- Email: [email protected]
Pancreatic reserve and early evolution in type 1 diabetes mellitus
Track 2. Clinical Research & Care R= -0.26). In a multivariate analysis BMI, duration, age, HbAi¢ and therapy with sulphonylureas could only explain 17% of ppCp variation. Sixteen patients with low ppCp (<0.6 nmol/1) were identified, indicating a need for more intensified insulin therapy, but in the majority of our patients ppCp was not clinically useful in choosing treatment. Based on these data routine analysis of postprandial C-peptide in patients with type 2 diabetes cannot be recommended.
P278 The Diabcare-Asia, Bangladesh Project: Management of Diabetes in Bangladesh H. MAHTAB, M.G. Kibriya. DiabCare-Asia Bangladesh Project; Research Division, BIRDEM, Diabetic Association of Bangladesh. The Diabcare-Asia Project is a large-scale multinational study including 12 Asian countries. The study aims to provide an overview of diabetes management and late complication status in Asia. This paper presents an overview on diabetes care in Bangladesh. Total 1503 Type-2 diabetic patients (m=901, f=602) were randomly selected from our out-patient department. The mean (4-SD) age was 50.954-10.32 yr., duration of diabetes was 6.784-5.38 yr. Overall mean body mass index (BMI) was 24.294-3.27 kg/m2 and the majority (62.3%) had BMI <25 kg/m2. BMI>25 was more frequently encountered among the female compared to male (50.7% vs. 28.8%, p<0.001). Hypertension (BP>=140/90 mm Hg or on antihypertensive medication) was found in 35.8% cases and Isolated Systolic Hypertension (ISH) was found in 13.4% cases. Overall hypertension was more frequently encountered among female (54.5% vs. 47.4%, p=0.003). Glycaemic control assessed by HbAlc (n=1373) and fasting blood glucose (FBG) (n=1364) was unsatisfactory. Mean HbAlc was 7.94-1.85%; 36.7% of patients had HbAlc =<7%, 24.4% had HbAlc 7-8% and the rest 38.9% had HbAlc >8%. Mean FBG was 9.074-3.3 mmol/l; only 15.0% patients had FBG =<6.1 mmol/1, 27.9% had FBG 6.1-7.8mmol/1 and rest 57.1% had FBG >7.8 mmol/l. Mean total cholesterol (CHOL) (n=1176) and triglycerides (TG) (n=852) was 195.424-39.67 mg% and 204.74-116.22 mg% respectively. Hypercholesterolaemia (CHOL>200 mg%) was found in 43.4% cases and hypertriglycerideaemia (TG> 150 mg%) in 63.4% cases. Proportion of patients on diet control alone, oral hypoglycaemic agent (OHA), insulin and combination of insulin & OHA was 19.5%, 58.7%, 14.6% and 7.2% respectively. The data suggest the need of improvement of diabetic care delivery in Bangladesh.
P279 Application of the Staged Diabetes Management (SDM) in Diabetic Subjects at Taiwan - A Prospective One-Year Follow-Up Study S.J. LIU, Wayne H.H. Sheu, S.Y. Lin, M.Y. Hsu. Diabetic Center, Taichung Veterans General Hospital Taichung, Taiwan, Province of China Recent introduction of disease state management system for diabetes, called staged diabetes management (SDM) has been implemented worldwide. However, its long-term application and adherence in Asian diabetic subjects remains unjustified. A total of 115 Chinese type 2 diabetic individuals (mean4-SD) (mean age 644-10 years, mean BMI 25.74-3.6 kg/m2) were subjected to SDM program for 6-9 months and 79 of diabetic individuals served as control at same period. Administration of SDM reduced levels of fasting plasma glucose (2104-68 vs 1814-37 mg/dl, p<0.001) and HbAlc (7.94-1.8 vs 7.54-1.4%, p<0.04) but not the values of BMI. There was no alteration of glycemic control in subjects with non-SDM group. One year later, 108 subjects (94%) in SDM group and 75 subjects (95%) in non-SDM group were evaluated again. Subjects in SDM group showed further reduction of fasting plasma glucose (2104-68 vs 173-1-36 mg/dl, p<0.001) but no change in HbAlc levels (7.94-1.8 vs 7.74-1.3, p=NS) as compared with those of baseline values. Type 2 diabetic subjects who were assigned to SDM group showed similar beneficial
$55
effect independent of gender, age (above or less than 60) or BMI value (above or less than 27 kgs/m2). Diabetic individuals whose HbAlc above 8% at baseline had constant reduction of HbA lc level one year later. There was also no alteration of glycemic control in subjects with non-SDM group. In conclusion, SDM program was effective in reducing fasting plasma glucose levels both short term and one year after administration of SDM. Only diabetic subjects with poor glycemic control showed constant reduction of HbA 1c level one year later. It is suggested that SDM program is applicable in Chinese type 2 diabetic subjects at Taiwan.
