Diabetes Research and Clinical Practice - Volume 120 - Supplement 1

PE-20

The relationship between type 2 diabetes and hearing

impairment

Hea Min YU

*, Kang Seo PARK

, Jae Min LEE

, Jun Hwa HONG

Division of Endocrinology and Metabolism, Department of Internal

Medicine, Research Institute of Clinical Medicine, Eulji University

Hospital, Korea

Object:

Recently, several studies have investigated the rela-

tionship between type 2 diabetes and hearing impairment, but

results were inconsistent. The objective of this study was to

identify the prevalence of hearing impairment and audiomet-

ric state of type 2 diabetes in the single center.

Methods:

A prospective survey was performed in 99 diabetic

patients who had attended the diabetic clinics in a Eulji

hospital between April 2015 and March 2016. The data

recorded included diabetic markers and results of pure-tone

audiometric tests at baseline and after 6 months of follow-up.

Audiometric thresholds for air-conduction stimuli in both ears

were established for frequencies at 500, 1,000, 2,000, and

4,000 Hz.

Results:

At baseline, 80.8% of patients had normal hearing on

both ears. 15.2% were mild hearing impairment, 3% were

moderate hearing impairment, and 1% were severe hearing

impairment, separately. After 6 months 18.4% were mild

hearing impairment and 1% were moderate to severe hearing

impairment on the right hearing. On the left hearing, 13.2%

were mild hearing impairment, 2% were moderate, and 1%

were severe.

Significant hearing improvement was shown on the left

hearing with comparing 16.4 dB at the baseline and 15.7 dB

after 6 months of follow-up (p = 0.024). However there was no

significant difference on the right hearing.

But, according to separate frequency, significant improvement

was shown on the right hearing at low and mid level

frequencies. The decibel was 11.7 dB at the baseline and

10.4 dB after 6 months (p = 0.005).

Conclusion:

The type 2 diabetes is strongly associated with

hearing impairment especially at low and mid level frequen-

cies. The most high risk factor of hearing impairment is age

and other several factors are ABI, total cholesterol, LDL

cholesterol.

PE-21

The effectiveness of multiplace chamber hyperbaric oxygen

therapy in treating refractory critical limb ischemia patients

complicated with diabetes mellitus

Sonoko KIRINOKI-ICHIKAWA

*, Gen TAKAGI

Yoshiaki KUBOTA

, Shuhei TARA

, Ikuyo TAKAGI

Masaaki MIYAMOTO

, Wataru SHIMIZU

Nippon Medical

School Hospital, Japan

Aim:

Angioplasty (e.g. peripheral artery bypass surgery and

endovascular therapy) plays the most important role in

treating refractory critical limb ischemia (CLI) in diabetes

patients, however, it still shows poor prognosis for below knee

ulcer lesions. We analyzed the effectiveness of multiplace

chamber hyperbaric oxygen therapy (HBOT) for angioplasty-

inapplicable, refractory CLI patients with diabetes.

Methods:

One hundred and nine consecutive angioplasty-

inapplicable refractory CLI patients

’

prognoses were retro-

spectively analyzed, comparing them for with or without

HBOT (53 patients with and 56 patients without). The end-

points were major leg amputation and death. The prognoses

relation to the presence or absence of autologous bonemarrow

cell implantation (BMCI) was also analyzed.

Results:

Average follow-up period was 9.1 years, average age

was 63.7 y.o., and 55% of patients were complicated with

diabetes. Overall survival rate was 74.5%, and limb salvage rate

was 72.5%. HBOT did not show effectiveness for improving

survival rate (p = 0.08, Log-Rank test), whereas it significantly

improved limb salvage rate (p < 0.01) in BMCI-treated patients.

Regarding BMCI-treated diabetic patients, HBOT combination

significantly improved limb salvage rate over that without

HBOT (p = 0.01, Log-Rank Test, p = 0.02, Mantel-Haenszel

analysis, odds = 0.3). On the other hand, HBOT-treated patients

had significantly better limb salvage rate (p = 0.01), but it made

no difference in survival rate (p = 0.1) in BMCI-inapplicable

patients. The same result was shown in BMCI-inapplicable

diabetic patients with or without HBOT (p = 0.01, Log-Rank

Test, p = 0.01, Mantel-Haenszel analysis, odds = 0.8). Diabetes

was one of the significant negative independent factors for

limb salvage in univariate analysis, however, a low-level of

albumin (cut off 3.15 mg/dL) was the independent factor for

poor prognosis in multivariate analysis (p = 0.04, odds = 0.04,

proportional hazards analysis).

Conclusions:

HBOT improved life expectancy in CLI patients

with diabetes, and it improved limb salvage rate in patients

who underwent combination HBOT and BMCI. HBOT showed a

tendency to improve even BMCI-inapplicable patients

’

(regard-

less of diabetic or not) survival rate when used as a last resort.

It is expected that HBOT together with BMCI can bring better

prognoses for angioplasty-inapplicable refractory CLI patients

with diabetes.

PE-22

High prevalence of early small fiber dysfunctions in patients

with type 2 diabetes detected by thermal thresholds of lower

extremities

Yi-Jing SHEEN

*, Wayne H.-H. SHEU

, Jiann-Liang LIN

Chuen-Der KAO

, Cho-Tsan BAU

Division of Endocrinology and

Metabolism, Department of Internal Medicine, Taichung Hospital,

Ministry of Health and Welfare,

Division of Endocrinology and

Metabolism, Department of Internal Medicine, Taichung Veterans

General Hospital,

Division of Neurology, Department of Internal

Medicine, Taichung Hospital, Ministry of Health andWelfare, Taiwan

Objectives:

Patients with type 2 diabetes are prone to devel-

oping peripheral neuropathy and peripheral arterial disease

(PAD) which might cause foot ulcerations and subsequent

amputations. Although toe-brachial index (TBI) is recom-

mended to detect PAD, diagnosis of early peripheral neur-

opathy, especially small fiber dysfunctions, are largely

undetermined.

Research Design and Methods:

We enrolled 725 (male/female:

372/353) patients with type 2 diabetes (mean ± SD: age, 67 ± 11

years) who received ankle-brachial index (ABI)/TBI/brachial-

ankle pulse wave velocity (ba-PWV) examinations, and the

quantitative sensory test for thermal (warm/cold) thresholds,

from January 2015 to December 2015. Those with a history of

apparent cardiovascular disease, arrhythmia, end-stage renal

disease, malignancy, amputation, and any diagnosed neur-

opathy of the lower limbs were excluded. The 2009 Chronic

Kidney Disease Epidemiology Collaboration creatinine equa-

tion was used to calculate estimated glomerular filtration rate

(eGFR), and albuminuria was measured by the urine albumin-

to-creatinine ratio.

Results:

A total of 539 (74.3%) study subjects had abnormal

thermal thresholds, with characteristics of older age, male sex,

higher systolic blood pressure, lower eGFR, proteinuria, lower

TBI values, and higher ba-PWV values, comparedwith patients

with normal cold or warm thresholds of the bilateral lower

limbs (all p < 0.05). Among patients with abnormal thermal

thresholds, 98% had a normal ABI, 84% had a normal TBI, 59%

had normal albuminuria levels, and 38% had relative optimal

glycemic control (hemoglobin A1c < 7%). In addition, all

patients with an abnormal ABI (n = 13) and 93% (87/94) of

patients with an abnormal TBI experienced abnormal cold or

warm thresholds of the lower extremities. After adjusting for

several confounding factors, age, male sex, and a low TBI

remained significantly associated with impaired thermal

thresholds.

Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65

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