- Email: [email protected]
Effects of resistance exercise in the deteriorations of cardiac contractility and mitochondrial uncoupling in cardiac muscle of diabetic animal model
Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65–S211
amputation, and death. COC and medical expense and organization of care were counted as independent variables. Result: Re-amputation rate is 23.26%, 1/3 amputated diabetes have been received ≧3 times amputation. The highest risk of amputation and re-amputation is high COC, which are 1.26 times ( p < 0.001) and 1.62 times (p < 0.001). Amputated diabetes patient had 3 times (p < 0.001) risk of specific diabetes associated death. Different medical organization type was not related to the risk of amputation. Low COC was related to poorer vascular and neurological outcome. Conclusion: We believed that diabetic foot care was a missing circle of the chain of multidiscipline diabetes care chain. PC-08 A patient centred care service model for enhancing Diabetes Mellitus management in primary care Jun LIANG1 *, M.L. CHAN1, C.W. LO1. 1Department of Family Medicine and Primary Health Care, New Territories West Cluster, Hospital Authority, Hong Kong Background: Diabetes Mellitus is an important disease managed in primary care setting. We have more than 40,000 DM patients with regular follow-up and management at 8 General Out-patient Clinics (GOPCs). This review aimed at assessment of the impact of this service model. Aims: 1/ To review the clinical outcome of the service model, in term of key performance indexes [KPI] such as HbA1c,BP and LDL level Methodology: Since March 2011, our clinics has implemented this structured integrated service model to enhance the quality care of DM patients, via structural and protocoldriven approved, provided by multidisciplinary professionals. The patients would be stratified into various risk categories for management by their usual doctors, nursing specialists, allied health professionals or experienced family physician for advance medical support such as insulin initiation and titration. Ongoing quality data in term of various KPIs were retrieved for clinic peer review for service enhancement and patient care management. Results: The KPIs after the implementation were promising with currently 50% of patient HbA1c < 7%, 50% of patient BP < 130/80 mmHg & 65% of patient LDL < 2.6 mmol/L. Conclusion: This service model is well-accepted by the patients with more than 85,000 attendances and over 90% of diabetic patients have benefited from this over 5 years. With the structural model provided by the primary care team and regular KPIs review, the patients’ chronic disease care improved and sustained, comparable to many international standard. PC-09 Effects of resistance exercise in the deteriorations of cardiac contractility and mitochondrial uncoupling in cardiac muscle of diabetic animal model Tae Hee KO1, Hyoung Kyu KIM1, Tae Nyun KIM2, Byoung Doo RHEE3, Kyung Soo KO3, Nari KIM1, Jong Chul WON3 *, Jin HAN1. 1Department of Physiology, College of Medicine, Cardiovascular and Metabolic Disease Center, Inje University, Busan, 2Department of Internal Medicine, Haeundae Paik Hospital, Cardiovascular and Metabolic Disease Center, College of Medicine, Inje University, 3Department of Internal Medicine, Sanggye Paik Hospital, Cardiovascular and Metabolic Disease Center, College of Medicine, Inje University, Seoul, Korea Background: Cardiomyopathy (CMP) in patients with type 2 diabetes is an important complication of long-standing hyperglycemia and known to be caused by characterized by diabetes-induced metabolic and mitochondrial disturbance. Resistance exercise (RE) has been recommended for measures of life-style modification in patients with type 2 diabetes. To date, the beneficial effects of RE in prevention of diabetic CMP
S89
and mitochondrial dysfunction of cardiomyocyte are uncertain. The aim of this study was to determine the effects of RE in the cardiac contractility and mitochondrial dysfunction in diabetic animal model. Design and methods: Fourteen Otsuka Long Evans Tokushima Fatty (OLETF) rats were assigned to sedentary control (SC, n = 7) and resistance exercise (RE, n = 7) groups at 26 weeks of age. Long-Evans Tokushima Otsuka (LETO, n = 7) rats were used as non-diabetic control. RE rats were trained by climbing a ladder 5 days per week. Body weight, lipid profiles, and IPGTT were evaluated at the time of 12 weeks exercise. In addition, cardiac function and mitochondrial structure of cardiomyocyte were assessed by echocardiography and electron microscopy. Mitochondrial respiration and ROS production were measured. Results: Weight gain and metabolic alterations characteristic of OLETF rats (SC) compared to LETO were reduced in RE rats despite to similar food consumption after 12 weeks of exercise. Reductions of ejection fraction and fractional shortening in SC were significantly reversed by RE. Collapsed sarcomeres and decreased number of mitochondria in SC were not observed in RE rats. In