- Email: [email protected]
SUN-LB284: Evaluation of Carbohydrate Restriction as Primary Treatment for Post-Gastric Bypass Hypoglycemia
S150 using receiver operating characteristic (ROC) curve analyses. Kaplan-Meier analysis and the log-rank test were used for comparison of OS postoperative outcomes. Results: Multivariate analysis revealed that CAR (>0.029/ <0.029) was significantly associated with OS (hazard ratio [HR], 2.741; 95% CI, 1.105–6.967; p = 0.029), as well as age (>78/≤78 years) (HR, 6.993; 95% CI, 1.456–56.36; p = 0.012), body mass index (≤20.0/>20.0 kg/m2) (HR, 2.713; 95% CI, 1.294–5.773; p = 0.008), and stage (III–IV/0–II) (HR, 4.577; 95% CI, 1.792–12.64; p = 0.001). A significant difference in OS was observed between patients with low CAR (≤0.029; average, 2,117 days; range, 78–3,316, days) and patients with high CAR (>0.029; average, 1,460 days; range, 11–3,432 days) ( p < 0.001). The area under the ROC curve for CAR (0.691) was superior to that for the neutrophil-to-lymphocyte ratio (0.541) and equivalent to that for the Glasgow Prognostic Score (0.692). Conclusion: CAR is a useful predictor of postoperative survival for patients with primary HCC. Disclosure of Interest: None declared
SUN-LB283 OVERWEIGHT, TYPE 2 DIABETES AND SURVIVAL IN AMYOTROPHIC LATERAL SCLEROSIS M. Requena1, C. Velasco1, C. Cuerda1, M. Camblor1, M. Motilla1, J. L. Muñoz-Blanco2, L. Arhip1, I. Catalina2, P. Garcia-Peris1, I. Breton1. 1Nutrition Unit, 2Neurology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Madrid, Spain Rationale: The influence of type 2 diabetes (DT2) on prognosis in Amyotrophic Lateral Sclerosis (ALS) patients is not well known. Our aim was to describe the overall survival and specifically at 24 months in ALS patients with DT2 and prediabetes ( preDT2) compared with nondiabetic (NoDT2) and to evaluate the influence of other metabolic factors. Methods: Retrospective study of a cohort of patients with ALS, divided into 3 groups according to the presence of DT2, preDT2 or NoDT2. Anthropometric and biochemical parameters were evaluated and time from first visit until death or until Nov 2015 was studied. Data are expressed as: mean ± SD (IQ range) or frequencies. Statistical analysis: Student’s t test, χ2-test, ANOVA, Pearson’s correlation coefficient and Kaplan-Meier analysis. Results: Two hundred and ten ALS patients, 57.1% males, aged 62.1 ± 13.7 years, BMI 25.7 ± 4.2 Kg/m2, were studied. 15% had DT2, 25.7% had preDT2 and 58.8% had NoDT2 (bulbar onset in 45.2%, 29.7% and 28.7% respectively; p = 0.068). The follow-up time was 26.3 ± 25 m (8–37), (spinal onset 30.4 ± 28.3 m and bulbar onset 17.5 ± 15 m; p = 0.001). Age at diagnosis was higher in DT2 ( p < 0.001). BMI was higher in DT2 and preDT2 (27.1 ± 4.7) kg/m2 vs NoDT2 (24.8 ± 3.6) kg/m2 ( p < 0.001). No association between survival time and BMI, HbA1c, albumin, CT, LDL, TG or ferritin was found; however we obtained a negative correlation with age ( p = 0.025) and a positive correlation with uric acid ( p = 0.038). Survival at 24 m was greater for BMI > 25 kg/m2 ( p = 0.042). Time until death and survival at 24 m was significantly higher in DT2. Conclusion: In our patients with ALS overweight is associated with increased survival. Those with DT2 have also a higher rate of survival, despite being older and having a BMI similar
Poster to preDT2 patients. More studies are needed to confirm this association. Disclosure of Interest: None declared
