- Email: [email protected]
Effect of bariatric surgery on diabetic nephropathy in obese type 2 diabetes patients in a local retrospective 2 year study
S190
Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65–S211
modification of the Edmonton obesity staging system (EOSS) were analyzed. In addition to HbA1c and fasting plasma glucose (FPG), a 75 g oral glucose tolerance test was performed in all non-diabetic subjects. In patients with known or newly diagnosed diabetes, 10-year atherosclerotic cardiovascular disease risk was assessed using established tools (ASCVD, UKPDS-risk score, ARRIBA). Results: [mean ± SEM; female vs. male] Among the 143 (80 female/63 male) patients with known or newly diagnosed diabetes, age (50.3 ± 1.5 vs. 49.0 ± 1.8 years), BMI (48.2 ± 1.4 vs. 47.9 ± 1.6 kg/m2) and diabetes duration (7.4 ± 1.3 vs. 7.8 ± 1.3 years) were not different between men and women. In contrast, we detected pronounced gender differences in the prevalence of known diabetes (29.1 vs. 50.5%), rate of newly diagnosed diabetes cases (33 vs.14.5%) and HbA1c (7.18 ± 0.2 vs. 8.15 ± 0.3%; p = 0.01). Clinical atherosclerosis was 2.8 times more prevalent (10.4 vs. 28.8%) and estimated 10-year atherosclerotic cardiovascular disease risk was significantly higher (factor 5.9/3.1/2.7 – ARRIBA/ASCVD/UKPDS) in the male cohort. Conclusions: Systematic prebariatric screening discloses both higher than expected diabetes prevalence in men and higher than expected numbers of newly detected type 2 diabetes in women. The rampant notion of diabetic women having the same or even higher atherosclerotic cardiovascular disease risk as compared to diabetic men, is apparently inapplicable in the context of very high BMI. In fact, obese diabetic men have 2.5 times more clinical atherosclerosis and three to six times higher 10-year atherosclerotic cardiovascular disease risk, than women. Thus, in contrast to published perception, female preponderance among qualifyers for bariatric surgery may be a misallocation of resources and a waste of bariatric risk reduction potential. Taken together, key aspects of prebariatric screening strategies are diabetes in obese women and ASCVD in obese men. Abbreviations: ASCVD, atherosclerotic cardiovascular disease; ARRIBA, absolute and relative risk reduction in general practice. PI-27 Increased overall mortality and presenting more advanced TNM stage of well differentiated thyroid cancer patients with type 2 DM Sheng-Fong KUO1, Jen-Der LIN2 *, Chuen HSUEH3, Tzu-Chieh CHAO4. 1Division of Endocrinology and Metabolism, Departments of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Keelung, 2Division of Endocrinology and Metabolism, Departments of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, 3Departments of Pathology, Chang Gung Memorial Hospital, Chang Gung University, 4Departments of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan Obesity, type 2 diabetes mellitus (DM) had been known increased risk of certain cancers. Metformin treatment in these patients may have better outcome. The purpose of our study is to realize the characteristics of type 2 DM patients with well differentiated thyroid cancer patients. In addition, we had compared clinical features and therapeutic outcome of thyroid cancer with and without type 2 DM. A retrospective analysis of adult thyroid cancer patients with or without type 2 DM admitted between January 2001 and December 2010 was performed at an institution. A total of 1,687 well-differentiated thyroid cancer patients with different histological patterns were enrolled. Among these subjects, 260 were type 2 DM patients. Patients with thyroid cancer and type 2 DM were significantly older than non-DM patients. The mean follow-up period of these patient were 6.1 ± 6.1 years. Thyroid cancer in type 2 DM was showed larger tumor size, and more advanced TNM stage than non-DM group. In addition, disease-specific mortality was higher in the type 2 DM group (2.7% vs. 1.2%); but the difference was not
statistical difference. Overall mortality was higher in type 2 DM patients (6.2% vs. 1.5%, p = 0.001). Thyroid cancer patients with type 2 DM showed a higher percentage of secondary primary cancers than those without DM (8.5% vs. 3.0%). In conclusion, type 2 DM diagnosed as thyroid cancer need to be underwent more aggressive surgical procedure and postoperative other modalities treatment. PI-28 Effect of bariatric surgery on diabetic nephropathy in obese type 2 diabetes patients in a local retrospective 2 year study Anthony CHAO1 *, Chee Fang SUM1, Benjamin LAM2, Anton CHENG3, Serena LOW4, Su Chi LIM1. 