a diagnosis of DM and 10 patients (29%) of pre-DM, with treatment with oral antidiabetics (primarily metformin) in 47% and associated insulin in refractory cases, corresponding to 19% of the cases.
Conclusion: The frequency of glucose changes in acromegaly is already high at diagnosis. Treatment of acromegaly allows reduction of glucose levels.
A161 Evaluation of the glycemic profile of patients with melito type 1 diabetes in use of continuous insulin infusion system
Camila Gagliardi Walter, Daniele Iop de Oliveira Caldoncelli, Caio Villaça Carneiro, Martha Camillo Jordão, Ravena Machado Massucatto, João Henrique Del Grandi Spontão, Thaís Picelli Pescarolo, Ariane Cantarella, Alexandre Eduardo Franzin Vieira, Maria Teresa Verrone Quilici, Carla Sanchez Bergamin Rizetto
PUC-SP, São Paulo, Brazil
Correspondence: Camila Gagliardi Walter
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A161
Introduction: The objective of the treatment of mellitus type 1 diabetes (DM1) is to mimic the endogenous secretion of insulin by pancreatic β cells to maintain glycemic levels within normal limits, aiming at the disappearance of symptoms, improvement of quality of life and reduction of acute and chronic complications. The main advantages of continuous insulin infusion (SICI) therapy are: reduced glycemic variability, reduced episodes of hypoglycemia and a more flexible lifestyle.
Objective: To evaluate the treatment of DM1 patients in the use of SICI.
Methods: Retrospective evaluation of medical records of DM1 patients using SICI followed at the endocrinology outpatient clinic. Time of disease, anthropometric and lipid profile, presence of severe hypoglycemia and chronic complications were evaluated. In addition, mean levels of glycated hemoglobin (HbA1c) were obtained 1 year prior to SICI treatment and 6 months later.
Results: The charts of 8 patients, all female, age 31.6 ± 6.8 years, 75% eutrophic, duration of DM1 17.2 ± 7.9 years were analyzed. Seven of the eight patients had a carbohydrate count and were under intensive bolus-based regimen; only 1 had fixed doses of insulin. Indications for treatment with SICI were: presence of severe hypoglycemia and glycemic variability. The time of treatment with SICI was 2.9 ± 2.3 years. As for the chronic complications, only the patient with the longest duration of the disease (30 years) had nephropathy and proliferative diabetic retinopathy, remaining stable and controlled over the years. During the use of SICI, it also developed neuropathy. In the present study, 50% of the patients had severe hypoglycemia before treatment with SICI and there was resolution in 100% of the cases. Likewise, we observed an improvement in glycemic levels, mean HbA1c 1 year before SICI treatment was 8.1% (± 1.39) and after 6 months, 7.5% (± 0.75).
Conclusion: Our sample showed improvement in episodes of severe hypoglycemia concomitant to the improvement of glycemic control in DM1 patients in the use of SICI (Fig. 1).
A162 Evaluation of the impact of pregnancy on glycemic control after birth on type 1 diabetes patients
Julia Magarão Costa, Natalia Treistman, Camille Castro, Joana Dantas, Marcus Miranda, Melanie Rodacki, Lenita Zajdenverg
UFRJ, Rio de Janeiro, Brazil
Correspondence: Julia Magarão Costa
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A162
Introduction: Women with inadequately controlled diabetes before and during pregnancy are at high risk to develop perinatal complications. A strict glycemic control is advised before and during pregnancy in these patients. To achieve glycemic goals, a multiprofessional program is offered. The intensification of gestational treatment could lead to changes in the patient‘s attitude, with long term improvement in glycemic control and self health care.
Objective: To evaluate post-gestational glycemic control in type 1 DM (T1DM) patients in a tertiary hospital.
Methods: Retrospective records evaluation of 16 patients with T1DM that were pregnant between 2005 and 2016. The data collected was: anthropometric measurements, disease duration, number of pre-and post-pregnancy consultations, maternal–fetal complications and mean HbA1c in the year before gestation, on the first and second year after delivery. When there was no pre-gestational HbA1c available, it was considered HbA1c in the first trimester. Results are described as percentage and mean ± standard deviation. Statistical analysis was made through the SPSS 17.0 program, considering p < 0.05 as significant.
Results: The mean age of the patients was 25.43 years (± 4.59) and the mean time of T1DM was 12.75 years (± 6.7). 18.8% (n = 3) had at least one chronic complication of DM while 18.8% (n = 3) had more than one chronic complication. The mean number of consultations in the year prior to pregnancy was 3.25 (± 1.7), 1 year and 2 years after the pregnancy was 3.8 (± 1.2) and 2.09 (± 0.7), respectively. The mean HbA1c 1 year before pregnancy was 8.69% (± 2.03), 1 year later was 9.04% (± 2.03) and 2 years after was 9.09% (± 1.74), without correlation with age, time of diagnosis and number of consultations before or after pregnancy. Before pregnancy, 37.5% of the patients presented HbA1c < 7%, after 1 year 12.5% of patients had HbA1c < 7% and 2 years after gestation 0% of the patients presented HbA1c < 7% %, p = 0.007. Patients who had HbA1c < 7.0% before gestation presented better control 1 year later than those with HbA1c > 7.0% (HbA1c 7.24 ± 0.49 vs10.11 ± 1.77%, p = 0.01).
Conclusion: Although they participated in a multiprofessional program, the patients presented worsening of glycemic control in the 2 years postpartum, as already described in the literature. Patients with better glycemic control had better postpartum control. There is need to implement new strategies to ensure better glycemic control for T1DM women after pregnancy.
A163 Evaluation of the knowledge about glycemic self-monitoring in patients with type 2 diabetes mellitus accompanied in an outpatient clinic
Rosimeire Fernandes de Oliveira, Maria Eugênia Silva Hitchon, Agma Leozina Viana Souza, Jaqueline Almeida Guimarães Barbosa, Janice Sepúlveda Reis, Ricardo Barsaglini, Maria Regina Calsolari
Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Minas Gerais, Brazil
Correspondence: Rosimeire Fernandes de Oliveira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A163
Background: Self-monitoring of capillary glycemia is one of the pillars of the control of Diabetes Mellitus, being essential to help achieve goals and prevent complications.
Objective: To evaluate the knowledge of patients with type 2 diabetes mellitus (T2DM), insulin users, about practice of glycemic self-monitoring.
Methods: A crosssectional study was carried out with a calculated sample of 60 patients, representing a Diabetes Center in Belo Horizonte, MG, during the first consultation by a nursing team. Data on patient knowledge about lancet use, hygiene and digital puncture, frequency of glycemic performance and recording, glycemic goals and lancet discarding were evaluated in an instrument developed and completed by the researchers (Table 1).
Results: Most of the participants were female (63.3%), aged between 35 and 60 years (51.7%) and more than 10 years of diagnosis (56.6%), with complete primary education (60%), retired (53.3%) and family income of up to 1 minimum wage (51.7%). About handwashing, only 13.3% of the individuals performed the technique correctly, with subsequent drying. The item with the highest assertiveness in glycemic self-monitoring was the correct insertion of the test strip (98.3%), followed by the placement of enough blood in the strip (93.3%). It was observed that it was easy to prepare and arm the lancet, as well as to position it correctly on the finger (84.4%), but only 43.5% did the lancet‘s graduation correctly. It was verified that a minority registered the results obtained (25%) and only 6,7% knew their glycemic goals. The study showed that reuse of the lancet is a common practice among patients, with 27 (45%) participants reusing, performing an average of 3 daily punctures with the same lancet.
Conclusion: Errors in the daily practice of glycemic self-monitoring can impair and delay diabetes control. The continuing education of patients with T2DM and their relatives is of fundamental importance in the treatment, contributing to ensure the correct realization of the capillary glucose monitoring and the achievement of treatment goals (Fig. 1).
A164 Evaluation of the knowledge and skills on self-monitoring blood glucose in patients and caregivers of patients with diabetes mellitus type 1
Cristina Figueiredo Sampaio Façanha1, Gisele Ferreira Camara1, Gabriel Melo Ferraz Pessôa1, Joana Cysne Frota Vieira1, Igor Torres Dias1, Guilherme Leite Barboza Gonçalves1, Isabele Moreno de Alencar1, Kaik Brendon dos Santos Gomes1, Kenya Vitória de Aguiar Queiroz1, Isabele Fontenele de Santiago Campos1, João Augusto Lima Bisneto1, Iohanna Maria Ponte Costa1, George Sales de Arruda1, Carol Machado Ferrer1, Adriana Costa e Forti2
1Unichristus, Ceará, Brazil; 2Centro Integrado de Diabetes e Hipertensão do Ceará, Ceará, Brazil
Correspondence: Cristina Figueiredo Sampaio Façanha
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A164
Introduction: The intensive treatment of Type 1 Diabetes Mellitus aims to mimetize the physiological profile of insulin secretion to achieve good metabolic control, and for that, the blood glucose self-monitoring is known to be a fundamental procedure. In order to have the complete benefit of that, the patient needs to master the technique, be able to interpret the results and turn it into actions to adjust the treatment. Aware of the importance, the federal law nº: 11.347 was raised, in 2007, to regulate the availability of these supplies on public health care settings.
Objective: To evaluate the management and the degree of understanding about the monitoring of blood glucose in patients and caregivers of patients with DM1 attending at a secondary level of care health service.
Methods: A cross-sectional, descriptive study with a sample of Type 1 DM patients enrolled in the blood glucose monitoring program in a referral health care service in Ceará, Brazil, in the period of 2016 and 2017. The data was collected through a questionnaire answered on the outpatient visits during the study period.
Results: A sample of 95 patients, being 60.22% female, with the mean age of 17 years old were evaluated. 73% received free test strips from the health care system program. 93.33% monitor the blood glucose on a daily basis, those of which 42.86% do it three times a day. However, 46.51% don’t test postprandial glucose monitoring. 81.72% understands the meaning of the glycose mesurements, and 91.40% of these claimed to have the knowledge about the normal goal of the treatment. In this group, 80% answered within the adequate range for fasting blood glucose, while for the postprandial values, only 52.63% of the answers were on the correct range. The self-adjustment of insulin dose based on blood glucose were performed by 65.22% of the patients. The limited access for the test strips and supplies due to economic reasons or inadequate distribution was the main limiting factor of the method.
Conclusion: The study data suggest that the access to the method is still limited. The knowledge of this population about the treatment goals are reasonable, however, this does not translate on the attitude of self-adjustment of the treatment, which is even less than the expected. The adherence to postprandial glucose monitoring is low among this population, also it is shown little knowledge about the postprandial goals of the treatment. Our study has not yet evaluated the influence of this behaviour in metabolic control.
A165 Evaluation of the lipid profile of wistar rats treated with increasing doses of prednisone
Fabrícia Gonzaga Fernandes, Mariana Pirani Rocha Machado, Kléber Eduardo de Campos
Universidade Federal de Mato Grosso, Mato Grosso, Brazil
Correspondence: Fabrícia Gonzaga Fernandes
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A165
Background: Glucocorticoids (GCs) are a group of drugs with immunosuppressive and antiinflammatory action, its mechanism of action is related to the suppressing the release of proinflammatory cytokines. In addition, GCs may interfere with carbohydrate metabolism, by antagonizing various peripheral actions of insulin, and from this action, trigger changes in the biochemical profile, mainly regarding the lipid representation. The present study aimed to evaluate the dose–response influence of prednisone in the biochemical profile of rats. For this, 36 male Wistar rats were distributed in five groups: control (CONT) administered with vehicle (n = 6); treated with prednisone (PRED) at doses of 0.625 mg/kg (PRED 0.625; n = 7); 1.250 mg/kg (PRED 1.25; n = 8); (PRED 2.5, n = 7) and 5.000 mg/kg (PRED 5.0; n = 7). The treatment was daily with a duration of 21 days, with fasting glycemic measures being evaluated in the first (zero) and last day (21). Then the rats were anesthetized and killed by decapitation, in order to collect the whole blood for serum biochemical analysis by spectrophotometry. All data were statistically evaluated with significance of 5%.
Results: In the measurement of glucose during treatment, a drop in blood glucose was observed on day 21 of treatment compared to day 0 only in the PRED 2.5 group (78.0 ± 3.9 vs. 93.5 ± 7.0 mg/dL). Regarding serum biochemical values at the end of treatment, the lipid levels decreased at high treatment doses group (PRED 2.5 and PRED 5.0 groups) related to the control, both for the levels of triglycerides: PRED 2.5 = 80.0 ± 29.7 mg/dL; PRED 5.0 = 76.0 ± 36.2 vs. CONT = 144.1 ± 39.6, as Very Low Density Lipoproteins, VLDL: PRED 2.5 = 16.0 ± 5.9 mg/dL; PRED 5.0 = 15.2 ± 7.2 vs. CONT = 22.8 ± 7.9; and also in High Density Lipoproteins, HDL: PRED 2.5 = 21.3 ± 7.3 mg/dL; PRED 5.0 = 23.8 ± 4.2 vs. CONT = 53.0 ± 7.7. Moreover, an increase of the enzyme alanine aminotransferase (ALT) was observed in the PRED group 1.25 (79.0 ± 25.1 U/L) compared to the control group (68.6 ± 24.8 U/L).
Conclusions: Even with no glycemic elevation due to the treatment of prednisone, the groups of higher doses (2.5 and 5.0 mg/kg) suggest a lipolysis action, promoting a decrease in triglyceride levels, VLDL and low levels of HDL. Therefore, it was concluded that high doses should be used with caution, because they can cause atherogenic particle accumulation, and metabolic acidosis due to the degradation of cholesterol.
Ethics approval: The study was approved by the Ethics Committee on Animal Research, approval number 23108.045215/2014-39.
A166 Evaluation of the nutritional status of a patient undergoing hemodialysis treatment submitted to a bariatric surgery: case report
Cristiane Fernandes Bettim, Vanessa Ceccatto, Marilia Rizzon Zaparolli
Uniandrade, Ceará, Brazil
Correspondence: Cristiane Fernandes Bettim
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A166
Case presentation Female patient, 49 year-old, obese, sedentary, hypertensive, with chronic kidney disease on hemodialysis, without family history of chronic kidney disease and obesity. After 10 months of hemodialysis he underwent vertical gastrectomy weighting 110 kg, BMI (body mass index) of 43 kg/m2, clinical examination performed in the clinic before the surgery indicated conscious, oriented, anicteric, afebrile, 110 × 70 mmHg arterial pressure. It was in use of 9 tablets a day of sevelamer phosphate chelator. On the third day after bariatric surgery, the patient returned to the hemodialysis treatment, obtaining weight reduction according to weight changes chart and BMI (graph 01) after bariatric surgery. Graph 01: Weighting changes and BMI after bariatric surgery in a patient on hemodialysis treatment. Patient followed restricted liquid diet for 15 days with good acceptance, making use of two food supplements, being an hypercaloric and hyperproteic and another hyperproteic. In the pasty diet followed it was used only the hypercaloric and hyperproteic supplement. After a year and 2 months, the patient follows a diet that varies from 817 to 848 kcal according to a 24-h reminder in dialysis days and non-dialysis days, considering the energetic value of the supplement. It follows with good food acceptance. Table 1: The micronutrients were calculated through a 24-h reminder performed in November 2016, 9 months after bariatric surgery, in that same reminder was considered the food supplement and also the polyvitamin/polimineral supplement administered in 3-month intervals.
Discussion: With the decrease of the patient weight, it achieved a slight improvement in the metabolic profile, reached a BMI of 33 kg/m2, obtained a percentage of weight loss (% PWL) of 23%, the weight lost was 25 kg, the percentage of weight excess (% PWE) was 17%, which increases the chance of the patient performing renal transplantation, previously denied by overweight. Micronutrient ingestion is mostly adequate, with the use of dietary supplement and polyvitamin/poliminerals it was possible to reach the recommendations for patients on hemodialysis and DRIS. The chelator was reduced to 1 tablet daily.
Conclusion: With this study it is possible to conclude that nutritional monitoring is of high relevance for this patient to reach the adequate macronutrients and micronutrients supply, according to the needs presented during the treatment. The monitoring of nutrient ingested is essential for the health and success of the treatment. Informed consent to publish had been obtained from the patient. (Fig. 1)
A167 Evaluation of the plantar sensibility of persons with diabetes mellitus before and after the implementation of educative intervention
Lidiane Aparecida Monteiro1, João Batista Moreira2, Viviane Graciele da Silva2, Eliene Souza Muro2, Ana Emilia Pace1, Denise Hollanda Iunes2, Erika de Cassia Lopes Chaves2
1USP, São Paulo, Brazil; 2UNIFAL, Minas Gerais, Brazil
Correspondence: Lidiane Aparecida Monteiro
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A167
Background: Plantar sensibility is an indicator to be investigated in the person with Diabetes Mellitus (DM), as soon as the injury of the peripheric nerve turns in the reduction or total loss of the protective sensibility of the cloths, making the vulnerable person to the injuries appearance and, consequently, to amputations of inferior members . Treatment of the consequences of the neuropatia for the feet, specifically, for the sensibility deficit, includes the education in health, the cares with the feet and the use of appropriate shoes. Purpose of the study to value the plantar sensibility of persons with DM before and after the educative intervention.
Methodology: Quantitative, descriptive study of the type daily pay and powders-interventions, developed in an Strategy of Health of the Family. Sample was composed by 35 persons above 18 years and I diagnose of DM more than 5 years ago. An instrument was applied for characterization and the plantar sensibility valued through the Monofilament of 10 g of Semmes–Weinstein and Score of Symptoms Neuropáticos. Sensibility was valued before and after eight fortnightly home meetings, which had the intention of teaching cares with the feet. Collected data were tabulated in an electronic spreadsheet of the program Excel 2007 and validated, being subsequently analysed by the program Statistical Package for the Social Sciences 21.0. Descriptive statistic was carried out for the characterization sociodemográfica and to analyse the results daily pay and powders-interventions, Anova was used with measures repeated with interest in the interaction. Project was approved by Institutution‘s Ethics Board of the Federal University of Alfenas, number 20376013.2.0000.5142.
Results: 64.2% of the volunteers was women, with low level of schooling and familiar income; 80% reported what had never the evaluated feet and in the same proportion, they were never orientated on the cares with the feet. Regarding the plantar sensibility valued through the Monofilament of 10 g and of ESN, the volunteers presented scores of 7.05 points in the first evaluation and 7.80 after the educative intervention, representing significant statistical improvement in the protective sensibility of the feet (p < 0.001).
Conclusion: Educative intervention based in the autocare with the feet contributed to the improvement of the plantar sensibility of the persons with DM, which can be made a list to the directions on the use of appropriate shoes that do not hold tight the feet, use of new shoes you punish 2 h in a day and of stockings without elastic or the change of the volunteers in the behavior and attentive glance for the feet during the evaluations.
A168 Evaluation of the profile of circulating micrornas in individuals with recent type 1 diabetes and healthy controls
Aritania Sousa Santos1, Edecio Cunha Neto2, Rosa Tsucheniro Fukui3, Nelson Vinicius Gonfinetti 4, Ludmila Rodrigues Pinto Ferreira5, Maria Elizabeth Rossi da Silva6
1FMUSP-USP, São Paulo, Brazil; 2Lab Immunology, Heart Institute (Incor)/Instituto de Investigação em Imunologia-iii/INCT, São Paulo, Brazil; 3FMUSP USP, São Paulo, Brazil; 4FMUSP, São Paulo, Brazil; 5Lab. Immunology, Heart Institute (InCor), São Paulo, Brazil; 6Professor Colaborador da FMUSP Responsável pelo Laboratório de Investigação Médica LIM-18 da FMUSP, São Paulo, Brazil
Correspondence: Aritania Sousa Santos
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A168
Type 1 Diabetes (T1D) is a heterogeneous disease resulted from numerous mechanisms that lead to chronic hyperglycemia. Genetic and environmental factors act on the pathophysiology of diabetes, but the molecular and cellular mechanisms underlying the disease are not fully understood, probably reflecting different genetic background and environmental triggering factors. Recently, a new mechanism of post-transcriptional regulation of genes, performed by small RNAs of 21–25 nucleotides called microRNAs (miRNAs), has favored the understanding of various biological processes and diseases. The objective of this study was to evaluate the influence of miRNAs on the pathophysiology of T1D.
Methods: The profile of 384 circulating microRNAs from 37 recent-onset T1D patients up to 6 months (17F/20 M), aged 12.89 ± 6.53 years, HbA1c levels of 7.8 ± 2.0% who tested positive for islet autoantibodies, was compared with those of 30 healthy controls (18F/12M), aged 16.28 ± 6.28, HbA1c of 5.4 ± 5.0%. The groups were paired for gender and age. Serum/Plasma kit- Qiagen was used for serum RNA extraction. Real-time PCR was performed in QuantStudio 12K equipment- Applied Biosystems TaqMan Low Density Array.
Results: Four serum miRNAs were upregulated in recent-onset T1D patients: hsa-miR-101 (3.9x; p = 0.04), hsa-miR-203 (2.3x; p = 0.04) and hsa-miR-21 (2.3x; p = 0.02), related to inflammation, apoptosis of beta cells and inhibition of insulin secretion, and hsa-miR-874(2.6x; p = 0.02), suppressor of angiogenesis. Two miRNAs were down-regulated in T1D: has-miR-125a-5p (0.5x; p = 0.04) and hsa-miR-191(0.5x; p = 0.04), both related to the control of immune response. The data suggests that circulating miRNAs can mirror T1D physiopathology, signaling inflammation, destruction and altered metabolism. Supported by São Paulo Research Foundation (FAPESP).
A169 Evaluation of the profile of patients with diabetic neuropathy at a public reference center
Karen Viviana Ivasiuten Gorejko, Janaina Petenuci, Davi Francisco Machado, Andressa Martins de Oliveira, Lucia Henriques Alves da Silva, Rosane Kupfer
Instituto Estadual de Diabetes y Endocrinologia Luiz Capriglione, Rio de Janeiro, Brazil
Correspondence: Karen Viviana Ivasiuten Gorejko
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A169
Introduction: Diabetic Neuropathy is a chronic microvascular complication defined as signs and/or symptoms of peripheral nerve dysfunction in individuals with Diabetes Mellitus (DM) after exclusion of differential causes. It is known that this condition is related to the risk of ulcerations and amputations at lower limbs. Furthermore, a significant portion of health spending on this population is due to foot complications. Preventive care and early treatment are essential, therefore specialized DM care centers should know about patients profile and look forward to appropriate support services to change this unfavorable scenario.
Objective: The objective of this study was to analyze the profile of patients with Diabetic Neuropathy treated at the State Institute of Diabetes and Endocrinology Luiz Capriglione (IEDE)/RJ.
Methodology: 257 patients referred to the support clinic in Diabetic Neuropathy were evaluated. Clinical and laboratory data were collected from medical records. The scales used were neuropathic symptom score (NSS) and neuropathic disability score (NDS).
Results: In the present study, we found a prevalence of ND of 8.2% in type 1 DM and 86% in type 2 DM, medium age of 58.7 years (but patients with type 1 DM were younger, p = 0.05), predominance of females (74.7%), time of diagnosis of DM greater than 15 years, with mean glycated hemoglobin (A1c) of 8.18%, and most of them had comorbidities (obesity, hypertension arterial and chronic kidney disease). Regarding the symptoms and signs, they presented NSS classified as moderate and NDS classified as mild. There were no significant differences related to the type of DM. Diabetic retinopathy was present at 64.2% of the patients. A prevalence of approximately 2% of signs and symptoms of Diabetic Neuropathy was detected in prediabetes patients.
