Newly-diagnosed Type 2 Diabetes Mellitus Research Articles

Predictors of coronary artery calcium burden in asymptomatic patients with newly diagnosed type 2 diabetes mellitus.

Long-standing diabetes mellitus is often associated with cardiovascular complications. We aimed to evaluate the presence, extent and composition of subclinical atherosclerotic plaques in coronary arteries by Computed Tomography in patients with newly diagnosed type 2 diabetes mellitus (NDT2DM), and to identify the predictors. In this study 101 consecutive patients with NDT2DM were included. Patients were categorized into five groups based on their Coronary Artery Calcium Score (CACS) ranging from 0, 0-10, 11-100, 101-400 to >400. All parameters were compared across these groups. The average patient age was 54.4 ± 11.6years and 48 (47.5%) were females. Eight (7.9%) patients had CACS 0, 6.9% CACS 1-10, 42.6% CACS 11-100, 22.8% CACS 101-400 and 19.8% had CACS >400. Multiple regression analysis for the general data identified weight (p = .04) and systolic blood pressure (p = .033) as independent predictors for CACS. Asymptomatic patients with NDT2DM in more than 90% of cases may present with calcified atherosclerotic plaques and this may be predicted by: patient weight and the level of systolic arterial pressure. Our study emphasizes the need for comprehensive care and early prevention of cardiovascular complications in individuals with NDT2DM.

Clinical characteristics and degree of cardiovascular risk factor control in patients with newly-diagnosed type 2 diabetes in Catalonia.

Women with type 2 diabetes mellitus (T2DM) face a greater risk of cardiovascular disease (CVD) and encounter challenges in managing cardiovascular risk factors (CVRF); however, limited data are available in individuals with newlydiagnosed T2DM. This study aimed to examine differences between women and men at the onset of T2DM in terms of clinical characteristics, glycaemic status, and CVRF management. This was a retrospective cohort study including subjects with newly-diagnosed T2DM from the System for the Development of Research in Primary Care (SIDIAP) database in Catalonia (Spain). Sex differences (Dif) were assessed at baseline and 1-year post-diagnosis, by calculating the absolute difference of means or proportions. A total of 13,629 subjects with newly-diagnosed T2DM were analyzed. Women were older and had a higher BMI than men. At baseline, women had higher total cholesterol [Dif (95%CI) 10 mg/dL (9.1/10.8)] and low-density lipoprotein cholesterol (LDL-c) [Dif (95%CI) 7 mg/dL (6.3/7.7)], while men had higher rates of smoking and alcohol intake. Lipid target achievement was lower in women, in both primary prevention (LDL-c < 100 mg/dL) [Dif (95%CI) -7.3 mg/dL (-10.5/-4.1)] and secondary prevention (LDL-c < 70 mg/dL) [Dif (95%CI) -8.3 mg/dL (-17.3/0.7)], along with lower statin and antiplatelet prescriptions, especially one year after diagnosis. Changes in clinical and laboratory data one year post-diagnosis revealed that, in the primary prevention group, men experienced greater improvements in total cholesterol, LDL-c and triglycerides, while women had less success in achieving CVRF control targets compared to men. Additionally, cardiovascular events, such as coronary artery disease and peripheral artery disease increased more in men than in women within the first year of diagnosis, especially in primary prevention subjects. Differences between men and women CVRF are already apparent at the onset of T2DM, particularly in primary prevention, with notable differences in lipid profile and target level attainment.

Serum Myonectin and Adropin Levels in Predicting Diabetes

Introduction: Myonectin is a myokine associated with type 2 diabetes mellitus and insulin resistance, and adropin is a peptide hormone that prevents IR and impaired glucose tolerance. Adropin is produced by the liver and regulates energy homeostasis. This research aimed to examine the serum levels of myonectin and adropin levels among prediabetes, newly-diagnosed type 2 diabetes mellitus, and healthy controls.&#x0D; Methods: For this cross-sectional study, a total of 167 individuals were divided into 3 subgroups using OGTT and HbA1c; 61 prediabetes (36.5%), 62 nT2DM (37.1%), and 44 healthy controls (26.3%). Serum levels of myonectin and adropin were assayed using enzyme-linked immunoassay kits. The anthropometric (age, gender, weight, height, waist/hip ratio -WHR-, waist and hip circumference, and body mass index -BMI-) and biochemistry findings of the participants were evaluated between the groups.&#x0D; Results: Our study showed that myonectin levels are associated with nT2DM and WHR (p = 0.028 and p = 0.015, respectively). The serum levels of myonectin are significantly correlated with systolic blood pressure values in the prediabetes group (p = 0.017). Linear regression analysis revealed that nT2DM affects the serum levels of myonectin, but not adropin values. The adropin levels are correlated with LDL-cholesterol, total cholesterol, and triglyceride levels in the nT2DM group (p = 0.002, p= 0.004, and p = 0.035, respectively).&#x0D; Conclusion: The findings of the previous studies are supported by those of this study and indicated that the serum levels of myonectin may be associated with newly-diagnosed T2DM patients. Serum myonectin levels could be a valuable marker for predicting diabetes mellitus.

