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Utilizing Telehealth Technology in Rural Alberta to Improve Glycemia in Patients with Type 2 Diabetes Mellitus
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Abstracts / Can J Diabetes 40 (2016) S2–S20
led to a decline in serum ATX activity, suggesting that ATX secretion from adipocytes is regulated by nutritional stimuli both acutely and chronically in vivo. We also observed that ATX secretion is increased in insulin-resistant 3T3-L1 adipocytes and that glucose and insulin independently and synergistically enhance ATX secretion from adipocytes and adipose tissue. To examine the effect of ATX on obesity and insulin signalling, ATX heterozygous whole body knockout mice (ATXhetKO) were fed a HFHS diet for 20 weeks. HFHS-fed ATXhetKO mice showed significantly lower body weights and serum triglycerides than HFHS-fed WT mice. Insulin signalling in skeletal muscle, perigonadal adipose tissue and liver was increased in HFHS-fed ATXhetKO mice when compared to WT, as evidenced by elevated phosphorylation of Akt and downstream targets. Taken together, this study suggests that stimulation of ATX secretion from adipocytes by glucose and insulin could underlie the nutritional regulation of ATX in vivo and that ATX plays an important role in the development of diet-induced obesity and obesity-induced insulin resistance in muscle, adipose tissue and liver. 58 Glucose Variability Around Exercise Persists in InsulinIndependent Human Islet Transplant Recipients DEANNA FUNK, SAEED REZA TOGHI ESHGHI, JORDAN REES, CHUFAN ZHANG, BECCA DYCK, KITTY CHEUNG, TOLU OLATEJU, NORMAND BOULÉ, PETER SENIOR, JANE YARDLEY Camrose, AB Glucose regulation around exercise is a major challenge for individuals with type 1 diabetes. Although clinical islet transplantation (ITx) prevents severe hypoglycemia, animal studies suggest that glucose regulation around exercise after ITx may not be normal. We hypothesized that changes in blood glucose (as estimated by continuous glucose monitoring [CGM]) during moderate aerobic exercise and glucose variability (estimated by CGM standard deviation) postexercise would be greater in ITx patients than those observed in control participants. On 2 separate days, 6 insulin-independent ITx individuals and 6 matched controls performed either 45 minutes of moderate cycling (60% of VO2 max) or 45 minutes of seated rest. Sessions were performed at the same time of day (late afternoon), in random order, separated by at least 48 hours. Participants were asked to replicate food timing and composition as closely as possible. ITx were matched with controls for age (50.0 vs. 50.0 years), height (165.2 cm vs. 165.8 cm), weight (63.3 kg vs. 65.5 kg), sex and physical activity levels. Exercise caused a significant decrease in CGM glucose in ITx participants (from 6.0±0.7 to 5.4±0.8 mmol/L; p=0.007) but not in matched controls (from 5.2±0.7 to 4.9±0.3; ns). During the 6 hours following exercise, mean CGM glucose levels were higher (7.9±1.1 vs. 5.7±0.6; p=0.002) and glucose variability was greater (CGM glucose SD 1.7±0.7 vs. 1.2±0.3; p=0.02) in ITx participants compared to controls. These data suggest that despite insulin independence, exerciseinduced glucose variability persists in islet transplant recipients. 59 Results of an International Corneal Confocal Microscopy (CCM) Consortium: A Pooled Multicentre Analysis of the Concurrent Diagnostic Validity of CCM to Identify Diabetic Polyneuropathy in Type 1 Diabetes Mellitus BRUCE A. PERKINS, LEIF E. LOVBLOM, VERA BRIL, KATIE EDWARDS, NICOLA PRITCHARD, ANTHONY RUSSELL, DANIÈLE PACAUD, KENNETH ROMANCHUK, JEAN MAH, ANDREW BOULTON, MARIA JEZIORSKA, ANDREW MARSHALL, RONI M. SHTEIN, RODICA POP-BUSUI, EVA L. FELDMAN, STEPHEN I. LENTZ, MITRA TAVAKOLI, NATHAN EFRON, RAYAZ A. MALIK Toronto, ON Aim: Several independent cohorts have implied that CCM may serve as a useful proxy measure of diabetic polyneuropathy (DPN). Through
an international pooled multicentre analysis, we aimed to confirm the type 1 diabetes-specific concurrent validity and determine diagnostic thresholds for identification of DPN by CCM. Methods: Through an collaborative effort of 5 cohorts, 516 participants (84 adolescent and 432 adults) with type 1 diabetes underwent CCM examination concurrently with determination of electrophysiology-based consensus criteria for DPN. Automated image analysis protocols were used to quantify the corneal parameters, including corneal nerve fibre length (CNFLAuto). Participants were randomly divided into derivation (n=260) and validation sets (n=256). Concurrent validity and diagnostic thresholds were determined from receiver operating characteristic curves and areaunder-the-curve (AUC). Results: Participants had mean age 42±19 years, mean diabetes duration 21±15 years, and 255 (49%) were female. DPN prevalence was 32%. Derivation and validation sets had similar characteristics. In the derivation set, DPN cases had lower corneal parameters values (p<0.001 for each compared to controls). CNFLAuto had the highest AUC at 0.77 and its optimal threshold of 12.5 mm/mm2 identified cases with 71% sensitivity and 69% specificity. This threshold identified cases with 68% sensitivity and 68% specificity in the validation set (AUC 0.74). Conclusions: We confirmed the concurrent diagnostic validity of CNFL for identifying DPN in patients with type 1 diabetes, despite an imperfect reference standard (electrophysiology) for defining DPN. These results strongly support implementation of CCM in research trials and the need for longitudinal studies evaluating the predictive validity of this technique.
