Diabetes Research and Clinical Practice - Volume 120 - Supplement 1

by the local Research Ethics Committee and subjects gave

written informed consent.

Results:

Thirty-seven T2DM-Mets patients consisted of 15

(40.5%) males and 22 (59.5%) females who met inclusion and

exclusion criteria were enrolled in this study. Their mean of

age was 51 ± 5.2 years old, duration of illness was 16.49 ± 23.4

months, A1C level was 8.5 ± 0.9%, BMI was 26.7 ± 4.5 kg/m

ADMA level was 0.572 ± 0.2 μmol/L, TNF-a level was 10.0 ± 16.5

pg/mL, and ba-PWV was 1,624.5 ± 295.5 cm/s. Spearman

’

correlation analysis showed that ADMA level was significantly

correlated with TNF-a level (p = 0.026; r = 0.366). However, no

significant correlation found with ba-PWV (p = 0.134; r = 0.251).

Conclusion:

ADMA level is correlated with TNF-a level in this

T2DM-MetS population.

PE-56

Limb preservation affects survival for diabetic patients with

infectious foot gangrenes

Cheng-Wei LIN

, Shih-Yuan HUNG

, I-Wen CHEN

Hui-Mei YANG

, Yu-Yao HUANG

Chang Gung Memorial

Hospital Linkou Branch, Taiwan

Objective:

Infectious gangrene of foot is a medical emergency

for diabetic patients. Lower-extremity amputation (LEA) is

usually inevitable for in such circumstance. Nevertheless, the

survival and factors associated mortality of these patients has

not been understood.

Method:

A total of 157 type 2 diabetic patients treated for

infectious foot gangrenes at a major diabetic foot center in

Taiwan from 2002 to 2009 were enrolled. Prompt major LEA

(above the ankle) for life saving was found in 59 patients (major

LEA one-stage group). Among 98 patients received initial

minor LEA (below the ankle) to remove gangrene tissue, 67

subjects successfully healed (minor LEA group) while 31

subjects needed further major LEA (major LEA two-stage

group). After treatment, their survival was followed as of

December 2012. Clinical information at admission was used

for survival analysis.

Result:

One hundred and nine patients died, with a median

survival time of 3.12 years. Age [hazard ratio 1.037 (95% CI

1.010

–

1.066)], dialysis state [2.173 (1.029

–

4.585)] and major LEA

[1.957 (1.113

–

3.443)] were independent factors associated with

mortality.

Patients in minor LEA group had better median survival time

(5.5 years) when compared withmajor LEA one-stage and two-

stage groups (1.8 and 2.7 years, respectively). The survival

curves of major LEA one-stage and two-stage groups revealed

no difference (Log rank P: 0.368).

Abnormal ankle-brachial index (ABI, >1.4 or

≦

0.9) was the

independent risk for healing failure that lead to two-stage

major LEA (multi-variable regression analysis by adjusted with

age, smoker, hypertension, major adverse cardiac event, and

renal function).

Conclusion:

In diabetic patients with infectious foot gang-

renes, major LEA and dialysis state were the factors affect

survival. Limb preservation to keep amputation level below

the ankle has better survival. The abnormal ABI is the

independent factor leading to two-stage major LEA.