Conclusions: Related to this population, the diagnosis of diabetic neuropathy was made only when the symptoms and signs were present after a long time of diagnosis of DM and the presence of risk factors previously described in the literature (hypertension, obesity, elevated HgA1c, duration of DM) as aggravating factors. Thus, reference centers must elaborate urgent preventive measures at a multidisciplinary form to provide education of the population and early detection and treatment of this complication with consequent reduction of unfavorable outcomes (Fig. 1).
A170 Evaluation of the use of injectables in type 1 diabetics followed in reference ambulatory
Priscila Macêdo Fernandes, Luana pontes Vasconcelos, Lívia Vasconcelos Martins, Lia Cavalcante Aragão, Milena Silva Sousa, Luciana Felipe Férrer Aragão, Virgínia Oliveira Fernandes, Ana Paula Dias Rangel Montenegro, Renan Magalhães Montenegro Junior, Annelise Barreto de Carvalho, Cláudio Artico Baptista, Priscila Isadora Scardovelli, Vinícius Batalini Rodrigues
UFC, Ceará, Brazil
Correspondence: Priscila Macêdo Fernandes
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A170
Introduction: Diabetes education is part of the integral care of the patient, interactively involving the affected individual and the educator. Patients systematically followed by a multiprofessional team have a better prognosis of the disease.
Objective: To evaluate the characteristics of diabetic patients, as well as their technique of injection.
Methods: A questionnaire was applied to patients with type 1 diabetes mellitus (DM1) and their caregivers. Numerical variables were described using mean; the categorical variables, absolute value and percentage. For a verification of associations, the Spearman correlation coefficient, Pearson‘s Chi square test and Kruskal–Wallis test were used.
Results: 105 patients, 3.8% infants, 11.5% pre-school children, 26.9% schoolchildren, 54.8% adolescents and 22.9% adults were evaluated; with a predominance of males (56.3%). The age at diagnosis of DM1 was 7.8 years and disease time was 3.4 years. A mean of glycosylated hemoglobin was 8.7% with a positive correlation to disease time (p = 0.029). A total insulin dose was 0.93 IU/kg/day, being 0.53 IU/kg/day (56.98%) in basal form. Slow-acting insulin analogues were used in 68% of the individuals, with an ultrafast action in 70.9%, NPH in 32% and regular in 29.1%. There was a higher total insulin and bolus dose in the adolescents, as well as lower dose not pre-school group (p = 0.006 and p = 0.013, respectively). Form of application: pen (65.4%), syringe (28.8%) and pump insulin (1.9%). The self-application of insulin in 50.5% of cases over 5 years, with a predominance of application 10 min before meals. A mean reuse of the needle for application of 8.13 times, being more frequent in adolescents (p = 0.021). Most used needle: 4 mm (42.2%). The injectables were discarded in the Health Units in 65% of the cases. The gluteal region was a less used version for medication (49.5%), with only 31.4% rotating in all muscle groups. While a lipohypertrophy (LH) was diagnosed by the physician in 46% of the patients, only 35.2% of them reported their presence. LH showed no correlation with type of basal insulin (p = 0.412) or bolus (p = 0.366).
Conclusion: There is still a lack of education about the use of injectables in diabetic patients. The educational process allows for injectable and improved practices, thus allowing better outcomes for the patient‘s health.
A171 Factors associated to reduced bone mineral density in type 2 diabetes mellitus
Fernanda Nascimento Faro, Érika Bezerra Parente, Mônica de Aguiar Medeiros, Mariana Mazeu Barbosa de Oliveira, Marília Tomiyoshi Asato, João Eduardo Nunes Salles
ISCMSP, São Paulo, Brazil
Correspondence: Fernanda Nascimento Faro
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A171
Introduction: Type 2 Diabetes Mellitus (T2DM) is associated with increased fracture risk besides higher Bone Mineral Density (BMD), compared to non-diabetic controls. Factors influencing fracture risk are well established in literature, however studies on BMD have shown contradictory results.
Objective: Evaluate risk factors for BMD variation and fractures in T2DM.
Methods: This cross-sectional study included patients with T2DM with lumbar and femoral BMD measurement by dual energy X-ray absorptiometry. Data was collected from medical records from July 2016 to June 2017. SPSS 13.0 was used for statistical analysis.
Results: 138 patients, 87% female, 64 ± 8.36 years, 67.2% overweight, 78.3% hypertension, 82.6% dyslipidemia and 97.3% were menopause women (84.8% without hormone therapy replacement). Duration of diabetes was 16 ± 10.09 years, 71.7% were using insulin, 26.1% with macrovascular complications (15.2% heart attack, 9.4% stroke and 11.6% peripheral artery disease) and 72.5% with microvascular complications (45.9% retinopathy, 51.4% neuropathy and 36.6% albuminuria). Mean glycated hemoglobin (HbA1c) was 7.7% ± 1.53. Osteopenia was present in 38.4% and osteoporosis in 24.6%. Only 8 (5.8%) presented clinical fracture, of which 7 had visual impairment and 1 was submitted to bariatric surgery. BMD and fracture risk had no correlation to HbA1c. BMD was inversely correlated to age (femoral neck e total hip), duration of the diabetes (three sites), fracture risk (three sites), microvascular complications (lumbar e femoral neck), albuminuria (femoral neck), neuropathy (lumbar). Higher BMD was correlated to male gender (lumbar) and higher BMI, Body Mass Index, (three sites). Fracture was positively correlated to duration of the diabetes (three sites) and insulin therapy (three sites), and negatively with albuminuria (three sites).
Conclusion: The prevalence of fractures in our population was lower than the literature and not correlated to A1c levels. Underdiagnosis of spine fractures might have contributed to this result. On the other hand, we observed negative correlation between microvascular complications and BMD that could be explained by the negative influence of diabetic microangiopathy on bone metabolism. The inversely correlation between fracture and albuminuria remains unclear, while the positively correlation of higher BMI and male gender is in accordance with previous data (Figs. 1, 2, 3).
A172 Familial hypobetalipoproteinemia: a case report
Amanda Vasconcelos Freitas, Akemy Allyne Menezes Barreto de Carvalho, Maria Cecília Martins Costa, Karlos Italo Souza Viana, Wladia Gomes de Paula, Tânia Maria Bulcão Lousada Ferraz
HGF, Fortaleza, Brazil
Correspondence: Amanda Vasconcelos Freitas
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A172
Abstract Patient, 19 years old, male, previously accompanied in a hospital of neurological rehabilitation by spastic paraparesis, equine tail syndrome and cognitive dysfunction. Spastic paraparesis was diagnosed after birth. The patient was referred to the Endocrinology Service of the General Hospital of Fortaleza for presenting hypocholesterolemia. As a clinical complaint, he had only reduced visual acuity. He denied diarrhea. Family history of unknown hypocholesterolemia. In view of the previous history of neurological pathology and hypocholesterolemia, the hypothesis of Familial Hipobetalipoproteinemia was raised. Diagnostic screening tests showed total cholesterol: 65 mg/dL, HDL: 40 mg/dL, LDL: 19.2 mg/dL and triglycerides: 29 mg/dL. Apolipoprotein B was below the reference value (50 mg/dL). Other tests such as vitamin D3, TSH, free T4, INR were normal. The patient underwent ophthalmologic evaluation with Optical Coherence Tomography (OCT), which detected hyperreflective points in layers of nerve fibers, suggesting lipid accumulation. Hipobetalipoproteinemia is a rare group of genetic diseases, with clinical manifestations initiated in childhood. In its homozygous form, the patient may present neurological and ophthalmological alterations, as well as diarrhea and acanthocytosis. In its heterozygous form, it may be asymptomatic. Early diagnosis and treatment with vitamin replacement is essential for the adequate development of the patient. The present case is relevant because of its rarity and to illustrate the possible consequences of a late diagnosis.
Informed consent to publish had been obtained from the patient.
A173 Feet reflexology in diabetic patients
Ana Raphaela Simoes1, Beatriz Bertolaccini Martinez1, Machado, Guilherme1, Martínez, Gabriela2, Schwart, Aline3, Silva, Adriana3
1Universidade do Vale do Sapucaí, Minas Gerais, Brazil; 2Department of Medicine, Centro Universitário das Faculdades Associadas de Ensino, São João da Boa Vista, São Paulo, Brazil; 3Department of Physiotherapy, Universidade do Vale do Sapucaí, Pouso Alegre, Minas Gerais, Brazil
Correspondence: Ana Raphaela Simoes
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A173
Background: The chronic nature of diabetes mellitus (DM) and the complexity of its treatment interfere with the patient‘s quality of life (QOL). Reflexology is one of the most popular complementary therapies in the world. It is a systematic practice in which applying some pressure to any particular points on the feet gives impacts on the health of related parts of the body.
Objectives: To evaluate the effects of feet reflexology on the quality of life of diabetic patients.
Methods: Randomized, controlled and single-blind clinical trial performed at a diabetes educational center, in Brazil. 68 subjects, diagnosed with type 2 DM and aged 18 years or more was selected for recruitment in the trial. The details of the study subjects’recruitment procedure are presented in a consorted flow diagram as shown below (Fig. 1). Reflexology is a systematic practice in which applying some pressure to any particular points on the feet impacts the health. According to the reflex theory, organs, glands and other parts of the body are linked to specific points on hands and feet (Fig. 1). For assessment of functional capacity the instruments for QOL (SF-36), and the Stanford Health Assessment Questionnaire Disability Index (HAQ-DI) were applied, before starting reflexology therapy and after 4 consecutive weeks. This research was conducted in accordance with the ethical recommendations of the Declaration of Helsinki. Conclusion Feet reflexology has improved the quality of life of diabetic patients, in functional capacity, role-physical, pain, role emotional aspects (Figs. 2, 3).
A174 Flash glucose monitoring system use on type 1 diabetes patients attending a public health system diabetes reference center at Belo Horizonte, Minas Gerais
Luciana Valadares Ferreira, Agma Leozina Viana Souza, Rosimeire Fernandes de Oliveira, Maria Eugênia Silva Hitchon, Alexandre Henrique da Silva, Alessandra de Cássia Lovato, Débora Bohnen Guimarães, Marina Moreno Wardi, Sônia Maria do Carmo Maulais, Paula Lamego Lourenço, Karima Fernanda Rosa Simão, Aleida Nazareth Soares, Janice Sepúlveda Reis
Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Minas Gerais, Brazil
Correspondence: Luciana Valadares Ferreira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A174
Background: Type 1 diabetes intensive treatment reduces complications risk and self-monitoring is essential to reach the goals. The flash glucose monitoring system (FGMS) consists of a subcutaneous sensor placed on the arm, which measures interstitial fluid’s glucose in real time by a reader which displays current and historical glucose levels and glucose trends, with good accuracy and no need of capillary blood glucose sample for calibration. FGMS’s use by public health system patients is surrounded by discussions about cost-effectiveness.
Objective: To evaluate FGMS’s use on patients attending a public health system type 1 diabetes reference center at Belo Horizonte.
Methods: Patients 13 years old or more, on self-monitoring practice without help and hemoglobin A1c (A1c) above 7.5% were invited. The sensor was placed during the visit and instructions about the use were given. After 14 days data was downloaded and doses adjustments were made.300 blood glucose test strips were provided and patients were instructed to perform daily 3 extra blood glucose tests beyond those usually performed. New evaluation was made after 3 months. The study was approved by Santa Casa of Belo Horizonte’s Ethics Board, approval 1.064.985 and written consent was obtained from participants.
Results: 15 patients joined the study, with mean age 30.3 ± 14.14 (16–55) years, 40% females, mean time of T1DM diagnosis of 10.47 ± 5.93 (2–26) years and education level of 93,7% attending up to high school (26.7% attending up to elementary school). There were 4 problem situations with the sensor (2 detachments, 1 early interruption of the operation and 1 skin reaction). Mean number of daily scans was 16.33 ± 11.43 (5–44), with a positive correlation with age (r2 = 0.538, p 0.038), percentage of measures within the glycemic target (r2 = 0.661, p 0.007) and negative with percentage of measures above the glycemic target (r2 = − 0.545, p 0.035), A1c prediction of the sensor (r2 = − 0.543, p0.037) and A1c after 3 months (r2 = − 0.656, p0.008). There was no correlation between education level and number of scans or intercurrences. There was no significant difference in A1c before [8.39 ± 0.86% (7.5–10.3)] and after 3 months [8.01 ± 1.17% (5.8–10.1)]. 20% of patients reached A1c ≤ 7%.
Conclusion: It is possible to use FGMS at brazilian public health system, even on low education level patients, with good acceptance and favoring treatment goals, related to the highest number of measured glucose levels.
A175 Flatbush diabetes—a case report
Anna Catarina Gatzk de Arruda, Manuel Victor Silva Inácio, Maisa Monsseff Rodrigues da Silva, Bruna Gheller, Ubirajara Cunha Aguiar, Mayara Volpi e Silva, Lérida Russi Garcia, Giovana Outuki, Guilherme Figueiredo Marquezine, Alexandre José Faria Carrilho
Universidade Estadual de Londrina, Paraná, Brazil
Correspondence: Anna Catarina Gatzk de Arruda
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A175
Case report: A 31-year-old African-Brazilian man was admitted to hospital reporting abdominal pain associated to vomiting, polyuria and polydipsia 3 days ago, and weight loss. The patient had no previous medical history and was not under medications. He had family history (FH) of type 2 Diabetes Mellitus (T2DM). At presentation, he had acanthosis nigricans in cervical/axillary regions, BMI = 46 kg/m2, was dehydrated and tachypneic, but no fever. Laboratory tests demonstrated blood glucose 690 mg/dL, severe diabetic ketoacidosis (DKA)—pH 7.0, HCO3 2.5 mEq/L, lactate 1.4 mmol/L and ketonuria. Once the DKA protocol was initiated, the patient’s pH level normalized within 24 h. Furthermore, the patient had glycated hemoglobin (HbA1c) 12.2%, low C-peptide level (1.7 ng/mL) and negative autoantibodies (AA)—anti-GAD, anti-insulin, anti-islet cell and anti-protein tyrosine phosphatase. After the acute phase, the patient was treated with metformin, basalbolus insulin therapy and received hospital discharge at the 5th day. Short-acting (regular) insulin was suspended in the end of the first month and maintained NPH insulin plus pioglitazone and metformin. After the second month, his fasting glycemia was 94 mg/dL and HbA1c 7.1%. At this time, NPH insulin was suspended and the patient was managed with only oral anti-diabetic agents.
Discussion: Idiopathic type 1 diabetes (T1DM), Flatbush and “Ketosis-prone” T2DM are denominations for a rare form of Diabetes Mellitus (DM) due to transitory pancreatic failure. It is characterized by DKA, absence of AA and low C-peptide levels. The pathogenesis remains unknown, but the suggested mechanisms are glyco and lipotoxicity, which affect the beta cells (BC) insulin secretion but, after the DKA treatment, lead to BC function recovery. This form of DM typically occurs among obese men at 40 years old with FH of T2DM. The treatment proceeds with reduction of insulin intake, resulting, in most cases, with its suspension. Final Considerations: This case illustrates a rare form of DM that, nevertheless, has been more frequently described. We reported an African–Brazilian patient with class III obesity and insulin resistance signs that was diagnosed with DKA and had absence of AA and low C-peptide levels. There was a good response to insulin sensitizers, and the insulin administration was suspended in the following months. The natural course of Flatbush diabetes is atypical, which makes its identification important in order to introduce an adequate management.
Informed consent to publish had been obtained from the patient.
A176 Follow-up of patients submitted to bariatric surgery in the university hospital of the federal university of Santa Catarina: clinical, laboratorial and socioeconomic profile
Manuella De Lucca Michels, Taís Ferreira Vilela, Fabíola Branco Filippin Monteiro, Liliete Canes Souza Cordeiro, Marisa Helena Cesar Coral, Alexandre Hohl, Marcelo Fernando Ronsoni, Simone van de Sande-Lee, Beatriz Marquardt Leite, Priscila Nobre Dantas Mattje, Camila Sartor Spivakoski
UFSC, Santa Catarina, Brazil
Correspondence: Manuella De Lucca Michels
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A176
The weight gain is a challange to the public health and researches have shown that it can be more common in some social groups. Obesity can present with chronic diseases and it is risk fator for vitamin D insufficiency/deficiency. Although bariatric surgery is an effective treatment for weight loss, it may aggravate a vitamin D insufficiency/deficiency already present in the preoperative period. In this prospective longitudinal descriptive study, socioeconomic, clinical and laboratory data of patients undergoing bariatric surgery at the University Hospital of the Federal University of Santa Catarina were described and analyzed, from the preoperative period until the 6th postoperative month. The quantitative variables were described in mean ± standard deviation, and the differences analyzed by the t student test for paired samples. The majority of the participants were female (88.1%) and those with the highest weight loss were in the 35–44 age group, family income per capita ≥ ½ and < 1 minimum wage, and incomplete or complete elementary education. A statistically significant decrease in body mass index was observed (49.0 ± 6.6 vs. 35.8 ± 5.5 kg/m2, n = 40, p < 0.0001); and an improvement in fasting blood glucose, triglycerides and high density lipoprotein cholesterol levels (p < 0.05). There was a decrease in the prevalence of hypertension, dyslipidemia and type 2 diabetes mellitus. There was also a high prevalence of vitamin D deficiency/insufficiency in all periods, but low use of cholecalciferol.
A177 Frequency of hypoglycemia and diabetes treatment satisfaction in adults with type 1 diabetes in use of long-acting insulin analogues
Gabriela Berlanda1, Gabriela H. Telo1, Barbara Corrêa Krug2, Rafael Scheffel1, Bruna Pasinato1, Fernando Iorra1, Beatriz D‘Agord Schaan1
1UFRGS, Rio Grande do Sul, Brazil; 2SES-RS, Rio Grande do Sul, Brazil
Correspondence: Gabriela Berlanda
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A177
Introduction: Strict glycemic control with multiple daily insulin injections is the focus of treatment for type 1 diabetes (T1D), but it is usually associated with an increase in the number of hypoglycemia episodes. Although long-acting insulin analogues have pharmacological properties to mimic physiologic insulin profile, literature is not unanimous in showing this effect in comparison to human insulin. In Brazil, only some states, including Rio Grande do Sul (RS), provide insulin analogues for T1D patients.
Objective: To evaluate the frequency of hypoglycemia and treatment satisfaction in patients with T1D using long-acting insulin analogues.
Methods: In this cross-sectional study, sample was calculated to represent 1382 T1D adults in 20 cities of RS who receive insulin analogues by the state. Demographics and clinical data were evaluated by a self-administered questionnaire. Satisfaction was assessed through the Satisfaction with Diabetes Treatment Questionnaire (DTSQs), a 6-item survey in which scores range from 0 to 36 (higher scores = greater satisfaction). The General Health Questionnaire (GHQ-12) was used to evaluate common mental disorders (CMD), which encompasses anxiety, depression and psychosomatic symptoms. A score ≥ 3 was used as a positive screening for CMD. Two groups were compared, according to the insulin regimen: long-acting + ultra-rapid acting insulin analogue (LUR) and NPH insulin + ultra-rapid acting insulin analogue (NUR).
Results: A total of 280 T1D patients were included, 230 on LUR (82.1%) and 50 on NUR (17.9%). Overall, the mean age was 40.4 ± 15.7 years, 51.4% were women and 90.3% were Caucasian. In a one-month period, no differences were observed between LUR and NUR groups regarding > 4 episodes of hypoglycemia (27.4% vs. 33.3%, p = 0.53), nocturnal hypoglycemia (28.2% vs. 30.9%, p = 0.72) and severe hypoglycemia requiring help of third parties (18.1% vs. 25.6%, p = 0.25), respectively. LUR patients presented a higher percentage of blood glucose monitoring measurements (≥ 4 tests/week) when compared to patients with NUR (99.6% vs. 88.9%, p < 0.001). The mean DTSQs score (31.9 ± 7.3 vs. 30.3 ± 5.2, p = 0.07) and the mean GHQ-12 score (4.7 ± 2.4 vs.4.6 ± 2.5, p = 0.80) were not different between LUR and NUR patients.
Conclusions: The use of long-acting insulin analogues did not add satisfaction or hypoglycemia episodes reduction when compared to NPH insulin in adults with T1D already in use of ultra-rapid acting insulin analogues. Support: FIPE-HCPA.
A178 Gastrointestinal gcg gene expression encoding glp-1 plasma concentrations in obese patients after roux in y gastric bypass (RYGB) may be associated with postoperative remission of type 2 diabetes mellitus (T2DM)
Danielle Cristina Fonseca, Priscila Sala, Raquel Susana Matos de Miranda Torrinhas, Natasha Mendonça Machado, Robson Kiyoshi Ishida, Marco Aurélio Santo, Eduardo Guimarães Hourneaux de Moura, Paulo Sakai, Ismael Francisco Mota Siqueira Guarda, Dan Linetzky Waitzberg
FMUSP, São Paulo, Brazil
Correspondence: Danielle Cristina Fonseca
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A178
Background: The prevalence of type 2 diabetes mellitus (T2DM) increases in parallel with obesity. After RYGB, obese patients with T2DM have improvement or reversal of hyperglycemia before significant weight loss. Postoperative anatomical changes in the gastrointestinal tract (GIT) may influence the gene expression of GIT tissues and their production of hormones involved in glycemic homeostasis, such as glucagon-like peptide 1 (GLP-1).
Objective: To correlate the gastrointestinal expression of GCG gene and GLP-1 plasma levels with markers of glycemic homeostasis in obese patients with or without complete remission of T2DM after 3 months of RYGB.
Methods: Gastrointestinal biopsies were obtained from 20 obese patients with T2DM before and after 3 months of RYGB and submitted to global and target transcriptomic analysis, by microarray and RT-qPCR techniques, respectively. GLP-1 and markers of glycemic homeostasis were measured in blood, collected fasting and after food testing, before and after 3 months of RYGB. After 1 year of RYGB, patients were classified as responsive (R) and nonresponsive (NR) to total remission of T2DM. Statistical analysis was performed by non-parametric tests. Area under the curve (AUC) was calculated by trapezoidal rule, correlation analyzes were performed by Spearman test and association between R and NR groups was performed by Mann–Whitney.
Results: After RYGB, there was a significant increase in GCG gene expression in all segments maintained on GIT (Table 1) in parallel to increase in plasma concentration after meal test (graph 1) < 0.05. GLP-1 AUC showed significant increase only in R patients after 3 months of RYGB. There was a significant inverse correlation between systemic concentrations of GLP-1 and HbA1c (Person = -0.581, p = 0.018).
Conclusion: Increased GLP-1 after RYGB occurred in parallel with increase in gastrointestinal transcription and was inversely correlated with postoperative remission of T2DM in obese women (Fig. 1).
