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A successfully treated case of extremely hyperglycemic crisis accompanied with rhabdomyolysis and acute kidney injury
Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65–S211
In the current study, we attempted to implement in situ eNOS/ NO up-regulation in/around skin wounds in a rat model of diabetes by using statin-loaded tissue engineering scaffolds (TESs). Statin-loaded TESs with different drug loading amounts were prepared by a technique of electrospinning. The obtained TESs were composed of uniform and randomly arrayed fibres, with diameters of 527 ± 80, 466 ± 117 and 550 ± 118 nm, and with theoretical statin loading amounts of 1.0%, 5.0% and 10.0%, respectively. During in vitro drug release, all the TESs exhibited fast release phase in the initial 4 days. The in vitro cell culture experiments showed that the statin-loaded TESs could restore the high-glucose induced low cell viability and decreasing NO synthesis capabilities in human umbilical vein endothelial cells. In the rat model of diabetes, statin-loaded TESs with different drug loading amounts were administered on the skin wounds, with blank TES and natural healing wound as control. With the analysis of immunohistochemistry and microdialysis, the statin-loaded TESs exhibited promotive effect on eNOS expression and NO synthesis in regenerated skin tissues during skin wound healing. Furthermore, the regenerated skin tissues in groups with statin-loaded TESs exhibited promoted angiogenesis and higher skin blood flow value in/around skin wounds, and showed faster wound closure. The present study indicated that the controlled release of statin from TESs may be a promising therapy for diabetic skin wound. This work was supported by the National Natural Science Foundation of China (81303239) and the Specialized Research Fund for the Traditional Chinese Medicine Clinical Research Center of China (JDZX2015128). PE-33 Vegetarian diet is associated with higher SBP and fasting serum triacylglycerol than omnivorous diet in Taiwanese type 2 diabetic Chih-Ming SUN1*, Hui-Chun HSU1, Shi-yu CHEN1. 1Tri Service General Hospital, Taiwan Vegetarian diets are thought to be efficacious for management of type 2 diabetes mellitus (T2DM), and have been shown to be associated with reduction in the prevalence of T2DM in cohort studies, however differences in vegetarian diet composition could result in diverse physiologic outcomes. The current study evaluated the metabolic effects of vegetarian, breakfast vegetarian (animal foods excluded only from the first meal of the day) and omnivorous dietary patterns in Taiwanese T2DM adults. Vegetarians (n = 69), breakfast vegetarians (n = 132), and omnivorous (n = 207) diabetic adults were recruited through chart review at a clinic in Taiwan. Individual demographic, anthropometric, and dietary preference data were collected from consenting participants, and blood glucose, hemoglobin A1c, serum creatinine and lipid profile were analyzed from 8-hour overnight fasting blood samples. Differences among groups were determined by Chisquare and Kruskal-Wallis tests (Statistical Package for the Social Sciences, version 12.0, IBM). Compared to omnivores, vegetarians had 5% higher systolic blood pressure ( p = 0.023) and 24% higher fasting serum triacylglycerol (p = 0.003) (15% higher than the recommended value), and 14% lower high-density lipoprotein cholesterol (p < 0.001). A dose-response relationship was observed between extent of vegetarianism and these metabolic parameters among the groups. Additionally, a higher prevalence of anti-hypertensive medication use was observed in the vegetarians compared to omnivores ( p = 0.003). Age, body mass index, waist to hip circumference ratio, diastolic blood pressure, duration of diabetes, fasting blood glucose, hemoglobin A1C, serum total cholesterol and low-density lipoprotein cholesterol, and serum creatinine did not vart
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significantly with dietary pattern. When data was analyzed by gender, diet effects were more pronounced for women than men. Female vegetarians had higher systolic blood pressure (p = 0.017) and serum triacylglycerol (p = 0.044), and lower high-density lipoprotein cholesterol ( p = 0.001) and hemoglobin A1c ( p = 0.034), and had higher prevalence of using antihypertensive medication (p = 0.014) than female omnivores. Higher systolic blood pressure and fasting serum triacylglycerol, and lower high-density lipoprotein cholesterol were observed in vegetarian compared to omnivorous type 2 diabetic adults. We hypothesize that selection of a contemporary Taiwanese vegetarian diet may result in alterations in macronutrient distribution, with excessive consumption of refined carbohydrates attributed to vegetarian convenience foods, as replacement of dietary protein and fat with refined carbohydrate has been associated with these observed metabolic alterations in other populations. Further investigation is necessary to identify specific dietary components of Taiwanese vegetarian diets that may be implicated in adverse metabolic changes. PE-34 A successfully treated case of extremely hyperglycemic crisis accompanied with rhabdomyolysis and acute kidney injury Chia-Luen HUANG1 *, Yi-Jen HUNG1, Chieng-Hsing LEE1. 