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DESMONDDoes it deliver for Aboriginal and Torres Strait Islander people
Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65–S211
PE-59 Outcome analysis of diabetic patients with or without albuminuria Wai Kin CHAN1, Szu-Tah CHEN1 *. 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taiwan Objective: This study retrospectively compared the clinical character and outcome of type 2 diabetic patients with normo(below 30 mg/L), micro- (30–299 mg/L) and macro- (above 300 mg/L) albuminuria Research design and methods: 79 type 2 diabetic nephropathic (DN) patients were retrospectively reviewed from 2013/01 to 2016/01. All patients were treated with oral anti-diabetes drugs and/or insulin; either angiotensin receptor blockers (ARB) or angiotensin-converting enzyme inhibitors (ACEI) were given in the albuminuria groups. Clinical data including urine albumin creatinine ratio (UACR), glycosylated hemoglobin (HbA1c), systolic blood pressure (SBP) and estimated glomerular filtration rate (eGFR) were analyzed. Patients were divided into normo-, micro- and macro-albuminuria groups according to their latest amount of spot urine albumin. All data were analyzed with Generalized Estimating Equation (GEE) to evaluate the changes in SBP, HbA1c, UACR and eGFR. Results: Our study includes 33 (41.8%) normal, 13 (16.5%) micro- and 33 (41.8%) macro-albuminuria patients aged 62.1 ± 10.6, 57.8 ± 11.9 and 65.6 ± 11.4 year-old, respectively. After adjusting age, sex and duration of diabetes, both albuminuric groups showed statistical significance of higher UACR (micro-: B = 103.66, SE = 40.24, p = 0.01, macro-: B = 1169, SE = 164.5, p < 0.0001) during the 3-year follow-up period. Macro-albuminuria group showed significantly higher level of HbA1c (B = 1.067, SE = 0.48, p = 0.027) and SBP (B = 11.89, SE = 4.25, p = 0.005) when compared to normal albuminuria group. Both normo- (B = −2.03/year, SE = 0.98, p = 0.038) and macro- (B = 200.76/year, SE = 86.31, p = 0.02) albuminuria groups showed significant annual UACR increment. Deterioration of renal function was found statistically significance in both normo- (B = −4.08/year, SE = 0.71, P < .0001) and macro- (B = 2.8/ year, SE = 0.87, P = 0.001) albuminuria groups by reducing annual eGFR without significant difference in their decreasing slope in all 3 groups. Finally, the rate of major adverse cardiac events (MACE) was similar in all 3 groups. Conclusions: Renin-angiotensin system blockers may protect DN patients from renal function exacerbation by reducing eGFR but not by preventing urinary protein loss in the abnormal albuminuria groups regardless of their degree of severity. PE-60 A study of increasing access to diabetic retinopathy screening and referral if indicated Yu-Ying CHANG1 *, Yen-Tzu LEE1, I-Chieh MAO1, Shih-Te TU1. 1 Lukang Christian Hospital, Taiwan Objective: The World Health Organization (WHO) statistics show that the possibility of suffering from blindness among diabetic patients is 10 to 20 times higher than that among people without diabetes. One researcher’s study also shows that the prevalence of diabetic retinopathy ranges from 15% to 45%. As such, a simplified ophthalmoscopy, ease of screening and referral will hopefully increase the access to diabetic retinopathy screening and referral if indicated, and more importantly, the knowledge of and prevention against diabetic eye disorders in diabetic patients. Method: Our Health Care Center has been equipped with ophthalmoscopy instruments for screening. Healthcare education and retinal photography may be performed at the same venue, improving the accessibility to screening in patients. The environmental features are designed to facilitate health promotion, and moreover, referral if indicated to our ophthalmologists is available for further follow-up and treatment.
