The CVOT Summit is an annual gathering and discussion forum held in Munich, Germany, and broadcast online. Its primary focus is on the data released annually from cardiovascular, kidney, and metabolic outcomes trials, and it showcases the latest treatment innovations in the areas of diabetes, obesity, CVD, CKD, nonalcoholic fatty liver disease (NAFLD); metabolic dysfunction associated steatotic liver disease, MASLD) and NASH (MASH).
Oral Presentations (OP)
OP 01: Micro- and Macroangiopathy Related to Diabetes: Beyond HbA1c, Should We Rely on New Glucose Metrics?
Bruno Guerci, Michaël Joubert; Nancy, France
Background and Aims: Clinical studies undeniably link chronic hyperglycemia, most accurately reflected by HbA1c, with the risk of developing diabetes-related complications, particularly microangiopathy (retinopathy, nephropathy, neuropathy). Beyond HbA1c, can and should new glucose metrics from continuous glucose monitoring (CGM) be relied upon, given the absence of interventional studies demonstrating that targeting time in range (TIR) and in tight range (TITR), reducing time spent in hyperglycemia and/or hypoglycemia based on CGM data, leads to a reduction in diabetes-related micro- and macrovascular complications?
Materials and Methods: Partial or retrospective association data provide some initial insight into this question. A first prospective observational cohort study conducted in Belgium among 515 adults with type 1 diabetes (T1D) treated with insulin pumps highlighted a relationship between the prevalence of diabetic complications and TIR (70-180 mg/dL). The duration of diabetes and TIR were independent risk factors for developing multiple microvascular complications. In another Portuguese observational study involving 161 subjects with T1D, microvascular complications were more strongly associated with TIR than with HbA1c, regardless of the adjustment models. An older study analyzed 3,262 patients with type 2 diabetes (T2D) with an overall prevalence of diabetic retinopathy (DR) of 23.9% and found a relationship between TIR and all stages of DR (mild, p=0.018; moderate, p=0.014; severe, p=0.019) after adjustment for age, sex, BMI, duration of diabetes, blood pressure, lipid profile, and HbA1c. Other studies conducted in T2D patients using professional CGM performed over 3-6 days or extended periods found an association between TIR and carotid intima-media thickness. TIR is also significantly and independently associated with lower extremity arterial disease or an increased risk of all-cause mortality and cardiovascular diseases. A lower TIR is also associated with more severe symptoms of diabetic peripheral neuropathy (DPN), and a 10% increase in TIR is significantly and inversely correlated with the severity of cardiac autonomic neuropathy. In addition, the prevalence of microvascular complications and macrovascular complications according to sensor-measured TITR/TIR was analyzed cross-sectionally in 808 patients with T1D.
Results: Each 10% increase in TITR (70-140 mg/dL) was independently associated with a lower incidence of any microvascular complication (OR=0.76; p<0.001), background and severe DR (OR=0.76-0.85; p<0.001-0.048, respectively), diabetic nephropathy (OR=0.80; p<0.001), DPN (OR=0.84; p=0.026) and cerebrovascular event (OR=0.65; p=0.010), and persisted after adjustment for HbA1c. CGM data on intra- and inter-day glucose variability are also significantly associated with the severity of DR and the presence of albuminuria, even after adjustment for numerous risk factors for these complications.
Conclusion: In conclusion, TIR and TITR are strongly associated with the risk of diabetes-related microvascular complications, while data on the relationship between novel glucose metrics and cardiovascular pathologies are based solely on the occurrence of intermediate or surrogate endpoints. These findings further substantiate the use of MCG in clinical practice as key measures in glycemic management and as evaluation criteria in interventional trials on clinical outcomes in both T1D and T2D.
