Diabetes Research and Clinical Practice - Volume 120 - Supplement 1 - October 2016

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glycation reaction in albumin strongly compared with
hemoglobin.
Aim: To analyze the correlation of glycated albumin (GA) and
hemoglobin A1c (HbA1c) with mean amplitude of glycemic
excursions (MAGE) and standard difference of blood glucose
(SDBG) and to provide theoretical evidences for complete
assessment of GA and chinese type 2 diabetic
patients.
Method: A total of 404 type 2 diabetic patients in our inpatient
department of endocrinology and metabolism from August,
2013 to February, 2014 were enrolled. Fasting plasma glucose
(FPG), HbA1c, GA, fasting C peptide (FCP), 2-hour postprandial
plasma glucose (2hPG), 2-hour C peptide (2hCP) were exam-
ined in all the subjects. The 3 day continuous blood glucose
monitoring of the enrolled subjects were performed by
continuous glucose monitoring system. MAGE and SDBG
were used to assess to glycemic excursions. Mean blood
glucose (MBG) was used to assess overall glucose level.
Results: (1) The 404 enrolled subjects included 228 men and
176 women with mean age of (59 ± 11) years, diabetes duration
of (9.1 ± 6.3) years, FPG of (7.9 ± 2.5) mmol/L, 2hPG of (13.3 ± 4.3)
mmol/L, HbA1c of (8.3 ± 1.9) %, GA of (22.4 ± 6.9)%, MAGE of
(5.6 ± 2.5) mmol/L, SDBG of (2.2 ± 0.9) mmol/L, MBG of (8.9 ± 2.0)
mmol/L. (2) Univariate correlation analysis showed that GA
had strong correlation with HbA1c (r = 0.836, P < 0.01). GA was
positively correlated with FPG, 2hPG and MBG (r = 0.604, 0.670,
0.650, P < 0.01). HbA1c was also positively correlated with
FPG, 2hPG and MBG (r = 0.603, 0.634, 0.661, P < 0.01). (3)
Univariate correlation analysis showed that GA had positive
correlation with MAGE and SDBG (r = 0.485, 0.529, P < 0.01).
HbA1c was also positively correlated with MAGE and SDBG
(r = 0.417, 0.495, P < 0.01). (4) Stepwise multivariate regression
analysis demonstrated that GA level was independently
correlated with the glycemic excursion indices including
MAGE and SDBG.
Discussion: Compared with HbA1c, GA can better reflect
postprandial glucose level and glycemic excursions.
PD-02
Effectiveness of diabetes quality improvement program in
Chia-yi region of Taiwan
Hsiang-Hsun CHUANG1,2, Chieh-Hsiang LU1–3*,
Cheng-Ren CHEN 1. 1Ditmanson Medical Foundation Chia-Yi
Christian Hospital, 2Department of Business Administration, College
of Management, National Chung Cheng University, 3Department of
Nursing, DAYEH University, Taiwan
Objective: Diabetes Mellitus is an endemic chronic disease that
causes the major health issues. The population of diabetes has
been doubling in the past two decades. It is found to be
associated with aging, obesity and western lifestyle. Through
its chronicity and multiple comorbidities, Diabetes mellitus is
the most known social-economic burden in our healthcare
system. This study is aim to evaluate the long-term effective-
ness of diabetes quality improvement program by the national
health insurance bureau.
Methods: This is a three year longitudinal follow-up study in a
teaching hospital from 2009 to 2011. Totally 3217 diabetic
patients receiving regular outpatient visit and entering the
diabetes quality improvement program were included in the
study. Medication cost of the hyperglycemia, hypertension
and hyperlipidemia and the major healthcare outcome
indicators were compared.
Results: The results showed that the total medication cost of
the hyperglycemia, hypertension and hyperlipidemia de-
creased gradually and reach statistical significance (p < 0.001);
there are also significant improvement in blood pressure
(p < 0.001), HbA1c (p = 0.006), total cholesterol (p < 0.001),
triglyceride (p = 0.003), HDL (p = 0.031) and LDL(p < 0.001).