P280 Pancreatic Reserve and Early Evolution in Type 1 Diabetes Mellitus C. LAMAS, J. Alfaro, N. Ga-Valcfircel, T. Motilla, P. Martinez, P. Manzano, A. Simal, E Botella. Diabetes and Nutrition Unit, Puerta de Hierro Hospital, Madrid, Spain Introduction: The pancreatic reserve test is a useful tool for the evaluation of the residual beta cell function, for the classification of diabetic patients and for the decision of starting insulin therapy in patients with type 2 diabetes mellitus. Some studies have shown a correlation between the results of this test and the presence of autoantibodies, the insulin requirements during the first months after diagnosis and the probability of a period of remission of the disease. Patients and methods: 49 patients with diabetes mellitus type 1, classified by clinical criteria and pancreatic reserve test, were evaluated at diagnosis with determination of the C-peptide at baseline and six minutes after a stimulus with 1 mg of I.V. glucagon, anti-islet cell (ICA), antiGAD and antithyroid antibodies. Daily dose of insulin per kg of body weight, glycosilated hemoglobine (HbA Ic) and spontaneous remission rate were evaluated one year after diagnosis. Results: C-peptide was 0.87-t-0.63 ng/ml at baseline and 1.464-1.06 ng/ml after glucagon. ICAs, antiGAD and antithyroid antibodies were positive in 53.1%, 13 out of 15 and 5 out of 43 patients, respectively. Mean insulin requirements one year alter diagnosis were 0.64-0.3 U/kg/d. Mean HbAlc was 7.064-1.27% (normal values 4.3-6.3%). Three was not significant correlation between pancreatic reserve at diagnosis (C-peptide at baseline and after glucagon) and insulin requirements or metabolic control one year after. Fourteen patients presented a partial remission and 6 a complete remission. We did not find significant differences in the pancreatic reserve or the autoinmunity between this group and the others patients. Conclusions: The pancreatic reserve test is useful in the diagnosis of type 1 diabetes mellitus, but it does not correlate with the early evolution of the disease in our patients. We could not find any predictor parameter of spontaneous remission.