S149
Result: Through this program, 3,278 patients successfully joined our hospital’s Diabetes Shared Care Network. During the period when the program was active (May 25, 2015 to October 23, 2015, for 5 months), 1,772 diabetic patients received screening. Compared with the same period in 2014, the number grew by 616 with a growth rate of 53.3%. Out of the 24 patients receiving ophthalmoscopy and indicated for referral, 14 were successfully referred to Ophthalmology, with a success rate of 58.3%. According to the analysis of the other 10 patients, 30% indicated that they did not feel ill while the 20% reported that they were under follow-up by Ophthalmology. Conclusion: Education on preventing diabetic eye complications and simple access may substantially improve the screening of diabetic eye disorders. The referral if indicated, however, is paramount. Over 40% of diabetic patients still refuse to be referred to Ophthalmology; the referral rate is only 58.3%. The reason for most cases is that patients do not have eye discomfort. The pre-program ophthalmoscopy focused on the number of screened patients (quantity) rather than further ophthalmology care for patients (quality). In the light of this program, it is hopeful that diabetic patients may be accessible to more comprehensive care for their eyes as a result of increased referral rate in screened patients if indicated, as well as widespread concept of early screening and early treatment among healthcare professionals and patients. PE-61 Correlation of glycemic control and arterial stiffness in patients with type 2 diabetes mellitus Jongky HENDRO PRAYITNO1 *, Soebagijo ADI1, Ari SOETJAHJO1, Askandar TJOKROPRAWIRO1, Agung PRANOTO1, Sony WIBISONO1, Sri MURTIWI1. 1Surabaya Diabetes and Nutrition Centre, Indonesia The PWV has been identified as an independent predictor for cardiovascular related mortality. The uncontroled T2DM induced hyperglycemic condition and caused depletion of endothelial nitric oxide (NO) which further leading to endothelial dysfunction. In this study we showed that poor glycemic control in patients with T2DM is associated with abnormal arterial stiffness. Methods: This is a cross sectional study. We recruited 50 patients with T2DM from out patient clinic. We excluded patient undergo Dialysis treatment, haemoglobin level <10 gr/ dL, and all of the sample were performed baseline data including the blood pressure, HbA1c levels and all patient were measured the arterial stiffness using ba-PWV. We evaluate the relationship of HbA1c levels and the result of ba-PWV test. Results: The mean of age was 58,98 ± 12,28 years, and the mean of HbA1c level: 7,69 ± 0,98%. The mean of PWV: 16,41 ± 2,43 m/ second. Test results showed the correlation between HbA1c level and PWV and shows strong and significant result (r = 0,403; P < 0,05). Conclusion: There was a significant correlation between Glycaemic control and arterial stiffnes in T2DM. PE-62 DESMOND…Does it deliver for Aboriginal and Torres Strait Islander people Deborah SCHOFIELD1, Asha SINGH1*, Helen MITCHELL1, Melissa ROBINSON1, Kylie MAHONY1. 1Diabetes WA, DESMOND Australia, Perth, Australia Background: Traditional methods of health promotion and education such as the distribution of materials and didactic program delivery has had limited success in reducing the burden of chronic diseases, especially in rural and remote Aboriginal communities. Evidence behind using a patient empowerment approach is mounting, with many
S150
Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65–S211