1300-P: Glucagon-Like Peptide-1 Levels Mirror Insulin Resistant States in Treatment-Naïve Type 2 Diabetes Mellitus

Introduction: In some Asian populations incretin system has been shown to be preserved in type 2 diabetes mellitus (T2DM). The association between fasting and post-OGTT glucagon-like peptide-1 (GLP-1) levels and insulin resistance in treatment-naïve T2DM population has not been clearly defined. Aim: To assess the insulin resistant states (IRS) by means of insulin resistance index (HOMA-IR) and relate this to the fasting and post-OGTT GLP-1 responses in treatment-naïve T2DM. Methods : Thirty-one treatment-naive T2DM subject underwent a 75-g OGTT. Fasting plasma glucose and insulin levels were obtained for HOMA-IR analyses along with plasma total GLP-1 concentrations measured at 0, 30 and 120 min. Results: Majority of the treatment-naïve T2DM patients were newly-diagnosed (n=28, 96.6%). The GLP-1 levels at 0, 30- and 120-min were 25.59 ± 10.87 pmol/L, 46.86 ± 18.36 pmol/L and 27.02 ± 13.37 pmol/L respectively. Fasting GLP-1, incremental GLP-1 at 30 min (∆GLP-130min) and ∆GLP-1120min were positively correlated with HOMA-IR (r=0.654, p&amp;lt;0.001; r=0.421, p=0.018; r=0.574, p=0.001 respectively). Conclusions: The novel finding of this study is that fasting and post-OGTT GLP-1 levels increased proportionately to IRS. This suggests an adaptive compensatory GLP-1 responses to overcome the worsening insulin resistance in treatment-naïve newly-diagnosed T2DM patients. Disclosure S.Chong: None. N.Sukor: None. S.A.Robert: None. K.Ng: None. N.A.Kamaruddin: Advisory Panel; Zuellig Pharma Holdings Pte. Ltd., Other Relationship; American Association of Clinical Endocrinologists, Speaker's Bureau; AstraZeneca, Boehringer-Ingelheim, Eli Lilly and Company, Merck Sharp &amp; Dohme Corp., Novo Nordisk. Funding National University of Malaysia (GUP-2017-066); Malaysian Endocrine &amp; Metabolic Society (L12-MEMS6)

Long-term effects of lowering postprandial glucose level on cardiovascular outcomes in early-stage diabetic patients with coronary artery disease: 10-year post-trial follow-up analysis of the DIANA study

AimsTo elucidate the long-term cardiovascular benefit of lowering postprandial hyperglycemia (PPG) in early-stage T2DM patients. MethodsThis 10-year post-trial follow-up study included 243 patients from the DIANA (DIAbetes and diffuse coronary Narrowing) study, a multi-center randomized controlled trial which compared the efficacy of one-year life-style and pharmacological (voglibose/nateglinide) intervention lowering PPG on coronary atherosclerosis in 302 early-stage T2DM subjects [impaired glucose tolerance (IGT) or newly-diagnosed T2DM] (UMIN-CTRID#0000107). MACE (all-cause death, non-fatal MI or unplanned coronary revascularization) were compared in (1) three assigned therapies (life-style intervention/vogliose/nateglinide) and (2) patients with and without improvement of PPG (reversion from IGT to NGT or from DM to IGT/NGT on 75 g oral glucose tolerance test). ResultsDuring the 10-year post-trial observational period, voglibose (HR = 1.07, 95%CI: 0.69–1.66, p = 0.74) or nateglinide (HR = 0.99, 95%CI: 0.64–1.55, p = 0.99) did not reduce MACE. Similarly, achieving the improvement of PPG was not associated with a reduction of MACE (HR = 0.78, 95%CI: 0.51–1.18, p = 0.25). However, in IGT subjects (n = 143), this glycemic management significantly reduced the occurrence of MACE (HR = 0.44, 95%CI: 0.23–0.86, p = 0.01), especially unplanned coronary revascularization (HR = 0.46, 95%CI: 0.22–0.94, p = 0.03). ConclusionsThe early improvement of PPG significantly reduced MACE and unplanned coronary revascularization in IGT subjects during the post-trial 10-year period.

Increased soluble endoglin levels in newly-diagnosed type 2 diabetic patients are associated with endothelial dysfunction.