P281 Compliance with, and Understanding of, Mealtime Advice in Patients with Type 2 Diabetes KIRSTINE BROWN FRANDSEN, J~rgen Smedegaard Kristensen. Novo Nordisk, Copenhagen, Denmark Outcome in Type 2 diabetes is improved when strict targets of glycaemic control are met with intensive treatment. However, regimens including sulphonylureas or insulin demand careful attention to carbohydrate intake. Poor compliance to regular mealtimes increases the risk of major hypoglycaemia, and the fear of repeated hypoglycaemia may jeopardize compliance to antidiabetic treatment. In this study, 123 patients with Type 2 diabetes, currently taking oral hypoglycaemic agents (> 60% receiving sulphonylureas) were surveyed to assess their understanding of/compliance with advice on mealtimes and carbohydrate intake. Groups of 8-10 patients in the USA, UK, Germany, France and Spain completed questionnaires and participated in informal, investigator-led group discussions. Most patients had received dietary advice, but many felt inadequately informed about their diabetes and drug treatment. Dietary advice was often vague, but universally recognised directives included the
P278 The Diabcare-Asia, Bangladesh Project: Management of Diabetes in Bangladesh H. MAHTAB, M.G. Kibriya. DiabCare-Asia Bangladesh Project; Research Division, BIRDEM, Diabetic Association of Bangladesh. The Diabcare-Asia Project is a large-scale multinational study including 12 Asian countries. The study aims to provide an overview of diabetes management and late complication status in Asia. This paper presents an overview on diabetes care in Bangladesh. Total 1503 Type-2 diabetic patients (m=901, f=602) were randomly selected from our out-patient department. The mean (4-SD) age was 50.954-10.32 yr., duration of diabetes was 6.784-5.38 yr. Overall mean body mass index (BMI) was 24.294-3.27 kg/m2 and the majority (62.3%) had BMI <25 kg/m2. BMI>25 was more frequently encountered among the female compared to male (50.7% vs. 28.8%, p<0.001). Hypertension (BP>=140/90 mm Hg or on antihypertensive medication) was found in 35.8% cases and Isolated Systolic Hypertension (ISH) was found in 13.4% cases. Overall hypertension was more frequently encountered among female (54.5% vs. 47.4%, p=0.003). Glycaemic control assessed by HbAlc (n=1373) and fasting blood glucose (FBG) (n=1364) was unsatisfactory. Mean HbAlc was 7.94-1.85%; 36.7% of patients had HbAlc =<7%, 24.4% had HbAlc 7-8% and the rest 38.9% had HbAlc >8%. Mean FBG was 9.074-3.3 mmol/l; only 15.0% patients had FBG =<6.1 mmol/1, 27.9% had FBG 6.1-7.8mmol/1 and rest 57.1% had FBG >7.8 mmol/l. Mean total cholesterol (CHOL) (n=1176) and triglycerides (TG) (n=852) was 195.424-39.67 mg% and 204.74-116.22 mg% respectively. Hypercholesterolaemia (CHOL>200 mg%) was found in 43.4% cases and hypertriglycerideaemia (TG> 150 mg%) in 63.4% cases. Proportion of patients on diet control alone, oral hypoglycaemic agent (OHA), insulin and combination of insulin & OHA was 19.5%, 58.7%, 14.6% and 7.2% respectively. The data suggest the need of improvement of diabetic care delivery in Bangladesh.
P279 Application of the Staged Diabetes Management (SDM) in Diabetic Subjects at Taiwan - A Prospective One-Year Follow-Up Study S.J. LIU, Wayne H.H. Sheu, S.Y. Lin, M.Y. Hsu. Diabetic Center, Taichung Veterans General Hospital Taichung, Taiwan, Province of China Recent introduction of disease state management system for diabetes, called staged diabetes management (SDM) has been implemented worldwide. However, its long-term application and adherence in Asian diabetic subjects remains unjustified. A total of 115 Chinese type 2 diabetic individuals (mean4-SD) (mean age 644-10 years, mean BMI 25.74-3.6 kg/m2) were subjected to SDM program for 6-9 months and 79 of diabetic individuals served as control at same period. Administration of SDM reduced levels of fasting plasma glucose (2104-68 vs 1814-37 mg/dl, p<0.001) and HbAlc (7.94-1.8 vs 7.54-1.4%, p<0.04) but not the values of BMI. There was no alteration of glycemic control in subjects with non-SDM group. One year later, 108 subjects (94%) in SDM group and 75 subjects (95%) in non-SDM group were evaluated again. Subjects in SDM group showed further reduction of fasting plasma glucose (2104-68 vs 173-1-36 mg/dl, p<0.001) but no change in HbAlc levels (7.94-1.8 vs 7.74-1.3, p=NS) as compared with those of baseline values. Type 2 diabetic subjects who were assigned to SDM group showed similar beneficial
$55
effect independent of gender, age (above or less than 60) or BMI value (above or less than 27 kgs/m2). Diabetic individuals whose HbAlc above 8% at baseline had constant reduction of HbA lc level one year later. There was also no alteration of glycemic control in subjects with non-SDM group. In conclusion, SDM program was effective in reducing fasting plasma glucose levels both short term and one year after administration of SDM. Only diabetic subjects with poor glycemic control showed constant reduction of HbA 1c level one year later. It is suggested that SDM program is applicable in Chinese type 2 diabetic subjects at Taiwan.