1Diabetes Centre, Khoo Teck Puat Hospital, 2Family & Community Medicine, Khoo Teck Puat Hospital, 3General Surgery Dept, Khoo Teck Puat Hospital, 4 Clinical Research Unit, Khoo Teck Puat Hospital, Singapore Background: Numerous studies have examined the benefits and risks of Bariatric Surgery (BS) versus conventional therapy in the treatment of obese patients with type 2 diabetic mellitus (T2DM). BS has been shown to result in improvements in weight reduction, glycemic control, and even remission of diabetes. However, not many studies have looked at changes in microvascular complications after BS. Local data in this area is particularly lacking. Objective: To evaluate the effect of BS on Diabetic Nephropathy (DN) in obese T2DM subjects as measured by changes in urine albumin-to-creatinine ratio (uACR) or urine protein-to-creatinine ratio (uPCR). Subjects and methods: This was an observational retrospective cohort study. Data of 46 multi-ethnic obese T2DM subjects who were followed up for 2 years were retrieved from our hospital database of all BS done from January 2011 to December 2014 (n = 150). Glomerular filtration rate (eGFR) was computed using the modified MDRD formula and chronic kidney disease (CKD) stage was categorized based on KDIGO 2012 clinical practice guidelines. Conversion of uPCR to uACR was done by multiplying by 88.4: g/day = ×88.4 mg/ mmol. (KDIGO 2013). Results: Surgery performed included sleeve gastrectomy, Roux-en-Y gastric bypass and lap-band gastric bypass. Of the 46 subjects with T2DM, 23 had normal uACR and glomerular filtration rates (eGFR) >60 mL/min (1.73 m2) before the operation, including 1 who died. 1 patient with eGFR in CKD3a range had normal uACR before and after the operation. 8 had missing data ie no uACR results either before or after surgery. Only 14 T2DM patients had pre and post BS uACR data available for analysis. Of these 14 patients, 9 had GFR >60 mL/min (1.73 m2) before and after BS. 2 each had CKD stage 3a and stage 3b and 1 had CKD stage 4 before and after BS. In the 14 T2DM patients, the median uACR before and after BS was 10.4 mg/mmol (Interquartile range (IQR) 7.2–92.3) and 2.8 mg/mmol (IQR 0.9–22.9) ( p = 0.009). 12 out of the 14 subjects (85.7%) showed improvement of uACR after surgery. The remaining 2 showed worsening of uACR results, with one of them showing only insignificant increase (from 4.90 mg/mmol to 7.24 mg/mmol). Conclusions: Our data suggests that BS improves DN in obese T2DM subjects. Larger studies and randomized controlled trials, looking at local patients of different ethnic groups and for longer duration, are needed to confirm our data on renal profiles before and after BS. PI-29 Prevalence, clinical characteristics, and risk factors of sarcopenia in overweight patients with type 2 diabetes Kentaro YAMADA1*, Hitomi NAKAYAMA1, Munehisa TSURUTA1, Satomi KAKINO1, Seiko KAWANO1, Shinpei IWATA1, Mamiko KAWAHARA1, Yoshie OHTSUKA1, Yuji TAJIRI1. 1Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine, Japan
Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65–S211
modification of the Edmonton obesity staging system (EOSS) were analyzed. In addition to HbA1c and fasting plasma glucose (FPG), a 75 g oral glucose tolerance test was performed in all non-diabetic subjects. In patients with known or newly diagnosed diabetes, 10-year atherosclerotic cardiovascular disease risk was assessed using established tools (ASCVD, UKPDS-risk score, ARRIBA). Results: [mean ± SEM; female vs. male] Among the 143 (80 female/63 male) patients with known or newly diagnosed diabetes, age (50.3 ± 1.5 vs. 49.0 ± 1.8 years), BMI (48.2 ± 1.4 vs. 47.9 ± 1.6 kg/m2) and diabetes duration (7.4 ± 1.3 vs. 7.8 ± 1.3 years) were not different between men and women. In contrast, we detected pronounced gender differences in the prevalence of known diabetes (29.1 vs. 50.5%), rate of newly diagnosed diabetes cases (33 vs.14.5%) and HbA1c (7.18 ± 0.2 vs. 8.15 ± 0.3%; p = 0.01). Clinical atherosclerosis was 2.8 times more prevalent (10.4 vs. 28.8%) and estimated 10-year atherosclerotic cardiovascular disease risk was significantly higher (factor 5.9/3.1/2.7 – ARRIBA/ASCVD/UKPDS) in the male cohort. Conclusions: Systematic prebariatric screening discloses both higher than expected diabetes prevalence in men and higher than expected numbers of newly detected type 2 diabetes in women. The rampant notion of diabetic women having the same or even higher atherosclerotic cardiovascular disease risk as compared to diabetic men, is apparently inapplicable in the context of very high BMI. In fact, obese diabetic men have 2.5 times more clinical atherosclerosis and three to six times higher 10-year atherosclerotic cardiovascular disease risk, than women. Thus, in contrast to published perception, female preponderance among qualifyers for bariatric surgery may be a misallocation of resources and a waste of bariatric risk reduction potential. Taken together, key aspects of prebariatric screening strategies are diabetes in obese women and ASCVD in obese men. Abbreviations: ASCVD, atherosclerotic cardiovascular disease; ARRIBA, absolute and relative risk reduction in general practice. PI-27 Increased overall mortality and presenting more advanced TNM stage of well differentiated thyroid cancer patients with type 2 DM Sheng-Fong KUO1, Jen-Der LIN2 *, Chuen HSUEH3, Tzu-Chieh CHAO4. 