SUN-LB284 EVALUATION OF CARBOHYDRATE RESTRICTION AS PRIMARY TREATMENT FOR POST-GASTRIC BYPASS HYPOGLYCEMIA J. van Meijeren1,2, I. Timmer1,2, H. Brandts2, H. de Boer2. 1HAN University of Applied Sciences, Nijmegen, 2Rijnstate Hospital, Arnhem, Netherlands Rationale: Up to 15% of patients who underwent Roux-en-Y gastric bypass (RYGB) surgery may eventually develop postprandial hypoglycemia. Our aim was to evaluate the daily life efficacy of a carb-restricted dietary advice (CRD) of six meals per day with a 30 g carb maximum per meal in patients with documented post-RYGB hypoglycemia. Methods: Frequency and severity of hypoglycemic events were assessed retrospectively in 41 patients with documented postRYGB hypoglycemia before and after CRD, based on medical records and telephone questionnaires. Hypoglycemia was defined as a blood glucose <3.0 mmol/L. Patients self-reported dietary adherence was measured on a 1 to 10 scale. Results are expressed as mean values±standard error. Results: CRD decreased the frequency of hypoglycemic events from 38.0 ± 7.0 to 13.9 ± 5.0 per month, i.e. a decline of 63% ( p < 0.001). The lowest blood glucose measured during a hypoglycemic event increased from 2.1 ± 0.4 to 2.6 ± 0.2 mmol/L, an improvement of 0.5 ± 0.2 mmol/L ( p = 0.004). The number of times outside help was needed decreased from 3.6 ± 1.3 to 1.5 ± 1.0 times/month, a decrease of 58% ( p < 0.001). Higher self-report of dietary adherence (7.7 ± 0.3) was not associated with higher decrease of hypoglycemia per month (r = 0.016, p = 0.922). In fourteen patients (36.6%) the diet-induced reduction of hypoglycemic events was insufficient and required the start of insulin suppressive medication. Conclusion: A CRD, consisting of six meals with up to 30 g carbs each, is an effective treatment of post-RYGB hypoglycemia in the majority of patients. Additional medication is needed in about a third of patients. Disclosure of Interest: None declared
SUN-LB285 MINDFULNESS-BASED STRESS REDUCTION TRAINING FOR HPN PATIENTS: RESULTS OF A MIXED METHODS PILOT STUDY J. Beurskens1, B. van Gaal2, G. Huisman-de Waal2, G. Wanten3, A. Speckens4. 1Dept of Gastroenterology and Hepatology, Intestinal Failure Unit, Radboud University Nijmegen Medical Centre, 2Scientific Institute for Quality of Healthcare, IQ Healthcare, 3Dept of Gatsroenterology and Hepatology, 4 Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands Rationale: Home parenteral nutrition (HPN) is the ultimate treatment for patients with chronic intestinal failure (CIF). Unfortunately, complications of HPN often lead to serious psychosocial complaints that compromise quality of life (QoL). While Mindfulness Based Cognitive Therapy (MBCT) holds promise in various diseases, its feasibility in the setting of patients with CIF and HPN has not been explored.
SUN-LB283 OVERWEIGHT, TYPE 2 DIABETES AND SURVIVAL IN AMYOTROPHIC LATERAL SCLEROSIS M. Requena1, C. Velasco1, C. Cuerda1, M. Camblor1, M. Motilla1, J. L. Muñoz-Blanco2, L. Arhip1, I. Catalina2, P. Garcia-Peris1, I. Breton1. 1Nutrition Unit, 2Neurology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Madrid, Spain Rationale: The influence of type 2 diabetes (DT2) on prognosis in Amyotrophic Lateral Sclerosis (ALS) patients is not well known. Our aim was to describe the overall survival and specifically at 24 months in ALS patients with DT2 and prediabetes ( preDT2) compared with nondiabetic (NoDT2) and to evaluate the influence of other metabolic factors. Methods: Retrospective study of a cohort of patients with ALS, divided into 3 groups according to the presence of DT2, preDT2 or NoDT2. Anthropometric and biochemical parameters were evaluated and time from first visit until death or until Nov 2015 was studied. Data are expressed as: mean ± SD (IQ range) or frequencies. Statistical analysis: Student’s t test, χ2-test, ANOVA, Pearson’s correlation coefficient and Kaplan-Meier analysis. Results: Two hundred and ten ALS patients, 57.1% males, aged 62.1 ± 13.7 years, BMI 25.7 ± 4.2 Kg/m2, were studied. 