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

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Chronic kidney disease (CKD) and carotid atherosclerosis are
well known to be risk factors for cardiovascular disease (CVD).
Recent studies have documented that carotid extra-media
thickness (EMT) is increased in patients with visceral obesity,
metabolic syndrome, and coronary artery disease (CAD).
However the clinical usefulness of EMT in relation to CVD is
not determined yet. We investigated associations of EMT
with intima-media thickness (IMT), pulsewave velocity (PWV),
and other surrogate markers for obesity and CVD in type 2
diabetic patients.
A total of 491 patients with type 2 diabetes were recruited.
Mean values of EMT and IMT were measured by using
ultrasound. Brachial-ankle PWV was assessed for arterial
stiffness. Anthropometric parameters including waist circum-
ference (WC), body fat, and appendicular skeletal muscle mass
were checked. Clinical and biochemical parameters for CVD
were assessed. Glomerular filtration rate (GFR) based on
creatinine (Cr) was estimated by using CKD-EPI equation. All
subjects were divided into three groups by GFR: GFR ≥ 90 mL/
min per 1.73 m 2 (n = 224), GFR 60–89 (n = 215), and GFR < 60
(n = 52).
Patients with GFR < 60 are more likely to be elderly and
hypertensive and have longer diabetic duration compared to
those with GFR ≥ 90. EMT, IMT, and PWV were significantly
greater in subjects with GFR < 60 than those with GFR ≥ 90.
(GFR ≥ 90 vs. GFR < 60: EMT = 726 ± 73 vs. 766 ± 94 μm, p < 0.01;
IMT = 675 ± 127 vs. 734 ± 160 μm, p < 0.01: PWV = 1535 ± 264 vs.
1901 ± 387 cm/sec, p < 0.001). EMT was positively correlated
with age, WC, Cr, and IMT and showed negative correlations
with HDL cholesterol and GFR. In multivariate regression
analysis, EMT was significantly associated with IMT, GFR, and
WC independent of age, gender, hypertension, documented
CAD, and HDL.
Carotid EMT was independently associated with IMT, GFR, and
WC in patients with type 2 diabetes. Further studies are
needed to explore a causal relationship between EMT and risk
factors for CVD.
PE-15
Evaluation of the potential nephroprotective effects of
metformin in diabetes – A systematic review
Kerry WILBUR1*, Kawthar AL TAWENGI 2. 1Qatar University
College of Pharmac, 2Heart Hospital, Qatar
Purpose: Nephropathy is an important sequelae of diabetes.
Current clinical study of the potential nephroprotective effects
of metformin in diabetes is small and outcomes of individual
studies insufficient to arrive at a firmconclusion. The objective
of this study is to evaluate the relationship between metfor-
min treatment and specific renal outcomes in patients with
type 2 diabetes mellitus (T2DM).
Methods: As part of a larger epidemiologic study of the
effects of metformin on renal outcomes among a diabetes
population in a Middle East country, we conducted a system-
atic review. Two authors independently performed compre-
hensive searches in relevant health care and conference
databases using pre-determined search terms. Included arti-
cles described metformin treatment arm compared to control
group(s) (active or otherwise) whereby baseline and follow-up
renal parameters of one or all of: (1) glomerular filtration rate
(GFR); (2) urinary albumin excretion (UAE); (3) albumin to
creatinine ratio (ACR); (4) other relevant renal outcome
described. Study year, population, design, duration, renal
outcome assessment method and outcome were extracted.
Authors independently assessed selected relevant articles
according to the Dow and Black framework and otherwise as
applicable according to the studies’ methodology.
Results: The initial search yielded 1,147 articles of which 6
meeting inclusion criteria and reporting sufficient renal
outcome data were included in the overall analysis totaling
98,193 subjects exposed to metformin. Most (n = 5) employed
prospective methodologies, with the 1 retrospective analysis
accounting for 62% of the evaluated patient population
(61,104). Comparators included thiazolidinediones (TZDs),
sulfonylureas (SUs), insulin, placebo, and lifestyle. Seven
different renal parameters were evaluated across the studies
over 12 weeks to 4 years. When change from baseline values is
compared, metformin demonstrated more pronounced
increase in albumin to creatinine ratio (ACR) than SUs (mean
difference [MD] 14.8 mg/g [−4.2 to 25] and TZDs (MD 18.8 mg/g
[18.5 to 19.1]). No significant difference in glomerular filtration
rate (eGFR) was observed between metformin and TZD (MD
0.22 mL/min [−0.24 to 0.68], while data between metformin
and SU was conflicting. Studies demonstrated that when
compared to SUs, metformin treatment preserved ACR and
GFR over time, but not when compared to TZDs.
Conclusion: Our analysis suggests that objective findings of
the potential nephroprotective effects of metformin are
lacking among well described epidemiological or prospective
clinical studies and further research is needed.
PE-16
The frequency of microalbuminuria in patients with newly
diagnosed type 2 diabetes mellitus in suburban population of
Jakarta, Indonesia
Ahmad Fariz Malvi Zamzam ZEIN1*, Nikko DARNINDRO 2.
1Department of Health, Central Board of Nahdlatul Ulama,
2Department of Internal Medicine, Cilincing Geneeral Hospital,
Indonesia
Background: Diabetic kidney disease (DKD) is the leading
cause of end-stage renal disease. It was reported that micro-
albuminuria has been associated with cardiovascular event,
with suboptimal compliance onmicroalbuminuriamonitoring
in patients with type 2 diabetes mellitus (T2DM). Yet, the
frequency of microalbuminuria in patients with T2DM in
suburban population is still unknown.
Method: The study was conducted in Cilincing General
Hospital, Jakarta, during Desember 2015 – February 2016.
The subjects were the patients who were referred from
primary health cares with clinically suspected for T2DM
during the study. Type 2 diabetes mellitus was diagnosed
according to Indonesian Society of Endocrinology guideline.
Albuminuria was assessed semi-quantitively using dipstick
test. Albuminuria was defined as any positive (1+, 2+, 3+, or 4+)
for dipstick results, and microalbuminuria was ranging from
1+ to 3+.
Result: There were 62 subjects in this study, mean age 59.58
years old (SD 8.77). Most of the subjects were female (75.80%).
The frequency of microalbuminuria in this study was 46.80%.
The mean initial fasting blood glucose in microalbuminuria
group were 262.28 + 98.24 mg/dL, higher than in non-micro-
albuminuria group (204.76 + 82.51 mg/dL). There were 15 sub-
jects (51.72%) in microalbuminuria group with eGFR (CKD-EPI)
<60 mL/min/1.73 m2, compared to 16 subjects (48.48%) in non-
microalbuminuria group. Of microalbuminuria group, 13
subjects (43.33%) were obese, 9 subjects (30.0%) were hyper-
tension, 1 subject (3.33%) was coronary heart disease, and 1
subject (3.33%) was tuberculosis.
Conclusion: The frequency of microalbuminuria in patients
with newly diagnosed T2DM in suburban population was
46.80%. Further investigation and monitor in association
between microalbuminuria and DKD are needed.
PE-17
Dyslipidemia in children with diabetes
Pei Kwee LIM1*, Rashida VASANWALA2, Tuck Seng CHENG2,
Ngee LEK2, Yuen Ching Angela HUI1, Soo Ting Joyce LIM1,
Fabian YAP2. 1Division of Nursing, Kk Women’s & Children’s
Hospital, 2Endocrine Service, Department of Paediatrics, KKWomen ’s
& Children’s Hospital, Singapore
Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65–S211 S135