Endothelial dysfunction (ED) contributes to the pathologic process underlying macrovascular complications, a common complication of type 2 diabetes mellitus (T2DM). Soluble endoglin (sEng) shed from the extracellular domain of the entire endoglin molecule blocks endothelial protection mediated by transforming growth factor-beta 1 (TGF-β1). The reactive hyperemia index (RHI), which is determined by reactive hyperemia peripheral arterial tonometry (RH-PAT), is a new index with which to evaluate ED. This study determined the changes in serum sEng levels in newly-diagnosed (untreated) T2DM patients and the correlation with the RHI. The T2DM group included 34 newly-diagnosed T2DM patients, while the control group included 53 healthy adults. The clinical data from the two groups were evaluated retrospectively. The intima-media thickness (IMT) of the common carotid artery (CCA) and the ankle-brachial index (ABI) of both legs were used to assess structural vascular changes. The serum sEng level was determined using an ELISA kit. Endothelial function was assessed using RH-PAT and the RHI was computed. The serum sEng level in the T2DM group was significantly greater than the control group, although the RHI was significantly lower in the T2DM group (p < 0.05). The serum sEng level was negatively correlated with the RHI in T2DM patents (r = 0.354, p = 0.041). The serum sEng level, CCA-IMT, and ABI were not significantly correlated with T2DM (p > 0.05). In summary, among newly-diagnosed T2DM patients, the serum sEng levels were inversely correlated with the RHI, and an elevated sEng level may be associated with ED.

Association of Hepcidin levels in Type 2 Diabetes Mellitus treated with metformin or combined anti-diabetic agents in Pakistani population.

To evaluate the impact of hepcidin and ferritin in pathogenesis and prognosis of type 2 diabetes mellitus subjects taking only metformin or combined anti-glycaemic agents. The observational case-control study was conducted at the Department of Physiology, Baqai Medical University, Karachi, from August 2019 to October 2020, and comprised subjects from both genders who categorised into equal groups as non-diabetic controls, newly-diagnosed type 2 diabetes mellitus patients without any treatment, type 2 diabetes mellitus patients with exposure to metformin only, type 2 diabetes mellitus patients taking oral hypoglycaemic agents along with metformin, type 2 diabetes mellitus patients taking only insulin, and type 2 diabetes mellitus patients taking insulin and oral hypoglycaemic agents. Fasting plasma glucose was determined using glucose oxidase-peroxidase method, glycated haemoglobin by high performance liquid chromatography, high-density lipoprotein and low-density lipoprotein by direct methods, cholesterol by cholesterol oxidase phenol 4-amino antipyrine peroxidase and triglycerides by glycerol phosphate oxidase-phenol 4-amino antipyrine peroxidase method. Serum levels of ferritin, insulin and hepcidin were evaluated using Enzyme-linked immunosorbent assay. Insulin resistance was assessed using homeostasis model assessment for insulin resistance. Data was analysed using SPSS 21. Of the 300 subjects, there were 50(16.66%) in each of the 6 groups. Overall, there were 144(48%) males and 155(51.66%) females. The mean age was significantly lower in the control group 34.72±7.87 compared to all the diabetic groups (p<0.05), and the same was the case with respect to all the parameters (p<0.05) except high-density lipoprotein (p>0.05). Besides, hepcidin level was significantly higher in the control group (p<0.05). Ferritin levels were significantly increased in newly-diagnosed T2DM subjects compared to the controls (p<0.05) while all other groups showed decreased ferritin levels (p<0.05). Hepcidin gave inverse correlation with glycated haemoglobin only in diabetics taking only metformin (r = -0.27, p=0.05). Anti-diabetes drugs not only addressed type 2 diabetes mellitus, but also reduced levels of ferritin and hepcidin that are found to play a role in diabetes development.

Serum irisin levels in newly diagnosed type-II diabetic patients: No association with the overall diet quality but strong association with fruit intake.

This study aimed to investigate the serum irisin levels and diet quality of newly-diagnosed type 2 diabetes mellitus (T2DM) patients in comparison with healthy controls and to identify the correlations between serum irisin levels with diet quality, anthropometric measurements and biochemical parameters. This case-control study was conducted with 38 newly-diagnosed T2DM patients and 38 healthy control individuals. Diet quality was calculated from the semi-quantitative food frequency questionnaire by using the Healthy Eating Index (HEI) 2015. The anthropometric measurements were taken and body composition was analyzed with bioelectric impedance analysis (BIA) method. Biochemical parameters and serum irisin levels were analyzed in blood samples which were obtained after overnight fasting. Irisin levels were higher in the T2DM group compared to the healthy control group (2.57±0.44ng/mL and 2.15±0.44ng/mL, respectively; p<0.001). The optimal cut-off value for irisin to predict T2DM was 2.195ng/mL (specificity=71.1%, sensitivity=78.9%). In both groups, irisin levels were not associated with overall HEI 2015; however, they were positively associated with total and whole fruit scores in the T2DM group (p<0.05). After adjustment according to age, sex and BMI, in the T2DM group HDL cholesterol positively affected by irisin levels, while in the control group triglyceride positively affected irisin levels (p<0.05). High levels of irisin in newly diagnosed T2DM patients compared to healthy individuals indicate that irisin may have a role in the monitoring and treatment of T2DM. Though irisin levels were not associated with total diet quality, they were associated with fruit consumption.

