The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 9
Slide Session
OS-CAD-12 Cardiology
The Infl uence of Antihypertensive Therapy on Serum Leptin Level in the Metabolic Syndrome
Suleyman MAMMAEV1, Aminat KARIMOVA1 Dagestan State Medical Academy, Russia1
Background: The central obesity and arterial hypertension (AH) are associated with the basic pathogenetic mechanism of metabolic syndrome (MS) - insulin resistance (IR).
Leptin - the adipose tissue hormone/cytokine plays an important role in AH pathogen- esis in MS.
Objectives: to fi nd out the infl uence of antihypertensive therapy in MS patients with AH on the leptin level.
Methods: 65 persons included in the study were divided into two groups: the main group - 40 patients (15 men and 25 women) with AH and MS, mean age 49,0±6,2 years, and the control group - 25 healthy people (11 men and 14 women), mean age - 43,7±7,2 years. The main group was randomized into two subgroups: 20 patients of the fi rst subgroup were treated by lisinopril (5-10 mg per day) and 20 patients of the second subgroup – by bisoprolol (5-10 mg per day) during 12 weeks. The anthropomet- rical measurements, biochemical blood analyses, fasting serum insulin and leptin levels estimations (by ELISA) were carried out in both groups before and after the therapy. IR index was evaluated by Homeostasis Model Assessment 2 (HOMA2) calculator.Results:
The mean baseline leptin levels were reliably higher in both subgroups compared to control group (56,1±35,3 ng/ml and 58,2±25,5 ng/ml, p<0,001). The decrease of its levels was revealed in both groups, but just in lisinopril subgroup these changes were statistically reliable (Δ= -6,67±6,8 ng/ml, p<0,001 and Δ= 1,47±5,94 ng/ml, p>0,05).
IR-HOMA2 that was signifi cantly increased in both subgroups at baseline also reliably decreased only in the fi rst subgroup (Δ IR-HOMA2 = -0,73±1,25, p=0,02).
Conclusions: The antihypertensive therapy with lisinopril leads to IR-HOMA2 and se- rum leptin levels decrease that can demonstrate the pathogenetic effects of lisinopril in MS, while bisoprolol doesn’t infl uence signifi cantly those parameters.
OS-END-01 Diabetes
The Relationship Between Hba1c and Blood Glucose Levels of 75 and 100 Gram Ogtt During Gestational Diabetes Diagnosis
Meral MERT1, Serhat PURCU2, Özlem SOYLUK1, Pinar KARAKAYA1, Yildiz OKUTURLAR3, Gonca TAMER4, Murat EKIN5, Sami HATIPOGLU6, Özlem HARMANKAYA3, A.Baki KUMBASAR3
Endocrinology and Metabolism, Bakirköy Dr. Sadi Konuk Research and Training Hospital, Turkey1, Family Medicine, Bakirköy Dr. Sadi Konuk Research and Training Hospital, Turkey2, Internal Medicine, Bakirköy Dr. Sadi Konuk Research and Training Hospital, Turkey3, Endocrinology and Metabolism, Istan- bul Medeniyet University, Göztepe Research and Training Hospital, Turkey4, Gynecology and Obstetrics, Bakirköy Dr. Sadi Konuk Research And Training Hospital, Turkey5, Pediatry, Bakirköy Dr. Sadi Konuk Research and Training Hospital, Turkey6
Background: The value of glycated hemoglobin (A1c) as a diagnostic or screening tool in gestational Diabetes Mellitus (GDM) is increasing with time. In our study we aimed to evaluate the relation of A1c and blood glucose levels of 75 and 50-100 gram glucose tolerance test (GTT) in pregnant patients who were screened for GDM retrospectively.
Methods: The parameters of 913 pregnant women screened for GDM during 24-28 th ges- tational weeks are evaluated. The two step screening with 50 gram and 100 gram GTT were used in 576 patients. Screening with 75 gram GTT were used in the remaining 337 patients.
Results: In the two step group 45 patients got the diagnosis of GDM directly after 50 gr GTT. After the second step 45 patients (%28) and in the 75 gram GTT group 182 of the patients (% 54) got the diagnosis of GDM. The A1c levels of patients with blood glucose levels above and under the limit levels at 2nd hour of 75 gram OGTT were signifi cantly different ( p=0.038). The A1c levels of patients having high blood glucose levels at 2nd hour in 75 gram OGTT were signifi cantly higher than patients having nor- mal blood glucose levels at 2nd hour of 75 gram OGTT. On the other hand correlation analyses showed no signifi cant relation between any blood glucose level of 100 gram OGTT and A1c level. Whereas in 75 gram OGTT 1st and 2nd hour blood glucose levels were found to have a signifi cant relation with A1c levels (P=0.001, P=0.001 respectively).