addition, decreased expression of the peroxisome proliferator-activated receptor gamma coactivator 1α (PGC-1α) and mitochondrial transcription factor A (TFAM) in SC were attenuated in RE. Higher proton leak in cardiomyocytes of SC represented by different mitochondrial oxygen consumption rate between oligomycin and antimycin A was attenuated in those of RE rats. Finally, increased production of ROS with lower mitochondrial membrane potentials were revered in SC with higher expression of mitochondrial superoxide dismutase 2 (SOD2). Conclusion: These data suggested that RE is effective in the prevention of diabetic CMP in relation to attenuation of metabolic disturbances and mitochondrial dysfunction, which may contribute to decreased contractility of diabetic heart in animal models. PC-11 The relationships between fasting plasma glucose and insulin resistance, first-, second-phase insulin secretion and glucose effectiveness in adolescents Te-Lin HSIA1 *, Dee PEI1, Chung-Ze WU2, Jun-Dian LIN3, Yang-Lin CHEN1. 1Cardinal Tien Hospital, 2Shung Ho Hospital, 3TriService General Hospital, Taiwan It is generally agreed that there are four factors which contribute to the occurrence of type 2 diabetes, namely, increased insulin resistance (IR), decreased glucose effectiveness (GE), first and second phase insulin secretion (FPIS, SPIS, respectively). Although these factors are studied. However, most of the literatures are non-Asian and with limited numbers of subjects. In the same time, there are no reports for adolescents. In this report, we investigated the relationships between fasting plasma glucose (FPG) and these four factors in a 18-year-old cohort. We enrolled 507 subjects; 18-year-old adolescents. The IR, GE, FPIS and SPIS were calculated by the equations we published. In short, by using age, body mass index (BMI) and metabolic components, these for factors could be estimated. The correlation between FPG and the four factors. Results: BMI was 20.11 ± 1.43 kg/m2, systolic and diastolic blood pressure was 116.46 ± 12.54 and 65.00 ± 8.97 mmHg, FPG was 93.13 ± 6.50 mg/dL, triglyceride was 70.98 ± 27.30 mg/dL and HDL-cholesterol was 51.8 ± 10.7 mg/dL. The IR was 3.67 ± 0.014 mmol/L, FPIS was 61.48 ± 26.30 μU/min, SPIS was 0.0402 ± 0.0095 pmol/mmol and GE was 0.0221 ± 0.0009 min−1. The correlation between FPG, IR, FPIS, SPIS and GE are 0.031, −0.132, −0.217 and −0.331 respectively. Other than the FPG and IR, all other correlations are statistically significant ( p < 0.001). Conclusion: In this 18-year-old adolescent cohort, elevation of FPG is mainly due to the decrease in the FPIS, SPIS and GE.
amputation, and death. COC and medical expense and organization of care were counted as independent variables. Result: Re-amputation rate is 23.26%, 1/3 amputated diabetes have been received ≧3 times amputation. The highest risk of amputation and re-amputation is high COC, which are 1.26 times ( p < 0.001) and 1.62 times (p < 0.001). Amputated diabetes patient had 3 times (p < 0.001) risk of specific diabetes associated death. Different medical organization type was not related to the risk of amputation. Low COC was related to poorer vascular and neurological outcome. Conclusion: We believed that diabetic foot care was a missing circle of the chain of multidiscipline diabetes care chain. PC-08 A patient centred care service model for enhancing Diabetes Mellitus management in primary care Jun LIANG1 *, M.L. CHAN1, C.W. LO1. 1Department of Family Medicine and Primary Health Care, New Territories West Cluster, Hospital Authority, Hong Kong Background: Diabetes Mellitus is an important disease managed in primary care setting. We have more than 40,000 DM patients with regular follow-up and management at 8 General Out-patient Clinics (GOPCs). This review aimed at assessment of the impact of this service model. Aims: 1/ To review the clinical outcome of the service model, in term of key performance indexes [KPI] such as HbA1c,BP and LDL level Methodology: Since March 2011, our clinics has implemented this structured integrated service model to enhance the quality care of DM patients, via structural and protocoldriven approved, provided by multidisciplinary professionals. The patients would be stratified into various risk categories for management by their usual doctors, nursing specialists, allied health professionals or experienced family physician for advance medical support such as insulin initiation and titration. Ongoing quality data in term of various KPIs were retrieved for clinic peer review for service enhancement and patient care management. Results: The KPIs after the implementation were promising with currently 50% of patient HbA1c < 7%, 50% of patient BP < 130/80 mmHg & 65% of patient LDL < 2.6 mmol/L. Conclusion: This service model is well-accepted by the patients with more than 85,000 attendances and over 90% of diabetic patients have benefited from this over 5 years. With the structural model provided by the primary care team and regular KPIs review, the patients’ chronic disease care improved and sustained, comparable to many international standard. PC-09 Effects of resistance exercise in the deteriorations of cardiac contractility and mitochondrial uncoupling in cardiac muscle of diabetic animal model Tae Hee KO1, Hyoung Kyu KIM1, Tae Nyun KIM2, Byoung Doo RHEE3, Kyung Soo KO3, Nari KIM1, Jong Chul WON3 *, Jin HAN1. 