A179 Glucocorticoid sensitivity might underlie metabolic abnormalities in patients with familial partial lipodystrophy type 2
Ana Teresa Prata Resende, Clarissa Silva Martins, Ana Carolina Bueno, Maria Cristina Foss-Freitas, Margaret de Castro
Universidade de São Paulo/USP, São Paulo, Brazil
Correspondence: Ana Teresa Prata Resende
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A179
Background: Familial partial lipodystrophy type 2 (FPLD2) is characterized by insulin resistance, adipose atrophy from the extremities, and truncal obesity. Due to the resemblance with Cushing’s syndrome, we hypothesized a glucocorticoid (GC) role in the pathogenesis of the metabolic abnormalities in FPLD2.
Objective and design: This prospective study, conducted at the Ribeirao Preto Medical School University Hospital, aimed to evaluate the phenotypic heterogeneity and GC sensitivity in 24 FPLD2 patients exhibiting LMNA mutations (p.R482W and p.R644C) and 24 matched controls.
Main outcome measures: Participants underwent anthropometric, body composition, metabolic profile, and adipokines and cytokines measurements. Plasma and salivary cortisol were measured in basal conditions and after 0.25, 0.5 and, 1.0 mg of dexamethasone (DEX) given at 2300 h. Glucocorticoid receptor and 11βHSDisoforms expression were assessed by qPCR.
Results: FPLD2 individuals presented increased waist and neckcircumferences, decreased hip circumference, peripheral skinfold thickness and fat mass. Patients also presented increased HOMA-IR and triglycerides, increased TNF-α, IL-1β, IL-6, and IL-10, and decreased adiponectin and leptin levels. After 0.5 mg DEX, salivary cortisol was less suppressed in FPLD2 patients. The clinical and biochemical phenotype was more pronounced in patients harboring LMNAp.R482W mutation. No differences were observed in the expressions of GRα, GRβ, 11βHSD1, and 11βHSD2.
Conclusions: FPLD2 patients exhibited phenotypic heterogeneity related to LMNA mutations. Patients also showed less ability to suppress cortisol after 0.5 mg DEX, which was the most effective dose to expose the spectral HPA axis sensitivity among groups. Increased levels of proinflammatory cytokines might contribute to decreased GC sensitivity in FPLD2.
A180 Glycemic control and associations between therapeutic adherence, quality of life, and hypoglycemia in adult subjects with type 1 diabetes
Janaina Petenuci, Olivia Jorge de Faria, Wellington Santana da Silva Júnior, Denise Prado Momesso, Rosane Kupfer
IEDE-RJ, Rio de Janeiro, Brazil
Correspondence: Janaina Petenuci
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A180
Background: In Brazil, only 11.6% of patients with type 1 diabetes mellitus (T1D) reach the glycated hemoglobin (A1c) target of < 7%. Possibly, factors such as therapeutic adherence (TA), quality of life (QOL), and hypoglycemia (HYPO) interact with each other and negatively impact glycemic control. However, studies evaluating these associations are scarce. Objective to evaluate glycemic control, prevalence of microvascular complications (MICRO), and possible associations between the scores of questionnaires for evaluation of TA, QOL, and HYPO in adults with T1D.
Methods: This was a cross-sectional study using questionnaires and secondary data of 50 patients with T1D, aged 18-50 years, on regular medical follow-up. The study was approved by the local ethics board (CAAE 57469816.7.0000.5266). All participants signed the informed consent form and answered the Self-Care Inventory-revised (SCI-R; score ranging from 14 to 70 points, the higher the score, the better the TA), the Diabetes Quality of Life Measure (DQOL-8; score ranging from 8 to 40; the higher the score, the worse the QOL), and the American Diabetes Association‘s Hypoglycemia questionnaire (one point was assigned for each gradation of responses to the questionnaire questions). The records of A1c values (last 03 months) and MICRO screening (last 12 months) were collected from medical charts. The results were expressed as relative value (%), mean ± SD, and median [p25–p75]. P < 0.05 was considered significant.
Results: The sample had a mean age of 28.2 ± 9.1 years and a mean time of diagnosis of 12.7 ± 7.7 years. Most of them were female (58%) and white (54%). Mean A1c was 8.4 ± 1.8%. There were 18% of retinopathy, 12% of albuminuria, and 6% of diabetic neuropathy. Median scores on SCI-R and DQOL-8 were 48 [43.2–53] and 22.5 [19.2–26.7], indicating modest TA and unsatisfactory QOL, respectively. A negative correlation was found to SCI-R and DQOL-8 (r = − 0.42; P < 0.01). Considering the A1c, there was a significant correlation to the DQOL-8 (r = 0.41; P < 0.01), a trend to an inverse correlation to the SCI-R (r = − 0.27; P = 0.05), and no correlation to the HYPO‘s questionnaire items.
Conclusions: Poor glycemic control, prevalent MICRO, modest TA, and unsatisfactory QOL were found in this adult sample with T1D. The increase in TA correlated with better QOL and a trend to lower A1c. Improvement in A1c was associated with improvement in TA and there was no association between A1c and HYPO-related issues.
A181 Glycemic control with continuous subcutaneous insulin infusion system: experience of a tertiary service
Beatriz Espinosa Franco1, Lizia Baruque Baylão1, Mariana Lima Mascarenhas Moreira1, Ariane Delai1, Milena Colombo Bruno1, Pryscilla Moreira de Souza Domingues1, Patrícia Moreira Gomes1, Maria Cristina Foss Freitas2
1HC FMRP USP, São Paulo, Brazil; 2FMRP USP, São Paulo, Brazil
Correspondence: Beatriz Espinosa Franco
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A181
Introduction: Continuous subcutaneous insulin infusion (CSII) system therapy maintains the release of micro doses of insulin 24 h a day in a precise and pre-programmed way to maintain stable glycemic control between meals and allows the release of insulin in bolus before meals, in order to mimic the physiological secretion of insulin. Studies have been shown efficacy, safety and improvement in the quality of life in patients taking this therapy, but have not shown significant impact on A1c.
Objective: To compare the effects on glycemic control (A1c), weight, basal insulin dose.
Methods: A retrospective study was carried out by reviewing the medical records of adult patients with type 1 diabetes mellitus (T1DM) in the use of CSII in a follow-up at the Diabetes outpatient clinic of a tertiary center. The glycemic control of the patients was evaluated through the measurement of A1c, weight, total basal insulin dose before and after CSII placement.
Results: In the year 2016, 1246 adult patients were treated in a tertiary Diabetes center; from these, 12 are using CSII. 66.6% are female, mean age is 29 yo, with mean time of diagnosis of 14.6 years. One patient has been in CSII since 2004; the majority (n = 8) started use after 2014. Three patients were already using CSII when they came for follow-up. Records of 7 patients had more complete data for analysis; 71% presented with weight gain after starting CSII (average gain of 10.96%), 1 patient lost weight and 1 maintained. In the analysis of 9 patients, 55% (n = 5) presented decrease of 12.76% in mean A1c, 3 patients a mean increase of 13.7%, and 1 maintained. The mean A1c before CSII was 7.3% and current 7.1%. The mean basal insulin dose on CSII was 26.44 IU. No one patient had diabetic ketoacidosis or skin infections in the cannulae or sensor placement during the use of CSII.
Conclusion: According to previous studies, patients who already have good glycemic control, the use of CSII did not have a great impact on the reduction of A1C. Our study has shown that patients presented weight gain in use of CSII despite the reduction of the basal insulin dose. Our challenges for the future: to avoid weight gain; better medical records (already in progress); to keep patients motivated to use the resources available in CSII (Fig. 1).
A182 Glycemic remote surveillance with the diabetes mellitus (DM) patients survey about the telemedicine: a pilot study results
Izidoro de Hiroki Flumignan, Marcus Vicinicius Chioming de Sá, Nelly Luz Rodriguez Flores
IFM-Instituto Flumignano de Medicina, Paraná, Brazil
Correspondence: Izidoro de Hiroki Flumignan
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A182
Introduction: The aim of this study was to investigate the influence of remote surveillance on glycemic control in diabetic patients and to evaluate their opinions about this new technology. Two questions to be answered: (1) Telemedicine monitoring can improve outcomes in diabetes? (2) What is the patient point of view about telemedicine?
Methods: 20 diabetes mellitus type I or II patients were recruited from a private clinic in a upper-middle class region—Copacabana—in Rio de Janeiro city, Brazil. The patients was classified by education level, social class, age, sex, and type of diabetes and if they use insulin or not user, limited in 25% of total population recruited. Was used specific glucometers provided by the sponsor to transmit wireless the results by modems using a cellular internet provider to a Medical Center. The Medical Center staff was; 2 doctors, 1 nurse and 3 technicians in nursing. Patients had their glucose level followed by internet site during the 80-day studies. Was defined the hyperglycemia or hypoglycemia level defined by the patient medical assistant, the nursing team inform by email or telephone the glucose level out of medical assistant parameters, that will be responsible to the medical decision conduct. The surveys were conducted in 3 different times, beginning, day 40th and at the end (with a window of 7 days).
Results: During the study 4,111 registered glucose measurements was stored and analyzed. During the study, 3 patients was excluded, one decided to dropped and two other diabetic due to no protocol compliance. The 3,696 glucose measures validate were calculated and analyzed. These results show that there were no statistical differences in the blood glucose levels of diabetic patients monitored by telemedicine when compared the begging period, from the 1st to 40th day with the final period, from day 41 to study end. The total period of study was 86 days. This study showed that our methodology applied to monitoring the glucose level from DM patients by telemedicine using Internet-based intervention, have not influence in the glycemic control of diabetic patients type I or II. The patient opinion surveys show that the patients older than 50 years (61% of total), in the beginning period, believed that the telemedicine could improve the glicemic control, and 67% answered that the telemedicine would take care of him, 62% of recruited would take part of the study even if their doctors did not invite him; only 5% declared felt watched (spying), 76% found them useful have a personal staff contacts to notify changes of glucose, 42% did not access the site, 58% preferred “send” the glucose levels once a day, 89% would recommend to other patients to use telemedicine. Concerned to others possibilities to be applied; 89% suggested include pressure control, 68% suggested weight control. In the study closer survey, 74% found that after the study, the methodology, applied (telemedicine using an internet-based intervention) was beneficial; 53% of patients are willing to pay for the service. The pilot study in telemedicine to private clinic DM patients answered two major questions proposed as the primary goal: Question (1): Telemedicine monitoring can improve outcomes in diabetes? Answer: No. Remark; the monitoring alone does not improve diabetes control. This monitoring may be associated with patient continuous motivational programs. Question (2): What is the patient point of view about telemedicine monitoring? Answer: Yes. Remark; Diabetics patients are open to use this technology because they feel care and do not feel spied. The patient survey shows that the Telemedicina could be recommend to others diabetics and a half of them are willing to pay for such services.
Discussion: This result may be due to the few medical interventions performed during the study, limited only to the serious cases of hyper-or hypoglycemia. We also understand that “not just monitoring diabetic’s glucose level”, but it is also necessary to include dynamic and motivational actions to have a better improvement of glycemic control in DM. More studies in this specific health care technology must be conducted in order to have better way to achieve the patient quality of live improvement associated to the cost decline.
A183 Glycemic responses, plasma lipids and body mass index after physical training in individuals with diabetes mellitus type 2
Juliana Vallim Jorgetto1, Giovanna Vallim Jorgetto2, Daniella Silva Oggiam1, Daniele Albano Pinheiro3
1UNIFESP, São Pauo, Brazil; 2unipinhal, São Pauo, Brazil; 3UNIFAE, São Pauo, Brazil
Correspondence: Juliana Vallim Jorgetto
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A183
Introduction: Currently, diabetes mellitus is considered as one of the main chronic diseases that affect man. It is a universal health problem, affecting all socioeconomic classes and affecting populations of countries at all stages of development. Its complications have an increasing impact on quality of life and mortality. The effects of regular physical activity on health have been widely documented. The association between physical inactivity and insulin resistance was first suggested in 1945, and since then new epidemiological studies have emerged demonstrating its relation with the presence of cardiovascular risk factors. On the other hand, physical exercise programs have shown efficacy in glycemic control, values of plasma lipids and consequently the Body Mass Index (BMI) of these individuals.
Objective: To analyze the effect of regular physical exercise of 36 weeks on glycemic control, plasma lipids and BMI in type 2 diabetic subjects from a Health Unit in the interior of São Paulo.
Methods: Metabolic variables were analyzed by fasting blood glucose, total cholesterol, HDL and LDL and BMI, which were recorded in the medical records of these patients (n = 25). The instruments used were the fasting blood test for laboratory evaluation and the anthropometric measurement (weight and height). The experimental treatment was a 36-week physical exercise program, three sessions per week with 50 min duration. Each session was divided as follows: 5 min of warming up with stretching exercises of MMSS and MMII and circumference of limbs and trunk; 35 min of walking and/or water aerobics and 10 min of cooling with stretching exercises and breathing and relaxation techniques. For the statistical analysis, the paired T test was used.
Results: The following mean values were obtained before and after physical training: 146.93 (+ 52.21) mg/dl and 121.16 (+ − 63.57) mg/dl for fasting glycemia; 215.96 (+ − 78.62) mg/dl and 195.05 (+ − 103.29) mg/dl for plasma lipids; 30.65 (+ − 15.79) kg/cm and 28.29 (+ − 11.16) kg/cm for BMI.
Conclusion: These results allow us to conclude that physical exercise is of great importance in the metabolic control, lipid profile and nutritional status of individuals with diabetes, improving these parameters.
A184 Glycemic variability and hypoglycemia evaluation with insulin degludec compared to insulin glargine U100 in the treatment of elderly patients with type 2 diabetes mellitus
Marcela Fiori Gomes da Costa, Érika Bezerra Parente, Mônica de Aguiar Medeiros, Marcelo Scomparin Said Monteiro, João Eduardo Nunes Salles
Santa Casa de São Paulo, São Pauo, Brazil
Correspondence: Marcela Fiori Gomes da Costa
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A184
Background: Type 2 Diabetes Mellitus (T2DM) is a prevalent disease in the elderly population and they are at high risk of hypoglycemia (HYPO). Insulin degludec has been suggested to have both lower risk of hypoglycemia and less glycemic variability (GV). The primary objective of this study is to evaluate GV and hypoglycemia comparing insulin degludec (Ideg) to insulin glargine U100 (Iglar) as a basal insulin for elderly patients with T2DM.
Secondary objectives: Evaluation of duration and number of hypos (total, nocturnal and severe) and the total insulin daily dose (TDD) in each group.
Methods: It is a pilot study with ten patients during six weeks, randomized, prospective, controlled and open label trial. Inclusion criteria: T2DM, age over 60 years, A1C from 7 to 10%, use of NPH insulin with or without oral antidiabetic drugs. Patients were randomized 1:1 to receive once daily Ideg (n = 5) or Iglar‐U100 (n = 5) before breakfast time. They were evaluated for glucose variability (GV) and HYPOs by continuous glucose monitoring (CGM) after 2 weeks of treatment with either insulin.
Results: They are expressed in median (minimum–maximum). GV had no difference in 24‐h mean glucose between groups (Ideg = 168 (151–206) vs Iglar = 169 (138–193) mg/dL. P = 0.84) as well as the standard deviation from the mean (Ideg 69 (42– 83) vs Iglar 45 (41–66). P = 0.22). Overall HYPOs were similar in both groups (Table 1). The TDD (U/kg/dia) were similar in the beginning between groups [Ideg = 0.38 (0.12–0.59) vs Iglar = 0.21 (0.15–0.53). p = 0.69) as well as at the end of the trial (Ideg 0.36 (0.12–0.55) vs Iglar 0.24 (0.18–0.54). P = 0.54]. Comparing the two methods used for monitoring the blood glucose (GCM or self monitoring of blood glucose (SMBG)) we found that CGMS was able to detect more HYPOs than SMBG for the total HYPOs (SMBG = 12 vs CGM = 20. P = 0.03) and nocturnal (SMBG = 2 vs CGM = 11. P = 0.02). 40% of the total number of HYPOs and 81% of the nocturnal HYPOs were missed when using SMBG instead of CGMS. More than 50% of HYPOs occurred during the night (Figs. 1, 2).
Conclusion: Both groups showed similar rates of GV, number and duration of HYPOs. There was no difference regarding the TDD between groups at the end of the study. A higher number of total and nocturnal HYPOs were diagnosed by CGM compared to SMBG. As a pilot study, its major limitation is the small number of patients and the short period of the trial.
A185 Glycemic variability and vitamin D levels in type 1 diabetes mellitus patients
João Felício Abrahão Neto1, Henrique da Costa Miranda1, Manuela Nascimento de Lemos2, Fabrício de Souza Resende2, Hana Andrade de Rider Brito2, Danielle Dias da Silva2, Eder Moreira do Nascimento2, Raquel Okamura Abensur2, Alan Pinheiro Fernandes2, Karem Miléo Felício2, Marcia Costa dos Santos2, Franciane Trindade Cunha de Melo2, Ana Carolina Contente Braga de Souza2, Natércia Neves Marques de Queiroz2, Lilian de Souza D’Albuquerque Silva2, Nathalie Abdallah Zahalan2, João Soares Felício2
1Universidade do Estado do Pará, Pará, Brazil; 2Universidade Federal do Pará, Pará, Brazil
Correspondence: João Felício Abrahão Neto
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A185
Background: Data in recent literature suggest that the daily fluctuations on the blood levels of glucose may play an important role in both glycemic control and the development of complications in Type 1 Diabetes Mellitus (T1DM). In consequence, glycemic variability (GV), a variable defined by the quantification of daily glycemic oscillations through specific methodologies and calculations, was created. In parallel, the relationship and potential benefits of 25-OH-Vitamin D (VD) have been explored, with studies demonstrating an effect of VD on insulin resistance, pancreatic beta cell function and on the immunological pathways of T1DM. It is suggested that VD may be important both in the etiology of T1DM and in glycemic control. Therefore, our study aimed to evaluate the relationship between GV and VD in patients with T1DM.
Methods: We evaluated the serum levels of VD and the GV of 22 patients. For assessing the GV, all patients were submitted to the Continuous Glucose Monitoring System (CGMS), for an average of 3 days.
Results: We found that patients with VD deficiency had higher GV when compared to patients with normal levels of this hormone (p < 0.01). Additionally, a correlation was found between the VD status (normal or deficient levels) with the GV (r = 0.5; p < 0.05). Conclusions: Our pilot study was the first to associate VD and GV. Studies with more patients are needed in order to confirm our results, and further establish the relationship between VD and GV.
A186 Haptoglobin levels are associated with type 2 diabetes mellitus and they are influenced by HP1-HP2 polymorphism, obesity, and hypertension
Kathryna Fontana Rodrigues1, Nathalia Teixeira Pietrani1, Laura Machado Lara Carvalho1, Adriana Aparecida Bosco2, Valéria Cristina Sandrim3, Cláudia Natália Ferreira1, Karina Braga Gomes Borges1
1UFMG, Minas Gerais, Brazil; 2Instituto de Ensino e Pesquisa da Santa Casa, Minas Gerais, Brazil; 3UNESP, São Paulo, Brazil
Correspondence: Kathryna Fontana Rodrigues
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A186
Introduction: Type 2 diabetes mellitus (T2DM) and obesity, mainly visceral obesity, have been associated with a low grade inflammatory state and immune system activation. Haptoglobin (Hp) is an acute-phase protein that primarily scavenges the hemoglobin (Hb) released into circulation, either by hemolysis or by normal red blood cell turnover, preventing Hb-related oxidative damage. Hp is mainly synthesized by hepatocytes and by non-hepatic cells, including adipocytes.
Objective: To evaluated the association between Hp levels with Hp1-Hp2 polymorphism, clinical and laboratorial parameters in T2DM patients.
Methods: We evaluated 102 patients with clinical and laboratorial diagnosis of T2DM and 62 age-, gender-, and body mass index (BMI)-matched non-diabetic control. Hp levels were measured in EDTA plasma samples using Quantikine® ELISA Human Haptoglobin Immunoassay (R&D Systems, USA) by ELISA method. Molecular analyzes of Hp1-Hp2 polymorphism were performed by specific twostep allelic polymerase chain reaction (PCR) technique. Statistical analysis was performed with SPSS (version 17.0) using Kruskal–Wallis, Mann–Whitney, Student t test, and qui-square test with residual analysis. A p value < 0.05 was considered statistically significant.
Results: Hp levels were higher in the T2DM group [1.15 (0.52) g/L] when compared with control group [0.88 (0.58) g/L—p = 0.005]. Hypertensives T2DM patients exhibited higher Hp levels (1.19 ± 0.46 g/L) when compared with normotensives patients (0.80 ± 0.26 g/L—p = 0.021). Obese T2DM patients (1.27 ± 0.47 g/L) showed higher Hp levels than obese controls (0.95 ± 0.40 g/L—p = 0.009) and non-obese patients (1.00 ± 0.41 g/L—p = 0.003). Hp-Hp1 genotype showed association with T2DM according additive (OR = 3.038, IC 95% 1.127–8.192; p = 0.036) and dominant (OR = 0.320, IC 95% 0.118–0.839; p = 0.010) inheritance models. Considering these inheritance models, it was verified that Hp levels are lower in Hp2 allele carriers (p = 0.001 and p = 0.020).
Conclusion: These results suggest that Hp levels are associated with T2DM physiopathology and are influenced by Hp1-Hp2 polymorphism, obesity, and hypertension.
A187 HBA1C, FPG, hypoglycemia, and basal insulin dose with insulin degludec (IDEG) vs insulin glargine 100 u/ml (GLA-100): lessons from the begin program
Geremia B. Bolli1, David R. Owens2
1University of Perugia, Perugia, Italy; 2Diabetes Research Group, Swansea University, UK
Correspondence: Geremia B. Bolli
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A187
Background: The safety and efficacy profiles of IDeg, a long-acting basal insulin analog, were evaluated in the BEGIN program. This review reports comparative glycemic control, hypoglycemia, and insulin dose profiles of IDeg vs Gla-100, focusing only on basal-oral treatment trials in type 2 diabetes (T2DM) from the BEGIN program.
Method: HbA1c, FPG, confirmed (< 56 mg/dL) or severe hypoglycemia, and insulin dose data (including dose increase needed for a 1.0% HbA1c decrease) from the selected BEGIN trials (n = 4) comparing IDeg and Gla-100 in people with T2DM on basal-oral treatment were reviewed.
Results: HbA1c reduction with IDeg was non-inferior vs Gla-100, although, consistently, a greater (non-significant) reduction with Gla-100 was seen in each trial (Table 1A). FPG reduction was greater with IDeg. Rates of confirmed (< 56 mg/dL) or severe hypoglycemia at any time (over 24 h) were similar with IDeg and Gla 100, but were lower with IDeg during the nighttime (Table 1A). Absolute insulin dose increases tended to be greater with Gla 100; however, when adjusted for a 1.0% HbA1c reduction, they were more frequently higher with IDeg (Table 1B).
Conclusion: In studies of IDeg vs Gla-100 in people with T2DM on basal-oral treatment from the BEGIN program, HbA1c reduction was slightly greater with Gla-100 while rates of hypoglycemia were either similar (hypoglycemia at any time) or lower (nocturnal hypoglycemia) with IDeg. Insulin dose requirements, when adjusted for 1.0% HbA1c reduction, were generally higher with IDeg vs Gla-100. This is an ENCORE abstract previously presented at ATTD2016. Funding and editorial support provided by Sanofi (Fig. 1).
