The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 11
Slide Session
OS-END-08 Diabetes
Diabetes Mellitus in Young People: Clinical and Molec- ular Genetic Aspects
Alla OVSYANNIKOVA1, Oksana RYMAR1, Vladimir MAXIMOV1, Mikhail VOEVODA1 Federal State Budget Institution, Russia1
Background: The aim was to investigate the clinical, laboratory and genetic determi- nants of diabetes mellitus in patients with debut of disease before 25 years of age and family history of diabetes in Siberia.
Methods: We examined 70 people with debut of diabetes before 25 years of age with family history of diabetes: 5 patients who we verifi ed MODY 2 (after molecular genetic testing), 33 diagnosed with type 1 diabetes at 32 - 2 type. All patients had a clinical examination, blood sampling for biochemical, hormone and molecular genetic (research glucokinase gene) analyzes.
Results: Missense mutations in the glucokinase gene were localized in exons 1,4 and 7. The “classical” symptoms of debut were in 94% of patients with 1 type of diabetes.
Asymptomatic debut of “diabetes no type 1” was in 60% of patients. Allergic reac- tions dominated among the comorbidities in patients with diabetes. Pathologies of the gastrointestinal tract (diabetes mellitus type 1 -27%, 2 type -12 %, MODY 2-20%), thyroid (18 %, 28 % and 40 % respectively), hypertension (18 % with type 1, 28 % - type 2) were in these patients. Peripheral diabetic neuropathy and diabetic retinopathy prevailed among the complications. Statistical differences were found in glucose, glycated hemoglobin, C-peptide, C-reactive protein among laboratory parameters in patients with diabetes mellitus type 1 and type 2.
Conclusions: 1. We discovered a new one missense mutation and three previously described mutations in the glucokinase gene. 2. Young patients with type 1 diabetes had “classic” symptoms. Patients with “diabetes not type 1” had not clinical symptoms (60%) and had normal body weight (84 %). 3. Allergic reactions and diseases of the thyroid gland dominated in all types of diabetes mellitus in patients of the young age.
OS-END-09 Diabetes
Discrepancies Between the Glycosylated Hemoglobin (HbA1c) Based Criteria and Glucose Based Criteria for Diagnosis of Diabetes and Pre-Diabetes
Sujan SHARMA1, Raj Kumar SHRESTHA2, Siddha BR MAGAR1, Prabin GYAWALI2, Rajendra KOJU3
Dhulikhel Hospital-Kathmandu University Hospital, Nepal1, Dhulikhel Hospital-Kathmandu University Hospital, Nepal2, Dhulikhel Hospital-Kathmandu University Hospital, Nepal3
Background: The number of people with diabetes is increasing globally; hence neces- sitate identifying diabetes earlier and more effi ciently. Recently, American Diabetes Association (ADA) recommended the use of glycated hemoglobin (HbA1c) as an alternative to glucose based criteria for diagnosing type 2 diabetes and pre-diabetes.
Previous studies have suggested that some level of discrepancy may exist between the HbA1c- and glucose-based criteria and may vary by race, ethnicity, sex, and age in various populations. Consequently, evaluation of discrepancies can help to determine which diagnostic criterion should be used to diagnose diabetes in a given population. Hence, we aimed to evaluate the discrepancies between HbA1c- and glucose-based criteria for diagnosis of diabetes and pre-diabetes in Nepalese population.
Methods: A total of 2502 subjects aged 30 years or older, who attended university hospital and subjected for measurement of HbA1c, fasting plasma glucose (FPG) and 2-hour plasma glucose (PPG) level were recruited in the study. Newly diagnosed dia- betes and pre-diabetes were defi ned by ADA-glucose based and ADA- HbA1c criteria.
Statistical analyses were performed using SPSS software to evaluate discripancies.
Results: The percentages of newly diagnosed individuals with diabetes were 12.87
% (322/2502) using the FPG criterion and 14.55 % (364/2502) using the HbA1c criterion. Signifi cant discordance occurred for 3.28% (82/2502) with HbA1c- and Glucose- based criteria and for 1.68% (42/2502) with HbA1c- and FPG- criteria.
Among the study subjects, 2.86 % of individuals with a FBG and 2.12% of individuals with HbA1c were found to be pre-diabetes.
Conclusions: Significant discordance exists between the HbA1c- and glu- cose-based diagnostic criteria for diagnosis of diabetes and pre-diabetes in Nepalese population. Hence, we concluded that using glucose based criteria merely may result in an underestimation of diabetes and pre-diabetes.