60 Utilizing Telehealth Technology in Rural Alberta to Improve Glycemia in Patients with Type 2 Diabetes Mellitus JEFFREY WINTERSTEIN*,† Edmonton, AB Telehealth technology is a relatively new vehicle to the provision of healthcare services. It enables patients residing in remote or rural areas to access healthcare services through secured videoconferencing technology. It has many potential benefits for patients and the healthcare system in general, including increased access to specialized care, improved response time, timely diagnosis and less costly treatments. Patients with type 2 diabetes mellitus (T2DM) require regular visits to monitor metabolic parameters and for proper chronic disease management. The objectives of this observational study of patients in rural Alberta utilizing telehealth are to determine the proportion of patients who attended their scheduled telehealth appointments and to evaluate the benefits in terms of improved glycemic control as seen by change in A1C at baseline (BL) and after their follow-up visit, approximately 3 months later. At BL, all patients (n=25) had an A1C >7.5% (above target as per the Canadian Diabetes Association guidelines). This patient population was 57% female and 52% First Nations. All patients were given prescriptions of an antihyperglycemic agent to reduce their A1C levels, which would be reviewed at the follow-up appointment. Attendance rate, defined as a scheduled patient appearing at his/her appointment, was found to be at 88%. This group also had a decrease in their A1C (2.2% mean A1C decrease) relative to BL within 4 months. Additionally, 28% had reached a target A1C <7.0% within 4 months. In summary, this data suggests that the use of telehealth in a rural Alberta population was associated with positive patient outcomes in terms of patient attendance and subsequent A1C improvement.
Abstracts / Can J Diabetes 40 (2016) S2–S20
led to a decline in serum ATX activity, suggesting that ATX secretion from adipocytes is regulated by nutritional stimuli both acutely and chronically in vivo. We also observed that ATX secretion is increased in insulin-resistant 3T3-L1 adipocytes and that glucose and insulin independently and synergistically enhance ATX secretion from adipocytes and adipose tissue. To examine the effect of ATX on obesity and insulin signalling, ATX heterozygous whole body knockout mice (ATXhetKO) were fed a HFHS diet for 20 weeks. HFHS-fed ATXhetKO mice showed significantly lower body weights and serum triglycerides than HFHS-fed WT mice. Insulin signalling in skeletal muscle, perigonadal adipose tissue and liver was increased in HFHS-fed ATXhetKO mice when compared to WT, as evidenced by elevated phosphorylation of Akt and downstream targets. Taken together, this study suggests that stimulation of ATX secretion from adipocytes by glucose and insulin could underlie the nutritional regulation of ATX in vivo and that ATX plays an important role in the development of diet-induced obesity and obesity-induced insulin resistance in muscle, adipose tissue and liver. 58 Glucose Variability Around Exercise Persists in InsulinIndependent Human Islet Transplant Recipients DEANNA FUNK, SAEED REZA TOGHI ESHGHI, JORDAN REES, CHUFAN ZHANG, BECCA DYCK, KITTY CHEUNG, TOLU OLATEJU, NORMAND BOULÉ, PETER SENIOR, JANE YARDLEY Camrose, AB Glucose regulation around exercise is a major challenge for individuals with type 1 diabetes. Although clinical islet transplantation (ITx) prevents severe hypoglycemia, animal studies suggest that glucose regulation around exercise after ITx may not be normal. We hypothesized that changes in blood glucose (as estimated by continuous glucose monitoring [CGM]) during moderate aerobic exercise and glucose variability (estimated by CGM standard deviation) postexercise would be greater in ITx patients than those observed in control participants. On 2 separate days, 6 insulin-independent ITx individuals and 6 matched controls performed either 45 minutes of moderate cycling (60% of VO2 max) or 45 minutes of seated rest. Sessions were performed at the same time of day (late afternoon), in random order, separated by at least 48 hours. Participants were asked to replicate food timing and composition as closely as possible. ITx were matched with controls for age (50.0 vs. 50.0 years), height (165.2 cm vs. 165.8 cm), weight (63.3 kg vs. 65.5 kg), sex and physical activity levels. Exercise caused a significant decrease in CGM glucose in ITx participants (from 6.0±0.7 to 5.4±0.8 mmol/L; p=0.007) but not in matched controls (from 5.2±0.7 to 4.9±0.3; ns). During the 6 hours following exercise, mean CGM glucose levels were higher (7.9±1.1 vs. 5.7±0.6; p=0.002) and glucose variability was greater (CGM glucose SD 1.7±0.7 vs. 1.2±0.3; p=0.02) in ITx participants compared to controls. These data suggest that despite insulin independence, exerciseinduced glucose variability persists in islet transplant recipients. 