A188 Health and nutritional literacy of adults with type 1 diabetes mellitus
Rosana de Morais Borges Marques, Maiara Ferreira Rizzo, Priscilla Lourenço de Carvalho Félix
UFG, Goiás, Brazil
Correspondence: Rosana de Morais Borges Marques
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A188
Introduction: Literacy in health and in nutrition is the degree to which individuals are able to obtain, process, and understand basic health and nutrition information and guidelines necessary to make appropriate decisions regarding their treatment.
Objective: To assess the degree of literacy in health and nutrition and its associations with the therapy, the glycemic control and the nutritional status of adults with type 1 diabetes.
Methodology: Participated in the study 47 adults of both sexes, that were regularly attended in a school hospital. Participation on study was voluntary after the signing of the Informed Consent Term. The project is approved by the Ethics and Research Committee. The collected data were related to socioeconomic and demographic characteristics, treatment, glycemic control, body mass index and waist circumference. The degree of literacy in health and nutrition was valued by validated instruments, the S-TOFHLA and the NVS-BR. The association was analyzed by Chi square test, with a significance level of 5%.
Results: The participants had a mean age of 27 years (SD 0.04), the majority were female (66%) and with a high school education (64%). The predominant monthly household income was up to two minimum wages (66%) and only 74.5% had sanitary sewage. The mean age at diagnosis was 10 years (SD 0.01) and 40.4% of the participants reported already had some complication due to diabetes. Few participants (21%) still used human insulin, but almost all of them (96%) rotated the fields of insulin application. The mean capillary glycemia was 178 mg/dL (SD 85.25), the median fasting was 164 mg/dL (67–454) and the median of HbA1c was 8.5% (4.1–18). Overweight was prevalent in 19% of participants and cardiovascular risk, measured by waist circumference, in 22%. Most of the participants (83%) presented inadequate or borderline health and nutrition literacy. The characteristics of gender, schooling and income were not associated to literacy in health and nutrition, as well as to variables anthropometric. Health literacy influenced the worst glycemic control evaluated by fasting glycemia.
Conclusion: The study participants presented inadequate literacy in health and nutrition, and the low health literacy influenced on the weak glycemic control.
Keywords: Diabetes Mellitus, Nutritional Status, Treatment Adherence, Health Literacy Ethics Approval The project is approved by the Ethics and Research Committee (CEP/CONEP) under the number CAAE: 62108616.1.3001.5078. Consent to publish Informed consent to publish has been obtained from all the participants of the study.
A189 Health literacy and stress related to diabetes as impacting factors in adherence to treatment and glycemic control of type 1 diabetic patients
Camila Thais de Carvalho Messora, Maria Cândida Ribeiro Parisi, Arnaldo Moura Neto, Elizabeth João Pavin
UNICAMP, São Paulo, Brazil
Correspondence: Camila Thais de Carvalho Messora
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A189
Background: The treatment of type 1 diabetes mellitus (T1DM) is complex and includes insulin injections, dose adjustments, glycemic monitoring, carbohydrate counting and physical activity. The management of these competences is essential for adherence and glycemic control. Health literacy assesses the reading and understanding of health information and decisionmaking. Diabetes-related stress (DD) can cause burnout and negatively impact selfcare. Both literacy and DD affect adherence to treatment.
Objective: To evaluate the levels of health literacy and DD in T1DM patients and the impact on adherence to treatment and glycemic control.
Methods: We studied 90 patients with T1DM, 18 years of age and over, both sexes. Questionnaires: standard for clinical, laboratorial and sociodemographic data; Test of Functional Healty Literacy in Adults-STOFHLA for literacy; Brief Medication Questionnaire-BMQ for adhesion and Problem Area in Diabetes-B-PAID for DD. The patients participated in the research after signing the consent form approved by CEP-UNICAMP.
Results: 90 diabetics patients type 1, 68.8% women, age 33.9 year ± 11.4; glycated hemoglobin (HbA1C) 9% ± 2.1, T1DM time 19.2 year ± 9.3. 86.6% presented adequate literacy, 6.6% marginal and 6.6% inappropriate. The average score of PAID was 42.1 ± 25.2 and 53% of scores were >=40 (high stress). BMQ: adherence/likely adhesion in 52.2% e non-adherence/likely low adhesion in 47.7%. Statistically significant factors in univariate regression-related adherence were: PAID (p = 0.04 OR = 1.02) and arterial hypertension (p = 0.04 OR = 2.66 for presence). When we analyzed the domain regimen of the BMQ for non-adhesion by univariate regression, we obtained: age p = 0.009 OR = 1.05 for older age, marital status p = 0.020 OR = 4.22 for married, arterial hypertension p = 0.004 OR = 4.16 for presence, dyslipidemia p = 0.010 OR = 3.50 for presence, occupation p = 0.004 OR = 5.08 for non-occupancy. The multivariate regression, Stepwise selection criterion, showed that variables related to non-adherence were: marital status p = 0.005 OR = 5.05 for married, arterial hypertension p = 0.005 OR = 6.86 for presence, retinopathy p = 0.042 OR = 4.08 for absence, occupation p = 0.005 OR = 6.72 for nonoccupancy. HbA1C was not associated with literacy, adherence and DD.
Conclusion: Health literacy is adequate in most T1DM and more than half of them have high DD. High scores of PAID, dyslipidemia, arterial hypertension, marital status, non-retinopathy and non-occupancy were associated with non-adherence, all of which except PAID were independent risk factors for worsening adherence to T1DM treatment.
Keywords: T1DM, health literacy, diabetes distress, adherence to treatment.
A190 Hemichorea-hemiballism in hyperglycemic non-ketotic state: case report
Ana Carolina Viana Mattos1, Luana Machado Figueredo1, Agnes Neves Santos2, Gisele de Sá Mascarenhas1, Gabriel Oliveira do Carmo1, Aline Andrade de Lucena1, Ana Claudia Rebouças Ramalho1
1UFBA, Bahia, Brazil; 2HSR, São Paulo, Brazil
Correspondence: Ana Carolina Viana Mattos
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A190
Case presentation: Woman, 60 years old, diagnosed at 59 years old with type 2 diabetes (T2DM), high blood pressure and dyslipidemia. Was using pre-mixed insulin 25/75 (0.67 U/Kg) without the proper control and reported that she had been experiencing tremor-like involuntary movements on the left side of her body for the past week. At the exam, showed choreiform movements on the left side of her body, facial dyskinesia and faster blinking on the left, no other neurological deficits. Laboratorial exams revealed a HbA1C level of 16.7% and fasting blood glucose (FBG) 384 mg/dL, no other changes. Was hospitalized, and latter exams showed HbA1c 12%, FBG 122 md/dL, urine tests showed no ketones, no other changes. Cranial resonance showed T1-hypersignal in correspondence with right side putamen nucleus, suggesting neurotoxicity by non-ketotic hyperglycemia. During treatment, there was remission in the neurological state after glycemic control and the introduction of haloperidol and baclofen. After release, the patient remained asymptomatic, using regular and NPH insulins (0.56U/Kg) and metformin (1000 mg/day), without haloperidol and baclofen, and the last results showed a HbA1c level of 5.8%.
Discussion: The occurrence of hemichorea-hemiballism is characterized by involuntary movements on one side of the body and is usually the product of structural lesions in the contralateral subtalamic nucleus and striatum, side effects of vascular events and, less often, associated to metabolic, neoplastic or infectious causes. The neurological findings presented related to non-ketotic hyperglycemia and the involvement of basal nuclei configure a rare T2DM complication. The hypothesis is that hyperglycemia followed by cerebral hypoperfusion and the emergence of anaerobic metabolism reduces the GABA levels, which results in dysfunction of the basal ganglia. The case shows an unusual manifestation of T2DM, reinforcing the importance of early recognition and treatment of the syndrome. The prognosis is good and the adequate glycemic control is the basis of the treatment, it is often times enough to solve the symptoms. However, the treatment through the use of neuroleptics, benzodiazepines or antiepileptics might be necessary.
Conclusion: This is a case of non-ketotic hemichorea-hemiballism in a patient with poorly controlled T2DM, showing a complete recovery of its signals and symptoms after the normalization of glycemic levels.
Informed consent to publish had been obtained from the patient.
A191 Heterologous adipose derived mesenchymal stem cells and vitamin D supplementation in patients with recent-onset type 1 diabetes mellitus: effects on glycemic variability
Joana R. Dantas1, Maria Fatima C. Pereira1, Marina O. Soares1, Debora L. Souto1, Karina R. Silva1, Cesar Claudio-da-Silva1, Carlos Eduardo B.Couri2, Debora Daga3, Carmen Lucia Kuniyoshi Rebelatto3, José Egídio Paulo de Oliveira1, Lenita Zajdenverg1, Leandra S. Baptista1, Melanie Rodacki1
1UFRJ, Rio de Janeiro, Brazil; 2USP-Ribeirão Preto, São Paulo, Brazil; 3PUC-Paraná, Paraná, Brazil
Correspondence: Joana R. Dantas
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A191
Introduction: Glycemic variability (GV) correlates directly with the microvascular complications of type 1 diabetes (T1D). The continuous glucose monitoring system (CGM) demonstrates efficacy in improving glycated hemoglobin and reducing hypoglycemia in patients with T1D.
Objective: To evaluate the safety and efficacy of infusion of heterologous adipose tissue-derived mesenchymal stem cells (ADMSCs) of healthy donors + daily cholecalciferol (VIT D) in patients with recent-onset T1D, and the effects on glycemic variability indexes.
Methods: 1. ADMSCs extraction • This is a prospective, randomized, open trial, in which patients with T1D of short duration were randomized to receive heterologous MSCs derived from adipose tissue in a single infusion plus daily oral cholecalciferol (2.000UI). • Adipose tissue samples were obtained from liposuction and processed and cultivated in culture medium chemically defined for MSCs. 2. Patients selection • Patients with T1D were included, between 15 and 35 years and GAD antibody (+). • All patients were diagnosed with T1D 4 months or less at the time of MSCs infusion. • Exclusion criteria: Diabetic ketoacidosis, drugs that interfere in immune response, pregnancy, malignant neoplasms, HIV (+), Hepatitis B or C. 3. ADMSCs infusion • The ADMSCs were infused in a single dose in peripheral vein (kg x 106). 4. Daily oral cholecalciferol supplementation (2.000UI) 5. Continuous glucose monitoring (CGM) • Data analysis of 72 h CGM (Ipro Medtronic) was performed in 6 T1D patients, assessed at baseline (T0), and 3(T3) months after the ADMSCs infusion. All patients received standardized dietary guidance according to the American Diabetes Association. • Descriptive analysis were made and the following GV indexes were calculated: mean, standard deviation (SD), J-Index, M-value, glycemic risk assessment in diabetes equation (GRADE), high blood glucose index (HBGI), low blood glucose index (LBGI), mean amplitude of glucose excursions (MAGE). Mann–Whitney test were used to compare results at baseline and after follow-up with statistic significance of p < 0.05. Specific formula were used to calculate the GV indexes.
Results: Six patients received ADMSCs infusion and completed 3 months follow-up. Table 1 describes the patients baseline characteristics. The mean blood glucose detected in CGM was 5534 mmol/L (T0), and 5848 mmol/L (T3) (p 0.602). There was a significant reduction in SD of glycemias 3 months after the infusion (TO = 1.929, T3 = 0.934, p 0.037). For the other GV indexes no significant difference was found between groups. All patients presented an excellent glycemic control, with the following frequency: hypoglycemia (TO 2%, T3 0.7%), hyperglycemia (T0 12.2%, T3 8.3%), and normoglycemia (T0 85.8%, T3 91%).
Discussion: In patients with T1D, infusion of heterologous ADMSCs + oral VIT D improved blood glucose SD, suggesting that this intervention has some impact on β cell function. Although the intervention did not result in any improvement in the other GV indexes, all patients presented excellent glycemic control. It is still necessary a control group without intervention and a longer follow up of these patients to better define the effect of ADMSCs infusion in pancreatic function (Fig. 1, 2, 3).
A192 Heterologous adipose derived mesenchymal stem cells and vitamin D supplementation in patients with recent-onset type 1 diabetes mellitus: preliminary results
Joana Rodrigues Dantas1, Débora B. Araujo1, Debora Daga2, Carmen Lucia Kuniyoshi Rebelatto2, Karina R Silva3, Debora L. Souto1, Cesar Claudio-da-Silva1, Leandra S. Baptista1, Maria Fatima C. Pereira1, Marina O. Soares1, Carlos Eduardo B.Couri4, Lenita Zajdenverg1, José Egídio P. Oliveira1, Melanie Rodacki1
1UFRJ, Rio de Janeiro, Brazil; 2PUC-Paraná, Paraná, Brazil; 3InMetro-Rio de Janeiro, Rio de Janeiro, Brazil; 4USP-Ribeirão Preto, São Paulo, Brazil
Correspondence: Joana Rodrigues Dantas
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A192
Objective: To evaluate the safety and efficacy of infusion of heterologous adipose tissue-derived mesenchymal stem cells (ADMSCs) of healthy donors + daily cholecalciferol (VIT D) in patients with recent-onset T1D.
Methods: In this prospective open trial, patients with recent-onset T1D received a single infusion of heterologous ADMSCs (Kg body weight x 106 cells) + daily oral VIT D (2.000UI). Adipose tissue samples were obtained from liposuction, processed and cultivated in medium chemically defined for ADMSCs. Patients with T1D for < 4 months, age between 16 and 35 years old and GAD antibody (+) were included. HbA1c, basal and stimulated C-peptide (CP) after a mixed meal, insulin dose, adverse events and Foxp3 expression in CD4 + cells were assessed at baseline (T0), after 1(T1) and 3 months (T3). T tests were used to compare results at baseline and after follow-up. The study was approved by the Ethics Board Federal University of Rio de Janeiro/HUCFF.
Results: Six patients received infusion of ADMSCs. Their mean age was 27 ± 7.7 y/o and 3 were males. VIT D levels were 30.4 ± 12.8 ng/ml, e 38.3 ± 6.9 ng/ml e 47.9 ± 8.5 ng/ml. Basal CP basal was 0.8 ± 0.4 ng/dl, CP T1 = 0.9 +/0.5 ng/dl and CP T3 = 0.7 ± 0.3 ng/dl(p = 0.51). CP peak after stimuli was: T0 = 2.9 ± 1.3 ng/dl, T1 = 3.2 ± 1.9 and T3 = 2.6 ± 1.5 ng/dl(p = 0.51).HbA1c before intervention,T1 and T3 were, respectivelly,7.8 ± 1.26%, 6.6 ± 0.85% e 6.1 ± 0.42 (p = 0.06). Mean insulin dose (T0) was 0.32 ± 0.29U/kg initially, after 1 and 3 months was 0.28 ± 0.22U/kg and 0.25 ± 0.17 U/kg, respectivelly. There was an inverse correlation between peak CP and HbA1c on T3 (p0,03,r = -0,84). FoxP3 expression in CD4(+) T cells were 1.46 ± 1.47% on T0, 2.27 ± 3.36% on T1 and 3.31 ± 3.29 on T3, p = 0.89. Immediate adverse events were: transient headache (n = 6), mild local reactions (n = 6), tachycardia (n = 4), abdominal cramps (n = 1). Within the first week, 4 patients developed local thrombophlebitis and 2 had visual scotomas.
Conclusion: In patients with T1D, infusion of heterologous ADMSCs + oral VIT D is feasible and appears to be safe. Although the intervention did not result in any improvement in CP, insulin dose or Hb1c after three months, patients presented excellent glycemic control, preserved β cell function and low insulin requirements after the intervention. A prospective follow up will determine the ADMSCs effect on the pancreatic function.
A193 High doses of insulin in children with congenital generalized lipodistrophy (CGL) and serious insulin resistance
Livia Vasconcelos Martins, Luana Pontes Vasconcelos Lima, Priscila Macêdo Fernandes, Milena Silva Sousa, Annelise Barreto de Carvalho, Luciana Felipe Ferrer Aragão, Ana Paula Dias Rangel Montenegro, Virginia Oliveira Fernandes, Synara Cavalcante Lopes, Natasha Vasconcelos Albuquerque, Camilla Oliveira Duarte de Araújo, Renan Magalhães Montenegro Junior
UFC, Ceará, Brazil
Correspondence: Livia Vasconcelos Martins
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A193
Case: Child, 4 years old, female, with clinical diagnosis of CGL type 2 and diagnosis of diabetes for 1 year. At 4 years of age, using Glargina and Lispro insulin basal/bolus (5.1 IU/kg/day) presented mean daily capillary glycemia above 600 mg/dl, associated with irritability, low weight and voracious appetite. Interned for intravenous insulin therapy and nutritional adjustment with standardized diet of 1600 kcal/day fractionated in 7 meals. Initiated continuous infusion of regular insulin (RI), 6.1UI/kg/day. Progressive dose adjustments were made, mean increase of 1UI/kg/day, to 26.6 IU/kg/day, were divided into 3 different basal (6 h at 12 h 1.18 IU/kg/h, 12 h at midnight 1.28 IU/kg/h and 1.01 IU/kg/h from midnight to 6 h), reaching a mean capillary glycemia of 283 ± 99 mg/dl. Subsequently, it was modified to intramuscular administration, in 5 application times, without differences in glycemic averages. On the 36 th day, Degludeca insulin was introduced (9.3 IU/kg/day) associated with RI (18.2 U/kg/day), evolving within the first 24 h with improved glycemia (180 ± 42 mg/dl). After this period, the blood glucose level was 232.6 ± 74.7 mg/dl and the bolus was increased to 23.7 UI/kg/day, maintaining a blood glucose level of 260 ± 79 ml/dl. After approximately fivefold increase in the initial insulin dose, there was improvement in glycemia, irritability, weight gain and decreased appetite.
Discussion: CGL is characterized by loss of body fat and its deposition in atypical sites, predisposing to the development of insulin resistance (IR) and its complications such as DM, hypertriglyceridemia and hepatic steatosis. In CGL, IR is more severe, using high doses of insulin that often do not guarantee adequate control. It is possible that the scarcity of subcutaneous(SC) tissue makes it difficult for the insulins action that need this substrate to metabolize. Degludeca, because in its mechanism of action the formation of complex multihexamers with slow and continuous release of monomers in the blood circulation and its distribution in the circulation due to high affinity with serum albumin could be a treatment option for patients with lipodystrophy, providing better therapeutic response.
Final comments: Reported child with LGG and severe RI who presented clinical improvement with the use of very high doses of insulin. Due to the significant reduction of SC tissue, insulins with an independent mechanism of release of this tissue seem to be an option in the therapy in these patients.
Informed consent to publish had been obtained from the patient.
A194 High prevalence of comorbidities and complications related to diabetes in patients linked to a care line
Anne Caroline Ferreira Queiroga1, Juliana Mineu Pereira Medeiros1, Roberta Freitas Celedonio1, Natália Aguiar Moraes Vitoriano1, Maria Iara Socorro Martins1, Vanessa Santos Vieira2, Francisca Diana da Silva Negreiros1, Caroliny Gonçalves Rodrigues Meireles1, Camyla Bandeira Miranda1, Cristiany Azevedo Miranda1, Tatiana Rebouças Moreira1, Synara Cavalcante Lopes1, Josenília Maria Alves Gomes1, Virgínia Oliveira Fernandes1, Renan Magalhães Montenegro Júnior1
1UFC, Ceará, Brazil; 2FIC, Ceará, Brazil
Correspondence: Anne Caroline Ferreira Queiroga
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A194
Introduction: The Diabetes Care Line (DCL) is a specialized interdisciplinary service that treats patients with comorbidities and some degree of diabetes mellitus (DM) decompensation and/or chronic complications, articulating resources and practices guided by clinical guidelines.
Objective: To describe clinical and sociodemographic´s profile in referred patients to a DCL in Fortaleza-CE, Brasil.
Method: Descriptive, quantitative study, conducted from March to July 2017, through the analysis of medical records. The study was approved by the Institution‘s Ethics and Research Committee Nº. 1.956.803 e CAAE: 64549817.0.0000.5045.
Results: The sample consisted of 66 patients, with a mean age of 64.0 ± 9.7 years, 54.5% (36) of the female sex. 53.1% (35) were married, 21.2% (14) single and 18.2% (12) widowers (Table 1). As for schooling, 25.8% (17) had incomplete elementary education, 19.7% (13) complete elementary education, 18.2% (12) complete secondary education and 16.7% (11) were literate. type 2 DM, 92.4% (61), 4.5% (3) with type 1 DM and 3.1% (2) with maturity onset diabetes of the young (MODY) based on clinical history. The time of diagnosis of DM was 14.5 ± 7.6 years. Dyslipidemia was present in 92.4% (61), systemic arterial hypertension in 84.4% (56), cardiovascular disease in 56.1% (37) and obesity in 42.4% (28). Regarding complications, diabetes renal disease was present in 31.8% (21), peripheral neuropathy in 54.5% (36), diabetic retinopathy in 28.7% (19) and diabetic foot in 13.6% (9).
Conclusion: There was a high prevalence of comorbidities and complications related to DM in the population referred to the DCL. These data may suggest the need for prior referrals from non-specialized services, with a view to better control of the disease and comorbidities, as well as prevention or delay of complications (Fig. 1).
A195 High prevalence of psychiatric disorders and association with increased frequency of acute and chronic complications in pacients with type 1 diabete mellitus: cross-sectional evaluation in the south of Brazil
Thiago Malaquias Fritzen, Isabele Beatris Denk, Saskia Costa de Boer, Letícia Schwerz Weinert
UFPEL, Rio Grande do Sul, Brazil
Correspondence: Thiago Malaquias Fritzen
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A195
Introduction: Psychiatric disorders in patients with type 1 diabetes may interfere with the quality of care and increase the risk of acute and chronic complications.
Aim: To establish the prevalence of psychiatric disorders and drug abuse in a population of patients diagnosed with type 1 diabetes mellitus regularly followed in a specialized public health center of the south of Brazil.
Methods: Cross-sectional, retrospective study. We reviewed clinical and laboratory variables from patients’ medical records, and we applied a questionnaire to evaluate drug use and anxiety disorder and PHQ-2 and PHQ-9 questionnaires for the diagnosis of depression. Patients older than ten years with, at least, one medical appointment in the last year were included. All patients signed an informed consent form. The study was approved by the Ethics Committee of our institution.
Results: Fifty-four patients with a mean age of 26 years, 52% men, with a median diabetes duration of 9 years, were evaluated. Of these, 5 (9.3%) smoked, 14 (25.9%) drinked alcohol, 2 (3.7%) used illicit drugs, 28 (51.9%) had at least one psychiatric illness, 26 (48.1%) had anxiety and 12 (22.2%) a diagnose of depression. The prevalence of diabetic nephropathy (60% vs 12.5%, p = 0.002), macrovascular disease (25% vs 4.7%, p = 0.033), peripheral neuropathy (50% vs 4.7%, p < 0.001) and diabetic retinopathy (41.6% vs 4.7%, p = 0.001) were higher in patients with depression when compared to patients without the disease. Regarding acute complications, there was no difference in diabetic ketoacidosis episodes (p = 0.661) between groups. However, 66.6% of the patients with depression had severe hypoglycemia in comparison to 19% of the control group (p = 0.001). When evaluating patients with anxiety, there was no statistical significance between the groups for acute and chronic complications.
Conclusion: The prevalence of psychiatric disorders and drug abuse was extremely high in patients with type 1 diabetes mellitus. Depression was associated with an increase in acute events and chronic complications related to diabetes.