OS-END-10 Diabetes
Pathogenetic Factors of Anemia Development in Pa- tients with Early Stages of Diabetic Nephropathy
Ivan PCHELIN1, Alexander SHISHKIN1 St. Petersburg State University, Russia1
Background: Anemia occurs early and predicts high risk of cardiovascular events and death in patients with diabetic nephropathy (DN). It may result from various factors including erythropoietin defi ciency, iron and vitamin defi ciencies, systemic infl amma- tion and others. In this study we assessed the relative contribution of different patho- genic factors involved in development of anemia in patients with early stages of DN.
Methods: We investigated 95 anemic patients with type 2 diabetes mellitus and chronic kidney disease (CKD) stages 1-3. Glomerular fi ltration rate was estimated by Cockcroft-Gault formula. Anemia was defi ned according to WHO criteria. To assess the pathogenic factors of anemia we measured serum levels of erythropoietin (EPO), ferritin, vitamin B12, folic acid, interleukin-1ß (IL-1ß), interleukin-6 (IL-6) and tumor necrosis factor-a (TNF-a) using immunoassay.
Results: We found EPO defi ciency in 46,3%, low ferritin levels – in 11,6%, vitamin B12 defi ciency – in 1,1% and folic acid defi ciency in 2,1% patients. The prevalence of EPO defi ciency was increasing with progression of DN, while the prevalence of low ferritin levels was decreasing. Elevated serum cytokine levels were observed in the following percentage of patients: IL-1ß – 86,3%, IL-6 – 70,5%, TNF-a – 21,1%. Hemoglobin (Hb) levels correlated negatively with concentrations of these cytokines. Pearson’s correla- tion coeffi cients were as follows: r= -0,273 (Hb/IL-1ß), r= -0,500 (Hb/IL-6), r= -0,311 (Hb/TNF-a), p<0,05. After exclusion of patients with EPO, iron, vitamin B12 or folic acid defi ciency the strength of correlations increased: r= -0,523 (Hb/IL-1ß), r= -0,677 (Hb/IL-6), r= -0,490 (Hb/TNF-a), p<0,05.
Conclusions: The results of the study suggest that anemia in patients with early stag- es of DN is multifactorial. EPO defi ciency and systemic infl ammation are common in this group of patients. Thorough evaluation of factors leading to anemia in patients with early stages of DN should be used to improve response to treatment and out- comes.
OS-END-11 Diabetes
Increased Risk of Diabetes and Post-Diabetes Adverse Events in Patients with Stroke: Two Nationwide Retro- spective Cohort Studies
Chien-Chang LIAO1, Ta-Liang CHEN1 Taipei Medical University Hospital, Taiwan R.O.C1
Background: The relationship between stroke and diabetes is not completely under- stood. This study evaluated diabetes risk and post-diabetes adverse events in patients with stroke.
Methods: We identified 7681 adults newly diagnosed with stroke in 2000-2003 using Taiwan’s National Health Insurance Research Database. A comparison cohort of 30,724 adults without stroke was randomly selected from the same dataset, fre- quency matched by age and sex. Diabetes events in 2000-2008 were ascertained from medical claims. Adjusted hazard ratios (HRs) and 95% CIs of diabetes associated with stroke were calculated. A nested cohort study of 21,147 patients with inpatient care for diabetes between 2004 and 2010 were calculated adjusted odds ratios (ORs) and 95% CIs of adverse events after diabetes in patients with and without stroke.
Results: During 222,477 person-years of follow-up, there were 8183 newly diagnosed diabetes cases. The incidences of diabetes for people with stroke and without were 69.5 and 30.0 per 1,000 person-years, respectively (P < 0.0001). Compared with people without stroke, the adjusted HR of diabetes was 3.45 (95% CI 3.26-3.66) for people with stroke. The ORs of post-diabetes pneumonia, urinary tract infection, and mortality associated with stroke were 1.28 (95% CI 1.07-1.53), 1.49 (95% CI 1.30-1.71), and 1.55 (95% CI 1.07-2.24), respectively.
Conclusions: Stroke was associated with diabetes risk. Patients with stroke had more adverse events and subsequent mortality after diabetes. Prevention of diabetes and post-diabetes adverse events is needed in this susceptible population.
WITHDRAWAL