Novel Subgroups and Chronic Complications of Diabetes in Middle-Aged and Elderly Chinese:A Prospective Cohort Study.

BackgroundDiabetes mellitus, especially type 2 diabetes mellitus (T2DM), is regarded as highly heterogeneous. Novel diabetes phenotypes by cluster analysis have been proposed in Europeans but may show different cluster features in Asians. The applicability of cluster analysis in middle-aged and elderly Chinese community T2DM patients needs further investigation.MethodsParticipants were recruited from Jiading community in Shanghai, China. We adopted k-means cluster analysis in 1130 patients (aged ≥ 40 years) with newly-diagnosed T2DM at baseline. Cluster analysis was performed based on seven variables, including fasting plasma glucose, 2 hours postprandial blood glucose, age at diagnosis, body mass index, hemoglobin A1c, homoeostatic model assessment estimates of β-cell function and insulin resistance. All subjects were re-examined at 4.4 years later. Metabolic associated fatty liver disease was diagnosed using B-ultrasound, hepatic fibrosis by non-invasive scores, renal and cardiovascular status by subclinical biomarkers. Multivariable logistic regression models were used to compare the risks of complications between clusters.ResultsPatients were classified into 4 clusters. 381 (33.7%), 456 (40.4%), 87 (7.7%), and 206 (18.2%) patients were separately assigned to mild age-related diabetes (MARD), mild obesity-related diabetes (MOD), severe insulin-deficient and insulin-resistant diabetes (SIDRD), or severe obesity-related and insulin-resistant diabetes (SOIRD), respectively. Participants in MARD, SOIRD, and SIDRD clusters were associated with significantly increased risks of different complications. SOIRD and SIDRD showed novel features in Chinese T2DM patients that were different from those in Europeans.ConclusionsThe refined diabetes phenotypic approach was applicable to Chinese middle-aged and elderly T2DM patients. Patients in different clusters presented significantly different characteristics, progression of metabolic features, and risks of diabetic complications.

Greater Glycemic Burden Is Associated with Further Poorer Glycemic Control in Newly-Diagnosed Type 2 Diabetes Mellitus Patients.

Aims: hyperglycemia impairs pancreatic β-cell function instantly, also known as glucotoxicity. It is unknown whether this insult is temporary or sustained, and little real-world evidence needs to reflect the relationship between hyperglycemic burden, per se, and glycemic durability. Materials and Methods: a retrospective observational cohort study was conducted to recruit newly-diagnosed type 2 diabetes mellitus (T2DM) patients. Durability was defined as the episode from first glycated hemoglobin A1c (HbA1c) below 7.0% to where it exceed 8.0% (with treatment failure) or where study ended (without treatment failure). Glycemic burden was defined with the area above a burden value line (HbA1c = 6.5%) but under the HbA1c curve (AUC), and it was then divided into two compartments with the demarcation timepoint once HbA1c was treated below or equal to 7.0%; the former AUC’ represented the initial insult; the latter AUC” represented the residual part. Multivariable regression models assessed factors associated with durability in whole participants and two distinct subgroups: patients with baseline HbA1c > 7.0% or ≤7.0%. Results: 1048 eligible participants were recruited and analyzed: 291 patients with treatment failure (durability 26.8 ± 21.1 months); 757 patients without treatment failure (durability 45.1 ± 31.8 months). Besides age, glycemic burden was the only constant determinant in the two subgroups. AUC’ or AUC” increased treatment failure, respectively, in baseline HbA1c > 7.0% or ≤7.0% subgroup [per 1%/90 days hazard ratio (95% confidence interval): 1.026 (1.018–1.034) and 1.128 (1.016–1.253)]. Other determinants include baseline HbA1c, initial OAD, and education level. Conclusions: in patients with newly-diagnosed T2DM, glycemic durability was negatively associated with greater glycemic burden.