A196 High prevalence of type 2 diabetes mellitus in familial hypercholesterolemia among participants of hipercol Ceará program
Natasha Vasconcelos Albuquerque1, Maria Helane Costa Gurgel Castelo2, Raul Dias dos Santos Costa3, Cinthia Elim Jannes3, Synara Cavalcante Lopes1, Lívia Aline de Araújo Batista1, Gabriela Nogueira Cavalcante1, Elyane Rocha Lima Sá2, Rafaella Roque Chagas2, Frederico Luis Braz Furtado1, Manuela Montenegro Dias de Carvalho2, Daniel Duarte Gadelha2, Virgínia Oliveira Fernandes1, Renan Magalhães Montenegro Junior1, Alexandre da Costa Pereira3
1UFC, Ceará, Brazil; 2HUWC, Ceará, Brazil; 3INCOR-SP, São Paulo, Brazil
Correspondence: Natasha Vasconcelos Albuquerque
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A196
Background: Familial hypercholesterolemia (FH) is a genetic disease characterized by severely elevated LDL cholesterol (LDL-C) levels that lead to an increased risk factor for cardiovascular disease an early age. Type 2 Diabetes Mellitus (T2DM) is an additional cardiovascular risk which can also occur in FH patients. International studies described the prevalence of T2DM less than 10% among FH patients. But in Brazil, few studies reported the prevalence of T2DM among FH. The objective of this study was to describe the prevalence of T2DM among FH participants from a genetic screening program for FH.
Method: A cross-sectional study of patients evaluated in “Active Genetic Screening Program for Familial Hypercholesterolemia in Ceará” - HIPERCOL CEARÁ” in a referral medical service in Ceará-Brazil from 2013 to 2017. The screened subjects had a LDL-cholesterol levels above 210 mg/d. A molecular study was also performed for gene mutation analysis (LDL receptor, ApoB protein and inhibitor protein PSK9). The first-degree relatives (FDR) of genetic confirmed cases were also evaluated.
Results: Among the 122 participants evaluated, 19.7% (24/122) was previously diagnosed for T2DM. Of these the mean age was 57.8 (± 12.4) and 83,3% was female. The genetic study was positive in 27.9% (34) of the patients. All of them presented LDL receptor gene mutation In this subgroup, the T2DM prevalence was 20.8%. Of these, 87.5% were the index cases.
Conclusion: It was observed a high prevalence of T2DM in patients with clinical diagnosis of FH, specially the index cases. Other studies are needed, but these data may suggest the need for early detection of T2DM among FH patients. Ethics Approval This study was performed according Good Clinical Practices Guidelines. The HIPERCOL program has ethical approval (3757/12/013) and all patients given an informed consent form.
A197 High-sensitivity c-reactive protein as main biomarker of cardiometabolic risk in obese children and adolescents
Carlos Alberto Menezes1, Paulo Roberto Santana de Melo2, Gabriela Correia Matos de Oliveira2, Luís Jesuíno Oliveira Andrade2
1Universidade EstaduaL de Santa Cruz, Bahia, Brazil; 2UESC, Bahia, Brazil
Correspondence: Carlos Alberto Menezes
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A197
Background: Childhood obesity is already considered a worldwide public health problem and its etiopathogeny is based on a low-grade chronic inflammatory process induced by cellular hypoxia and release of cytokines with hepatic C-reactive protein production .
Objective: To establish the importance of high-sensitivity C-reactive protein (HSCRP) as main biomarker of cardiometabolic risk in obese children and adolescents.
Materials and methods: Study involving a case group (CG) with 235 children and adolescents (128 girls and 107 boys) with a body mass index (BMI) above the 97th percentile and a Z-score greater than + 3, mean age of 10.0 ± 2.5 years. The control group consisted of 107 (GCc) nonobese children (55 girls and 52 boys), mean age of 10.0 ± 2.3 years. The HSCRP, fasting glucose, total cholesterol and fractions (HDL-c, LDL-c), triglycerides and homocysteine were evaluated.
Results: The HSCRP showed a mean value of 2.36 ± 1.28 mg/dl (0.7–9.1- IC: 0.7–9.1-95%) in the GC, and 0.01 ± 0, 1 mg/dl (0.01-0.1-IC: 0.01–0.1-95%) in the GCc. In the GC group, the HSCRP levels were higher in boys. The BMI and waist circumference were elevated in CG in relation to GCc (P = 0.0001). The changes in fasting blood glucose levels (P = 0.05), total cholesterol (P = 0.001), LDL (P = 0.001), HDL (P = 0.0001) and triglycerides (P = 0.0001) were statistically in the CG. Homocysteine did not show statistically significant changes in GC.
Conclusion: The HSCRP can be validated as the main biomarker of cardiometabolic risk in obese children and adolescents.
A198 Hiperglycemia secondary to glucagonoma: a case report
Mariana Mendes da Silva, Rafael Gomes de Olivindo, Tainã Aci Amaral de Oliveira, Carolina Parente Gress do Vale, Loraine Albiero Pellucci, Priscila Sueli Moreira Pereira, Rafael Gomes de Olivindo
Hospital Santa Marcelina, São Paulo, Brazil
Correspondence: Mariana Mendes da Silva
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A198
Introduction: Glucagonoma is a pancreatic neuroendocrine tumor derived from alpha-cells of the islets of Langerhans. It is marked by tumoral autonomous production of glucagon, resulting in hyperglycemia and necrolytic migratory erythema (ENM), erythematous circinate lesion with areas of necrosis and sloughing. The incidence is 0.01–0.1 new cases per 100,000 people.
Case report: ISS, female, 39 years old, hospitalized in 2015 for investigation of cholestatic syndrome associated with pancreatic mass of 51x48 mm evidenced on abdominal tomography (15/05/03). The patient underwent corpocaudal pancreatectomy and total splenectomy, with free surgical margins, but with angiolymphatic invasion. Anatomopathology showed well differentiated pancreatic endocrine carcinoma. The patient received chemotherapy with gemcitabine which was replaced by Folfirinox. However, after 1 year without medical follow-up, she returned presenting weight loss, cutaneous disseminated lesions in the upper and lower limbs (Fig. 1), trunk and genitalia, angular cheilitis, macroglossia, deep venous thrombosis of the lower limbs and glycemia above 400 mg/dl. Figure 1: Cutaneous disseminated lesions It was used several antimicrobial regimens to treat skin lesions, unsuccessful, and performed biopsies of the skin, that diagnosis psoriasiform spongious dermatitis. The case was referred to the endocrinology departament and we did the diagnosis of glucagonoma, based on the symptoms and skin lesions, confirmed by pancreatic glucagon levels of 722 pg/ml (reference value < 208 pg/ml). During monitoring, the pacient presented a sudden decrease in the level of consciousness, initially associated with hypoglycemia (52 mg/dl), sodium of 117 mEq/l and potassium of 7.4 mEq/l, without improvement with endovenous correction. We considered diagnosis hypothesis of adrenal insufficiency and after offered hydrocortisone, it was observed improvement in her condition in 24 h. The skin lesions were treated with zinc vitamin supplement and Octreotide, that was effective in reducing the number and extent of lesions, as well as reducing insulin doses.The patient is currently undergoing outpatient follow-up maintaining the use of zinc, prednisone, Octreotide and insulin with adequate glycemic control.
Conclusion: The necrolytic migratory erythema associated with hyperglycemia is important for the clinical recognition of glucagonoma, and its early diagnosis is essential for a successful curative therapy. Informed consent to publish had been obtained from the patient (Fig. 1).
A199 How to extend and evaluate self-care behavior in the patient with type 1 diabetes mellitus
Giovana Piazzetta, Denise Beheregaray Kaplan, Silmara Oliveira Leite
Hospital Cruz Vermelha-Filial Paraná; Paraná; Brazil
Correspondence: Giovana Piazzetta
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A199
Type 1 diabetes mellitus (DM1) is a chronic disease that needs specific knowledge and skills for self-care. Brazil’s health system provides insulin analogues for better posology and adaptation. According to the 11.347 (2006) law, the right for supplies must be coupled with diabetes education. The absence of this important element is probably one reason for unsatisfactory glycemic controls. In this project, we created an educational method using a motivational approach with groups, aiming to improve DM1 selfmanagement. The motivational approach differentiates itself by helping the patient to understand his/her ambivalence and to define his/her own goal, as well as creating motivation for a lifestyle change based on the interest of health and the patient’s own values. It has a practical focus, using the techniques of problem solving, goal setting and exploration of the patient’s personal reasons for making a change, and a non-confrontational style of questioning. The team had previous training in the technique of motivational interview as to apply this approach in four group sessions once a month. These sessions consisted of providing general knowledge and information about diabetes and its self-care in a participatory and dynamic manner, with an exchange of experiences among the participants. For the approach to be motivational, some guiding principles are essential: empathy, open-ended questions, reflective listening, working with patients’ ambivalence and resistance, as well as the construction of intrinsic motivation and confidence towards change. Activities such as the identification of personal values, the definition of action-oriented plans, the evaluation of the success and difficulty of each plan, the setting of goals and the metric of importance and confidence help delineate this method. It is possible to evaluate the impact of an educational activity using this approach by applying the Diabetes Self-Management Profile (DSMP) before and after the activities. The DSMP is a new and specific instrument for evaluating DM1 patients’ self-care, with psychometric properties validated in the Portuguese language. Compared to other questionnaires it has less bias in its application, due to the introduction that “normalizes” non-adherence. To test this methodology, we recruited DM1 patients from Cruz Vermelha Hospital’s endocrinology clinic. We did not obtain enough sample for statistical significance, however we had positive returns from participants and positive individual results (Fig. 1).
Keywords: group education, motivational principles, Diabetes Self-Management Profile.
A200 Hyperosmolar hyperglycemic state during pregnancy
Karen Viviana Ivasiuten Gorejko1, Janaina Petenuci1, Fabiana Pereira Lopes2, Jessica Tatiana Mendoza1, Davi Francisco Machado1, Rodrigo Gomes de Souza3, Rosane Kupfer1
1Instituto Estadual de Diabetes y Endocrinologia Luiz Capriglione, Rio de Janeiro, Brazil; 2Hospital da Mulher Heloneida Studart, Rio de Janeiro, Brazil; 3Instituto Estadual de Diabetes y Endocrinologia Luiz Capriglione-Hospital da Mulher Heloneida Stuart, Rio de Janeiro, Brazil
Correspondence: Karen Viviana Ivasiuten Gorejko
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A200
Case report: A 28 year-old patient, first pregnancy, a gestational age of 38 weeks, asymptomatic, was hospitalized with a dead fetus. She had no regular prenatal follow-up. Her capillary blood glucose reported = 116 mg/dL (2nd trimester), she did not have treatment for diabetes mellitus (DM). She had no other comorbidities but a positive family history for type 2 DM and a pre-gestational BMI = 31; with a presence of acanthosis nigricans. She was labor inducted (LI), but she did not undergo any blood glucose measurement at the time of admission. After 48 h, the patient was taken to the surgical center for cesarean section, with a history of prolonged labor, maternal “exhaustion” and lowering of the level of consciousness, as well as hypotension and dehydration. She was Hydrated and submitted to anesthetic induction but then she developed with cardiorespiratory arrest (CRA) - electrical activity without pulse. Laboratory tests showed: blood glucose = 927 mg/dL, acute renal failure (ARF)—ClCr < 15 mL/min, pH 6.96 (HCO3 = 13.3), plasma osmolarity = 339.5 mOsm/L. Ketonuria and ketonemia was not measured. Venous insulinization and hydration was initiated, with improved of glycemia and acidosis. However, the pacient progressed with severe sepsis and multiple organ dysfunction, and she died after 4 days of hospitalization. Discussion: There are few reports on Hyperosmolar Hyperglycemic State (HHS) in pregnancy. HHS is a severe complication (mortality: 15–60%), often associated with previous type 2 DM, especially in undiagnosed cases. Due to the increase prevalence of pregnant women with DM 2, it is a situation that may become more frequent, and it deserves the attention of professionals dealing with pregnant women. Precipitating causes previously documented in the literature are numerous: infection, discontinuation of insulin treatment, and hyperglycemic medications. The best way to prevent is with a properly diagnose and treatment, as well as increase the diabetes educational programs.
Comments: In spite of this case did not match, clearly, criteria for HHS (pH and HCO3 values), the probability of complications is high. In addition, the severe ARF associated, certainly contributed to worsen the acidosis parameters. The message is clear: pregnant, diabetic prior, should be carefully evaluated in regard to prenatal and in-hospital care, especially in the case of an inadequate treatment and severe intercurrences such as infections and abortions (Figs 1, 2).
Informed consent to publish had been obtained from the patient.
A201 Hypoglycemia as a function of HBA1C in type 2 diabetes (T2DM): insulin glargine 300 u/ml in a patient-level meta-analysis of edition 1, 2, and 3
Riccardo C. Bonadonna1, Jean-François Yale2, Claire Brulle-Wohlhueter3, Emmanuelle Boëlle-Le Corfec3, Pratik Choudhary4, Timothy S. Bailey5
1Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy; 2McGill University, Montreal, QC, Canada; 3Sanofi, Paris, France; 4Diabetes and Nutritional Sciences, King’s College London, London, UK; 5AMCR Institute, Escondido, CA, USA
Correspondence: Riccardo C. Bonadonna
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A201
Basal insulin therapy can be a compromise between achieving glycemic targets and avoiding hypoglycemia, dependent on how intensively insulin is titrated. In the phase 3a EDITION 1, 2 and 3 studies, insulin glargine 300 U/mL (Gla-300) provided equivalent glycemic control to insulin glargine 100 U/mL (Gla-100) with less hypoglycemia in people with T2DM. The objective of the current analysis was to evaluate rates of confirmed (≤ 70 mg/dL) or severe hypoglycemia over 6 months of treatment with Gla-300 or Gla-100 in these EDITION studies, as a function of HbA1c. Meta-analysis was performed on patient-level data, and annualized hypoglycemia rate as a function of HbA1c at month 6 was fitted using a negative binomial regression model. Adding a treatment-by-HbA1c interaction term to the model did not significantly improve the goodness of fit (interaction p-value 0.937 and 0.829 for anytime [24 h] and nocturnal [00:00-05:59 h] hypoglycemia, respectively). Therefore the model without interaction describes the data accurately: people treated with Gla-300 experienced a consistently lower rate of confirmed (≤ 70 mg/dL) or severe hypoglycemia vs. those treated with Gla-100, regardless of HbA1c at month 6 (Figure). In conclusion, these results suggest that treatment with Gla-300 vs. Gla-100 could allow people with T2DM to achieve equivalent glycemic control with less hypoglycaemia. Study codes: NCT01499082, NCT01499095 and NCT01676220. This is an ENCORE abstract previously presented at ADA2016. Funding and editorial support provided by Sanofi. (Fig. 1)
A202 Hypoglycemia in non-diabetics—evaluation and conduct—experience of a tertiary service
Pryscilla Moreira de Souza Domingues1, Lizia Baruque Baylão1, Mariana Lima Mascarenhas Moreira1, Ariane Delai1, Milena Colombo Bruno1, Beatriz Espinosa Franco1, Patrícia Moreira Gomes1, Maria Cristina Foss Freitas2
1HC FMRP USP, São Paulo, Brazil; 2FMRP USP, São Paulo, Brazil
Correspondence: Pryscilla Moreira de Souza Domingues
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A202
Introduction: Hypoglycemia, defined by the Whipple triad, is uncommon in non-diabetics and requires careful evaluation.
Objective: To analyze cases of hypoglycemia in hospitalized patients between January 2000 and June 2017 in a tertiary service.
Method: Retrospective descriptive study of 32 cases of hypoglycemia by reviewing medical records. The patients had previous diagnosis of hypoglycemia in the health unit. At admission, were excluded hepatic, renal and adrenal insufficiency, hypopituitarism, leukemia, and were collected blood glucose, insulin, proinsulin and peptide C. 59% of the patients performed 72 h of prolonged fasting.
Results: 62.5% of the patients were women; the average age was 42 years. Symptoms reported: loss of consciousness (62.5%), convulsions (43.7%), sweating (59.3%), tremors (50%), visual turbidity (40%), mental confusion, palpitations (25%) and nausea (12.5%). Improvement of symptoms with feeding in 56.2% of the cases. The median time to diagnosis was 30.7 months. 15 patients had hypoglycemia in the supervised prolonged fasting test, with a mean of 18 h for their occurrence. Laboratory hypoglycaemia was confirmed in 27 patients (84.3%), with mean blood glucose of 35.5 mg/dl and insulin of 55.6 uU/ml. The diagnoses were: 11 cases of insulinoma, 3 cases of primary hyperplasia of islets (IHP), 3 of factitious, 4 of endogenous hyperinsulinemia without insulinoma image, 2 due to inadvertent use of sulfonylurea, 2 after bariatric surgery, 1 of reactive hypoglycemia, 1 of hypoglycemia secondary to the production of IGFII per tumor (hemagiopericytoma with metastases to the liver) (3.1%) and 1 of persistent hyperinsulinemic hypoglycemia of childhood. 2 patients lost follow-up, 2 had no confirmation of hypoglycaemia. Ten insulinoma patients and three HPI patients (1 in another service) were operated on. The insulinomas were located: 5 in the head (50%), 2 in the tail (20%), 1 in multiple sites (10%), 1 in the body (10%) and 1 still awaiting an anatomopathological report.
Conclusion: Prolonged supervised fasting helped in the exclusion of factitious hypoglycemia. In cases of endogenous hyperinsulinemia, hypoglycemia was reached within a few hours of fasting. Neuroglycopenic symptoms were more prevalent than adrenergic, probably due to long-term symptoms. The literature reports a homogeneous distribution of insulinomas in the pancreatic segments, in our sample we observed a higher prevalence in the head of the pancreas.
A203 Hypothalamic TGF-B1 downregulation improves energy homeostasis in mice fed on high-fat diet
Natália Ferreira Mendes, Joana Margarida Gaspar, Licio Augusto Velloso, Eliana Pereira Araújo
Universidade Estadual de Campinas, São Paulo, Brazil
Correspondence: Natália Ferreira Mendes
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A203
Background: Obesity and its associated comorbidities are growing fast worldwide. Increased adiposity contributes to the low-grade inflammation which leads to insulin resistance and increases the risk of developing type 2 diabetes mellitus. In the hypothalamus, the inflammation leads to an impairment of the energy and glucose homeostasis. The disruption in glucose homeostasis observed in mice fed on high-fat diet (HFD) is associated, at least in part, to the excess of TGF-β1 levels in the hypothalamus. Increased hypothalamic TGF-β1 levels lead to atypical activation of NF-kB, boosting the inflammatory response. However, the molecular mechanisms involved in this deregulation have not yet been fully elucidated.
Aim: To investigate the role of hypothalamic TGF-β1 in response to the inflammation triggered by saturated fatty acids from the diet. Materials and methods: In all experiments we have used eight-week-old male mice (C57BL/6). TGF-β1 knocking down have been performed through a bilateral injection of a lentiviral shRNA particle (TRCN94) in the arcuate nucleus of the hypothalamus (ARC). Immediately after surgery, animals were divided into two groups (scramble and TRCN94) and began to receive HFD for two weeks. Food intake and body mass were measured throughout the study. At 14th day post-surgery, animals were sacrificed and their tissues were removed for analysis. The study was approved by Institutional Animal Care and Use Committee from State University of Campinas (CEUA 4331-1A).
Results: As expected, in the hypothalamus TGF-β1 was colocalized with glial cells. TGF-β1 downregulation in the ARC has prevented the body mass gain and fat mass accumulation. TRCN94 group showed lower BAT mass, was protected from HFD-induced thermogenesis impairment, and showed increased locomotor activity when compared to scramble group. No differences were observed in the food intake, in the glucose homeostasis and in the hypothalamic inflammation between groups, despite TRCN94 group have shown lower levels of fasting blood glucose.
Conclusion: Hypothalamic TGF-β1 downregulation improves energy homeostasis by increasing BAT activity and locomotor activity that results in lower body mass gain, preventing the development of obesity. Funding: FAPESP (2016/17810-3).
A204 Identification of HNF1B gene mutations in a brazilian sample selected by hyperglycemia and renal cysts
Renata Pires Dotto1, Lucas Santos de Santana2, Susan Chow Lindsey1, Lilian Araújo Caetano2, Luciana Ferreira Franco1, Regina Célia M. S. Moisés1, João Roberto de Sá1, Ita Pfeferman Heilberg1, José Luiz Nishiura1, Milena Gurgel Teles2, Magnus R. Dias-da-Silva1, Fernando M. A. Giuffrida3, André Fernandes Reis1
1UNIFESP, São Paulo, Brazil; 2USP, São Paulo, Brazil; 3UNIFESP/UNEB, São Paulo, Brazil
Correspondence: Renata Pires Dotto
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A204
Introduction: There are at least 14 described subtypes of MODY (maturity onset diabetes of the young). Mutations in the HNF1B gene are associated with multiorgan disease, including HNF1B-MODY (MODY5), morphological abnormalities of the kidney (mainly renal cysts) and pancreas, and low serum magnesium levels. Due to this clinical heterogeneity, there is much debate about the best criteria for HNF1B genetic screening.
Aim: To investigate HNF1B mutations in a sample of Brazilian patients selected by hyperglycemia and renal cysts.
Methods: Thirty-three unrelated subjects with clinical suspicion of HNF1B mutation defined as Diabetes Mellitus (DM)/prediabetes (as per the ADA criteria) and renal cysts were selected. Other data were collected from medical records. Genotyping was performed by Sanger sequencing and multiplex ligation-dependent probe amplification (MLPA). Available relatives were recruited in positive cases.
Results: Two individuals had mutations. 1- Male, 36 yrs old, BMI 22,9 kg/m2 with a HNF1B heterozygous whole gene deletion (p.Met1_Trp557del), DM since age 13 yrs, using NPH and Regular insulin, negative GAD and IA2 antibodies, C-peptide 1,4 ng/mL, fasting glucose 231 mg/dL, HbA1c 7,1%, creatinine 1,17 mg/dL, creatinine clearance (CrCl) (CKD-EPI) 92,2 mL/min, magnesium 0,9 mg/dL (NR:1.7–2.6 mg/dL). Imaging demonstrated body and tail pancreatic agenesis, besides renal cysts. The same mutation was seen in his father, who had DM, renal cysts, and pancreatic tail agenesis, in a normoglycemic brother with renal cysts and pancreatic body/tail agenesis, and a sister with pancreatic body hypoplasia and agenesis of the pancreas tail, renal cysts, and bicornuate uterus. 2- Male, 38 years old, BMI 19,4 kg/m2, DM diagnosed at age 12 yrs, using NPH insulin since one year after the diagnosis, negative GAD and IA2 antibodies, C-peptide 0,9 ng/mL fasting glucose 165 mg/dL, HbA1c 13.2%, creatinine 1.2 mg/dL, CrCl: 76.2 mL/min, magnesium 1,0 mg/dL, renal cysts, with a previously described p.Pro328 fs (C.983del C) mutation. Patient 2 had no known familial history of DM or renal cysts, and no relatives were available for testing.
Conclusion: Screening for HNF1B mutations in patients with hyperglycemia and renal cysts showed a 6% positivity rate.
Informed consent to publish had been obtained from the patient.
