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Effects of bariatric surgery on microvascular dysfunction and metabolic profile in morbid obesity
Abstracts / Atherosclerosis 252 (2016) e1ee196
results may in part explain the positive effects of bariatric surgery on cardiovascular morbidity and mortality in morbidly obese patients.
EAS16-0621, METABOLIC ABNORMALITIES AND ATHEROSCLEROSIS: DIABETES. EFFECTS OF BARIATRIC SURGERY ON MICROVASCULAR DYSFUNCTION AND METABOLIC PROFILE IN MORBID OBESITY M. Naeimi Kararoudi 1, G. Lupattelli 1, S. Ministrini 1, V. Bianconi 1, M.A. Ricci 1, S. De Vuono 1, P. mariani 1, A. Moriconi 1, M. Boni 2, E. Mannarino 1, L. Pasqualini 1. 1 University of Perugia, Department of Medicine, PERUGIA, Italy; 2 University of Perugia, Department of Surgery, Foligno, Italy Objectives: Clinical and experimental evidence suggests that microvascular dysfunction is a potential factor explaining the association among obesity, insulin resistance and vascular damage. The purpose of the current report was to investigate the effect of weight loss, one year after bariatric surgery on metabolic profile and skin microvascular reactivity, due to few related studies. Methods: Thirty seven morbidly obese subjects (age 44.7±13.3 years, male 27%, BMI 44.4±6 kg/m2) who were free of previous cardiovascular events, eligible for bariatric surgery, were included in the study. Before and one year after surgery (sleeve gastrectomy), Post-Occlusive Reactive Hyperemia (PORH) of the forearm skin was evaluated by laser-Doppler flowmetry. Results: After intervention, we observed a significant reduction in BMI kg/m2, p<0.0001), HOMA index (44.4±6 kg/m2vs 32,8±0,8 (4,48±0,64vs1,45±0,13, p< 0,05), HbA1c (6,23±0,29 vs 5,43±0,07, p< 0,05) and a meaningful increase in PORH (1196,03±1087,76 PU vs 1828,16±1541,78 PU,p<0,05). Additionally, a significant change of PORH was found in patients with HOMA index above the cut-off of 3.5, (1119,40±1231,34 PU vs 2090,28±2118,60 PU,p¼0,001), and in patients with higher levels of HbA1c, above 5,7%,(1130,57±1468,71 vs 2294,87±2395,29,p¼0,005), both corresponding to the median value of our population. Also a significant correlation between the increase of PORH and the reduction of both HOMA index (rho¼-0,341,p<0,048) and HbA1c (rho¼-0,444, p¼ 0,05) was observed. Conclusions: Our study showed the bariatric surgery improves the microvascular dysfunction associated with morbid obesity. Furthermore, the improvement of insulin resistance might be involved in benefits of sleeve gastrectomy in morbid obese patients.
EAS16-1041, METABOLIC ABNORMALITIES AND ATHEROSCLEROSIS: DIABETES. FACTORS DETERMINING AND STRATEGIES FOR IMPROVING TREATMENT ADHERENCE IN PATIENTS WITH TYPE 2 DIABETES MELIITUS: DOCTOR, COMMUNITY PHARMACIST AND PATIENT PERSPECTIVES. ADHERI2 STUDY andez-Mijares 2, M. Rodríguez-de Miguel 1, M.J. E. Labrador-Barba 1, A. Hern ~ a 1, F.J. Alonso Moreno 4. 1 Mylan, Medical Faus-Dader 3, M.L. Orera-Pen Department, Madrid, Spain; 2 Hospital Dr. Peset, Service of Endocrinology, Valencia, Spain; 3 Universidad de Granada, Department of Biochemistry and Molecular Biology, Granada, Spain; 4 SESCAM, C. S. Sillería, Toledo, Spain Objectives: To describe the perception of treatment adherence by patients with type 2 diabetes mellitus (T2DM) from the perspective of doctors, community pharmacists and patients. Materials and Methods: Observational, descriptive, transversal, study performed on a sample of 1,019 doctors, 493 pharmacists and 1,013 patients with T2DM. Results: The data from 998 doctors, 419 pharmacists and 963 patients were available for analysis. In patients, the average diagnosis time for T2DM was 11.3 years. The Morisky-Green test showed non-adherence for 34.6% of patients.