OP 02: The Impairment of Myocardial Structure in Patients with Type 2 Diabetes Mellitus without Cardiovascular Disease
Ivanna Zubovych, Yevhen Marushko, Yanina Saienko, Oleksandr Halchenko, Danylo Vebs, Borys Mankovsky; Kyiv, Ukraine
Background and Aims: There is a growing body of evidence suggesting a high prevalence of diabetic cardiomyopathy (DM-CMP), which is characterized by gradual myocardial structural remodeling and functional deterioration in patients with diabetes mellitus (DM) in the absence of evident underlying factors such as coronary artery disease, valvular pathology, or others. However, the diagnostics of DM-CMP and its pathogenesis are not well established.The aim of this study was to evaluate cardiac extracellular volume (ECV) and systolic function in patients with type 2 diabetes without known cardiovascular disease.
Materials and Methods: We enrolled 26 patients with type 2 DM and no previously known cardiovascular disease: 19 males and 7 females, aged 60.5 ± 10.2 years (data are presented as mean ± SD) with a BMI of 32.7 ± 6.4 kg/m², an HbA1c of 7.5 ± 1.6%, and a duration of diabetes of 4.1 ± 3.5 years. The control group included 15 healthy subjects (9 males and 6 females), aged 58.2 ± 10.7 years with a BMI of 30.2 ± 5.7 kg/m², and an HbA1c of 5.0 ± 1.9%. ECV was assessed by magnetic resonance imaging of the heart by a 3T MR scanner. The evaluation of segmental myocardial contractility was performed by global longitudinal strain (GLS) during stress echocardiography in a 17-segment scheme (in longitudinal parasternal, four-, and two-chamber projections). The statistical analysis was performed by ANOVA test.Results: Subjects in both groups did not differ by the left ventricle ejection fraction assessed by MRI in patients with diabetes and the control group (59.8 ± 8.3% vs 59.4 ± 6.3%; p<0.05). The mean value of NT-proBNP in patients with diabetes was 74.6 ± 39.8 pg/ml, which was in line with the absence of clinical signs of heart failure. We found that ECV in patients with diabetes was significantly higher than in controls (36,7 ± 6.0% vs. 27.5 ± 3.4%; p<0.001). The mean value of GLS of the left ventricle in patients with diabetes was higher compared to the control group (-16.1 ± 2.2% vs. -18.6 ± 2.5%; p<0.01). The correlation analysis showed a strong positive association between the duration of diabetes on the one side, and ECV (r=0.73, p<0.05), and GLS of the left ventricle (r=0.61, p<0.05) on the other side. Also, there was a strong association between HbA1c and ECV (r=0.80, p<0.05) and between HbA1c and GLS of the left ventricle (r=0.67, p<0.05).
Conclusion: We found that patients with type 2 DM had significantly increased ECV and GLS values compared to the control group, which may indicate the development of diabetic cardiomyopathy. The longer duration of diabetes and worse metabolic control play a role in the pathogenesis of the revealed abnormalities of the myocardium. The subclinical systolic myocardial dysfunction found in patients with type 2 diabetes mellitus without cardiovascular disease could be considered a sign of diabetic cardiomyopathy.
OP 03: Characterizing the Healthcare Resource Use and Costs for Patients Aged 65-89 Years with Laboratory Evidence of CKD With and Without a Recorded Diagnosis
Jieling Chen, Salvatore Barone, Eric Wittbrodt; Gaithersburg, USA
Background and Aims: In the United States (US), as many as 9 in 10 individuals with chronic kidney disease (CKD) lack awareness of their condition. Despite being undiagnosed, patients may continue to access healthcare services to manage symptoms, complications, and comorbidities of underlying CKD outside of guideline-directed medical therapy (GDMT) for CKD. However, there is little evidence on how the resource burdens of patients with undiagnosed CKD compare to those that are diagnosed, which can impede healthcare decision making. This retrospective observational study characterized the healthcare resource use (HCRU) and associated costs for patients with versus without a recorded diagnosis for CKD, among Humana Medicare Advantage (MA) members in the US with laboratory evidence of CKD.