A205 Identification of risk factors for diabetic foot in the first preventive examination of patients with type 1 diabetes mellitus attended in a public service of reference in Minas Gerais
Maria Eugênia Silva Hitchon, Agma Leozina Viana Souza, Rosimeire Fernandes de Oliveira, Aleida Nazareth Soares, Tatiane Géa Horta, Janice Sepúlveda Reis, Maria Regina Calsolari
Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Minas Gerais, Brazil
Correspondence: Maria Eugênia Silva Hitchon
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A205
Background: Diabetic foot is one of the most worrying complications in patients with diabetes, since it is the main cause of lower limb amputation. Patients with Type 1 Diabetes Mellitus (T1DM) may have a delay in the detection of risk factors for injuries due to the time elapsed to start the tracing. Identifying these factors early can contribute to the elaboration of a more appropriate educational program for this group, starting early after diagnosis or at admission to the outpatient service.
Objective: Identify risk factors for diabetic foot in patients with T1DM on admission to a specialized outpatient clinic for neuropathy and diabetic foot.
Methods: A cross-sectional study, with an analysis of 181 medical records of patients with T1DM, with five or more years of illness, attended by an interdisciplinary team between 2004 and 2014 and forwarded to the first outpatient care on neuropathy and diabetic foot of reference public service in Minas Gerais. Data related to the socioeconomic, clinical profile, physical changes in the feet and prevention guidelines of the diabetic foot were analyzed. The study was approved by Institution’s Ethics Board.
Results: Among the 181 patients referred, the following diagnoses were confirmed: retinopathy (35.4%), nephropathy (27.8%), diabetic neuropathy (17%) and neuropathic pain (20.5%), however, only 88 performed the consultation in the center of neuropathy and diabetic foot. Of these, the majority were female (51.1%), aged 38.23 ± 11.65 years, diagnosis time of 17.7 ± 9.84 years, ambulatory follow-up of 2.82 ± 1,75 years, incomplete high school (33.7%), monthly income between 1 and 2 minimum wages (69.6%) and glycated hemoglobin of 8.19 ± 1.6%. In relation to the physical alterations of the feet, the most common were plantar hyperkeratosis (66.7%), callus (33.0%), fissures (23.7%), onychomycosis (17%) and ulcers (2.4%). The use of adequate footwear (66.3%) and good foot hygiene (92.5%) were predominant.
Conclusion: The study detected a failure in the educational process and in the patients orientations regarding the importance of foot evaluation, with a high percentage of non-appointment schedules and modifiable risk factors for diabetic foot, which could have been identified by foot inspection in habitual consultations and previously treated, regardless of the time of illness and the beginning of the traces, also showing that the patient did not identify such factors as risk of lesions and amputations.
A206 Iglarlixi fixed-ratio combination in patients with HbA1c > 9%: lixilan-O subgroup analysis
Melanie Davies1, David Russell-Jones2, Thomas M. Barber3, Cecile Baradez4, Michael A. Baxter4, Rory J. Mccrimmon5
1Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK; 2Department of Diabetes and Endocrinology, University of Surrey, Guildford, UK; 3Warwick Medical School, University of Warwick, Coventry, UK; 4Sanofi, Guildford, UK; 5Division of Molecular & Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
Correspondence: Melanie Davies
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A206
In patients (pts) with T2DM and HbA1c ≥ 9% (75 mmol/mol), the ADA/EASD guidelines recommend considering a dual combination of metformin + oral antidiabetics (OADs), a glucagon-like peptide-1 receptor agonist (GLP-1 RA), and/or basal insulin; NICE recommends premixed insulins. Both guidelines suggest that pts with high HbA1c may require basal ± prandial insulin replacement to expedite reaching target HbA1c. The 30- week randomized LixiLan-O trial (NCT02058147) treated pts with T2DM uncontrolled on metformin ± another OAD with iGlarLixi (insulin glargine [iGlar] + lixisenatide [Lixi] fixed-ratio combination), iGlar, or Lixi. This LixiLan-O exploratory subgroup descriptive analysis, assessed whether iGlarLixi, which improves fasting and postprandial glucose, demonstrated findings consistent with the primary trial results in pts with baseline HbA1c ≥ 9% (iGlarLixi, n = 49; iGlar, n = 55; Lixi, n = 29). iGlarLixi showed greater HbA1c reductions (− 2.9%) at Week 30 vs. iGlar (− 2.5%; least squares [LS] mean difference, − 0.4%; p = 0.03) and Lixi (− 1.7%; LS mean difference, − 1.2%; p < 0.0001); only the iGlarLixi group achieved a mean HbA1c < 7.0% (Fig. a, b). iGlarLixi also mitigated weight gain with iGlar (Fig. c). In pts with HbA1c ≥ 9%, iGlarLixi provided benefits generally consistent with the primary LixiLan-O analysis. These findings support iGlarLixi as part of stepwise intensification in pts with high HbA1c. Study code: NCT02058147(Fig. 1).
A207 Immunization against influenza: knowledge and accession of persons with diabetes of a health promotion program
Danielle Cardoso Portilho, Francineide Pereira da Silva Pena, Diego Quaresma Ferreira, Jemima Cordeiro Messias Malcher Miranda, Jessica Gomes da Silva, Rafael Pinto da Silva, Jessica Monteiro Cunha, Sônia Silva Alves, Gabriela de Souza Amanajás, Adriane Stefanny Rocha Ribeiro, Ediene Sterfany Marques Vale, Amiraldo Dias Gama, Tallitha Barbosa da Luz, Emanuel de Jesus Vaz Bittencourt, Maria Silvia da Costa Silva, Angel Tamna Souza de Souza, Suzana Maria da Silva Ferreira Lima, Fábio Rangel Santos Cardoso
UNIFAP, Amapá, Brazil
Correspondence: Danielle Cardoso Portilho
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A207
Introduction: People with Diabetes Mellitus (DM) are more susceptible to complications from influenza viral infections. In the population above 60 years, these infections are more pronounced. Thus, immunization, indicated by the World Health Organization since 1963, should be an essential strategy for primary care, and it‘s been described as a measure of greater effectiveness in coping with the problem, preventing hospitalizations, complications and consequently reducing morbimortality. This way, the propagation of knowledge and adherence are fundamental to achieving such benefits.
Objective: To estimate vaccine coverage and to identify the importance of knowledge and adherence of immunization against influenza in people with DM receiving clinical assistance in the Health Promotion Program.
Method: Cross-sectional studies with a quantitative approach, with no qualification of semiprothetic formats, socio-demographic variables, clinical and immunization, after flu vaccination campaign in 2017. Data analyzed: no SPSS version 22.0. The study was approved by the Ethics and Research Committee (Comitê de Ética e Pesquisa) (CEP) of the Federal University of Amapá (Universidade Federal do Amapá), with Postal Code/CEP number: 38390014.4.0000.0003.
Results: Of the 77 active participants, 44 agreed to participate in the study, with prior signature of a Free and Informed Consent Term. On the characterization of the sociodemographic profile: mean age of 60.2 years (Table 01), being (79.5%/n = 35) female; predominant race was brown (75.0%/n = 33); marital status (38.6%/n = 17) were married; source of income predominantly domestic and retirees, both with (18.2%/n = 8) (Table 5). Regarding the characterization of the disease, (100%) demonstrated to have Type 2 DM (Table 2), with a mean time of diagnosis of 9.4 years (Table 3). Concerning influenza vaccine adherence, (20.5%/n = 9) reported having fear/vaccine related urges; (25%/n = 11) were not immunized in the previous year and of these (13.6%/n = 6) remained unimmunized in the current year, stating as main reason the possible reactions that the vaccine may cause. As to the importance of immunization (95.5%/n = 42), the main objective was to “prevent and/or fight influenza” predominating (59.1%/n = 26); (6.8%/n = 3) were not aware of the importance/purpose of immunization (Table 4).
Conclusion: There was satisfactory immunization coverage of people with DM who agreed to participate in the study, but regarding the importance, purpose and benefits that immunization provides for their health, their knowledge is limited only to the side effects of the vaccine, reflected in the immunization adherence shown (Figs. 1, 2).
A208 Impact of cardiovascular rehabilitation program in individuals with diabetes from a private outpatients institution in São Paulo
Marcela Alves Teixeira Furtado, Camila Yumi Senaga, Thais Pellegrino Miranda, Julia de Paiva Fonseca de Campos, Pedro Gabriel Melo de Barros e Silva, Karen Cunha Pachon, Eneas Antonio Rocco, Viviane Aparecida Fernandes, Valter Furlan
Amil-Total Care SP, São Paulo, Brazil
Correspondence: Marcela Alves Teixeira Furtado
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A208
Introdution: Diabetes Mellitus (DM) is a complex disease that requires care in order to decrease risk of complications and glycaemic levels. A healthteam from a Private Outpatient Institution (POI) started a Cardiovascular Rehabilitation Program in order to prevent complications and to encouragepatients to practice physical activity.
Objective: To show the impact of Program’s adherence. POPULATION: all DM patients from POI (N = 58), that attended all Rehabilitation Program sessions. People ofboth sexes, age average: 41 ± 20,5 years old; Body Mass Index (BMI): 34% eutrophic, 67% overweight. Epidemiological characteristics: 98% DM 2, who were 86% hypertensive, 83% dyslipidemic,78% with atheroesclerotic disease,14% with heart failure,7% with COPD (chronic obstructive pulmonary disease) and 88% with CAD (coronary artery disease).
Methods: DM patients who were referred to join the Program(N = 58) were followed for the 36 sessions in the POI. Atthe beginning of rehabilitation program and at end of it, they were requested to fillin a Quality of Life Questionare-SF-36, excluding patients with cognitive deficit, in order to evaluate if there was Quality of Life (QL) improvement. Data were tabulated and evaluated along with others quantity and quality variables, being presented as media, standard deviation and graphics with values expressed inpercentages of prevalence.
Results: Among those patients, we noted that 67% had been seen regularly by a secondary sector (endocrinologist), identified by ACTIVE. The patients without regular medical follow- up were nominated as administrative DISCHARGE. It was detected that, 7%of ACTIVE, had at the end better HbA1c (glycated haemoglobin) levels, 6% remained the same and e 21% worsened. In comparison with those patients, only 41% of administrative DISCHARGEgroup improved HbA1c levels, 35% remained the same and 24% worsened. Besides the HbA1c, improvement of SF-36 was compared. ACTIVE had a 68% improvement by the end of the Program. It was compared better and worse SF 36 results with patients’ HbA1c levels (Figs. 1 and 2): Fig. 1: Relation Between SF 36 result and HbA1c levels in administrative DISCHARGE patients Fig. 2: Relation Between SF 36 result and HbA1c levels in ACTIVE patients
Conclusions: Analyzing the 58 patients included in the Program for 2 years, it shows the importance of a proper medical follow up, as a transdisciplinary and multiprofissional care to prevent disease complications. The best HbA1c levels and adherence to Rehabilitation program was in the ACTIVE group.
A209 Impact of continuous subcutaneous insulin infusion system (CSII) in child and adolescent treatment: follow up for 10 years
Ivana van der Linden Nader1, Adriane Codevilla Mata de Sousa2, Desiree Mata de Sousa3
1APAE Anápolis, Goiás, Brazil; 2Secretaria Municipal de Goiania, Goiás, Brazil; 3Faculdade Unievangelica, Goiás, Brazil
Correspondence: Ivana van der Linden Nader
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A209
There is increasing evidence that Continuous subcutaneous Insulin Infusion System (CSII) can improve quality of life, ensuring flexibility and improved glycemic control including a reduction in severe hypoglycaemia. However, there are few Brazilian studies on the subject. CSII therapy physiologically reproduces insulin levels, with the basal rate through continuous automatic delivery of microinfusions adjusted by hour, complemented by user calculation and bolus delivery for postprandial glycemic control or correction, with more predictable release, and, time of recognition and decision-making before becoming serious. In asymptomatic hypoglycemia, evidence suggests a reversal of this condition if events are avoided. This reduction in hypoglycemia will only occur if the CSII has been programmed correctly and the user has made the proper decision when managing problems, interpreting, and acting on the basis of blood glucose. During 2006 to 2016, we followed 46 children and adolescents attended by an endocrinologist of the private health system, with support from Multidiscisplinar Center focused on this therapy. About 5 years ago, the SUS (Single Health System—Brazilian public system) created a specialized center for CSII users, for global multidisciplinary educational monitoring (nutritionist, nurse and psychologist), with production of performance reports to support the decision of the medical teams. In the follow-up, 56.5% are female and 43.4% male, between the ages of 2 and 26 years (mean ± SD: 15 ± 2.35 years), with 9 previous users of CSII. Groups were separated into users (old) and those who initiated CSII in the Center (new). In the old group, CSII time ranged from 7 to 11 years (mean 9.11 years), A1C ranged from 7.9% in the pre-CSII to 8.25% at the beginning of follow-up at the Center and 7.07% at follow-up. In the new group the CSII time ranged from 5 months to 5 years (mean 4.5 years), A1C ranged from 8.37% in the pre-CSII to 7.14% in the SICI post in the center. There were no new complications in the period. There were only 2 events of severe hypoglycemia hospitalized for handling error by the caregiver in those 10 years. An effective partnership between professional staff and the user is a key factor in achieving success in therapy. Continuous support for users is an essential component of the service, which must be delivered by a specialized and experienced multidisciplinary team.
A210 Impact of hemodialysis on insulin doses in patients with type-1 diabetes mellitus and endstage kidney disease
Rafael Kitayama Shiraiwa, Lara Bessa Campelo Pinheiro Cavalcante, Márcia Silva Queiroz
FMUSP, São Paulo, Brazil
Correspondence: Rafael Kitayama Shiraiwa
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A210
Introduction: Kidneys are responsible for the clearance of one-third of circulating insulin, and its progressive function loss has been associated with a decrease in clearance capacity. Besides, glucose loss through dialysis fluid and insulin adsorption to the membrane modify glycaemic control and insulin doses during hemodialysis (HD). The objective of this study was to evaluate the HD influence in type-1 diabetes mellitus (T1DM) patients on renal replacement therapy.
Methods: The doses of insulin used on non-HD days were compared with those on HD days in 32 T1DM patients followed in diabetes outpatient clinic.
Results: Twenty women and 12 men were included with mean age 38.2 ± 8.6 years and diabetes duration 25.4 ± 6.2 years. Hemoglobin glycated (HbA1c) during last year ranged from 5.6 to 11.3%, mean 8.0 ± 1.1%. Total daily dose (TDD) of insulin in non-HD and HD days were 0.50 ± 0.19 and 0.45 ± 0.18 units/Kg/day, respectively. Regarding schedule for hemodialysis, we observed lower TDD (20 ± 9 units and 35 ± 17 units, respectively, p:0.04) and basal insulin dose (10 ± 5 units and 23 ± 18 units, respectively, p:0.04) for patients underwent to HD on intermediate-shift compared to those at afternoon-shift. The mean of HbA1c and fructosamine did not reach significant difference concerning to early-morning, intermediate or afternoon HD shift schedule.
Conclusion: TDM1 individuals on renal replacement therapy require lower insulin doses in HD days. HD patients on intermediate-shift have lower basal dose than those on afternoon-shift, probably by the decreased insulin doses at lunch time, in order to avoid hypoglycemia during HD session. The knowledge of the daily routine of T1DM patient in HD by diabetes healthcare team is essential to adjustments of insulin doses.
A211 Impact of the implementation of inpatient multidisciplinary glucose control team and institutional protocols in the glicemic control of hospitalized patients
Denise P Momesso, Claudia dos Santos Silva, Marcela Calomeni Fernandes Garrido, Aline G. Santos, Luciana Reis, Maria de Fátima M. Muino, Dayane Ribeiro, Ana Paula Vieira Cabra, Jacqueline Farret, Monica Cabral, Anna Haegler, Mariana Vasques, André Volschan
Hospital Pró-Cardíaco, Rio de Janeiro, Brazil
Correspondence: Denise P Momesso
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A211
Introduction: There is a growing recognition that glycemic control is a critical element in inpatient care. The optimal management of blood glucose in the hospital remains a great challenge. We introduced a hospitalwide inpatient glucose management program in our hospital that included the establishment of a multidisciplinary glycemic control team (MGCT) in June/2014. The aims of this study were to describe and evaluate the impact of the implementation of a MGCT and institutional inpatient glycemic control protocols in the glycemic control of hospitalized patients.
Methods: We performed a retrospective analysis of the medical records and of the point-of care glucose monitoring (POCT) of the hospitalized patients before (may/2014) and after (may/2017) the implementation of the MGCT. The institutional inpatient glycemic control protocols are in accordance with the international recommendations. All the patients admitted to the institution have their glycaemia monitored using the POCT Abbott® Precision PXP glucometer. The study was approved by the local Ethics Committee.
Results: We analyzed a total of 6888 and 7869 POCT from 389 and 545 patients in may/2014 and July/2015, respectively. The mean glycemia was of 158.9 ± 60.7 mg/dl and 150.3 ± 57.8 mg/dl in may/2014 and may/2017, respectively (p < 0,001). There was a reduction of 17.8% in the rates of hyperglycemia ≥ 180 mg/dl in may/2017 compared to may/2014 (19.3% and 23.5%, respectively; p < 0.001). Hyperglycemia ≥ 300 mg/dl was reduced in 28.5% in may/2017 compared to may/2014 (1.8% and 2.5%, respectively; p = 0.003). Hypoglycemia ≤ 40 mg/dl was observed in 0.1% and 0.2% of the patients in may/2017 and may/2014 (non statistically significant reduction of 34%; p = 0.34). In may/2014, 34.2% of the prescriptions were not in accordance with the institutional protocol and this was reduced to 7.5% in may/2017 (p < 0.001).
Conclusions: The implementation of hospitalwide glycemic control program was associated with significant reduction on hyperglycemic events. The key elements for these achievements were the development of institutional inpatient glycemic control protocols, the establishment of a MGCT, and the continuous educational programs for hospital personnel. Altogether, these actions resulted in improvement of processes of care, patient’s safety and clinical outcomes of hospitalized patients.
A212 Impact of time to basal insulin initiation on glycemic control and health care costs in T2DM patients: an analysis of U.S. commercial claims data
Lawrence Blonde1, Elisheva Lew2, Denis Raccah3, Juliana Meyers4, Mayank Ajmera4, Keith Davis4, Monica Bertolini2, Bruno Guerci5
1Ochsner Medical Center, New Orleans, LA, United States; 2Sanofi, Paris, France; 3Department of Diabetology, University Hospital Sainte-Marguerite, Marseille, France; 4RTI Health Solutions, Research Triangle Park, NC, United States; 5Department of Diabetology, Metabolic Diseases, and Nutrition, University of Lorraine, Vandoeuvre-lès-Nancy, France
Correspondence: Lawrence Blonde
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A212
Objectives: Many patients who would benefit from insulin therapy do not receive it in a timely manner. This study assessed HbA1c control and health care costs in a real world setting using a retrospective commercial claims database.
Methods: Patients with a T2DM diagnosis (ICD-9-CM codes 250.x0 or 250.x2) from 1/1/2007 to 12/31/2014, were identified in the MarketScan database. Patients initiating basal insulin (BI) and with an HbA1c > 7% in the 6 months pre-BI initiation were identified. Patients were required to have 24 months pre- and 12 months post-BI initiation health plan enrollment and were stratified by time with uncontrolled HbA1c (> 7%) before BI initiation (i.e., < 6, 6-12, 12-18, 18-24 months). Study measures included pre- and post-BI initiation HbA1c and health care costs.
Results: A total of 5422 patients met the inclusion criteria. Before BI initiation, mean (SD) HbA1c was 9.8% (2.0), with 50.3% of patients uncontrolled < 6, 18.3% 6-12, 13.7% 12-18, and 17.8% 18-24 months. There was little variation in baseline HbA1c by duration of time uncontrolled. Mean (SD) HbA1c reduction was 1.4 (2.4) but 48.1% of patients had HbA1c > 8% during follow-up. Patients with uncontrolled HbA1c < 6 months had the largest reduction in HbA1c (mean [SD] change of 1.8% [2.7], 58.4% HbA1c < 8%), while patients with uncontrolled HbA1c 18-24 months had the smallest change in HbA1c (mean [SD] change of 1.0% [2.0], 38.4% HbA1c < 8%). Costs in the 12 months post-BI initiation ranged from mean (SD) $14,621 ($22,654) among patients uncontrolled for 12-18 months to $18,816 ($40,793) < 6 months.
Conclusions: Despite improvements in HbA1c following BI initiation, almost half of patients had HbA1c > 8% during follow-up, with patients with the longest period of uncontrolled HbA1c during baseline least likely to achieve HbA1c < 8%. This study suggests there would be benefit from earlier introduction of BI or alternative therapeutic options to assist patients in achieving HbA1c targets. This is an ENCORE abstract previously presented at ADA2017. Funding and editorial support provided by Sanofi.
A213 Impact of using an automatic bolus calculator for the glycemic control of type 1 diabetes mellitus patients receiving multiple daily insulin injections
Cecilia Kauffman Rutenberg Feder, Delane Schapira Wajman, Nilza Maria Scalissi, Adriano Namo Cury, Joao Eduardo Nunes Salles, Mariana Vilela Pereira
ISCMSP, São Paulo, Brazil
Correspondence: Cecilia Kauffman Rutenberg Feder
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A213
Introduction: Type 1 diabetes mellitus is a chronic disease characterized by hyperglycemia that may lead to chronic complications. The strict glycemic control is a key in the prevention of these long term complications. In spite of both technological development and intensive insulin therapy, most of T1DM patients are far away from their suggested ranges. One of the main challenges in the therapy is the meal insulin bolus calculation. The suitable adjustment of the insulin dose for a given carbohydrate amount present in a meal is key to success in the postprandial control and in the T1DM management.
Objective: Assessing the impact on the glycemic Control in T1DM patients using the blood glucose meter Accu-Check Performa Connect with an automatic bolus calculator (ABC).
Method: This is a prospective, non-randomized and controlled 12 week clinical trial, with 26 over 16 year-old T1DM patients, whose HbA1c were equal or superior to 6.5%, who have T1DM diagnostic for more than 1 year, and following a multiple daily insulin injections (MDI) therapy, plus adjusted postprandial insulin doses according to each meal carbohydrates count. The intervention Group used the Accu-Chek Performa Connect glucometer linked to the mobile phone ABC app, and the Control Group continued with their standard blood glucose meter, with manual bolus. The download of data collected from their devices was used for dose adjustments in the whole treatment period.
Results: A total of 13 patients completed the study (Control, n = 6; Connect, n = 7). The Connect Group patients showed an important improvement in their Estimated Mean Glycemia (EMG), reaching statistical significance (p = 0.01). Percentages of both hyperglycemia and normoglycemia have also presented relevant improvement (p = 0.004 and p = 0.015, respectively). Statistical significance was not reached between groups in severe hypoglycemia (< 50 mg/dl). HbA1c decreased more in the Connect Group, but without reaching statistical significance (p = 0.315).
Conclusion: This was the first Brazilian prospective, controlled, non- randomized trial with T1DM patients, aiming to evaluate the ABC impact on the glycemic improvement of these subjects. In this study, it was possible to see the improvement of some glycemic parameters, without increasing the occurrence of severe hypoglycemia. However, further studies are needed to better evaluate the impact of the glycemic improvement, mainly to access the HbA1c reduction.