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With regard to the factors determining treatment adherence: 92.4% of doctors, 74.5% of pharmacists and 88.1% of patients considered important the knowledge of the consequences of non-adherence. For 97.5% of doctors, 72.2% of pharmacists and 86.1% of patients the presence of adverse events was considered important. The payment or co-payment of treatment is important for adherence for 80.8% of doctors and patients, and for 48.6% of pharmacists. With regard to strategies for improving treatment adherence: 95.5% of doctors and 82.3% of patients considered important the role of the nurse as educator. For 96.1% of doctors, 90.3% of pharmacists and 70.6% of patients the support from relatives or friends is important to improve adherence to treatment. Conclusion: Doctors emphasise the presence of adverse effects as important factor for adherence, rather than pharmacists and patients. Pharmacists played down the importance of cost or co-payment for treatment. The importance of the various factors determining treatment adherence is similar for physicians and patients. In general, pharmacists attached less importance to all aspects.
EAS16-0728, METABOLIC ABNORMALITIES AND ATHEROSCLEROSIS: DIABETES. PREVALENCE OF 25 HYDROXY-VITAMIN D DEFICIENCY AND ITS CORRELATION WITH GLYCEMIC CONTROL IN DIABETIC PATIENTS S. Lahiani 1, K. Bouzid 1, 2, I. Oueslati 3, K. Khiari 3, N. Bchir 3, A. Melki 3, A. Bartkiz 1, H. Ben Ahmed 4, H. Baccar 4, J. Abdelmoula 1, N. Ben ^pital Charles Nicolle, Biochemistry, Tunis, Tunisia; 2 Ho ^pital Abdallah 3. 1 Ho Charles Nicolle, Laboratory of Engineering of Proteins and Bioactive ^pital Charles Molecules INSAT: LR 11EES24:LIP-MB, Tunis, Tunisia; 3 Ho ^pital Charles Nicolle, Cardiology, Nicolle, Endocrinology, Tunis, Tunisia; 4 Ho Tunis, Tunisia Objectives: It has been reported that 25 hydroxy-vitamin D (25OHD) deficiency may be associated with metabolic disorders such as type 2 diabetes. The aim of the present study was to determine the prevalence of 25OHD deficiency and to assess its relationship with glycemic control among type 2 diabetic patients. Methods: We conducted a cross sectional analysis in 59 type 2 diabetic patients. Fasting blood specimens were collected to measure fasting glucose, HbA1c and 25OHD levels. Predefined thresholds were used to categorize 25OHD status: 30 ng/ml normal level, [10-30] 25OHD insufficiency and <10 ng/ml 25OHD deficiency. Results: Among the 59 participants (sex ratio¼1.46), the mean age was 57.85±8.67 years. The average value of 25OHD was 14.68±5.48 ng/ml [726.1] in all patients, 14.5 ± 6.6 ng/ml in well managed patients and 15.1 ± 5.5 ng/ml in poorly controlled patients (p¼0.7). Eighteen patients had 25OHD deficiency (30%), 40 had 25OHD insufficiency (68%) and only one patient had a normal value of 25OHD. Statistic analysis showed a significant positive correlation between duration of diabetes and VitD level (r¼0.26, p¼0.04). However, There were virtually no correlations between VitD and glycemic control: vitD and fasting glucose: r¼-0.118, p¼0.3; vitD and HbA1c: r¼0.01, p¼0.8. Conclusions: Poor vitamin D status was highly prevalent among our patients. This condition seems to be with no consequences on diabetic control. However, it may increase the risk of cardiovascular disease. Therefore, screening and management of vitD deficiency are important in diabetic patients.
EAS16-0557, METABOLIC ABNORMALITIES AND ATHEROSCLEROSIS: DIABETES. COMBINED DEVELOPMENT OF MACROVASCULAR AND CHRONIC KIDNEY DISEASE IN TYPE 2 DIABETES ASSOCIATED WITH POLYMORPHISM OF TNF-a GENE O. Vikulova 1, N. Lebedeva 1, A. Zheleznyakova 1, A. Nikitin 2, M. Shamkhalova 1, M. Shestakova 3. 1 Endocrinology Research Center, Diabetic nephropathy department, Moscow, Russia; 2 Federal Research Clinical Center of Federal Medical and Biological Agency, Laboratory of genetics,
results may in part explain the positive effects of bariatric surgery on cardiovascular morbidity and mortality in morbidly obese patients.