1Department of Physiology, College of Medicine, Cardiovascular and Metabolic Disease Center, Inje University, Busan, 2Department of Internal Medicine, Haeundae Paik Hospital, Cardiovascular and Metabolic Disease Center, College of Medicine, Inje University, 3Department of Internal Medicine, Sanggye Paik Hospital, Cardiovascular and Metabolic Disease Center, College of Medicine, Inje University, Seoul, Korea Background: Cardiomyopathy (CMP) in patients with type 2 diabetes is an important complication of long-standing hyperglycemia and known to be caused by characterized by diabetes-induced metabolic and mitochondrial disturbance. Resistance exercise (RE) has been recommended for measures of life-style modification in patients with type 2 diabetes. To date, the beneficial effects of RE in prevention of diabetic CMP
S89
and mitochondrial dysfunction of cardiomyocyte are uncertain. The aim of this study was to determine the effects of RE in the cardiac contractility and mitochondrial dysfunction in diabetic animal model. Design and methods: Fourteen Otsuka Long Evans Tokushima Fatty (OLETF) rats were assigned to sedentary control (SC, n = 7) and resistance exercise (RE, n = 7) groups at 26 weeks of age. Long-Evans Tokushima Otsuka (LETO, n = 7) rats were used as non-diabetic control. RE rats were trained by climbing a ladder 5 days per week. Body weight, lipid profiles, and IPGTT were evaluated at the time of 12 weeks exercise. In addition, cardiac function and mitochondrial structure of cardiomyocyte were assessed by echocardiography and electron microscopy. Mitochondrial respiration and ROS production were measured. Results: Weight gain and metabolic alterations characteristic of OLETF rats (SC) compared to LETO were reduced in RE rats despite to similar food consumption after 12 weeks of exercise. Reductions of ejection fraction and fractional shortening in SC were significantly reversed by RE. Collapsed sarcomeres and decreased number of mitochondria in SC were not observed in RE rats. In addition, decreased expression of the peroxisome proliferator-activated receptor gamma coactivator 1α (PGC-1α) and mitochondrial transcription factor A (TFAM) in SC were attenuated in RE. Higher proton leak in cardiomyocytes of SC represented by different mitochondrial oxygen consumption rate between oligomycin and antimycin A was attenuated in those of RE rats. Finally, increased production of ROS with lower mitochondrial membrane potentials were revered in SC with higher expression of mitochondrial superoxide dismutase 2 (SOD2). Conclusion: These data suggested that RE is effective in the prevention of diabetic CMP in relation to attenuation of metabolic disturbances and mitochondrial dysfunction, which may contribute to decreased contractility of diabetic heart in animal models. PC-11 The relationships between fasting plasma glucose and insulin resistance, first-, second-phase insulin secretion and glucose effectiveness in adolescents Te-Lin HSIA1 *, Dee PEI1, Chung-Ze WU2, Jun-Dian LIN3, Yang-Lin CHEN1. 1Cardinal Tien Hospital, 2Shung Ho Hospital, 3TriService General Hospital, Taiwan It is generally agreed that there are four factors which contribute to the occurrence of type 2 diabetes, namely, increased insulin resistance (IR), decreased glucose effectiveness (GE), first and second phase insulin secretion (FPIS, SPIS, respectively). Although these factors are studied. However, most of the literatures are non-Asian and with limited numbers of subjects. In the same time, there are no reports for adolescents. In this report, we investigated the relationships between fasting plasma glucose (FPG) and these four factors in a 18-year-old cohort. We enrolled 507 subjects; 18-year-old adolescents. The IR, GE, FPIS and SPIS were calculated by the equations we published. In short, by using age, body mass index (BMI) and metabolic components, these for factors could be estimated. The correlation between FPG and the four factors. Results: BMI was 20.11 ± 1.43 kg/m2, systolic and diastolic blood pressure was 116.46 ± 12.54 and 65.00 ± 8.97 mmHg, FPG was 93.13 ± 6.50 mg/dL, triglyceride was 70.98 ± 27.30 mg/dL and HDL-cholesterol was 51.8 ± 10.7 mg/dL. The IR was 3.67 ± 0.014 mmol/L, FPIS was 61.48 ± 26.30 μU/min, SPIS was 0.0402 ± 0.0095 pmol/mmol and GE was 0.0221 ± 0.0009 min−1. The correlation between FPG, IR, FPIS, SPIS and GE are 0.031, −0.132, −0.217 and −0.331 respectively. Other than the FPG and IR, all other correlations are statistically significant ( p < 0.001). Conclusion: In this 18-year-old adolescent cohort, elevation of FPG is mainly due to the decrease in the FPIS, SPIS and GE.