PE-57

TG/HDL-C ratio predicts development of albuminuria in type 2

diabetes with ACR <10 mg/gm. A prospective cohort study

Shyi-Jang SHIN

*, Kun-Der LIN

, Mei-Yueh LEE

Meng-Chuan HUANG

, Yi-Ching YANG

, Hung-Jen YANG

Tong-Yuan TAI

, Ken N KUO

, Chih-Cheng HSU

Kaohsiung

Medical University,

National Cheng Kung University,

Min Shen

General Hospital,

Taipei Jen Chi Relief Institution,

National Health

Research Institutes, Taiwan

Low normoalbuminuria (ACR < 10 mg/gm) is currently recog-

nized as near normal renal function in type 2 diabetes. We

hypothesized that TG/HDL-C ratio is the early biomarker to

predict the development of DKD for type 2 diabetes. We

enrolled 809 type 2 diabetic subjects with ACR < 30 mg/gm

between 2003 and 2005 and followed them through the end of

2012. Among them, 518 subjects had ACR < 10 mg/gm. The

average follow-up time was 6.2 years. The incidence rate ratio

and Cox proportional hazards model were used to evaluate the

association between baseline demographics and biochemical

variables and development of albuminuria in 518 subjects

with ACR < 10 mg/gm and 809 subjects with ACR < 30 mg/gm,

respectively. Among 809 subjects with ACR < 30 mg/gm, 390

entered in albuminuric stage while 205 subjects developed

albuminuria in 518 diabetes with ACR < 10 mg/gm. By using

Cox proportional hazards model, we found that education,

basal ACR and HOMA-IR in subjects with ACR < 30 mg/gm are

independent predictors for development of albuminuria,

whereas and education, basal ACR, and TG/HDL-C ratio are in

subjects with ACR < 10 mg/gm. Compared with those in the

lowest quartile of TG/HDH-C ratio, the multivariate HR for

those in the 2nd, 3rd, and highest quartiles were 1.08 (95% CI

0.66

–

1.79), 1.38 (0.85

–

2.24), and 1.71 (1.03

–

2.82), respectively

(trend test: P < 0.015) in diabetes p with ACR < 10 mg/gm.

According to the dose-response effects of TG/HDL-C ratio

shown in this prospective study, we conclude that TG/HDL-C

ratio could be an early predictor for development of albumin-

uria in type 2 diabetes.

PE-58

Specific responsibility team for vascular interventions in

diabetic foot decreases major lower limb amputation rate

Chih-min CHANG

, Zhong Zhi SHEN

, Shao-wen WENG

Jung-fu CHEN

Division of Endocrinology & Metabolism,

Kaohsiung Chang Gung Memorial Hospital, Taiwan

Objective:

In Kaohsiung Chang Gung Memorial Hospital

(KCGMH), patient with diabetic foot received treatment by an

intensive team care in internal medicine ward. The intensive

team was established by metabolic, plastic surgery, cardio-

vascular surgery and orthopedic specialist in 2005. And

another specific responsibility team for percutaneous trans-

luminal angioplasty (PTA) was also established by cardiologist

in 2011. This study aimed to assess the quality of diabetic foot

care provided in KCGMH before and after establishment of the

PTA team.

Method:

This was a retrospective review of data from 2013 to

2015 and in 2009 at Kaohsiung Chang Gung Memorial Hospital.

Patient who had been diagnosed with diabetic foot ulcer

during the study period were included. We collected the

comorbidities, chronic complications and interventions to

compare the differences of the major lower limb amputation

rate before and after establishment of the specific responsi-

bility PTA team.

Result:

In total, 428 patients with T2DM underwent diabetic

foot treatment at the KCGMH during the study period. When

comparing to the patients distribution in 2009, the rate of

comorbidities, including cerebral vascular accident, coronary

artery disease, end stage renal disease, hypertension, dyslipi-

demia are significantly higher in 2013 to 2015. The rate of

peripheral artery occlusive disease and people received

percutaneous transluminal angioplasty (PTA) in 2013 to 2015

are also significantly higher (29.0% vs. 7.6%, p < 0.001).

Furthermore, the rates of major lower limb amputation are

lower after the intervention of specific responsibility PTA team

(15.8% vs. 19.8%) and patients receiving PTA had significantly

lower amputation rates during this period (10.1% vs. 19.8%,

p = 0.026).

Conclusion:

This study suggests that the specific team of PTA

by cardiologist improves the major lower limb amputation rate

in patients with diabetic foot, even with more comorbidities

and chronic complications.

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

–

S211

S148