1Division of Endocrinology and Metabolism, Departments of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Keelung, 2Division of Endocrinology and Metabolism, Departments of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, 3Departments of Pathology, Chang Gung Memorial Hospital, Chang Gung University, 4Departments of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan Obesity, type 2 diabetes mellitus (DM) had been known increased risk of certain cancers. Metformin treatment in these patients may have better outcome. The purpose of our study is to realize the characteristics of type 2 DM patients with well differentiated thyroid cancer patients. In addition, we had compared clinical features and therapeutic outcome of thyroid cancer with and without type 2 DM. A retrospective analysis of adult thyroid cancer patients with or without type 2 DM admitted between January 2001 and December 2010 was performed at an institution. A total of 1,687 well-differentiated thyroid cancer patients with different histological patterns were enrolled. Among these subjects, 260 were type 2 DM patients. Patients with thyroid cancer and type 2 DM were significantly older than non-DM patients. The mean follow-up period of these patient were 6.1 ± 6.1 years. Thyroid cancer in type 2 DM was showed larger tumor size, and more advanced TNM stage than non-DM group. In addition, disease-specific mortality was higher in the type 2 DM group (2.7% vs. 1.2%); but the difference was not
statistical difference. Overall mortality was higher in type 2 DM patients (6.2% vs. 1.5%, p = 0.001). Thyroid cancer patients with type 2 DM showed a higher percentage of secondary primary cancers than those without DM (8.5% vs. 3.0%). In conclusion, type 2 DM diagnosed as thyroid cancer need to be underwent more aggressive surgical procedure and postoperative other modalities treatment. PI-28 Effect of bariatric surgery on diabetic nephropathy in obese type 2 diabetes patients in a local retrospective 2 year study Anthony CHAO1 *, Chee Fang SUM1, Benjamin LAM2, Anton CHENG3, Serena LOW4, Su Chi LIM1. 1Diabetes Centre, Khoo Teck Puat Hospital, 2Family & Community Medicine, Khoo Teck Puat Hospital, 3General Surgery Dept, Khoo Teck Puat Hospital, 4 Clinical Research Unit, Khoo Teck Puat Hospital, Singapore Background: Numerous studies have examined the benefits and risks of Bariatric Surgery (BS) versus conventional therapy in the treatment of obese patients with type 2 diabetic mellitus (T2DM). BS has been shown to result in improvements in weight reduction, glycemic control, and even remission of diabetes. However, not many studies have looked at changes in microvascular complications after BS. Local data in this area is particularly lacking. Objective: To evaluate the effect of BS on Diabetic Nephropathy (DN) in obese T2DM subjects as measured by changes in urine albumin-to-creatinine ratio (uACR) or urine protein-to-creatinine ratio (uPCR). Subjects and methods: This was an observational retrospective cohort study. Data of 46 multi-ethnic obese T2DM subjects who were followed up for 2 years were retrieved from our hospital database of all BS done from January 2011 to December 2014 (n = 150). Glomerular filtration rate (eGFR) was computed using the modified MDRD formula and chronic kidney disease (CKD) stage was categorized based on KDIGO 2012 clinical practice guidelines. Conversion of uPCR to uACR was done by multiplying by 88.4: g/day = ×88.4 mg/ mmol. (KDIGO 2013). Results: Surgery performed included sleeve gastrectomy, Roux-en-Y gastric bypass and lap-band gastric bypass. Of the 46 subjects with T2DM, 23 had normal uACR and glomerular filtration rates (eGFR) >60 mL/min (1.73 m2) before the operation, including 1 who died. 1 patient with eGFR in CKD3a range had normal uACR before and after the operation. 8 had missing data ie no uACR results either before or after surgery. Only 14 T2DM patients had pre and post BS uACR data available for analysis. Of these 14 patients, 9 had GFR >60 mL/min (1.73 m2) before and after BS. 2 each had CKD stage 3a and stage 3b and 1 had CKD stage 4 before and after BS. In the 14 T2DM patients, the median uACR before and after BS was 10.4 mg/mmol (Interquartile range (IQR) 7.2–92.3) and 2.8 mg/mmol (IQR 0.9–22.9) ( p = 0.009). 12 out of the 14 subjects (85.7%) showed improvement of uACR after surgery. The remaining 2 showed worsening of uACR results, with one of them showing only insignificant increase (from 4.90 mg/mmol to 7.24 mg/mmol). Conclusions: Our data suggests that BS improves DN in obese T2DM subjects. Larger studies and randomized controlled trials, looking at local patients of different ethnic groups and for longer duration, are needed to confirm our data on renal profiles before and after BS. PI-29 Prevalence, clinical characteristics, and risk factors of sarcopenia in overweight patients with type 2 diabetes Kentaro YAMADA1*, Hitomi NAKAYAMA1, Munehisa TSURUTA1, Satomi KAKINO1, Seiko KAWANO1, Shinpei IWATA1, Mamiko KAWAHARA1, Yoshie OHTSUKA1, Yuji TAJIRI1. 1Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine, Japan