Conclusions: The long-term effectiveness of diabetes quality
improvement program raised by the national health insurance
bureau has been shown to be promising. It not only reduced
the costs of pill burden but also improve the major cardiovas-
cular outcome indicators. Through these results, we urge that
the Ministry of Health and Welfare should invest more
resources in the raising quality care model of chronic diseases
especially the Diabetes Mellitus.
PD-03
Diabetic medications seldom deintensified in oldest old
diabetic patients – Lessons from Thailand
Soontaree NAKASATIEN1*, Yotsapon THEWJITCHAROEN1,
Sirinate KRITTIYAWONG1, Ekgaluck WANOTHAYAROJ1,
Somboon VONGTERAPAK1, Siriwan BUTADEJ1,
Areeya MALIDAENG1, Thep HIMATHONGKAM1. 1Theptarin
Hospital, Thailand
Background: In the recent study, older diabetes patients rarely
had their medicine dosages decreased or discontinued. Little is
known about medication deintensification on the growing
population called the “ oldest old” , those in their mid-80s
upwards. Therefore, the aim of this study was to describe the
frequency of diabetic medications deintensification and
diabetologists’ attitudes toward oldest old patients.
Methods: A retrospective review was conducted on medical
records of type 2 diabetes who are older than 85 years fromSep
2014 to August 2015 at Theptarin hospital which is one of the
largest diabetes centers in Thailand with over 2,000 registered
diabetes patients. Most diabetes patients have been treated at
diabetes clinic which has 12 diabetologists and diabetes care
team. Medications deintensification had been defined as
reducing or discontinuing diabeticmedications in the previous
180 days after the index measurement of A1C. The survey
regarding glycemic target in oldest old patients and the factors
they take into consideration when setting their patients’
glycemic target had also been studied to understand the
attitudes toward these patients.
Results: There were 143 (5.0% of total diabetic patients) oldest
old diabetes patients who attended regularly during the study
period. Ten patients deceased from various medical illnesses.
Of the 133 active follow-up patients (median time of follow-up
15 years, range 1–30 years), 70.7% was female, and duration of
diabetes was 20.1 ± 11.1 years. The mean of A1C was 6.7 ± 1.1%.
Very low level of A1C (less than 6.0%), moderately low level of
A1C (6.0–6.4%), safe margin of A1C (6.5–8.0%) were found in
23.3%, 22.6%, 39.8%, respectively. Regarding diabetic treat-
ments, oral hypoglycemic agent (OHA) dual therapy was the
most common treatment (26.3%) followed by OHA monother-
apy (22.6%), insulin alone (19.5%), diet therapy alone (12.7%),
and insulin plus OHA (8.3%). Among patients whose received
diabetic medications and resulted in very low or moderately
low level of A1C (less than 6.4%), only 19.6% underwent
deintensification. The parameters “ co-morbidity” was consid-
ered to be the most important factor in setting glycemic target
while “disease duration” ranked the lowest.
Conclusions: Even though diabetologists recognized that
diabetes treatment should less aggressive for older patients
and thosewith limited life expectancy. Only less than one-fifth
of oldest old patients with stable, albeit low A1C levels
underwent medications deintensification. Quality-of-care
initiatives should consider how to encourage appropriate
deintensification in order to decrease the harm of intensive
treatment and increased cost of care.
PD-04
Better improvements of indicators of β-cell function and
insulin resistance with liraglutide compared to sitagliptin in
Chinese T2DM patients
Yu LIU1, Jianlin GENG2, Yong LUO3, Fang BIAN 4, Xiaofeng LV 5,
Jialin YANG6, Jun LIU7, Yongde PENG8, Yukun LI9, Weiwei XU10,
Yiming MU11*. 1The Second Hospital of Jilin University, 2Harrison
International Peace Hospital, 3 Chong Qing Three Gorges Central
Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65–S211 S92