1 Division of Metabolism and Endocrinology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan We reported a 37-year-old man who demonstrated extremely high level of serum glucose (3,355 mg/dL) complicated with diabetic ketoacidosis and hyperosmolar hyperglycemic state after excessive consumption of sweetened beverage within one day. His blood sugar levels were gradually decreased by aggressive fluid resuscitation and insulin infusion. However, the laboratory evaluation revealed elevated levels of creatinine, creatinine kinase and myoglobin on day 2. Simultaneously, a huge renal stone was found on abdominal plain film. The diagnosis of rhabdomyolysis, staghorn stone and acute kidney injury were made based on these laboratory tests. Interesting, his creatinine kinase concentration continued to rise and persisted with high levels for one week even blood glucose, ketoacidosis and renal function were recovered. Finally, this case was successfully survived after aggressive treatments. Rhabdomyolysis is an uncommon but underestimated complication of hyperglycemic crisis. Hence, physicians should be alerted to this under detected complication of hyperglycemic crisis which may lead to acute renal failure yet can be easily diagnosed by a readily available test—the creatinine kinase level. PE-35 Comparison of clinical characteristics and outcomes of hospitalized patients with pneumonia between diabetic patients and non-diabetic patients in Japan Yoshinori MASUI1, Akahito SAKO1 *, Tadanao HARIGAE1, Akiko KAWAGUCHI1, Aki SAKURAI3, Teruhiko SATO2, Hidekatsu YANAI1. 1Department of Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, 2 Department of Respiratory Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, 3Department of Infectious Diseases, St. Luke’s International Hospital, Japan Background: Japan has become a super-aging society, and the number of patients with pneumonia has been increasing. Diabetes is associated with an increased susceptibility to infection and infection-related morbidity and mortality. However, current evidence showing the association between diabetes and pneumonia in Asian population is very limited. Objective: We aimed to elucidate the influence of diabetes on clinical characteristics and outcomes of pneumonia.
In the current study, we attempted to implement in situ eNOS/ NO up-regulation in/around skin wounds in a rat model of diabetes by using statin-loaded tissue engineering scaffolds (TESs). Statin-loaded TESs with different drug loading amounts were prepared by a technique of electrospinning. The obtained TESs were composed of uniform and randomly arrayed fibres, with diameters of 527 ± 80, 466 ± 117 and 550 ± 118 nm, and with theoretical statin loading amounts of 1.0%, 5.0% and 10.0%, respectively. During in vitro drug release, all the TESs exhibited fast release phase in the initial 4 days. The in vitro cell culture experiments showed that the statin-loaded TESs could restore the high-glucose induced low cell viability and decreasing NO synthesis capabilities in human umbilical vein endothelial cells. In the rat model of diabetes, statin-loaded TESs with different drug loading amounts were administered on the skin wounds, with blank TES and natural healing wound as control. With the analysis of immunohistochemistry and microdialysis, the statin-loaded TESs exhibited promotive effect on eNOS expression and NO synthesis in regenerated skin tissues during skin wound healing. Furthermore, the regenerated skin tissues in groups with statin-loaded TESs exhibited promoted angiogenesis and higher skin blood flow value in/around skin wounds, and showed faster wound closure. The present study indicated that the controlled release of statin from TESs may be a promising therapy for diabetic skin wound. This work was supported by the National Natural Science Foundation of China (81303239) and the Specialized Research Fund for the Traditional Chinese Medicine Clinical Research Center of China (JDZX2015128). PE-33 Vegetarian diet is associated with higher SBP and fasting serum triacylglycerol than omnivorous diet in Taiwanese type 2 diabetic Chih-Ming SUN1*, Hui-Chun HSU1, Shi-yu CHEN1. 