EAS16-0621, METABOLIC ABNORMALITIES AND ATHEROSCLEROSIS: DIABETES. EFFECTS OF BARIATRIC SURGERY ON MICROVASCULAR DYSFUNCTION AND METABOLIC PROFILE IN MORBID OBESITY M. Naeimi Kararoudi 1, G. Lupattelli 1, S. Ministrini 1, V. Bianconi 1, M.A. Ricci 1, S. De Vuono 1, P. mariani 1, A. Moriconi 1, M. Boni 2, E. Mannarino 1, L. Pasqualini 1. 1 University of Perugia, Department of Medicine, PERUGIA, Italy; 2 University of Perugia, Department of Surgery, Foligno, Italy Objectives: Clinical and experimental evidence suggests that microvascular dysfunction is a potential factor explaining the association among obesity, insulin resistance and vascular damage. The purpose of the current report was to investigate the effect of weight loss, one year after bariatric surgery on metabolic profile and skin microvascular reactivity, due to few related studies. Methods: Thirty seven morbidly obese subjects (age 44.7±13.3 years, male 27%, BMI 44.4±6 kg/m2) who were free of previous cardiovascular events, eligible for bariatric surgery, were included in the study. Before and one year after surgery (sleeve gastrectomy), Post-Occlusive Reactive Hyperemia (PORH) of the forearm skin was evaluated by laser-Doppler flowmetry. Results: After intervention, we observed a significant reduction in BMI kg/m2, p<0.0001), HOMA index (44.4±6 kg/m2vs 32,8±0,8 (4,48±0,64vs1,45±0,13, p< 0,05), HbA1c (6,23±0,29 vs 5,43±0,07, p< 0,05) and a meaningful increase in PORH (1196,03±1087,76 PU vs 1828,16±1541,78 PU,p<0,05). Additionally, a significant change of PORH was found in patients with HOMA index above the cut-off of 3.5, (1119,40±1231,34 PU vs 2090,28±2118,60 PU,p¼0,001), and in patients with higher levels of HbA1c, above 5,7%,(1130,57±1468,71 vs 2294,87±2395,29,p¼0,005), both corresponding to the median value of our population. Also a significant correlation between the increase of PORH and the reduction of both HOMA index (rho¼-0,341,p<0,048) and HbA1c (rho¼-0,444, p¼ 0,05) was observed. Conclusions: Our study showed the bariatric surgery improves the microvascular dysfunction associated with morbid obesity. Furthermore, the improvement of insulin resistance might be involved in benefits of sleeve gastrectomy in morbid obese patients.
EAS16-1041, METABOLIC ABNORMALITIES AND ATHEROSCLEROSIS: DIABETES. FACTORS DETERMINING AND STRATEGIES FOR IMPROVING TREATMENT ADHERENCE IN PATIENTS WITH TYPE 2 DIABETES MELIITUS: DOCTOR, COMMUNITY PHARMACIST AND PATIENT PERSPECTIVES. ADHERI2 STUDY andez-Mijares 2, M. Rodríguez-de Miguel 1, M.J. E. Labrador-Barba 1, A. Hern ~ a 1, F.J. Alonso Moreno 4. 1 Mylan, Medical Faus-Dader 3, M.L. Orera-Pen Department, Madrid, Spain; 2 Hospital Dr. Peset, Service of Endocrinology, Valencia, Spain; 3 Universidad de Granada, Department of Biochemistry and Molecular Biology, Granada, Spain; 4 SESCAM, C. S. Sillería, Toledo, Spain Objectives: To describe the perception of treatment adherence by patients with type 2 diabetes mellitus (T2DM) from the perspective of doctors, community pharmacists and patients. Materials and Methods: Observational, descriptive, transversal, study performed on a sample of 1,019 doctors, 493 pharmacists and 1,013 patients with T2DM. Results: The data from 998 doctors, 419 pharmacists and 963 patients were available for analysis. In patients, the average diagnosis time for T2DM was 11.3 years. The Morisky-Green test showed non-adherence for 34.6% of patients.