Association of dietary fiber intake with newly-diagnosed type 2 diabetes mellitus in middle-aged Chinese population

BackgroundEpidemiological evidence concerning dietary fiber on newly-diagnosed type 2 diabetes mellitus (T2DM) is sparse. Therefore, the purpose of this study was to investigate the relationship between dietary fiber intake and newly-diagnosed T2DM in a middle-aged Chinese population.MethodsUsing data from the Hangzhou Nutrition and Health Survey collected between June 2015 and December 2016, we investigated the associations between dietary patterns and the risk of chronic non- communicable diseases. Anthropometric measurements and samples collection for biochemical assays are conducted by the well-trained staff and nurse, respectively. Multivariable logistic regression analysis was used to analyze the effect of dietary fiber intake on the risk of newly-diagnosed T2DM in crude and adjusted models.ResultsAmong 3250 participants, 182 (5.6%) people were identified as newly-diagnosed T2DM. Pearson correlation coefficients revealed a significant inverse association of total dietary fiber with BMI, SBP, DBP, HbA1c and LDL-C in all participants, participants with and without T2DM (P < 0.05). Compared with the study participants in the first quartile (Q1, the lowest consumption)of dietary fiber intake, participants in the fourth quartile (Q4) had a lower prevalence of newly-diagnosed T2DM(OR = 0.70; 95%CI:0.49-1.00; P < 0.05), after adjustment for potential confounders.ConclusionsIn this middle-aged Chinese population, higher intake of dietary fiber was significantly associated with lower risk of newly-diagnosed T2DM. However, our findings need to be confirmed in future large-scale prospective studies.

Association between cholesterol efflux capacity and peripheral artery disease in coronary heart disease patients with and without type 2 diabetes: from the CORDIOPREV study

BackgroundPeripheral artery disease (PAD) is recognized as a significant predictor of mortality and adverse cardiovascular outcomes in patients with coronary heart disease (CHD). In fact, coexisting PAD and CHD is strongly associated with a greater coronary event recurrence compared with either one of them alone. High-density lipoprotein (HDL)-mediated cholesterol efflux capacity (CEC) is found to be inversely associated with an increased risk of incident CHD. However, this association is not established in patients with PAD in the context of secondary prevention. In this sense, our main aim was to evaluate the association between CEC and PAD in patients with CHD and whether the concurrent presence of PAD and T2DM influences this association.MethodsCHD patients (n = 1002) from the CORDIOPREV study were classified according to the presence or absence of PAD (ankle-brachial index, ABI ≤ 0.9 and ABI > 0.9 and < 1.4, respectively) and T2DM status. CEC was quantified by incubation of cholesterol-loaded THP-1 cells with the participants' apoB-depleted plasma was performed.ResultsThe presence of PAD determined low CEC in non-T2DM and newly-diagnosed T2DM patients. Coexisting PAD and newly-diagnosed T2DM provided and additive effect providing an impaired CEC compared to non-T2DM patients with PAD. In established T2DM patients, the presence of PAD did not determine differences in CEC, compared to those without PAD, which may be restored by glucose-lowering treatment.ConclusionsOur findings suggest an inverse relationship between CEC and PAD in CHD patients. These results support the importance of identifying underlying mechanisms of PAD, in the context of secondary prevention, that provide potential therapeutic targets, that is the case of CEC, and establishing strategies to prevent or reduce the high risk of cardiovascular events of these patients.Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT00924937. Unique Identifier: NCT00924937

The effect of short-term intensive insulin therapy in newly-diagnosed Type-2 diabetic patients.

Objectives:We aimed to determine the effect of short-term intensive insulin therapy (SIIT) on long-term glycemic control in newly-diagnosed Type-2 diabetes mellitus (nT2DM) patients.Methods:In this retrospectively study conducted at Sakarya University Medical Faculty Training and Research Hospital Outpatient Clinic between 2016 and 2019, 65 nT2DM patients were enrolled soon after their SIIT was initiated and were followed for at least a year. Intensive insulin treatment was discontinued after three or 12 months in a total of 65 (23–73-year-old) patients who had been newly diagnosed with T2DM. Intensive insulin therapy was discontinued when glycemic control and the target Glycated Hemoglobin (HbA1c) level had been attained, after which oral anti-diabetic drug (OAD), long-term insulin, and diet therapies were pursued.Results:There was a significant decrease in mean HbA1c from 11.25±1.96% to 6.67±1.07%. Fasting plasma glucose (FPG) was found to be an independent predictor of whether intensive insulin therapy could be discontinued after three months in a model that included FPG, HbA1c, and body mass index measured at baseline. Patients with FPG>13.8 mmol/L were 7.6 times more likely to require intensive insulin therapy beyond three months. There were significant decreases in HbA1c and low-density lipoprotein-cholesterol concentration, but no change in C-peptide between baseline and 3 months of therapy.Conclusion:These results demonstrate that in nT2DM patients, intensive insulin therapy could be effective on long-term glycemic control and high FPG prior to three months of SIIT may predict poor long-term glycemic control.

The risk of hip fractures in individuals over 50years old with prediabetes and type 2 diabetes - A longitudinal nationwide population-based study.