organisations adopting client-centred approaches that empower individuals to build confidence and take responsibility of their health. Despite high rates of type 2 diabetes and diabetes-related complications in Aboriginal communities, there is a lack of evidence based diabetes self-management programs designed for Aboriginal people. The DESMOND program is an evidencebased, quality diabetes self-management program where participants are supported to discover/share knowledge of their personal journey with diabetes. The Diabetes Education and Self-Management Ongoing and Newly Diagnosed (DESMOND) program is one example of this. DESMOND is a client-centred diabetes education program that uses innovative adult learning theories and philosophies to build confidence, skills and promote diabetes self-management. Diabetes WA is trialling the effectiveness of the program, and this approach, in Australian Aboriginal communities. Aim: This project aims to explore the cultural fit, effectiveness and sustainability of delivering DESMOND in Aboriginal communities. Method: Diabetes WA developed and strengthened partnerships with a number of health services across the state of Western Australia to enable DESMOND trained diabetes educators to deliver the program to Aboriginal communities in Perth and regional Western Australia. Following completion of the program, attendees were invited to share their experience of DESMOND, its cultural fit and what changes they would recommend to improve the program. Results: Qualitative data was collected and preliminary results show that Aboriginal participants felt respected by educators and open discussions, storytelling and hands-on activities were enjoyable. A number of minor adjustments have been made to the program, with the length of the program, access to biomedical results, and appropriateness of foods used presenting challenges. Evaluation measures are currently in place to assess participant’s HbA1c, cholesterol and blood pressure three to six months post program. Discussion: Adapting the DESMOND program to meet the needs of Aboriginal and Torres Strait Islander people has the potential to slow the progression of diabetes, impact biomedical results, and lead to a reduction in diabetes-related complications. Additionally the results of this trial will contribute to best practice evidence on effective, sustainable chronic disease education for Aboriginal communities. PE-63 A novel scoring system for the early detection of diabetic kidney disease in patients with type 2 diabetes Chih-Hung LIN1,2, Tzu-Ling TSENG3, Wei-Ya LIN3, Hsiang-Chi WANG3, Lee-Ming CHUANG1,2*. 1Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, 3Bio Preventive Medicine Corp., Hsinchu, Taiwan Background: Diabetic kidney disease (DKD) is one of the most common diabetic complications, as well as the leading cause of end-stage renal disease (ESRD) worldwide. At present, urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) are the standard diagnostic methods for DKD. However, their accuracies are limited due to the heterogeneous disease nature, especially in type 2 diabetes (T2DM). DN_Score is a scoring system generated from the profiles of DNlite, a urinary biomarker panel composed of alpha2-HS-glycoprotein precursor (AHSG), alpha-1-antitrypsin (A1AT) and acid-1-glycoprotein (AGP). In this cross-sectional study, we investigated the correlation between DN_Score and clinical profiles of patients with T2DM, in order to evaluate its potential for diagnosis of DKD. Methods: 308 patients with T2DM and UACR <300 mg/g were enrolled in this study. Phenotypic and biochemistry
profiles were recorded. DN_Score was calculated according to the urinary DNlite profile. UACR and the composite Kidney Disease Improving Global Outcomes (KDIGO) classification system were used for assessing the severity and risk of DKD. Results: There were 174 male and 134 female participants. The mean age was 60.64 ± 9.84 years. The mean DN_Score was 10.69 ± 0.9. The DN_Score in participants with UACR <30 and ≥30 mg/g was 10.42 ± 0.72 and 11.89 ± 0.63, respectively (P < 0.01). While classified by the KDIGO system, the DN_Score in participants with low, moderate-increased, high and veryhigh risk was 10.41 ± 0.72, 11.74 ± 0.7, 12.56 ± 0.29, 12.19 ± 0.03, respectively (P < 0.01). Intercorrelations of DN_Score were found with BMI, ACR, eGFR, blood pressure, fasting plasma glucose, HbA1c and plasma triglyceride level. After adjustment for significant covariates, DN_Score was significantly associated with UACR (P < 0.01) Conclusions: DN_Score is correlated significantly with the traditional indicators of DKD in the early stage of the disease. Long-term outcome study will be necessary to validate the predictive role of DN_Score on the progression of DKD. PE-64 The relationship between CVR-R and 2-year glycemic control in type 2 diabetic patients Kaoru ISO1 *, Keiichi MUKAI2, Yuuki KAKUMAE1, Koji ISHI1, Hiromi OHUCHI1. 