Materials and Methods: Integrated administrative claims and laboratory results data from MA members was used. Patients 65-89 years old at index date with two consecutive laboratory measurements indicative of stage 3a or 3b CKD recorded 90-270 days apart from 2017-2019 were included for analysis. The HCRU and healthcare costs for patients with and without a recorded CKD diagnosis were compared.
Results: A total of 173,447 and 82,161 patients with and without a recorded stage 3 CKD diagnosis, respectively, were included in the analysis. Patients without a recorded CKD diagnosis had 91.6% (1.3/1.4) and 91.4% (1.4/1.5) of mean annual hospitalizations for stage 3a and 3b, respectively, compared to those with a recorded diagnosis. For mean annual emergency department visits, the relative burden of patients without a recorded diagnosis was 91.3% (2.4/2.6) [3a] and 89.5% (2.6/2.9) [3b]. Additionally, patients without a recorded CKD diagnosis had an 85.0% (8.6/10.2) [3a] and 80.9% (8.8/10.9) [3b] relative burden for mean annual physician office visits. Furthermore, patients without a recorded CKD diagnosis had 86.1% ($3,029/$3,517) [3a] and 78.1% ($3,356/$4,299) [3b] in median annual medical costs, and 81.4% ($842/$1,035) [3a] and 68.7% ($977/$1,422) [3b] in median annual pharmacy costs, compared to those with a recorded diagnosis.
Conclusion: Patients exhibiting laboratory evidence of stage 3 CKD without a recorded CKD diagnosis experienced high HCRU and associated costs. These results demonstrate the importance of monitoring and recording a diagnosis after biochemical confirmation of CKD and promptly initiating GDMT to mitigate disease progression. Regardless of recorded diagnosis status, stage 3 CKD patients incur high HCRU and costs which should be considered in future CKD economic models.
Grant/Support Information: The authors are employees of AstraZeneca.
OP 04: Improvement of Health-Related Quality of Life after Bariatric Surgery in Patients with Severe Obesity and Type 2 Diabetes
Tamar Shervashidze, Rusudan Kvanchakhadze, David Abuladze, Liana Jashi Miranda Shervashidze, Khatuna Chakvetadze; Tbilisi, Georgia
Background and Aims: Over the past few decades, obesity has become the most common preventable metabolic disease. The main cause of obesity is a long-term imbalance between energy consumption and expenditure. Obesity is associated with an increased risk of type 2 diabetes, cardiovascular disease, certain cancers, depression, reduced quality of life, and premature death. People with severe and complex obesity suffer from social stigma and discrimination related to their weight which is in turn associated with negative physical and psychological outcomes. Bariatric surgery is the most frequently used and effective intervention for the treatment of obesity, which is accompanied by improvements in metabolic disorders and comorbidities.
Materials and Methods: We examined 30 patients with severe obesity and type 2 diabetes who underwent bariatric surgery 2 years earlier. 16 patients were female (mean age 38 ± 3 years) and 14 patients were male (mean age 40 ± 3 years). The average body mass index (BMI) in females was 37.8 kg/m², and the average BMI In males was 42 kg/m². Physical activity, glucose control, and Health-Related Quality of Life (HRQOL) were assessed according to the "Healthy Days Measures" questions from the Centers for Disease Control and Prevention (CDC).
Results: HbA1c level decreased from 8.2 ± 1.2 % to 6.5 ± 1.3% in male patients after 2 years. HbA1c level in female patients decreased from 7.9 ± 1.2% to 5.7 ± 1.1%. A marked decrease in BMI from 41.5 ± 2 kg/m² to 32.8 ± 1.8 was documented after bariatric surgery in males. In females the decrease was from 37.8 ± 2 kg/m² to 27.8 ± 1.2 kg/m². Healthy days estimate the number of recent days when a person’s physical and mental health was good (or better) and is calculated by subtracting the number of unhealthy days from 30 days. Healthy days were equally improved in the group of women and men. Tolerance and desire for physical activity also increased.