The present study aimed to investigate the association between type 2 diabetes mellitus (T2DM) and hip fractures using a large-scale nationwide population-based cohort that is representative of the Republic of Korea. We determined the risks of hip fractures in individuals with prediabetes and T2DM with different diabetes durations, and compared them with the risks of hip fractures in individuals without T2DM. A total of 5,761,785 subjects over 50years old who underwent the National Health Insurance Service medical checkup in 2009-2010 were included. Subjects were classified into 5 groups based on the diabetes status; Normal, Prediabetes, Newly-diagnosed T2DM, T2DM less than 5years, and T2DM more than 5years. They were followed from the date of the medical checkup to the end of 2016. The endpoint was a new development of hip fracture during follow-up. The hazard ratios (HRs) and 95% confidence intervals (CIs) of hip fractures for each group were analyzed using Cox proportional hazard regression models after adjusting for age, sex, smoking, alcohol drinking, regular exercise, body mass index, hypertension, dyslipidemia, and chronic kidney disease. The HRs of hip fractures were 1 in the Normal group, 1.032 (95% CI: 1.009, 1.056) in the Prediabetes group, 1.168 (95% CI: 1.113, 1.225) in the Newly-diagnosed T2DM2, 1.543 (95% CI: 1.495, 1.592) in the T2DM less than 5years and 2.105 (95% CI: 2.054, 2.157) in the T2DM more than 5years. The secular trend of the HRs of hip fractures according to the duration of T2DM was statistically significant (P<.001). Subgroup analyses also showed the same increasing pattern of the HRs of hip fractures according to the duration of T2DM in both sexes and all age groups (50-64years, 65-74years, over 75years). In summary, this large-scale, retrospective, longitudinal, nationwide population-based cohort study of 5,761,785 subjects demonstrated that the risks of hip fractures started to increase in prediabetes and was associated linearly with the duration of T2DM. The secular trend of risks of hip fractures according to the duration of T2DM was consistent in both sexes and all age groups.

SAT-204 ACTH-Producing Pheochromocytoma, a Challenging Disease to Diagnose and Manage

Background: ACTH-producing pheochromocytomas (APP) are a rare cause of ectopic Cushing’s syndrome (CS), representing <6% of these cases. No guidelines exist on the management of these tumors. Clinical case: A 41-year-old woman presented to the ED with a 6-month history of newly-diagnosed T2DM and difficult-to-control hypertension. Three weeks prior to admission she developed fatigue, dyspnea on exertion, and generalized weakness particularly severe in the lower extremities (LE) limiting her ability to ambulate. She denied headaches, palpitations and diaphoresis. Initial vital signs included HR 111 beats/min and BP 217/112 mmHg. On physical exam she had classic findings of CS with severe LE weakness. Laboratory testing was consistent with ACTH-dependent CS (ACTH 463 pg/mL [0-45], cortisol 70.8 mcg/dL [3-23], potassium 2.7 mMol/L [3.1-5.1]). She failed both the low dose (1 mg) and high dose (8 mg) dexamethasone suppression tests. MRI of the pituitary gland ruled out a pituitary lesion. IPSS was not deemed necessary by Neurosurgery. CT abdomen showed a 4.2 cm right adrenal lesion and bilateral adrenal hyperplasia. This prompted workup for pheochromocytoma that revealed elevated plasma metanephrines (4.1 nMol/L, [<0.5]) and 24hr urine metanephrines (5329 mcg/day, [182-739]). A diagnosis of APP was entertained. Doxazosin 1 mg BID was added to her other antihypertensives with improvement in blood pressure. Ketoconazole 200 mg TID was started as a bridge for surgery. Patient underwent right unilateral adrenalectomy one month after initial presentation. ACTH and cortisol levels before surgery were 534 pg/mL and 87 mcg/dL, respectively, suggesting that ketoconazole was not effective. Both ACTH and cortisol levels decreased to 26 pg/mL and 14.4 mcg/dL, respectively, immediately after surgery. There was prompt subjective symptomatic improvement, including mild recovery of LE strength. Her blood pressure normalized and only spironolactone was continued. She was started on a prednisone taper. Pathology revealed a 4.2 pheochromocytoma and diffuse adrenocortical hyperplasia. Tumor cells stained positive for ACTH on immunohistochemistry. On follow up visit 2 months after surgery patient was feeling well and ambulating without difficulty. Labs were remarkable for normal plasma fractionated metanephrines, and A1c 5.1% on metformin alone (down from 4 medications on initial presentation). Conclusion: Diagnosis and management of APP can be challenging. Alpha-blockers should be started promptly. Definitive treatment with unilateral adrenalectomy is curative and has been recommended as the preferred approach.1 Ketoconazole may be used as bridge therapy for surgery, though some studies suggest its efficacy might be lower in ectopic CS.2 Response to other pharmacologic agents is largely unknown.