1Tokyo Kamata Medical Center, 2Yokohama Shinmidori General Hospital, Japan Background: Diabetic autonomic neuropathy (DAN) is a manifestation of diabetic neuropathy. DAN is frequently observed in patients with a long duration of diabetes and causes various symptoms once it advanced. Autonomic nerve dysfunction can be expressed quantitatively by a coefficient of variation in R-R intervals (CVR-R). Objective: The aim of the study was assess the relationship between the autonomic nerve disturbance and glycemic control in type 2 diabetic patients. Material and Methods: Fifteen patients (male 7, female 8) with uncontrolled type 2 diabetes were enrolled. All patients firstly were received with intensive insulin therapy. HbA1c were measured every 2 month. ECGs were recorded in the resting position and 100 consecutive R-R intervals were processed computer. CVR-R were measured at baseline and 2year later. Results: At baseline, age, duration, BMI and HbA1c were 63.9 years old, 9.9 year, 24.2 kg/m2 and 10.3%. The mean HbA1c was significantly lower in 1-year’s (6.9%) and 2-year’s (6.9%) than the baseline’s. CVR-R was significantly higer in 2-year’s (3.00%) than the baseline’s (2.02%). Conclusion: These results suggest that long-term glycemic control may ameliorate diabetic autonomic neuropathy. PE-65 The effect of nutrition counseling on glycemic control and cognitive function in type 2 diabetic patients Chia-Hsin YU1, Po-Wen YANG2, Yu-Pei SUNG2, Cheng-Hsueh CHIEN1, Lin-Hui LI1, Huang-Yu CHANG1, Shyh-Hsiang LIN3 *. 1Department of Dietetics, Keelung Hospital, Ministry of Health and Welfare, 2Internal Medicine, Keelung Hospital, Ministry of Health and Welfare, 3School of Nutrition and Health Sciences, Taipei Medical University, Taiwan Objective: It’s known that blood glucose was associated with cognitive function in animal studies. In addition, poor glycemic control has emerged as a possible risk factor for cognitive decline among elderly adults with diabetes mellitus (DM). Medical nutrition therapy is important in managing DM. The aim of this study was to evaluate the effects of the
PE-59 Outcome analysis of diabetic patients with or without albuminuria Wai Kin CHAN1, Szu-Tah CHEN1 *. 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taiwan Objective: This study retrospectively compared the clinical character and outcome of type 2 diabetic patients with normo(below 30 mg/L), micro- (30–299 mg/L) and macro- (above 300 mg/L) albuminuria Research design and methods: 79 type 2 diabetic nephropathic (DN) patients were retrospectively reviewed from 2013/01 to 2016/01. All patients were treated with oral anti-diabetes drugs and/or insulin; either angiotensin receptor blockers (ARB) or angiotensin-converting enzyme inhibitors (ACEI) were given in the albuminuria groups. Clinical data including urine albumin creatinine ratio (UACR), glycosylated hemoglobin (HbA1c), systolic blood pressure (SBP) and estimated glomerular filtration rate (eGFR) were analyzed. Patients were divided into normo-, micro- and macro-albuminuria groups according to their latest amount of spot urine albumin. All data were analyzed with Generalized Estimating Equation (GEE) to evaluate the changes in SBP, HbA1c, UACR and eGFR. Results: Our study includes 33 (41.8%) normal, 13 (16.5%) micro- and 33 (41.8%) macro-albuminuria patients aged 62.1 ± 10.6, 57.8 ± 11.9 and 65.6 ± 11.4 year-old, respectively. After adjusting age, sex and duration of diabetes, both albuminuric groups showed statistical significance of higher UACR (micro-: B = 103.66, SE = 40.24, p = 0.01, macro-: B = 1169, SE = 164.5, p < 0.0001) during the 3-year follow-up period. Macro-albuminuria group showed significantly higher level of HbA1c (B = 1.067, SE = 0.48, p = 0.027) and SBP (B = 11.89, SE = 4.25, p = 0.005) when compared to normal albuminuria group. Both normo- (B = −2.03/year, SE = 0.98, p = 0.038) and macro- (B = 200.76/year, SE = 86.31, p = 0.02) albuminuria