59 Results of an International Corneal Confocal Microscopy (CCM) Consortium: A Pooled Multicentre Analysis of the Concurrent Diagnostic Validity of CCM to Identify Diabetic Polyneuropathy in Type 1 Diabetes Mellitus BRUCE A. PERKINS, LEIF E. LOVBLOM, VERA BRIL, KATIE EDWARDS, NICOLA PRITCHARD, ANTHONY RUSSELL, DANIÈLE PACAUD, KENNETH ROMANCHUK, JEAN MAH, ANDREW BOULTON, MARIA JEZIORSKA, ANDREW MARSHALL, RONI M. SHTEIN, RODICA POP-BUSUI, EVA L. FELDMAN, STEPHEN I. LENTZ, MITRA TAVAKOLI, NATHAN EFRON, RAYAZ A. MALIK Toronto, ON Aim: Several independent cohorts have implied that CCM may serve as a useful proxy measure of diabetic polyneuropathy (DPN). Through
an international pooled multicentre analysis, we aimed to confirm the type 1 diabetes-specific concurrent validity and determine diagnostic thresholds for identification of DPN by CCM. Methods: Through an collaborative effort of 5 cohorts, 516 participants (84 adolescent and 432 adults) with type 1 diabetes underwent CCM examination concurrently with determination of electrophysiology-based consensus criteria for DPN. Automated image analysis protocols were used to quantify the corneal parameters, including corneal nerve fibre length (CNFLAuto). Participants were randomly divided into derivation (n=260) and validation sets (n=256). Concurrent validity and diagnostic thresholds were determined from receiver operating characteristic curves and areaunder-the-curve (AUC). Results: Participants had mean age 42±19 years, mean diabetes duration 21±15 years, and 255 (49%) were female. DPN prevalence was 32%. Derivation and validation sets had similar characteristics. In the derivation set, DPN cases had lower corneal parameters values (p<0.001 for each compared to controls). CNFLAuto had the highest AUC at 0.77 and its optimal threshold of 12.5 mm/mm2 identified cases with 71% sensitivity and 69% specificity. This threshold identified cases with 68% sensitivity and 68% specificity in the validation set (AUC 0.74). Conclusions: We confirmed the concurrent diagnostic validity of CNFL for identifying DPN in patients with type 1 diabetes, despite an imperfect reference standard (electrophysiology) for defining DPN. These results strongly support implementation of CCM in research trials and the need for longitudinal studies evaluating the predictive validity of this technique.
60 Utilizing Telehealth Technology in Rural Alberta to Improve Glycemia in Patients with Type 2 Diabetes Mellitus JEFFREY WINTERSTEIN*,† Edmonton, AB Telehealth technology is a relatively new vehicle to the provision of healthcare services. It enables patients residing in remote or rural areas to access healthcare services through secured videoconferencing technology. It has many potential benefits for patients and the healthcare system in general, including increased access to specialized care, improved response time, timely diagnosis and less costly treatments. Patients with type 2 diabetes mellitus (T2DM) require regular visits to monitor metabolic parameters and for proper chronic disease management. The objectives of this observational study of patients in rural Alberta utilizing telehealth are to determine the proportion of patients who attended their scheduled telehealth appointments and to evaluate the benefits in terms of improved glycemic control as seen by change in A1C at baseline (BL) and after their follow-up visit, approximately 3 months later. At BL, all patients (n=25) had an A1C >7.5% (above target as per the Canadian Diabetes Association guidelines). This patient population was 57% female and 52% First Nations. All patients were given prescriptions of an antihyperglycemic agent to reduce their A1C levels, which would be reviewed at the follow-up appointment. Attendance rate, defined as a scheduled patient appearing at his/her appointment, was found to be at 88%. This group also had a decrease in their A1C (2.2% mean A1C decrease) relative to BL within 4 months. Additionally, 28% had reached a target A1C <7.0% within 4 months. In summary, this data suggests that the use of telehealth in a rural Alberta population was associated with positive patient outcomes in terms of patient attendance and subsequent A1C improvement.