1Tri Service General Hospital, Taiwan Vegetarian diets are thought to be efficacious for management of type 2 diabetes mellitus (T2DM), and have been shown to be associated with reduction in the prevalence of T2DM in cohort studies, however differences in vegetarian diet composition could result in diverse physiologic outcomes. The current study evaluated the metabolic effects of vegetarian, breakfast vegetarian (animal foods excluded only from the first meal of the day) and omnivorous dietary patterns in Taiwanese T2DM adults. Vegetarians (n = 69), breakfast vegetarians (n = 132), and omnivorous (n = 207) diabetic adults were recruited through chart review at a clinic in Taiwan. Individual demographic, anthropometric, and dietary preference data were collected from consenting participants, and blood glucose, hemoglobin A1c, serum creatinine and lipid profile were analyzed from 8-hour overnight fasting blood samples. Differences among groups were determined by Chisquare and Kruskal-Wallis tests (Statistical Package for the Social Sciences, version 12.0, IBM). Compared to omnivores, vegetarians had 5% higher systolic blood pressure ( p = 0.023) and 24% higher fasting serum triacylglycerol (p = 0.003) (15% higher than the recommended value), and 14% lower high-density lipoprotein cholesterol (p < 0.001). A dose-response relationship was observed between extent of vegetarianism and these metabolic parameters among the groups. Additionally, a higher prevalence of anti-hypertensive medication use was observed in the vegetarians compared to omnivores ( p = 0.003). Age, body mass index, waist to hip circumference ratio, diastolic blood pressure, duration of diabetes, fasting blood glucose, hemoglobin A1C, serum total cholesterol and low-density lipoprotein cholesterol, and serum creatinine did not vart
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significantly with dietary pattern. When data was analyzed by gender, diet effects were more pronounced for women than men. Female vegetarians had higher systolic blood pressure (p = 0.017) and serum triacylglycerol (p = 0.044), and lower high-density lipoprotein cholesterol ( p = 0.001) and hemoglobin A1c ( p = 0.034), and had higher prevalence of using antihypertensive medication (p = 0.014) than female omnivores. Higher systolic blood pressure and fasting serum triacylglycerol, and lower high-density lipoprotein cholesterol were observed in vegetarian compared to omnivorous type 2 diabetic adults. We hypothesize that selection of a contemporary Taiwanese vegetarian diet may result in alterations in macronutrient distribution, with excessive consumption of refined carbohydrates attributed to vegetarian convenience foods, as replacement of dietary protein and fat with refined carbohydrate has been associated with these observed metabolic alterations in other populations. Further investigation is necessary to identify specific dietary components of Taiwanese vegetarian diets that may be implicated in adverse metabolic changes. PE-34 A successfully treated case of extremely hyperglycemic crisis accompanied with rhabdomyolysis and acute kidney injury Chia-Luen HUANG1 *, Yi-Jen HUNG1, Chieng-Hsing LEE1. 1 Division of Metabolism and Endocrinology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan We reported a 37-year-old man who demonstrated extremely high level of serum glucose (3,355 mg/dL) complicated with diabetic ketoacidosis and hyperosmolar hyperglycemic state after excessive consumption of sweetened beverage within one day. His blood sugar levels were gradually decreased by aggressive fluid resuscitation and insulin infusion. However, the laboratory evaluation revealed elevated levels of creatinine, creatinine kinase and myoglobin on day 2. Simultaneously, a huge renal stone was found on abdominal plain film. The diagnosis of rhabdomyolysis, staghorn stone and acute kidney injury were made based on these laboratory tests. Interesting, his creatinine kinase concentration continued to rise and persisted with high levels for one week even blood glucose, ketoacidosis and renal function were recovered. Finally, this case was successfully survived after aggressive treatments. Rhabdomyolysis is an uncommon but underestimated complication of hyperglycemic crisis. Hence, physicians should be alerted to this under detected complication of hyperglycemic crisis which may lead to acute renal failure yet can be easily diagnosed by a readily available test—the creatinine kinase level. PE-35 Comparison of clinical characteristics and outcomes of hospitalized patients with pneumonia between diabetic patients and non-diabetic patients in Japan Yoshinori MASUI1, Akahito SAKO1 *, Tadanao HARIGAE1, Akiko KAWAGUCHI1, Aki SAKURAI3, Teruhiko SATO2, Hidekatsu YANAI1. 1Department of Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, 2 Department of Respiratory Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, 3Department of Infectious Diseases, St. Luke’s International Hospital, Japan Background: Japan has become a super-aging society, and the number of patients with pneumonia has been increasing. Diabetes is associated with an increased susceptibility to infection and infection-related morbidity and mortality. However, current evidence showing the association between diabetes and pneumonia in Asian population is very limited. Objective: We aimed to elucidate the influence of diabetes on clinical characteristics and outcomes of pneumonia.