groups showed significant annual UACR increment. Deterioration of renal function was found statistically significance in both normo- (B = −4.08/year, SE = 0.71, P < .0001) and macro- (B = 2.8/ year, SE = 0.87, P = 0.001) albuminuria groups by reducing annual eGFR without significant difference in their decreasing slope in all 3 groups. Finally, the rate of major adverse cardiac events (MACE) was similar in all 3 groups. Conclusions: Renin-angiotensin system blockers may protect DN patients from renal function exacerbation by reducing eGFR but not by preventing urinary protein loss in the abnormal albuminuria groups regardless of their degree of severity. PE-60 A study of increasing access to diabetic retinopathy screening and referral if indicated Yu-Ying CHANG1 *, Yen-Tzu LEE1, I-Chieh MAO1, Shih-Te TU1. 1 Lukang Christian Hospital, Taiwan Objective: The World Health Organization (WHO) statistics show that the possibility of suffering from blindness among diabetic patients is 10 to 20 times higher than that among people without diabetes. One researcher’s study also shows that the prevalence of diabetic retinopathy ranges from 15% to 45%. As such, a simplified ophthalmoscopy, ease of screening and referral will hopefully increase the access to diabetic retinopathy screening and referral if indicated, and more importantly, the knowledge of and prevention against diabetic eye disorders in diabetic patients. Method: Our Health Care Center has been equipped with ophthalmoscopy instruments for screening. Healthcare education and retinal photography may be performed at the same venue, improving the accessibility to screening in patients. The environmental features are designed to facilitate health promotion, and moreover, referral if indicated to our ophthalmologists is available for further follow-up and treatment.
S149
Result: Through this program, 3,278 patients successfully joined our hospital’s Diabetes Shared Care Network. During the period when the program was active (May 25, 2015 to October 23, 2015, for 5 months), 1,772 diabetic patients received screening. Compared with the same period in 2014, the number grew by 616 with a growth rate of 53.3%. Out of the 24 patients receiving ophthalmoscopy and indicated for referral, 14 were successfully referred to Ophthalmology, with a success rate of 58.3%. According to the analysis of the other 10 patients, 30% indicated that they did not feel ill while the 20% reported that they were under follow-up by Ophthalmology. Conclusion: Education on preventing diabetic eye complications and simple access may substantially improve the screening of diabetic eye disorders. The referral if indicated, however, is paramount. Over 40% of diabetic patients still refuse to be referred to Ophthalmology; the referral rate is only 58.3%. The reason for most cases is that patients do not have eye discomfort. The pre-program ophthalmoscopy focused on the number of screened patients (quantity) rather than further ophthalmology care for patients (quality). In the light of this program, it is hopeful that diabetic patients may be accessible to more comprehensive care for their eyes as a result of increased referral rate in screened patients if indicated, as well as widespread concept of early screening and early treatment among healthcare professionals and patients. PE-61 Correlation of glycemic control and arterial stiffness in patients with type 2 diabetes mellitus Jongky HENDRO PRAYITNO1 *, Soebagijo ADI1, Ari SOETJAHJO1, Askandar TJOKROPRAWIRO1, Agung PRANOTO1, Sony WIBISONO1, Sri MURTIWI1. 