Effect of dapagliflozin on obstructive sleep apnea in patients with type 2 diabetes: a preliminary study

ObjectiveThe aim of this case-control study was to assess the efficacy of dapagliflozin combined with metformin for type-2 diabetes mellitus (T2DM) with obstructive sleep apnea hypopnea syndrome (OSAHS).MethodsA total of 36 patients with newly-diagnosed T2DM and OSAHS were randomized divided into two groups. Eighteen OSAHS patients with T2DM, who were treated with dapagliflozin and metformin, were assigned as the dapagliflozin group. These patients were given dapagliflozin and metformin for 24 weeks between February 2017 and February 2018. Another 18 OSAHS patients with T2DM, who were treated with glimepiride and metformin for 24 weeks, were assigned as the control group. Fasting plasma glucose (FPG) level, postprandial blood glucose (PPG), hemoglobin A1C (HbA1c), fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), blood lipids, body mass index (BMI), blood pressure, apnea-hypopnea index (AHI), minimum oxygen saturation (LSpO2), and Epworth Somnolence Scale (ESS) score were measured before and at 24 weeks after the initiation of treatment.ResultsIn the dapagliflozin group, triglyceride (TG), systolic pressure (SBP) and diastolic pressure (DBP) significantly decreased following treatment, while high-density lipoprotein cholesterol (HDL-C) significantly increased (P < 0.05). Furthermore, a reduction in AHI, an increase in LSpO2 and a decrease in ESS score were observed in the dapagliflozin group (P < 0.05), but not in the control group. Moreover, blood glucose, HbA1c, HOMA-IR, and BMI significantly decreased in these two groups, and the decrease was more significant in the dapagliflozin group.ConclusionThese present results indicate that dapagliflozin can significantly reduce glucose, BMI, blood pressure and AHI, and improve hypoxemia during sleep and excessive daytime sleepiness, which thereby has potential as an effective treatment approach for OSAHS.

1195-P: Effect of Dapagliflozin on Obstructive Sleep Apnea in Patients with Type 2 Diabetes: A Randomized Controlled Trial

Background: Obstructive sleep apnea hypopnea syndrome (OSAHS) is closely correlated to obesity and T2DM. Lose weight is helpful for OSAHS patients. Dapagliflozin, a new hypoglycemic drug, was found to reduce weight of T2DM patients, just like metformin. Therefore, they might have potential therapeutic effects on OSAHS patients with T2DM. Aim: A randomized controlled trial was designed to observe the effects of dapagliflozin combined with metformin on body mass index (BMI), and the ventilation and sleep quality of patients with OSAHS combined with T2DM, as well as some metabolic indicators. Methods: 36 enrolled OSAHS patients with newly-diagnosed T2DM were randomly assigned to two groups (dapagliflozin group and control group). These patients in dapagliflozin group were given dapagliflozin and metformin for 24 weeks, while controls were given glimepiride and metformin for 24 weeks. apnea-hypopnea index (AHI), minimum oxygen saturation (LSpO2), Epworth somnolence scale (ESS) score and some metabolic indicators were measured before and at 24 weeks after the initiation of treatment. Results and Conclusion: Our study indicate that dapagliflozin can significantly reduce glucose, BMI, blood pressure and AHI, and improve hypoxemia during sleep and excessive daytime sleepiness (Table 1), which thereby has potential as an effective treatment approach for OSAHS. Disclosure Q. Sun: None. Y. Tang: None. M. Zhang: None.

MON-151 Hypertriglyceridemia and Acute Pancreatitis Leading to Ketoacidosis in a Patient with Type 2 Diabetes

