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￭ Sat-271 ￭
The duration of abdominal obesity has stronger association with risk for development of diabetes
성균관의대 강북삼성병원
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정인하, 이은정
Background/Aims: Whether simple obesity assessed by body mass index (BMI) or abdominal obesity is more related with development of diabetes is not clear. We aimed to analyze the relationship between duration of obesity and abdominal obesity and the risk for diabetes in 16186 non-diabetic Korean par- ticipants in a health screening program. Methods: In 16186 participants (mean age 43 years) in a health screening program, in whom medical examina- tions were performed consecutively for 5 years, the duration of obesity was assessed by body mass index (BMI)≥25 kg/m2 and by waist circumference (WC) ≥ 90cm in men, and ≥85 cm in women. Those who had diabetes were excluded from baseline. After 4 years, the development of diabetes was ana- lyzed according to the number of years in which the participants were obese. Results: After 4 years, 446 (2.8%) participants developed diabetes. The pro- portion of participants who had simple obesity assessed by BMI and abdominal obesity assessed by WC, for 0, 1 ,2, 3, 4, and 5 years were 61.0, 4.6, 3.8, 3.7, 4.5, 22.3%, and 65.3, 7.7, 4.7, 4.6, 5.5, 12.2%. The risk for diabetes development significantly increased as the number of years being obese increased from zero to 5 years with zero obese year group as the reference after adjustment for confounding variables {hazard ratio (HR) 1.623; 95% confidence in- terval (CI) 1.050~2.509, in 5 consecutive years’ obese group}. When the groups were divided by the number of years on abdominal obesity defined by WC, the risk for diabetes development significantly increased from zero years to 5 years of consecutive years of having abdominal obesity with zero year of ab- dominal obesity as the reference after adjustment for confounding factors (HR 1.992; 95% CI 1.176~3.142, in 5 consecutive years’ abdominally obese group). Conclusions: Having longer duration of abdominal obesity than simple obesity had stronger correlation with development of diabetes, suggesting worse influence of abdominal obesity to pathogenesis of diabetes than simple obesity assessed by BMI.
￭ Sat-272 ￭
The use of denosumab for hemodialysis refractory hypercalcemia in end stage renal disease.
순천향대학교 서울병원 내분비대사내과
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정지윤, 박형규
Introduction: Severe hypercalcemia is a medical emergency. However, hypercalcemia managements through massive intravenous hydration or bi- sphosphonate are challenging for a patient with decreased renal function. Denosumab, a monoclonal antibody to receptor activator of nuclear factor kap- pa-B ligand, is recently used to treat osteoporosis. We report the first case of denosumab use for hemodialysis (HD) refractory hypercalcemia in a patient with end stage renal disease (ESRD). Case: A 79-year-old woman with Alzheimer’s disease, diabetes mellitus, cerebral infarction, ESRD on HD presented with altered mental status, fever, sputum for 4 days. She was admitted for pneumonia, treated with antibiotics and underwent intermittent HD 3 times a week. Her initial serum corrected calcium (Ca) was 8.8 mg/dL but on day 10, it increased to 14.2 mg/dL. Diagnostic tests such as PTH, 25(OH) Vitamin D, PTHrP, serum free light chain, serum and urine electrophoresis, Chest computed tomography (CT), Abdomen CT, tumor markers, Vitamin A and TSH showed negative results. Immobilization-related hypercalcemia was subsequently diagnosed. She underwent intermittent HD with low-calcium dialysate but corrected Ca was 17.9 mg/dL on day 20. On day 22-26, she underwent continuous renal replacement therapy (CRRT). While on CRRT, corrected Ca was 7.7~13.0 mg/dL. On day 28, she restarted intermittent HD and then, corrected Ca was 15.8mg/dL. Left with limited options, she was treated with deno- sumab for refractory hypercalcemia. On day 29, denosumab 60 mg was given subcutaneously (SC). On day 35, corrected Ca was 19.7 mg/dL and denosu- mab 120 mg was given SC. On day 43, 3rd dose of denosumab 120 mg was given SC. Ca levels began to decrease and on day 51, corrected Ca was 12.8 mg/dL. She was discharged to a long-term care facility with a plan to inject denosumab every 4 weeks. Conclusion: We report the first case of denosumab use in HD refractory hypercalcemia in South Korea. Our case suggests that denosumab can be used as an alternative treatment for HD refractory hyper- calcemia in a patient with ESRD whose treatment options are limited due to decreased renal function.