1Surabaya Diabetes and Nutrition Centre, Indonesia The PWV has been identified as an independent predictor for cardiovascular related mortality. The uncontroled T2DM induced hyperglycemic condition and caused depletion of endothelial nitric oxide (NO) which further leading to endothelial dysfunction. In this study we showed that poor glycemic control in patients with T2DM is associated with abnormal arterial stiffness. Methods: This is a cross sectional study. We recruited 50 patients with T2DM from out patient clinic. We excluded patient undergo Dialysis treatment, haemoglobin level <10 gr/ dL, and all of the sample were performed baseline data including the blood pressure, HbA1c levels and all patient were measured the arterial stiffness using ba-PWV. We evaluate the relationship of HbA1c levels and the result of ba-PWV test. Results: The mean of age was 58,98 ± 12,28 years, and the mean of HbA1c level: 7,69 ± 0,98%. The mean of PWV: 16,41 ± 2,43 m/ second. Test results showed the correlation between HbA1c level and PWV and shows strong and significant result (r = 0,403; P < 0,05). Conclusion: There was a significant correlation between Glycaemic control and arterial stiffnes in T2DM. PE-62 DESMOND…Does it deliver for Aboriginal and Torres Strait Islander people Deborah SCHOFIELD1, Asha SINGH1*, Helen MITCHELL1, Melissa ROBINSON1, Kylie MAHONY1. 1Diabetes WA, DESMOND Australia, Perth, Australia Background: Traditional methods of health promotion and education such as the distribution of materials and didactic program delivery has had limited success in reducing the burden of chronic diseases, especially in rural and remote Aboriginal communities. Evidence behind using a patient empowerment approach is mounting, with many
S150
Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65–S211
organisations adopting client-centred approaches that empower individuals to build confidence and take responsibility of their health. Despite high rates of type 2 diabetes and diabetes-related complications in Aboriginal communities, there is a lack of evidence based diabetes self-management programs designed for Aboriginal people. The DESMOND program is an evidencebased, quality diabetes self-management program where participants are supported to discover/share knowledge of their personal journey with diabetes. The Diabetes Education and Self-Management Ongoing and Newly Diagnosed (DESMOND) program is one example of this. DESMOND is a client-centred diabetes education program that uses innovative adult learning theories and philosophies to build confidence, skills and promote diabetes self-management. Diabetes WA is trialling the effectiveness of the program, and this approach, in Australian Aboriginal communities. Aim: This project aims to explore the cultural fit, effectiveness and sustainability of delivering DESMOND in Aboriginal communities. Method: Diabetes WA developed and strengthened partnerships with a number of health services across the state of Western Australia to enable DESMOND trained diabetes educators to deliver the program to Aboriginal communities in Perth and regional Western Australia. Following completion of the program, attendees were invited to share their experience of DESMOND, its cultural fit and what changes they would recommend to improve the program. Results: Qualitative data was collected and preliminary results show that Aboriginal participants felt respected by educators and open discussions, storytelling and hands-on activities were enjoyable. A number of minor adjustments have been made to the program, with the length of the program, access to biomedical results, and appropriateness of foods used presenting challenges. Evaluation measures are currently in place to assess participant’s HbA1c, cholesterol and blood pressure three to six months post program. Discussion: Adapting the DESMOND program to meet the needs of Aboriginal and Torres Strait Islander people has the potential to slow the progression of diabetes, impact biomedical results, and lead to a reduction in diabetes-related complications. Additionally the results of this trial will contribute to best practice evidence on effective, sustainable chronic disease education for Aboriginal communities. PE-63 A novel scoring system for the early detection of diabetic kidney disease in patients with type 2 diabetes Chih-Hung LIN1,2, Tzu-Ling TSENG3, Wei-Ya LIN3, Hsiang-Chi WANG3, Lee-Ming CHUANG1,2*. 1Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, 3Bio Preventive Medicine Corp., Hsinchu, Taiwan Background: Diabetic kidney disease (DKD) is one of the most common diabetic complications, as well as the leading cause of end-stage renal disease (ESRD) worldwide. At present, urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) are the standard diagnostic methods for DKD. However, their accuracies are limited due to the heterogeneous disease nature, especially in type 2 diabetes (T2DM). DN_Score is a scoring system generated from the profiles of DNlite, a urinary biomarker panel composed of alpha2-HS-glycoprotein precursor (AHSG), alpha-1-antitrypsin (A1AT) and acid-1-glycoprotein (AGP). In this cross-sectional study, we investigated the correlation between DN_Score and clinical profiles of patients with T2DM, in order to evaluate its potential for diagnosis of DKD. Methods: 308 patients with T2DM and UACR <300 mg/g were enrolled in this study. Phenotypic and biochemistry
profiles were recorded. DN_Score was calculated according to the urinary DNlite profile. UACR and the composite Kidney Disease Improving Global Outcomes (KDIGO) classification system were used for assessing the severity and risk of DKD. Results: There were 174 male and 134 female participants. The mean age was 60.64 ± 9.84 years. The mean DN_Score was 10.69 ± 0.9. The DN_Score in participants with UACR <30 and ≥30 mg/g was 10.42 ± 0.72 and 11.89 ± 0.63, respectively (P < 0.01). While classified by the KDIGO system, the DN_Score in participants with low, moderate-increased, high and veryhigh risk was 10.41 ± 0.72, 11.74 ± 0.7, 12.56 ± 0.29, 12.19 ± 0.03, respectively (P < 0.01). Intercorrelations of DN_Score were found with BMI, ACR, eGFR, blood pressure, fasting plasma glucose, HbA1c and plasma triglyceride level. After adjustment for significant covariates, DN_Score was significantly associated with UACR (P < 0.01) Conclusions: DN_Score is correlated significantly with the traditional indicators of DKD in the early stage of the disease. Long-term outcome study will be necessary to validate the predictive role of DN_Score on the progression of DKD. PE-64 The relationship between CVR-R and 2-year glycemic control in type 2 diabetic patients Kaoru ISO1 *, Keiichi MUKAI2, Yuuki KAKUMAE1, Koji ISHI1, Hiromi OHUCHI1. 1Tokyo Kamata Medical Center, 2Yokohama Shinmidori General Hospital, Japan Background: Diabetic autonomic neuropathy (DAN) is a manifestation of diabetic neuropathy. DAN is frequently observed in patients with a long duration of diabetes and causes various symptoms once it advanced. Autonomic nerve dysfunction can be expressed quantitatively by a coefficient of variation in R-R intervals (CVR-R). Objective: The aim of the study was assess the relationship between the autonomic nerve disturbance and glycemic control in type 2 diabetic patients. Material and Methods: Fifteen patients (male 7, female 8) with uncontrolled type 2 diabetes were enrolled. All patients firstly were received with intensive insulin therapy. HbA1c were measured every 2 month. ECGs were recorded in the resting position and 100 consecutive R-R intervals were processed computer. CVR-R were measured at baseline and 2year later. Results: At baseline, age, duration, BMI and HbA1c were 63.9 years old, 9.9 year, 24.2 kg/m2 and 10.3%. The mean HbA1c was significantly lower in 1-year’s (6.9%) and 2-year’s (6.9%) than the baseline’s. CVR-R was significantly higer in 2-year’s (3.00%) than the baseline’s (2.02%). Conclusion: These results suggest that long-term glycemic control may ameliorate diabetic autonomic neuropathy. PE-65 The effect of nutrition counseling on glycemic control and cognitive function in type 2 diabetic patients Chia-Hsin YU1, Po-Wen YANG2, Yu-Pei SUNG2, Cheng-Hsueh CHIEN1, Lin-Hui LI1, Huang-Yu CHANG1, Shyh-Hsiang LIN3 *. 1Department of Dietetics, Keelung Hospital, Ministry of Health and Welfare, 2Internal Medicine, Keelung Hospital, Ministry of Health and Welfare, 3School of Nutrition and Health Sciences, Taipei Medical University, Taiwan Objective: It’s known that blood glucose was associated with cognitive function in animal studies. In addition, poor glycemic control has emerged as a possible risk factor for cognitive decline among elderly adults with diabetes mellitus (DM). Medical nutrition therapy is important in managing DM. The aim of this study was to evaluate the effects of the