A214 Implementation of the diabetes reference center at schools in Minas Gerais
Ana Paula Gonçalves dos Reis, Agma Leozina Viana Souza, Alessandra de Cássia Lovato, Alexandre Henrique da Silva, Débora Bohnen Guimarães, Karima Fernanda Rosa Simão, Luciana Valadares Ferreira, Maria Eugênia Silva Hitchon, Marina Moreno Wardi, Paula Lamego Lourenço, Rosimeire Fernandes de Oliveira, Sônia Maria Maulais, Stephanie Araújo de Oliveira, Janice Sepúlveda Reis
Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Minas Gerais; Brazil
Correspondence: Ana Paula Gonçalves dos Reis
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A214
Background: School is the space where students spend most of their time, so there is a need for a team prepared to receive the student with diabetes, a disease that has an impact on the life of the individual as well as that of their family members. In the current scenario, parents feel insecure about taking their children to school due to the lack of preparation of a large part of the school staff.
Objective: To describe the creation and functioning of a Diabetes Reference Center at Schools (DRCS) in the Public Health System, for the training of the public and private schools of Minas Gerais.
Methods: Project developed by the interdisciplinary team of a Public Diabetes Center in Minas Gerais, with financial support from FAPEMIG (Foundation for Research Support of the State of Minas Gerais) and divided into 4 stages (Table 1).
Results: From August 2016 to July 2017, 147 public and private schools from the metropolitan region of Belo Horizonte were enrolled. Of these, 71 (48%) did not attend the scheduled and confirmed face-to-face training, performing only the online stage, requesting a rescheduling for times outside of the school days, justifying lack of school support for release from training, among other reasons. Most participants (87%) rated their knowledge to help a child with diabetes as unsatisfactory at the time of enrollment. In the evaluation of the training, in a scale from very good to bad, the participants classified as very good: the initial contact with the DRCS and the scheduling (84.62%), quality of the material sent by email in the first stage of the training (88.46%), content presented in face-to-face training (100%) and quality of didactic material used in tablets (92.31%). All respondents answered the questionnaire “yes” to the question “Do you feel better prepared to help a child with diabetes in the school environment?”
Conclusion: The creation of the DRCS and the adopted model have met the objective of training of the school teams, enabling their inclusion in the treatment of children with diabetes. However, the lack of importance given to the subject in the country, both by government agencies and by the direction of schools, have required diversified strategies to enable training in different circumstances and difficulties, such as distance education, the final phase of the project. Ethics Approval The study was approved by Santa Casa of Belo Horizonte Institution’s Ethics Board, approval number 1.064.985 and written consent was obtained from all participants (Fig. 1).
A215 Improved glycemic control with carbohydrate counting for adjustment of fast-acting insulin aspart vs. insulin aspart in subjects with type 1 diabetes
Athena Philis-Tsimikas, Bruce W Bode, Edward Franek, Ludger Rose, Kristine Buchholt, Marek Demissie, Thomas R Pieber, Juliana dos Santos e Paula
Novo Nordisk Farmaceutica do Brasil, São Paulo, Brazil
Correspondence: Athena Philis-Tsimikas
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A215
Insulin delivery based on carbohydrate counting (CC) is the gold standard for improving glycemic control in type 1 diabetes (T1D). A post hoc analysis of onset 1, a 26-week, phase 3 trial, assessed methods for adjusting the dose of mealtime fast-acting insulin aspart (faster aspart) and insulin aspart (IAsp), each with insulin detemir. Subjects with previous experience continued CC (HbA1c, faster aspart and IAsp 7.6%) and remaining subjects used a simple bolus algorithm (BA; HbA1c, faster aspart 7.5%, IAsp 7.6%). Faster aspart showed a statistically significant greater reduction in HbA1c vs. IAsp, and non-inferiority was confirmed (Fig. 1). With CC, HbA1c reduction was statistically significantly greater for faster aspart vs. IAsp (est. treatment difference: − 0.19% [95% CI − 0.30; − 0.09]) but was similar for both treatments with a BA. Rate of hypoglycemic episodes and bolus insulin dose were similar between treatments across adjustment methods. No significant differences in total insulin dose or weight gain were observed between treatments with either adjustment method. Faster aspart was effective in glycemic control regardless of adjustment method. For patients with T1D capable of dosing based on CC, faster aspart may offer improved glycemic control vs. IAsp, with similar weight gain and insulin dose, and without an increased risk of hypoglycemia.
A216 Improvement of glycemic control in DM2 patient after association of GLP-1 receptor agonist to insulin therapy, independent of weight loss
Paula Aragão Prazeres de Oliveira, Alessandra Medeiros Brandão Alberto de Mello, Bruna Gonçalves dos Santos Oliveira, Deborah Ravenna Chaves Brainer de Britto, João Francisco de Melo Neto
UPE, Pernambuco, Brazil
Correspondence: Paula Aragão Prazeres de Oliveira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A216
LC, male, 66 years old, type 2 diabetic for 3 years, using Gliclazide 60 mg/day and Metformin 1500 mg/day. He reported asthenia and difficulty losing weight. Laboratory tests showed poor glycemic control (HbA1c = 9.6%) and weight = 107.1 kg. Therapy with Insulin Degludec 16U was started to control glycotoxicity, suspension of gliclazide and maintenance of metformin. After 30 days, the glycemic control was improved, GJ = 171 mg/dl, HbA1c = 8.2%, but with increased appetite and difficulty to perform physical activities. To optimize patient glycemic control and weight loss, Liraglutide 1.2 mg/day was initiated. On the 30-day return, HbA1c presented 7.6%, GJ = 153 mg/dl and weight = 105.9 kg, and Liraglutide dose was increased to 1.8 mg/day. After 4 months of maximal Liraglutide dose, patient presented a 3 kg weight loss, but with continuous decrease of HbA1c (7.0%), an improvement that remained until the last evaluation (total weight loss = 6 kg/5.60% of total weight with HbA1c = 6.4%). The insulin dose was reduced to 10 U and reassessed in 30 days for possible discontinuation of insulin therapy. GLP- 1 receptor agonists stimulate insulin secretion in a glucose-independent manner, inhibit glucagon secretion and hepatic glucose output, delay gastric emptying, induce satiety, reduce appetite, and cause weight loss. They were superior in glycemic control and weight when compared to other DM2 treatment options. Compared to DPP-4 inhibitors in 11 of 13 studies, they were superior in glycemic control and in 14 of 14 studies, were superior in weight loss. With sulfonylureas, they showed superiority in HbA1C control in 7 of 10 studies and weight loss in 10 of 10 studies. Compared with insulin therapy it also demonstrated superiority in weight loss in all studies and was superior in the control of HbA1c in 23 of 30 studies. Liraglutide, regardless of weight loss, showed a decrease in HbA1c in quartile analysis of weight loss (Liraglutide 18 mg-LEAD-3). It is a therapeutic option with action well established in weight loss, metabolic and glycemic improvement in the DM2 patient. However, its action on HbA1C reduction was independent of weight loss, evidencing intensive glycemic control with HbA1C between 6.5 and 7.0% even with discrete or even absent weight loss.
Informed consent to publish had been obtained from the patient.
A217 Improvements in blood glucose level and blood pressure after the performance of the bariatric surgery
Dayanne de Lima Veiga1, Bianca Bittar Falco2, Priscilla Oiring do Valle1
1HAC; São Paulo, Brazil; 2Hospital Ipiranga, São Paulo, Brazil
Correspondence: Dayanne de Lima Veiga
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A217
Introduction: Obesity is a chronic and multifactorial disease that implies in many difficult-to control metabolic problems, such as diabetes and hypertension. It is known that there are several modalities of bariatric surgeries resulting in significant weight loss and improvement in blood glucose and blood pressure levels. Moreover, in some cases the patient returns to normoglycemic levels after bariatric surgery. Weight loss can also be observed.
Objective: To evaluate the clinical and metabolic profile of patients with obesity after bariatric surgery.
Methods: A cross-sectional study was carried out in the Multidisciplinary Outpatient Clinic of Obesity and Metabolic Surgery at Ana Costa de Santos Hospital. Laboratory tests data were collected from the medical records of twenty patients who had undergone bariatric surgery and were afterwards seen in this outpatient clinic.
Results: Twenty-four percent of patients lost weight after bariatric surgery. Patients have postoperative time ranging from 15 days to 1 year. Eleven patients out of sixteen had undergone the surgery 3 months before they participated in this study. Fasting blood glucose level decreased in nine percent in patients who had undergone the surgery. Five patients stopped taking medications they had been using previously.
Conclusion: Results point bariatric surgery as an important therapeutic option due to its potential to reverse diabetes and improve blood glucose level and blood pressure in patients who have morbid obesity.
A218 In silico projection of the molecular structure of microrna over-expressed in type 2 diabetes
Luis Jesuino de Oliveira Andrade1, Alcina Maria Vinhaes Bittencourt2, Gustavo Magno Baptista3, Gabriela Correia Matos de Oliveira4, Candice Messias Barbosa Santos5, Ronaldo Adriano Dourado Alvres5, Lidiany Oxenford da Silva5
1PpGCS-UESC-Bahia, Brazil; 2Faculdade de Medicina-UFBA, Bahia, Brazil; 3PpCCS-UESC-Bahia, Brazil; 4Faculdade de Medicina-UNIME-Bahia, Brazil; 5UESC, Bahia, Brazil
Correspondence: Luis Jesuino de Oliveira Andrade
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A218
Introduction: Molecular biology studies demonstrate that microRNAs (miRNAs) seem to play a fundamental role in triggering and progression of type 2 diabetes (DM2), as well as, have been suggested as a novel biomarker for DM2 prediction. The miRNAs are small noncoding RNAs with 19–25 nucleotides that implicate in post transcriptional control of gene expression in multicellular organisms by disturbing the stability in processes such as translation, resulting in target miRNAs degradation or silencing.
Objective: To develop in silico projection of molecular structure of miRNA already defined as biomarker for DM2 prediction.
Methods: A search was performed on the nucleotide sequence of 4 miRNAs already defined as biomarker for DM2 prediction, performing in silico projection of the molecular structure of the following miRNAs: miR-455-5p, miR-454-3p, miR-144-3p and miR-96-5p. The nucleotides were selected using GenBank that is the NIH genetic sequence database. The sequences obtained were aligned with the Clustal W multiple alignment algorithms. For the molecular modeling, the structures were generated with the RNAstructure, a fully automated miRNAs structure modelling server, accessible via the Web Servers for RNA Secondary Structure Prediction.
Results: We demonstrated a search for nucleotide sequence and the projection of the molecular structure of the following miRNA: miR-455-5p (Fig. 1), miR-454-3p (Fig. 2), miR-144-3p (Fig. 3) and miR-96-5p (Fig. 4).
Conclusion: In this study we show in silico secondary structures projection of selected of 4 miRNA defined as biomarker for DM2 prediction through computational biology (Fig. 1).
A219 Incidence of diabetes mellitus in patients treated in the ubs horto forestal of Itaperuna-RJ
Wilian de Freitas Junior, Gisela Machado Altoé, Nikyallan Soares Rodrigues, Mychelly Dias de Medeiros Chiarelli, Kleivia da Silva Damas, Taís Freire Soares Pereira de Souza, Gustavo Assed Kik, Leo Ribeiro Chiarelli
UNIG; Rio de Janeiro, Brazil
Correspondence: Wilian de Freitas Junior
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A219
Introduction: Brazil, following the world trend, has undergone processes of demographic, epidemiological and nutritional transition since the 1960s, and in recent years an increase in the number of deaths caused by chronic non-transmissible diseases, hypertension and diabetes mellitus (DM). It is estimated that 12% of the Brazilian population suffers from DM, resulting in changes in patterns of occurrence of pathologies, emphasizing cardiovascular. In order to respond to this challenging situation, the Ministry of Health organizes surveillance strategies in Basic Health Units (UBS).
Objective: The objective of this study was to evaluate the incidence of diabetic patients followed in a UBS through a basic research, raised by medical students, that aimed to evaluate cardiovascular risk and possible associations and correlations with other clinical and laboratory variables in the scenario of the Northwest Fluminense.
Method: We evaluated 105 patients who were followed at the Basic Health Unit of the Horto Florestal neighborhood, Itaperuna, RJ, from August 2014 to April 2015, in a randomized study. Data collection was completed using the information reported by the patients during the consultations and after receiving the results of laboratory tests related to the protocol, together with a home visit for interview and blood pressure measurement. The risk equation was based on the Framingham score, with one of the predictors being diabetes, which was stratified by the fasting glucose test of the patients under study.
Results: The profile of the protagonists that made up the sample universe of the research represented 80% of the female sex and 20% of the male sex, only; 20% in the age group up to 44 years; 41% between 45 and 59 years; and 39% over 60 years. The exploration revealed that 88 people from the sample space, reflecting the percentage of 83.8% of the total, do not have a diagnosis of Diabetes Mellitus (DM), while those suffering from the metabolic syndrome correspond to 16.2%. Although the result showed to be higher than expected nationally, the comparison is dubious and evidenced bias in the statistical studies against the analysis of age.
Conclusion: Despite the importance of DM, there is a shortage of studies that investigate the epidemiological characteristics of this condition in the Brazilian population.
A220 Increased urinary ADAMTS13 levels correlate with renal disease in animal model of type 1 diabetes mellitus
Michelle Teodoro Alves Vieira1, Mylena Mayra Oliveira Ortiz1, Guilherme Victor Oliveira Pimenta dos Reis1, Kathryna Fontana Rodrigues1, Caroline Pereira Domingueti2, Paula Alves Santos do Carmo3, Ana Cristina Simões e Silva1, Luci Maria Santana Dusse1, Stanley de Almeida Araujo4, Ana Paula Fernandes1, Karina Braga Gomes Borges1
1UFMG, Minas Gerais, Brazil; 2UFSJR, Minas Gerais, Brazil; 3Exército Brasileiro, Brazil; 4UFOP, Minas Gerais, Brazil
Correspondence: Michelle Teodoro Alves Vieira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A220
Introduction: ADAMTS13 is a proteolytic enzyme responsible for large von Willebrand factor (vWF) multimers degradation, in order to prevent the hypercoagulability process. This enzyme is mainly synthesized in the liver, but is also expressed in platelets, endothelial cells and kidney.
Objectives: To compare the plasma levels of ADAMTS13 and vWF, as well as ADAMTS13 gene expression in liver and kidney, in type 1 diabetic mice and controls (nondiabetic).
Methods: Type 1 diabetes mellitus was induced in 10 male C57BL/6 mice by intraperitoneal injection of streptozotocin. Control group mice (n = 10) received sodium citrate buffer. The levels of ADAMTS13, vWF and urinary albumin excretion were detected using the ELISA technique. The capillary blood glucose levels were obtained with a glucometer. The mRNA was extracted from liver and kidney samples and the ADAMTS13 gene expression was investigated by real-time PCR. Statistical analyzes were performed in SPSS v. 13.0 software. Values of p < 0.05 were considered significant.
Results: The urinary levels of ADAMTS13 in diabetic group were higher when compared to the control group (p = 0.001), which accompanies histopathological findings in the kidney, characterized by mesangial expansion and interstitial fibrosis in the diabetic group. There was no significant difference between plasma levels of ADAMTS13 and vWF between the groups (p > 0.05). The gene expression of ADAMTS13 was higher in the liver (2.53×) of diabetic animals, when compared to the control group, but in renal tissue, the gene expression of ADAMTS13 was not different between the groups (1.00×). In addition, urinary ADAMTS13 levels showed a positive correlation with urinary albumin excretion (r = 0.820, p = 0.001) and blood glucose levels (r = 0.901, p < 0.001).
Conclusions: Loss of ADAMTS13 enzyme in the urine correlated with diabetic kidney disease in the mice. In addition, the data suggest that increased mRNA expression of ADAMTS13 in the liver is critically important for the plasma regulation of this enzyme, and consequently of vWF
A225 Individuals with long-standing type 1 diabetes have residual C- peptide after a mixed meal and sulfonylurea
Renata Midori Hirosawa, Monica Andrade Lima Gabbay, Felipe Crispim, Sergio Atala Dib
EPM - UNIFESP, São Paulo, Brazil
Correspondence: Renata Midori Hirosawa
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A225
Introduction: Post-death pancreatic analysis of patients with long-standing type 1 diabetes mellitus (T1DM) has found residual β-cells. The development of an ultra-sensitive assay for the detection of small amounts of C-peptide showed that T1DM, even decades after diagnosis, may present a basal hormone secretion. However, it is important to know if this residual beta cell function respond to meals or to insulin secretagogues.
Objective: This study aimed to determine the prevalence of residual beta cell function in individuals with long-standing T1DM using an ultrasensitive Cpeptide after a mixed-meal and oral dose of sulfonylurea.
Methods: 129 patients who had clinical diagnosis of T1DM and diabetes duration of > 5 years (ADA criteria, SBD) were recruited from a tertiary care center. Fasting blood was taken for measurement of C-peptide (ELISA; Mercodia® (Uppsala, Sweden; cat.Nº10-1141-01). Thirty one patients (24,5%) had C-peptide > 10 pmol/L or 0.03 ng/ml. Six patients were randomly recruited to undergo a mixed-meal tolerance test + oral 5 mg glibenclamide.
Results: 51.9% ♂, age: 22.7 + 7.1 years; duration of diabetes mellitus (DDM): 12.6 + 6.4 years, BMI: 23.2 + 3.7 kg/m2 and HbA1c: 8.7 + 1.6%. The presence of detectable fasting C-peptide was inversely associated with DDM (rs: − 0.35, p, 0.0001). Among chronic complications, a fasting C-peptide > 1.5 pmol/L (0.004 ng/ml) was associated with a lower percentage of patients with nephropathy (63.2 vs 36.8%, p = 0, 0187). In the 6 T1DM patients (age: 25.5 + 7.6, DDM: 15.2 + 6.7, BMI: 23.8 + 3.2, HbA1c: 7.9 + 0.6) who underwent the mixed meal tolerance test + sulfonylurea, 4 (66.7%) had a positive response (C-peptide > 200 pmol/L (0.6 ng/ml).
Conclusions: Patients with long-duration T1DM present residual beta cell secretion, related to a lower prevalence of nephropathy and had a positive response to a mixed-meal and secretagogue stimulus. This residual secretion suggests the presence of functional β cells that can potentially be worked for its preservation and regeneration.
A226 Influence of diabetes mellitus on balance and plant pressure
Cristiany Azevedo Martins, Camylla Bandeira Miranda, Frederico Luis Braz Furtado, Juliany Ferreira Forte, Francisca Janiele Ribeiro Tavares, Patrícia Pinho Cardoso, Natália Aguiar Moraes, Maria Iara Socorro Martins, Karolyna Vitoriano Campos Barros, Daniela Gardano Bucharles Mont’Alverne, Renan Magalhães Montenegro Júnior
UFC, Ceará, Brazil
Correspondence: Cristiany Azevedo Martins
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A226
Introduction: Diabetes Mellitus (DM) is a heterogeneous set of metabolic disorders which has as a consequence hyperglycemia. Changes in balance and gait increase the risk of falls and foot injuries in individuals with DM.
Objective: To verify the influence of balance and plantar pressure in individuals with DM1, DM2 and healthy.
Methods: Observational, transverse, descriptive and comparative study performed at a Health Post in the city of Fortaleza, from August to October 2016. All participants performed an evaluation of static balance and plantar pressure through Baropodometry. For comparison between groups, we used the ANOVA test and for the correlations Pearson‘s correlation coefficient was applied, considering a significance level equal to or less than 5% (p < 0.05).
Results: 99 individuals (19 individuals with DM1Group A, 61 with DM2Group B and 19 without DM—Group C) were recruited. Regarding the homogeneity between groups, there was a statistically significant difference between groups A and B and B and C with respect to age (p = 0.000) and between A and B in relation to the diagnosis time (p = 0.000) (Table 1). There was a significant difference between groups A and B in the latero-lateral mean deviation (Xlateral) (p = 0.0213) and between groups B and C, Xlateral (p = 0.0192) and in the mean velocity of anteroposterior deviation (Anterior vel.) (p = 0.05). Groups A and B evidenced a significant statistic difference for right foot plantar pressure (p = 0.0137) and left foot plantar pressure (p = 0.0137). Between groups B and C, there was difference for the maximum plantar pressure of the left foot (p = 0.047). When intragroup association was performed, in Group A was observed a strong association between Anterior Vel. with the mean velocity of latero-lateral deviation (Lateral Vel.) (r = , 7210, p = 0.0005). In group B, was verified a strong association between Anterior Vel. with the Lateral Vel. (r, 8466, p = 0.0000) (Table 2). An association between age and static balance was also verified in all variables, with the exception of anteroposterior deviation in group B (Table 2).
Conclusion: The participants with DM2 have worse values of static balance, and right and left foot pressures, beyond the maximum pressure of the left foot, when compared with the DM1 and control groups. Age appears to have been a harmful factor for group B participants (Fig. 1)
A228 Influence of educational intervention in the knowledge of people with diabetes mellitus
Lidiane Aparecida Monteiro1, João Batista Moreira2, Viviane Graciele da Silva2, Eliene Souza Muro2, Bianca Bacelar de Assis2, Ana Emília Pace1, Denise Hollanda Iunes2, Erika de Cásssia Lopes Chaves2
1USP, São Paulo, Brazil; 2UNIFAL, Minas Gerais, Brazil
Correspondence: Lidiane Aparecida Monteiro
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A228
Background: Health education aims to change behavior in order to benefit the clinical condition, through the contact of health professionals with people diagnosed with chronic diseases, which is effective in relieving fear and anxiety and understanding the disease. Perception of self-care activities with the feet is important to measure the knowledge gaps of people with Diabetes Mellitus (DM), which favors the prevention of plantar lesions and consequent amputation. In this perspective, this study aimed to evaluate the effect of the educational intervention on self-care with the feet in the knowledge of people with DM.
Methodology: Descriptive study of the pre and post-intervention type developed in a FHS. Sample consisted of 45 (35 + 10 pilot) people diagnosed with DM for more than 5 years. An instrument was applied to characterize and evaluated the knowledge through a questionnaire composed of 16 questions with dichotomous answers (Sim-0 and No-1), in which “Yes” means knowledge of the prevention activities of the diabetic foot. In this way, the lower the average of the answers, the better the knowledge. Knowledge was evaluated before and after eight fortnightly household meetings, which had the intention to teach care with the feet. Data collected were tabulated in an Excel 2007 spreadsheet and analyzed by SPSS 21.0. Descriptive statistics were performed for sociodemographic characterization and to analyze the results pre- and post-intervention, Anova was used with repeated measures with interest in the interaction. Project was approved by Institutution‘s Ethics Board of the Federal University of Alfenas, number 20376013.2.0000.5142.
Results: 64.4% of the volunteers were women, with low level of education and family income; more than 80% reported that they never had their feet evaluated and in the same proportion they were never told about foot care. Regarding the knowledge of self-care activities, the study volunteers presented statistically significant better means in the second evaluation (1.94), when compared to the first one (8,17) (p < 0.001).
Conclusion: Educational intervention contributed to the improvement in the knowledge of self-care activities with the feet of people with DM. Home health education allows the inclusion of family members, knowledge of individual needs and the adequacy of care according to the reality of each person, a determining factor for behavior change and knowledge acquisition.