Conclusion: Bariatric surgery significantly reduces BMI in patients with obesity and T2D. Patients regained their desire to live, desire to appear in society, increased their self-esteem, and decreased rates of anxiety and depression. Post-treatment improvement in the patient’s HRQOL should not only be considered as an additional effect of bariatric surgery, but also as an important determinant of continued adherence to physician recommendations.
OP 05: Aldosterone Synthase Inhibitor Vicadrostat (BI 690517) ± Empagliflozin in a CKD Phase II Trial: Effects on Albuminuria and SBP in Patients with/without T2D
Peter Rossing, Sibylle J Hauske, Lisa Cronin, Hiddo J L Heerspink, Juliane Meyerhoff, Bo Ji, Shimoli V Shah, Zhichao Sun, Dick de Zeeuw, Katherine R Tuttle, on behalf of the ASi in CKD group; Copenhagen, Denmark
Background and Aims: Vicadrostat (BI 690517) is a highly selective aldosterone synthase inhibitor (ASi) in clinical development for the treatment of CKD and heart failure. This multinational, randomised, dose-finding, phase II trial (NCT05182840) investigated the efficacy and safety of ASi, given alone or in combination with the SGLT2 inhibitor empagliflozin in addition to standard of care with renin-angiotensin system inhibitor (RASi) in people who had CKD. Herein, we present the primary findings along with secondary analyses by T2D status.
Materials and Methods: Adults with CKD receiving maximally tolerated doses of RASi were randomised (R1) 1:1 to receive background empagliflozin 10 mg or placebo (PBOEMPA) during an 8-week run-in, then re-randomised (R2) 1:1:1:1 to receive ASi (3 mg, 10 mg, or 20 mg) or PBOASI for 14 weeks. The primary endpoint was change in urine albumin:creatinine ratio (UACR) from R2 (baseline) to Week 14. UACR response (≥30% reduction), changes in systolic blood pressure (SBP), and safety outcomes were also assessed from R2 to Week 14. Subgroup analyses were performed by T2D status.
Results: Of 586 participants randomised at R2 (33% female, mean age 63.8 y), 414 (71%) had T2D. Baseline demographic and clinical characteristics of the overall population were mostly similar across ASi dose groups; however, those with T2D had higher mean BMI, SBP, and eGFR, and higher median UACR, than those without T2D.In the overall population, UACR change [95% CI] from baseline to Week 14 was –3% [–19 to 17] with PBOASI, vs –22% [–36 to –7], –39% [–50 to –26], and –37% [–49 to –22] in the ASi 3 mg, 10 mg, and 20 mg monotherapy groups, respectively, with similar absolute reductions when added on top of background empagliflozin. These reductions in UACR with ASi versus PBOASI were consistent in participants with and without T2D (PINTERACTION=0.38). Response rates based on ≥30% UACR reduction with ASi were more pronounced when added to empagliflozin:51% (31/61) and 70% (42/60) by ASi 10 mg monotherapy or with background empagliflozin, respectively. ASi consistently reduced SBP, with greater reductions observed when given on top of empagliflozin (PBO-corrected change (95% CI) with ASi 10mg monotherapy –1.8 mmHg [–8.1 to 4.5] vs –7.8 mmHg [–13.7 to –1.9] with background empagliflozin). Treatment with ASi was generally well tolerated and raised no unexpected safety signals.
Conclusion: In people with CKD, ASi dose-dependently reduced albuminuria when given with or without empagliflozin, with more pronounced effects on UACR response rates and SBP when ASi was given in combination with empagliflozin. Moreover, meaningful reductions in UACR were consistent in people with or without T2D. ASi represent a novel class of treatment for CKD that, combined with empagliflozin, will be further tested in a phase III trial in CKD (EASi-KIDNEY™, NCT06531824).
Grant/Support Information: The study was supported and funded by Boehringer Ingelheim.