e143
With regard to the factors determining treatment adherence: 92.4% of doctors, 74.5% of pharmacists and 88.1% of patients considered important the knowledge of the consequences of non-adherence. For 97.5% of doctors, 72.2% of pharmacists and 86.1% of patients the presence of adverse events was considered important. The payment or co-payment of treatment is important for adherence for 80.8% of doctors and patients, and for 48.6% of pharmacists. With regard to strategies for improving treatment adherence: 95.5% of doctors and 82.3% of patients considered important the role of the nurse as educator. For 96.1% of doctors, 90.3% of pharmacists and 70.6% of patients the support from relatives or friends is important to improve adherence to treatment. Conclusion: Doctors emphasise the presence of adverse effects as important factor for adherence, rather than pharmacists and patients. Pharmacists played down the importance of cost or co-payment for treatment. The importance of the various factors determining treatment adherence is similar for physicians and patients. In general, pharmacists attached less importance to all aspects.
EAS16-0728, METABOLIC ABNORMALITIES AND ATHEROSCLEROSIS: DIABETES. PREVALENCE OF 25 HYDROXY-VITAMIN D DEFICIENCY AND ITS CORRELATION WITH GLYCEMIC CONTROL IN DIABETIC PATIENTS S. Lahiani 1, K. Bouzid 1, 2, I. Oueslati 3, K. Khiari 3, N. Bchir 3, A. Melki 3, A. Bartkiz 1, H. Ben Ahmed 4, H. Baccar 4, J. Abdelmoula 1, N. Ben ^pital Charles Nicolle, Biochemistry, Tunis, Tunisia; 2 Ho ^pital Abdallah 3. 1 Ho Charles Nicolle, Laboratory of Engineering of Proteins and Bioactive ^pital Charles Molecules INSAT: LR 11EES24:LIP-MB, Tunis, Tunisia; 3 Ho ^pital Charles Nicolle, Cardiology, Nicolle, Endocrinology, Tunis, Tunisia; 4 Ho Tunis, Tunisia Objectives: It has been reported that 25 hydroxy-vitamin D (25OHD) deficiency may be associated with metabolic disorders such as type 2 diabetes. The aim of the present study was to determine the prevalence of 25OHD deficiency and to assess its relationship with glycemic control among type 2 diabetic patients. Methods: We conducted a cross sectional analysis in 59 type 2 diabetic patients. Fasting blood specimens were collected to measure fasting glucose, HbA1c and 25OHD levels. Predefined thresholds were used to categorize 25OHD status: 30 ng/ml normal level, [10-30] 25OHD insufficiency and <10 ng/ml 25OHD deficiency. Results: Among the 59 participants (sex ratio¼1.46), the mean age was 57.85±8.67 years. The average value of 25OHD was 14.68±5.48 ng/ml [726.1] in all patients, 14.5 ± 6.6 ng/ml in well managed patients and 15.1 ± 5.5 ng/ml in poorly controlled patients (p¼0.7). Eighteen patients had 25OHD deficiency (30%), 40 had 25OHD insufficiency (68%) and only one patient had a normal value of 25OHD. Statistic analysis showed a significant positive correlation between duration of diabetes and VitD level (r¼0.26, p¼0.04). However, There were virtually no correlations between VitD and glycemic control: vitD and fasting glucose: r¼-0.118, p¼0.3; vitD and HbA1c: r¼0.01, p¼0.8. Conclusions: Poor vitamin D status was highly prevalent among our patients. This condition seems to be with no consequences on diabetic control. However, it may increase the risk of cardiovascular disease. Therefore, screening and management of vitD deficiency are important in diabetic patients.
EAS16-0557, METABOLIC ABNORMALITIES AND ATHEROSCLEROSIS: DIABETES. COMBINED DEVELOPMENT OF MACROVASCULAR AND CHRONIC KIDNEY DISEASE IN TYPE 2 DIABETES ASSOCIATED WITH POLYMORPHISM OF TNF-a GENE O. Vikulova 1, N. Lebedeva 1, A. Zheleznyakova 1, A. Nikitin 2, M. Shamkhalova 1, M. Shestakova 3. 1 Endocrinology Research Center, Diabetic nephropathy department, Moscow, Russia; 2 Federal Research Clinical Center of Federal Medical and Biological Agency, Laboratory of genetics,