Introduction: We describe a case of type 2 diabetes presenting with acute pancreatitis (AP), hypertriglyceridemia, and diabetic ketoacidosis (DKA). Clinical Case: A 34-year-old Caucasian male presented to the emergency room with worsening intractable nausea and vomiting for 2 days. Medical problems included obesity, hypertension, hyperlipidemia, and fatty liver disease. He had a history of polysubstance use (denied recent alcohol intake) and noncompliance with self-care and was a known carrier for hemochromatosis. He gave a history of 30-lb weight loss over the past 6 weeks with associated polydipsia, polyuria, and abdominal pain. Six days prior to admission, the patient had been seen by his primary care physician for headache, nausea and vomiting, found to have a hemoglobin A1c of 13.5% (n=4.2-5.8%) and was started on metformin for newly-diagnosed T2DM. Physical exam revealed him to be afebrile, tachycardic (heart rate 145 bpm), and with a BP of 146/98 mmHg. Laboratory tests were significant for sodium 125 mmol/L (n=135-145mmol/L), potassium 4.0 mmol/L (n=3.5-5.1 mmol/L), anion gap 25 mmol/L (n=2-14 mmol/L), glucose 330 mg/dL (n=70-99 mg/dL), creatinine 1.5 mg/dL (n=0.5-1.3 mg/dL), lipase 268 U/L (n=8-78 U/L), triglyceride 1619 mg/dl (n<150 mg/dL), and negative alcohol and cardiac markers. Urine testing was positive for ketones with a negative drug screen. Arterial blood gas showed a pH of 7.27 (n=7.35-7.45), pCO2 19 mmHg (n= 35-45 mmHg), and pO2 111 mmHg (n=80-100 mmHg). CT of the abdomen revealed inflammation surrounding the pancreatic head, consistent with pancreatitis. The patient was admitted to the intensive-care unit for DKA and AP. He was treated with intravenous fluids and required an insulin drip for 72 hours before transitioning to subcutaneous insulin with resumption of oral nutrition as the pancreatic inflammation and gastrointestinal symptoms resolved. He was discharged on basal-bolus insulin therapy and lipid-lowering medications. Conclusion: Both DKA and AP are serious medical conditions with a high mortality rate when these two disorders occur simultaneously. Treatment requires aggressive fluid resuscitation with replacement of electrolytes and initiation of insulin. Identifying the potential trigger is key to preventing future occurrences. In the case presented, it is likely that primary hypertriglyceridemia, worsened by elevated glucose levels, was the etiologic factor for the onset of AP, which in turn precipitated DKA. However, it is also possible, though less likely, that uncontrolled hyperglycemia, glucose toxicity, and relative insulin deficiency led to increased production of very-low-density lipoprotein (VLDL) in the liver and its reduced clearance from the plasma, thus predisposing to hypertriglyceridemia. Close monitoring and appropriate therapy are required to control the latter and prevent future recurrences of AP and possibly DKA.

Thromboxane-Dependent Platelet Activation in Obese Subjects with Prediabetes or Early Type 2 Diabetes: Effects of Liraglutide- or Lifestyle Changes-Induced Weight Loss.

Thromboxane (TX)-dependent platelet activation and lipid peroxidation, as reflected in vivo by the urinary excretion of 11-dehydro-TXB2 and 8-iso-prostaglandin (PG)F2α, play a key role in atherothrombosis in obesity and type 2 diabetes mellitus (T2DM) since the earlier stages. Thirty-five metformin-treated obese subjects with prediabetes or newly-diagnosed T2DM were randomized to the glucagon-like peptide receptor agonist (GLP-RA) liraglutide (1.8 mg/day) or lifestyle counseling until achieving a comparable weight loss (−7% of initial body weight), to assess whether changes in subcutaneous (SAT) and visceral (VAT) adipose tissue distribution (MRI), insulin sensitivity (Matsuda Index) and beta-cell performance (multiple sampling OGTT beta-index), with either intervention, might affect TX-dependent platelet activation, lipid peroxidation and inflammation. At baseline, Ln-8-iso-PGF2α (Beta = 0.31, p = 0.0088), glycosylated hemoglobin (HbA1c) (Beta = 2.64, p = 0.0011) Ln-TNF-α (Beta = 0.58, p = 0.0075) and SAT (Beta = 0.14, p = 0.044) were significant independent predictors of 11-dehydro-TXB2. After achievement of the weight loss target, a comparable reduction in U-11-dehydro-TXB2 (between-group p = 0.679) and 8-iso-PGF-2α (p = 0.985) was observed in both arms in parallel with a comparable improvement in glycemic control, insulin sensitivity, SAT, high-sensitivity C-reactive protein (hs-CRP). In obese patients with initial impairment of glucose metabolism, the extent of platelet activation is related to systemic inflammation, isoprostane formation and degree of glycemic control and abdominal SAT. Successful weight loss, achieved with either lifestyle changes or an incretin-based therapy, is associated with a significant reduction in lipid peroxidation and platelet activation.

Design and implementation of an Omaha System-based integrated nursing management model for patients with newly-diagnosed diabetes

AimsThe aim of the present paper was to establish and implement an integrated nursing management model for patients with newly-diagnosed type 2 diabetes mellitus (T2DM) based on the Omaha System and to explore its impact on blood glucose levels, quality of life, and diabetes knowledge in these patients. MethodsA non-randomized concurrent controlled trial was designed and the study was conducted in a hospital on the east coast of China between September 2013 and November 2015. We screened for patients with newly-diagnosed T2DM in 12 clinics of 3 comprehensive hospitals. A total of 367 patients with newly-diagnosed T2DM were assigned into two groups. In the intervention group, patients received routine outpatient care plus integrated nursing management; in the control group, only routine outpatient care was given. Changes in blood glucose levels, quality of life, and diabetes knowledge in both groups before the intervention and 6 months after the intervention were observed and compared. ResultsAt the 6months, blood glucose levels, quality of life, and diabetes knowledge in the intervention group were significantly superior to those in the control group (all P<0.01). ConclusionsThe integrated nursing management model was able to improve patients’ glucose levels, quality of life, and diabetes knowledge.