88 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0161 Diabetes
A Pathological Anatomy Case of Ischemic Cardiomyo- pathy with Type 2 Diabetes
Masayuki KITAGAWA1, Jiro AKIBA1, Yukihiro SHIKAMA1, Ikuro OHTA1 Yamagata Prefectural Kahoku Hospital, Japan1
Background: It seems that there is a close relation to diabetes and cardiomyopathy.
The concept of diabetic cardiomyopathy is present, and the relevance of cardiomy- opathy and diabetes is considered to be the eternal theme in clinical diabetes. We experienced pathological anatomy of the diabetic patient who died of heart failure, and resulted in diagnosis of ischemic cardiomyopathy this time. When considering the relation of diabetes and cardiomyopathy, this pathological anatomy case was consid- ered to be a precious case, and was reported.
Case Report: The patient was 77-year-old male diagnosed with type 2 diabetes mel- litus. He was going to hospital regularly from 59 years old. Medical treatment was given to him by the insulin, and HbA1c was controlled from 6.2% to 4.9%. Although pancreatic head cancer was pointed out in abdomen MRI at the age of 76, it was advanced age, and also since it was suffering from the renal insuffi ciency of Cr 3.2 mg/dl, the operation of a pancreatic cancer was not wished. Heart failure advanced and the patient died at the age of 77. A family’s consent of pathological anatomy was obtained, and pathological anatomy was enforced.
Results: It was diagnosed by pathological anatomy that a main cause of death was ischemic cardiomyopathy. In pathological anatomy of the heart, fi brosis has spread between cardiac muscles and to the circumference of a blood vessel, and it was diag- nosed as the ischemic cardiomyopathy by chronic ischemia.
Conclusions: The concept of diabetic cardiomyopathy is present. Diabetic cardio- myopathy is characterized by interstitial fi brosis, apoptosis. We considered that the ischemic cardiomyopathy in this case might also be related to diabetic cardiomyopa- thy. When considering the relation of diabetes and cardiomyopathy, this pathological anatomy case was considered to be a precious case, and was reported.
PS 0162 Diabetes
Changes in Pharmacological Treatment Pattern for Type 2 Diabetes in Five Years: Before and After the In- troduction of Dipeptidyl Peptidase-4 (dpp-4) Inhibitor at a Diabetes Specialist Clinic in Tokyo
Yuko WATANABE1, Miyuki NOGAWA2, Yoshiaki KAWAGOE1, Hitomi FUJII1, Takaichi MIYAKAWA2
Tama-Center Mirai Clinic, Japan1, Kunitachi Mirai Clinic, Japan2
Background: The national health survey in 2011 estimated nearly 20 million Japanese adults are being or possibly having diabetes mellitus. Treatment for type 2 diabetes mellitus requires multiple oral antidiabetic agents (OADs) and/or insulin in the long run. In 2009, the fi rst DPP-4 inhibitor sitagliptin launched, and currently seven DPP-4 inhibitors are available in Japan.
Aim: We conducted this survey in order to reveal changes in pharmacological treat- ment pattern, especially before and after the introduction of DPP-4 inhibitors, and to delineate its effi cacy on glycemic control.
Methods: We reviewed the electric medical record from March 1st to May 31st in 2008, that is one year before the introduction of DPP-4 inhibitor, and the same period in 2013. As for pharmacological agents, we focused on six classes of OAD, Insulin and GLP-1 receptor agonists (GLP-1 RAs). Primary outcomes were the number and propor- tion of patient using each drug. Secondary outcome was mean HbA<sub>1c</sub>.
Statistical analyses were performed by JMP5.0.1J using SAS.
Results: Total number of patient increased by 40 % in 5 years. While SU and BG users increased moderately and insulin users tended to decrease, DPP-4 inhibitors use reached to 65% of the patients in 2013 (Table). TZD use remained the same despite bladder or other cancer issue, mainly because our mean dose was less than 15mg/d (median 7.5mg/d). Glinides and AGI use declined rapidly probably due to the restric- tion on DPP-4 inhibitors when prescribed. HbA<sub>1c</sub> improved signifi cantly (P<0.05) compared to year 2008.
Conclusions: The introduction of DPP-4 inhibitor made treatment pattern changed substantially, and glycemic control improved. Further study is needed to evaluate cost-effectiveness of multiple drug combinations.
PS 0163 Diabetes
Correlation of Serum Lipid Profi le with Glycemic Con- tol in Type 2 Diabetes Mellitus Patients
Fatimah Siti HASIBUAN1
North Sumatera Medical University, Indonesia1
Background: Type 2 diabetes mellitus is an increasingly important medical and public health issue. Patients with type 2 diabetes mellitus have an increased prevalence of lipid abnormalities, contributing to their high risk of cardiovascular diseases (CVD) compared with people without diabetes. Dyslipidemia is an important component of the metabolic syndrome observed in type 2 diabetes mellitus patients and is charac- terized by moderate hypertriglyceridemia and low levels of HDL-C. Glycemic control might have important impact on lipid profi le in type 2 diabetes mellitus patients.
Methods: This cross sectional study was carried out in endocrine polyclinic of Rumah Sakit Haji Adam Malik Medan. The samples were collected on the basis of convenient sampling. Brachial venous samples were collected for HbA1 and serum lipid profi le.
Based on their HbA1c, patients were divided into two groups : group 1 that had good glycemic control (HbA1c < 7%) and group 2 that had poor glycemic control (HbA1c >
7%). The serum lipid profi le was compred with reference to the glycemic control. The data obtained were analyzed using SPSS version 17.
Results: A total of 28 patients were included in this study,13 males and 15 females.
There were 8 patients in group 1 and 20 patients in group 2. The mean age of total sample was 52.57 years. The mean total cholesterol was 202.88 in group 1 versus 21.45 in group 2 (p=0.28). The mean triglycerides was 154.38 in group 1 versus 203.00 in group 2 (p=0.29). The mean HDL-C was 60.75 in group 1 versus 44.60 in group 2 (p=0.02). The mean LDL-C was 139.88 in group 1 versus 166.25 in group 2 (0.09 Conclusions: In type 2 diabetes mellitus patients good glycemic control is associated with statistically signifi cant differences in the level of HDL-C.