P280 Pancreatic Reserve and Early Evolution in Type 1 Diabetes Mellitus C. LAMAS, J. Alfaro, N. Ga-Valcfircel, T. Motilla, P. Martinez, P. Manzano, A. Simal, E Botella. Diabetes and Nutrition Unit, Puerta de Hierro Hospital, Madrid, Spain Introduction: The pancreatic reserve test is a useful tool for the evaluation of the residual beta cell function, for the classification of diabetic patients and for the decision of starting insulin therapy in patients with type 2 diabetes mellitus. Some studies have shown a correlation between the results of this test and the presence of autoantibodies, the insulin requirements during the first months after diagnosis and the probability of a period of remission of the disease. Patients and methods: 49 patients with diabetes mellitus type 1, classified by clinical criteria and pancreatic reserve test, were evaluated at diagnosis with determination of the C-peptide at baseline and six minutes after a stimulus with 1 mg of I.V. glucagon, anti-islet cell (ICA), antiGAD and antithyroid antibodies. Daily dose of insulin per kg of body weight, glycosilated hemoglobine (HbA Ic) and spontaneous remission rate were evaluated one year after diagnosis. Results: C-peptide was 0.87-t-0.63 ng/ml at baseline and 1.464-1.06 ng/ml after glucagon. ICAs, antiGAD and antithyroid antibodies were positive in 53.1%, 13 out of 15 and 5 out of 43 patients, respectively. Mean insulin requirements one year alter diagnosis were 0.64-0.3 U/kg/d. Mean HbAlc was 7.064-1.27% (normal values 4.3-6.3%). Three was not significant correlation between pancreatic reserve at diagnosis (C-peptide at baseline and after glucagon) and insulin requirements or metabolic control one year after. Fourteen patients presented a partial remission and 6 a complete remission. We did not find significant differences in the pancreatic reserve or the autoinmunity between this group and the others patients. Conclusions: The pancreatic reserve test is useful in the diagnosis of type 1 diabetes mellitus, but it does not correlate with the early evolution of the disease in our patients. We could not find any predictor parameter of spontaneous remission.
P281 Compliance with, and Understanding of, Mealtime Advice in Patients with Type 2 Diabetes KIRSTINE BROWN FRANDSEN, J~rgen Smedegaard Kristensen. Novo Nordisk, Copenhagen, Denmark Outcome in Type 2 diabetes is improved when strict targets of glycaemic control are met with intensive treatment. However, regimens including sulphonylureas or insulin demand careful attention to carbohydrate intake. Poor compliance to regular mealtimes increases the risk of major hypoglycaemia, and the fear of repeated hypoglycaemia may jeopardize compliance to antidiabetic treatment. In this study, 123 patients with Type 2 diabetes, currently taking oral hypoglycaemic agents (> 60% receiving sulphonylureas) were surveyed to assess their understanding of/compliance with advice on mealtimes and carbohydrate intake. Groups of 8-10 patients in the USA, UK, Germany, France and Spain completed questionnaires and participated in informal, investigator-led group discussions. Most patients had received dietary advice, but many felt inadequately informed about their diabetes and drug treatment. Dietary advice was often vague, but universally recognised directives included the