A229 Influence of metabolic control in the stature of type 1 diabetes children diagnosed in the pre-school period
Mariana Gassen Santos1, Marina Bressiani2, César Geremia2, Marcia Puñales2
1Hospital da Criança Conceição, Instituto da Criança com Diabetes (ICDRS), Porto Alegre, Brazil; 2Instituto da Criança com Diabetes (ICDRS), Porto Alegre, Brazil
Correspondence: Mariana Gassen Santos
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A229
Backgrounds: Some studies suggest that poor metabolic control may compromise linear growth and final height of children and adolescents with type 1 diabetes (T1DM), but it is still controversial. Others have demonstrated that some patients at T1DM onset had higher Z scores of weight and height.
Aim: To evaluate the influence of metabolic control on linear growth of T1DM children diagnosed at the preschool age.
Methods: Data were obtained from medical records of 67 T1DM children followed up for at least 3 years. Glycated hemoglobin-HbA1c (Immunoturbidimetry, normal range value: 4.8–5.9%) was collected every 3–4 months and, considering the annual average for growth assessment (ideal: < 7.5%, acceptable: 7.5–8.5%, regular: 8.6–9.4% and poor: ≥ 9.5%). The anthropometric data (weight, height, body mass index) and growth velocity was defined according to World Health Organization (WHO) adjusted to age and gender and Z scores.
Results: The sample included 67 children, with a mean age of 4.3 ± 1.5 years at the 1st visit, age at T1DM onset of 4.0 ± 1.4 years and T1DM duration of 0.28 years (IQR: 0.16–0.41), 50.7% being male. In the 1 st evaluation: Z weight, Z height and Z BMI scores were 0.62 (− 0.16–1.42), 0.26 (− 0.74–0.82) and 0.86 (0.19–1.81), respectively, with no differences between gender and over the years. In the course of the follow-up years, a worsening of HbA1c was observed (p = 0.002). In the group overall, the growth velocity was significantly not different in comparison to metabolic control, nevertheless a tendency to a slower growth rate was observed in those with worse control (p = 0.07). Notably, the Z height was significantly lower in the 4th year of follow-up (p = 0.046) in those with regular/poor metabolic control.
Conclusion: Our results show that children with T1DM onset at pre-school age had increased Z weight, Z height and Z BMI scores at diagnosis. Additionally, the data suggest that poor metabolic control could influence growth and long-term Z height score in this age group.
A230 Influence of neuropathy in the range of motion, strength and discharge of weight and balance in type II diabetic patients
Cristiany Azevedo Martins, Camylla Bandeira Miranda, Frederico Luis Braz Furtado, Juliany Ferreira Forte, Francisca Janiele Ribeiro Tavares, Patrícia Pinho Cardoso, Natália Aguiar Moraes, Maria Iara Socorro Martins, Karolyna Vitoriano Campos Barros, Daniela Gardano Bucharles Mont’Alverne, Renan Magalhães Montenegro Júnior
UFC, Ceará, Brazil
Correspondence: Cristiany Azevedo Martins
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A230
Introduction: Static and dynamic changes in joint movement, muscle strength (MS) and balance modify plantar load distribution and increase the risk of ulcerations in patients with type II diabetes mellitus, and peripheral diabetic neuropathy (PDN) may aggravate these conditions.
Objective: To evaluate functional kinesiological possible changes in balance and gait in individuals diagnosed with type II DM with and without PDN.
Method: Observational, transversal, descriptive and comparative study, performed at a health post in the city of Fortaleza, from August to October 2016. A functional kinesiological evaluation (measures of ankle joint amplitude (AJA), MS of the lower members) and baropodometry (for evaluation of the plantar load distribution postural balance) were performed. T test was used for comparison between the groups and Pearson‘s correlation coefficient for the associations between the variables, being considered statistically significant when p ≤ 0.05.
Results: 60 individuals were evaluated being allocated in two groups, 42 participants in group A (without PDN) and 18 in group B (with PDN). The groups were homogeneous in relation to the diagnosis time of the disease, but were different in relation to age (p = 0.002) (Table 1). The vast majority of the participants presented altered AJA, below the values considered normal (Table 2), but without differences between groups. In MS, group A presented more force than group B (p ≤ 0.05), except for the right tibialis anterior and left sural triceps muscles. In baropodometry (mean deviation, mean velocity, static and dynamic mean pressure) no statistically significant differences between groups were found. In intragroup associations, was verified a moderate correlation between static mean pressure and dynamic mean pressure between right and left feet in both groups (Group without PN r = , 571, p < 0.0000 and with PN r = , 532 p < 0.0002) and between latero-lateral deviation and the mean velocity of this deviation in both groups (Group without PN r = , 471, = 0.0213 and with PN r = ,423 p = 0.0320).
Conclusion: Patients with type II DM have decreased range of motion, regardless of whether they have PN or not. There is no difference between the balance and the plantar pressure between the two groups. Individuals affected by PDN have more changes in muscle strength. Informed consent to publish had been obtained from the patient (Fig. 1).
A231 Information tool for those who live with people who have diabetes
Lucas Xavier de Oliveira, Mark Thomaz Ugliara Barone, Ronaldo Jose Pineda-Wieselberg, Lucas Leme Galastri
ADJ Diabetes Brasil, São Paulo, Brazil
Correspondence: Lucas Xavier de Oliveira
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A231
Introduction: Information about diabetes is directed primarily to diabetes and the risk of developing a dysfunction. However, it is forgotten that family members and friends of those who have diabetes also need these informations.
Objective: Educate people who live with those who have diabetes, through specific information published in Blog prepared for this.
Methodology: The blog “Meu amigo com diabetes” was created and the Facebook fan page of the same name was created to publish and disseminate the texts weekly (Monday), always accompanied by illustrative images. The method was to analyze the number of views in the texts and the number of visits to the blog. Along with the “likes” in the publications and on the Facebook page.
Results: The blog was created on June 15, 2015, and July 23, 2017, had more than 65,000 hits, from various parts of the world, including: Portugal, France, and the US has twice as much access to Brazil. The fan page of the blog, in the same period, was “like” by more than 1600 people. The publication with more access, had more than 2750 hits, reaches 6400 people on facebook, with 96 shares. In January 2017, the page received access to more than 7000 readers. In addition, an informative image had a reach of 26,400 people, with 113 shares. The publications have been very shared on Facebook, mostly by people who have diabetes find it useful to relay to their acquaintances. The blog has an average of 57 hits per day, including weekends and holidays. Publications are diverse, covering commemorative dates, diabetes reading tips, basic and advanced diabetes knowledge, and reporting on events that involve diabetes throughout the year.
Conclusion: What we can conclude is that this new form of education has pleased many people, even with diabetes or diabetes. Sharing this with friends and relatives who understand diabetes better and overcome challenges, overcoming myths and improving treatment, making it a motivator. We realize that with each publication, the blog increases the reach, which favors that our goals are achieved. In addition to the rapid growth in blog visits and fans, and the significant number of views, “likes” and sharing posts. We were commended for the initiative, the content of the blog and the page art, addressing a theme as delicate as diabetes.
A232 Inos mediated by obesity in experimental models of aging induces increased post-translational mechanisms and hypothalamic insulin resistance
Kelly Cristiane Gabriel de Almeida1, Vagner Ramon Rodrigues Silva2, Luciene Lenhare2, Carlos Kiyoshi Katashima2
1Faculdade de Ciências Médicas-FCM/UNICAMP, Campinas, SP, Brasil; 2Faculdade de Ciências Médicas-FCM/Depto. de Clínica Médica/UNICAMP, Campinas, SP, Brasil
Correspondence: Kelly Cristiane Gabriel de Almeida
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A232
Introduction: Obesity and diabetes prevalence in elderly subjects has an important role in clinical-epidemiological. Life styles and poor food habits associate with body weight excess are factor that contribute for comorbidities and also aging process. In this sense, central nervous systems (CNS), in particular, the hypothalamus is pivotal for modulate the body weight maintenance by metabolic signals. Evidence suggests that aging process and type 2 diabetes (DM2) are related with inflammation and post-transcriptional mechanism of s-nitrosation (S-NO) of proteins. S-NO is characterized as a post-transcriptional modification that modulates cellular functions by iNOS protein. On the other hands, the role of S-NO in the hypothalamus during aging process and DM2 remain unknown.
Objective: Investigate the role of iNOs and S-NO mechanism into insulin in the hypothalamus of old rats.
Methods: We used the western blotting tecniques, biotinilation of proteins (S-NO), PCR real-time (pPCR), intracerebroventricular injection (ICV) of oxide nitric donor (GSNO), INOS inhibitor (L-N6-(l-iminoethyl) Lysine (L-NIL) and exercise protocol were combined for analyse the nitrosation in hypothalamics tissues of old rats. This study was approved by ethics committee (CEUA 2016-1).
Results: Chronic treatment ICV in the hypothalamus with GSNO in Young rats enhance S-NO of IRβ and Akt, following of increased food intake and body weight reducing insulin sensitivity. Also, in old rats, in basal conditions, was observed increase of hiperphagia, body weight and overexpression of (iNOS), S-NO of IRβ and Akt characterizing insulin resistance. Mecanically or by physical exercise inhibition of iNOS, recuperate IRβ and Akt expression in the hypothalamus improving insulin sensitivity in old rats promoting satiety.
Conclusion: Taken together, we suggest, at least in parts, that hypothalamic S-NO-induced iNOS is a post-transcription of insulin resistance and, may be a target against diabetes during aging process.
A233 Inpatients diabetes education: analysis of the needs and the effectiveness of educators in knowledge and behavior change after discharge
Magda Tiemi Yamamoto, Thalita Barreira Modena Cardim, Thais Lins dos Santos, Ana Cláudia dos Santos, Gustavo Daher, Daisa de Mesquita Escobosa, Tatiane Ramos Canero, Claudia Regina Laselva, Flavia Nascimento de Camargo, Rogério Silicani Ribeiro
HIAE, São Paulo, Brazil
Correspondence: Magda Tiemi Yamamoto
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A233
During hospitalization, diabetes educators may identify difficulties and promote DM selfmanagement after discharge. Education promotes safety, better glycemic control and prevents readmission. However, inside the hospital, stress, concurrent procedures and the trend to lower length of stay compromise the patient‘s adherence and the effectiveness of these approaches.
Objectives: To identify the main difficulties for self-care and to evaluate the impact of education on knowledge and behavior change after discharge.
Results: Since 2015, 430 patients with DM were evaluated (mean 66 years, range 15–97 years), including 82% with DM2 and 9% DM1. On average, length of stay was 18 days. The main reason for admission were respiratory and cardiovascular diseases and cancer, respectively. DM was the main reason for admission of 43 hospitalizations. In patients with previous DM, 73% had A1c > 7. The mean duration of DM and A1c was 24 years and 8.3%, respectively. The educational needs were assessed using a adapted questionnaire regarding diet, physical activity, medications, insulin, glycemic control, foot care, hypoglycemia and hyperglycemia. Each item was scored from 0 to 10 and those with lower scores were prioritized during education. The initial questionnaire was answered by 317 (74%) patients. The most frequent difficulties, were: insulin management, hypoglycemia and hyperglycemia, foot care and glucose monitoring. After initial intervention, 153 patients (48%) were reevaluated in 876 visits (mean 2.12 visits/patient). The level of knowledge about insulin use (n = 122) increased from 5 ± 4 to 7 ± 3. Scores for knowledge about hypoglycemia and hyperglycemia increased from 6 ± 3 to 9 ± 2 and from 6 ± 3 to 8 ± 3 (both P < 0.05), respectively. Foot care and glucose monitoring increased from 7 ± 3 to 8 ± 2 and 7 ± 3 to 8 ± 3 (both P < 0.05), respectively. After 30 days of discharge, 62 (19%) of 317 patients were contacted. In this subgroup, 82% were satisfied with the intervention, 84% were aware about the need for follow-up regarding DM, 73% improved their diet. Only 39% were more active.
Conclusion: Besides barriers in the hospital to DM education, the intervention of educators may improve knowledge for self-care and promote adherence to medical follow-up and healthy eating after discharge.
A234 Insulin degludec (IDEG) shows consistent risk reductions across hypoglycemia definitions vs. insulin glargine U100 (IGLAR) in the switch 1 and 2 trials
Carol Wysham1, Janusz Gumprecht2, Wendy S. Lane3, Lone Nørgård Troelsen4, Deniz Tutkunkardas5, Simon Heller6
1Spokane, WA, USA; 2Zabrze,Poland; 3Asheville, NC, USA; 4Søborg, Denmark; 5Sheffield, United Kingdom; 6Sheffield, UK
Correspondence: Carol Wysham
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A234
Insulin degludec (IDeg) is a basal insulin with a mean half-life of over 25 h and a flat glucose-lowering profile. The phase 3a development program demonstrated HbA1c non-inferiority with IDeg in patients with type 1 (T1D) and type 2 (T2D) diabetes versus insulin glargine (IGlar) U100, and significantly reduced rates of overall symptomatic and asymptomatic hypoglycemia (T2D) and nocturnal symptomatic and asymptomatic hypoglycemia (T1D and T2D) that were most pronounced in the maintenance period. 4 In two phase 3b trials in patients with T1D (SWITCH 1) and T2D (SWITCH 2, rates of overall symptomatic and nocturnal symptomatic hypoglycemia with IDeg versus IGlar U100 were lower in both the maintenance and full treatment periods. Rates of severe hypoglycemia with IDeg versus IGlar U100 were lower in both the maintenance and full treatment periods in SWITCH 1, but only during the full treatment period in SWITCH 2 Two 64-week, double-blind, treat-to-target crossover trials compared the hypoglycemia risk of IDeg once daily (OD) vs. IGlar OD in type 1 (SWITCH 1) or type 2 diabetes (SWITCH 2). A1C non-inferiority was confirmed in both trials. SWITCH 1 had a significant reduction in hypoglycemia in the maintenance period across hypoglycemia definitions with IDeg vs. IGlar. SWITCH 2 also had a significant reduction across definitions in the maintenance period with IDeg, except severe hypoglycemia (due to the few events reported), although the rate ratio was comparable with the other definitions (Figs. 1, 2). Similar reductions were seen in the full treatment period. Overall, hypoglycemia reductions were consistent across hypoglycemia definitions, especially during the nocturnal period
A235 Insulin degludec in the treatment of extreme resistance to subcutaneous and intramuscular insulin- driasm
Sarah Simaan, Isabella Cristina Paliares, Viviane de Paula Pretti Reis, Fernanda Correia Salles, Filipe Dias de Souza, Rachel Teixeira Leal Nunes, Sérgio Atala Dib, João Roberto Sá
UNIFESP, São Paulo, Brazil
Correspondence: Sarah Simaan
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A235
Case report: Two female patients with 26 (patient 1) and 22 (patient 2) years old were included in this report. They were diagnosed with type 1 diabetes mellitus (DM 1) at 5 and 6 years respectively and were referred to our service due to frequent episodes of diabetic ketoacidosis (DKA) despite the use of continuous subcutaneous insulin infusion pump. It was suspected of diabetes mellitus with resistance to insulin administered subcutaneously or intramuscularly (DRIASM). Patient 1 underwent an isolated pancreas transplantation (PTA), with chronic rejection after 13 months. After the loss of pancreatic allograft, she was hospitalized several times due to DKA. After that it was decided to perform a therapeutic test with IDeg. In December 2015, she started to use insulin degludec (IDeg), with reduction of hospitalizations. She remained in use of IDeg 80 UI/d and lispro 600 UI/d. Patient 2 was successfully submitted to PTA, with allograft loss after 15 months. An insulin challenge test was performed with SC and IM NPH/Glargina/Detemir and IV regular insulin. There was a reduction in plasma glucose and an increase in plasma insulin with IV insulin, as opposed to SC or IM routes. To prove the effectiveness of IDeg, we measured insulin, C-peptide and glycemia after SC administration of IDeg-70 UI (Table 1). The patient maintained glycemia between 55 and 107 mg/dL and a detectable plasma insulin (75.7 μUI/mL) with 2 episodes of hipoglycemia (Fig. 1). She remained in use of IDeg 80 UI/d and aspart 2000 UI/d.
Discussion: DRIASM is a rare syndrome, characterized by extreme resistance to SC and IM insulin, whose pathophysiology remains unknown . There are few treatments available and most are ineffective. The use of intraperitoneal insulin pump is the therapy with the best result so far, but it is not available in Brazil . Another possibility is the PTA, initially proposed by our group and then performed in other countries . IDeg is a new-generation basal insulin analogue, formulated in the presence of phenol and zinc to create a solution of di-hexamers. After SC injection, the di-hexamers form a stable depot of multi-hexamer chains, with gradual dissociation of these chains into absorbed monomers . According to our test IDeg was able to be absorbed and to reduce plasma glucose differently from all previously basal insulins.
Conclusion: IDeg was effective in the treatment of DRIASM, with reduction in hospital admissions and DKA episodes.
A236 Insulin glargine 300 U/ml (GLA-300) provides more even 24-hour pharmacokinetic (PK) and pharmacodynamic (PD) profiles vs. insulin degludec 100 U/ml (DEG-100) in T1DM
Timothy S. Bailey1, Jeremy Pettus2, Ronan Roussel3, Stephen Davis4, Karin Bergmann5, Magali Maroccia6, Nassr Nassr5, Oliver Klein7, Geremia Bolli8, Raphael Dahmen5
1AMCR Institute, Escondido, CA, USA; 2University of California, San Diego, CA, USA; 3Assistance Publique Hôpitaux de Paris, Bichat Hospital, Paris, France; 4Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA; 5Sanofi, Frankfurt am Main, Germany; 6Umanis, Levallois-Perret, France; 7Profil, Neuss, Germany; 8University of Perugia, Perugia, Italy
Correspondence: Timothy S. Bailey
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A236
The aim of this multiple-dosing, crossover, euglycemic glucose clamp study was to compare steady-state PK/PD profiles of Gla-300 vs. Deg-100 in two parallel cohorts with fixed once-daily dosing regimens in T1DM. For both insulins, participants received 0.4 (n = 24) or 0.6 U/kg/day (n = 24) at ~ 8 am for 8 days. Main endpoint: within-day variability (fluctuation) of smoothed glucose infusion rate (GIR) over a 24-h dosing period (GIR-smFL0-24). Other endpoints: relative degree of serum insulin concentration (INS) 24-h fluctuation (Frel), area under the INS time curve (INS-AUC). Within-day GIR variability (GIR-smFL0-24) was 20% lower with Gla-300 vs. Deg-100 at 0.4 U/kg/day (p = 0.047; Figure) but comparable at the 0.6 U/kg/day dose. Gla-300 provided more constant PK profiles than Deg-100 at both the 0.4 (Figure) and 0.6 U/kg/day dose levels; the relative degree of INS fluctuation (Frel) of Gla-300 was 13% and 17% lower vs. Deg-100 at 0.4 and 0.6 U/kg/day, respectively. Distribution of INS-AUC0-24 (6-h fractions; 0–6, 6–12, 12–18 and 18–24 h) was consistently more even with Gla-300 (25, 26, 26 and 23%) than with Deg-100 (23, 29, 26 and 21% [data the same at both dose levels]). Morning dosing of Gla-300 provides more even 24-h action profiles in T1DM at 0.4 U/kg/day and more constant steady-state serum concentrations vs. Deg-100, consistently across dose levels. This is an ENCORE abstract previously presented at ADA2017. Funding and editorial support provided by Sanofi (Fig. 1)
A237 Insulin glargine/lixisenatide fixed ratio combination improves glycaemic variability in type 2 diabetes
Ronnie Aronson1, Guillermo Umpierrez2, William Stager3, Boris Kovatchev4
1LMC Endocrinology Centres, Toronto, Canada; 2Emory University, Atlanta, Georgia, USA; 3Sanofi US, Inc., Bridgewater, Westport, Connecticut, USA; 4University of Virginia Health System, Charlottesville, Virgina, USA
Correspondence: Ronnie Aronson
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A237
Background and aims: iGlarLixi is a once-daily titratable, single injection of a fixed-ratio combination of insulin glargine 100 U/mL (Gla-100) and lixisenatide, and is in development for the treatment of type 2 diabetes.
Materials and methods: This post hoc analysis compared glycemic variability (GV) as measured by the high blood-glucose index (HBGI) and area under the curve (AUC) of patient self-monitored plasma glucose (SMPG) 7-point profile data from the Phase 3, 30-week LixiLan-O trial comparing iGlarLixi, Gla-100, and lixisenatide in 1170 patients uncontrolled on metformin ± 1 other oral antidiabetes drug [OAD], and the LixiLan-L trial comparing iGlarLixi with Gla-100 in 736 patients uncontrolled on basal insulin ± 1 or 2 OADs. In both trials, only metformin was continued upon study initiation and dosing was either optimized up to 2000 mg/day or stabilized ≥ 1500 mg/day.
Results: Compared with Gla-100 or lixisenatide alone, iGlarLixi resulted in a statistically significant improvement in GV profiles as indicated by the HBGI and AUC metrics (see Table), without a clinically significant change in the low blood-glucose index as a proxy for hypoglycemia (remaining < 1.0 for all). In addition, statistically significant mean blood-glucose level reductions were achieved.
Conclusion: In conclusion, iGlarLixi demonstrated a cumulative decrease in GV, greater than each of its components (Gla-100 and lixisenatide), in both the LixiLan-O and LixiLan-L trials. Study codes: NCT02058160 and NCT02058147. This is an ENCORE abstract previously presented at EASD2016. Funding and editorial support provided by Sanofi (Fig. 1).
A238 Interaction between obstructive sleep apnea, insulin resistance and non-alcoholic fatty pancreatic disease: signaling pathway design
Luís Jesuino de Oliveira Andrade1, Alcina Maria Vinhaes Bittencourt2, Gabriela Correia Matos de Oliveira3, Gustavo Magno Baptista4, Lidiany Oxenford da Silva5, Ronaldo Adriano Dourado Alves5, Candice Messias Barbosa Santos5
1PpGCS-UESC-Bahia, Brazil; 2Faculdade de Medicina-UFBA, Bahia, Brazil; 3Faculdade de Medicina-UNIME-Bahia, Brazil; 4PgGCS-UESC-Bahia, Brazil; 5UESC, Bahia, Brazil
Correspondence: Luís Jesuino de Oliveira Andrade
Journal of Diabetology & Metabolic Syndrome 2018, 10(Supp 1):A238
Introduction: There is evidence of association between obstructive sleep apnea and insulin resistance, as well as, to fat deposition in the pancreas in a similar way to non-alcoholic fatty liver disease.
Objective: Demonstrate the interaction between obstructive sleep apnea, insulin resistance and non-alcoholic fatty pancreatic disease (NAFPD) by signaling pathway design.
Method: To investigate the involvement of metabolic signaling pathway, a search was performed using the Kyoto Encyclopedia of Genes and Genomes (KEGG), and the signaling pathway mapping was performed using the automatic annotation server of the KEGG. The signaling pathway map was realized using PathVisio program, a free available signaling pathway drawing software.
Results: The contigs were taken from the KEGG database and their mapped transcription represents the signaling pathway of the main biomolecules that triggers NAFPD. The interaction between obstructive sleep apnea, insulin resistance and inflammatory factors contributes to the possible development of fatty infiltration of the pancreas leading to the loss of β cells function, and even have links to the development of other metabolic disease (Fig. 1).