Conclusions: HbA1c may be used as an important tool in the diagnosis of GDM with blood glucose levels of OGTT.
OS-END-02 Diabetes
The Incidence of Diabetic Foot Ulcer on Lower Extrem- ity Amputation and All- Cause Mortality in Patients with Type 1 and 2 Diabetes in Miyoshi, Hiroshima
Shinsuke MIKAMI1, Takafumi SUGIHIRO2, Satoshi MOURI2, Yusuke UEDA1, Hitoshi SUSAWA1, Kengo KOBAYASHI1, Haruki TANAKA1, Kouichi TANAKA1, Yukihito HIGASHI3, Yasuki KIHARA4
Miyoshi Central Hospital, Japan1, Miyoshi Central Hospital, Japan2, Research Center for Radiation Genome Medicine Research Institute for Radiation Biology and Medicine Hiroshima University, Japan3, Hiroshima University Graduate School of Biomedical and Sciences, Japan4
Background: Foot ulcers are costly complication among diabetes patients. These patients have an increased risk of amputation and increased mortality rate. Early rec- ognition of the high-risk foot and suffi cient care will save legs and improve patients’
quality of life. Figures of incidence of foot ulcers varies and there are only limited information in relation the change of incidence over time. The aim of this study was to estimate 5-year risk for diabetic foot ulcer (DFU), lower extremity amputation (LEA) and all cause of death.
Methods: Retrospective cohort study including all subjects with diabetes enrolled in our diabetic outpatient clinic from beginning 2008 until middle 2014. Data were col- lected from clinical records.
Results: 528 subjects with mean age of 61.3 (±13.8), 57.4% were male. The mean of HbA1c in diabetic patients at baseline were 8.1% +/- 1.9%. Cumulative incidence was 1.3% for DFU, 0.18% for LEA and 4.7% for all-cause of death. The prevalence of cardiovascular and cerebrovascular conditions, pneumonia were 2.3%, 1.9%, 2.3%, re- spectively. Cause of deaths was cancer (64%), pneumonia (20%), cardiovascular death (4%).
Conclusions: Several factors may explain the incidence in diabetes-related LEAs. Di- abetes prevention strategies and controlling risk factors are important in people with type 1 and 2 diabetes.
OS-END-03 Diabetes
Evaluation of Oral Glucose Tolerance Test in Hyperlipi- demic Normoglycemic Patients
Feray AKBAS1, Hanife USTA ATMACA1, Cigdem ALKAC1, Betul BORKU UYSAL1, Burak ALKAC1, Mustafa BOZ1
Istanbul Training and Research Hospital, Turkey1
Background: Atherosclerotic coronary artery disease is an important health issue and a leading mortality reason in developed countries. In this study; we aimed to diagnose diabetes and other glucose disturbances early by evaluating the glycemic profi le in hyperlipidemic patients and to decrease the cardiovascular morbidity and mortality by an early intervention.
Methods: 46 female and 19 male, totally 65 hyperlipidemic normoglycemic patients were included in the study. Patients had no history of diabetes and normal fasting blood glucose levels and were diagnosed with hyperlipidemia during routine blood tests. There were no limitations for age, gender or body mass index. Coronary heart disease risk factors were questioned and fi ndings were used to determine the patho- logical low density lipoprotein (LDL) levels. 2-hour oral glucose tolerance test (OGTT) was performed for all patients. Results were evaluated according to American Diabetes Association (ADA) 1997 criteria.
Results: Mean total cholesterol level of patients was 236±41 mg/dl, mean trigliserid level was 223±141 mg/dl and mean LDL level was 153±38 mg/dl. According to OGTT results ; mean fasting blood glucose level was 95±13 mg/dl and mean 2nd hour glu- cose level was 128±34 mg/dl. According to ADA 97 criteria; OGTT of 33 (51%) patients were normal. 2 (3%) patients had impaired fasting glucose (IFG), 11 (17%) patients had impaired glucose tolerance (IGT) and 19 patients (29%) had diabetes.
Conclusions: Hyperlipidemia and diabetes are important risk factors for cardiovascular disease and they usually coexist. Identifi cation and early intervention of these risk factors are prognostically important. Thus; patients who are diagnosed with hyperlipi- demia should be screened for glucose disturbances as a secondary risk factor and by early intervention of both risk factors, cardiovascular morbidity and mortality should be decreased.