15% had DT2, 25.7% had preDT2 and 58.8% had NoDT2 (bulbar onset in 45.2%, 29.7% and 28.7% respectively; p = 0.068). The follow-up time was 26.3 ± 25 m (8–37), (spinal onset 30.4 ± 28.3 m and bulbar onset 17.5 ± 15 m; p = 0.001). Age at diagnosis was higher in DT2 ( p < 0.001). BMI was higher in DT2 and preDT2 (27.1 ± 4.7) kg/m2 vs NoDT2 (24.8 ± 3.6) kg/m2 ( p < 0.001). No association between survival time and BMI, HbA1c, albumin, CT, LDL, TG or ferritin was found; however we obtained a negative correlation with age ( p = 0.025) and a positive correlation with uric acid ( p = 0.038). Survival at 24 m was greater for BMI > 25 kg/m2 ( p = 0.042). Time until death and survival at 24 m was significantly higher in DT2. Conclusion: In our patients with ALS overweight is associated with increased survival. Those with DT2 have also a higher rate of survival, despite being older and having a BMI similar
Poster to preDT2 patients. More studies are needed to confirm this association. Disclosure of Interest: None declared
SUN-LB284 EVALUATION OF CARBOHYDRATE RESTRICTION AS PRIMARY TREATMENT FOR POST-GASTRIC BYPASS HYPOGLYCEMIA J. van Meijeren1,2, I. Timmer1,2, H. Brandts2, H. de Boer2. 1HAN University of Applied Sciences, Nijmegen, 2Rijnstate Hospital, Arnhem, Netherlands Rationale: Up to 15% of patients who underwent Roux-en-Y gastric bypass (RYGB) surgery may eventually develop postprandial hypoglycemia. Our aim was to evaluate the daily life efficacy of a carb-restricted dietary advice (CRD) of six meals per day with a 30 g carb maximum per meal in patients with documented post-RYGB hypoglycemia. Methods: Frequency and severity of hypoglycemic events were assessed retrospectively in 41 patients with documented postRYGB hypoglycemia before and after CRD, based on medical records and telephone questionnaires. Hypoglycemia was defined as a blood glucose <3.0 mmol/L. Patients self-reported dietary adherence was measured on a 1 to 10 scale. Results are expressed as mean values±standard error. Results: CRD decreased the frequency of hypoglycemic events from 38.0 ± 7.0 to 13.9 ± 5.0 per month, i.e. a decline of 63% ( p < 0.001). The lowest blood glucose measured during a hypoglycemic event increased from 2.1 ± 0.4 to 2.6 ± 0.2 mmol/L, an improvement of 0.5 ± 0.2 mmol/L ( p = 0.004). The number of times outside help was needed decreased from 3.6 ± 1.3 to 1.5 ± 1.0 times/month, a decrease of 58% ( p < 0.001). Higher self-report of dietary adherence (7.7 ± 0.3) was not associated with higher decrease of hypoglycemia per month (r = 0.016, p = 0.922). In fourteen patients (36.6%) the diet-induced reduction of hypoglycemic events was insufficient and required the start of insulin suppressive medication. Conclusion: A CRD, consisting of six meals with up to 30 g carbs each, is an effective treatment of post-RYGB hypoglycemia in the majority of patients. Additional medication is needed in about a third of patients. Disclosure of Interest: None declared
SUN-LB285 MINDFULNESS-BASED STRESS REDUCTION TRAINING FOR HPN PATIENTS: RESULTS OF A MIXED METHODS PILOT STUDY J. Beurskens1, B. van Gaal2, G. Huisman-de Waal2, G. Wanten3, A. Speckens4. 1Dept of Gastroenterology and Hepatology, Intestinal Failure Unit, Radboud University Nijmegen Medical Centre, 2Scientific Institute for Quality of Healthcare, IQ Healthcare, 3Dept of Gatsroenterology and Hepatology, 4 Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands Rationale: Home parenteral nutrition (HPN) is the ultimate treatment for patients with chronic intestinal failure (CIF). Unfortunately, complications of HPN often lead to serious psychosocial complaints that compromise quality of life (QoL). While Mindfulness Based Cognitive Therapy (MBCT) holds promise in various diseases, its feasibility in the setting of patients with CIF and HPN has not been explored.