OP 06: Endothelial Dysfunction and Cardiovascular Pathology in Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease
Kateryna Pivtorak, O Ivanchuk, T Shevchuk, I Fedzhaga, N Pivtorak, N Shevchuk; Vinnytsia, Ukraine
Background and Aims: The most common type of chronic liver diseases is metabolic dysfunction-associated steatotic liver disease (MASLD). It is closely linked to obesity, insulin resistance and cardiovascular pathology. The aim of this study was to evaluate the relationship between markers of endothelial dysfunction, insulin resistance, adipokines, and cholesterol level in patients with MASLD.
Materials and Methods: 246 patients with MASLD were examined. We determined the level of inflammatory mediators, endothelin (ET-1), von Willebrand factor (vWF) activity, the thickness of the intima-media complex, presence of atherosclerotic plaques and stenosis in the carotid arteries, as well as index HOMA-IR. The ratio between the content of adiponectin and leptin was represented as log A/L. Furthermore, an anthropometric survey and measurements of aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), the degree of liver fibrosis using elastography (FibroScan), ECG and echocardiography were conducted.
Results: Correlation analysis revealed a direct correlation between HOMA-IR and leptin (r=0.8; p=0.0017) and an inverse correlation between HOMA-IR and adiponectin (r=-0.66; p=0.0033) and index log A/L (r=-0.71; p=0.00001). It is evident that the decrease in the concentration of adiponectin with a parallel increase in the content of leptin is correlated with increased insulin resistance. A comparative analysis of the level of hsCRP inflammation markers in obese patients showed a direct relationship with HOMA-IR (r=0.58; p=0.05), glucose (r=0.44; p=0.0045) and insulin (r=0.66; p=0.0001) in the blood. The patients with MASLD and obesity showed a reduction in endothelium-dependent vasodilation, indicating the presence of endothelial dysfunction. The concentration of proinflammatory cytokines such as TNF-α and IL-6 in patients with MASLD was 3-7 times higher than in patients with a similar degree of obesity but without evidence of MASLD. The concentration of ET-1 in the blood plasma of patients with MASLD has a strong direct correlation with the degree of cardiovascular risk and cognitive deficit in surveyed patients. It was found that many inflammatory mediators (TNF-α, IL-1, IL-6) and markers (C-reactive protein, fibrinogen) highly correlate with the degree of obesity, the concentration of ET-1, vWF and markers of insulin resistance as a predictor for cardiovascular risk.
Conclusion: The development of MASLD is associated with the development of endothelial dysfunction, increasing levels of leptin, and decreasing levels of adiponectin in patients with MASLD.
OP 07: Consistency in Glucose Monitoring, Consistency in Care: Standardizing CGM Evaluation for Better Patient Outcomes
Guido Freckmann, Stefan Pleus, Manuel Eichenlaub, Delia Waldenmaier, Stephanie Wehrstedt, Manuela Link, Cornelia Haug; Ulm, Germany
Background and Aims: The advent of continuous glucose monitoring (CGM) systems marks a substantial advance in the management of diabetes. However, studies utilizing different CGM systems in parallel, have documented considerable discrepancies in CGM-based metrics such as time in range, glucose management indicator, and glycemic variability within the same patient. This may result in inconsistencies in data interpretation and clinical decision-making, emphasizing the critical need for standardization of CGM systems.
Materials and Methods: The discrepancy in measurement results between CGM systems can be attributed to a number of factors, including the diverse algorithms, sensor technologies, and approaches to calibration employed by each system. While standardizing the technologies themselves is not a viable option, establishing a standardized approach to the evaluation of CGM performance defining mandatory procedures and minimum acceptance criteria will enhance the comparability of CGM systems by defining a common target. The working group on CGM (WG-CGM) established by the International Federation of Clinical Chemistry and Laboratory Medicine is currently engaged in this endeavor.
Results: The WG-CGM identified three principal areas for standardization in CGM performance studies: (1) the distribution of reference glucose values and rates of change to be generated during testing, (2) the sample type used for reference measurements and (3) the reference measurement procedure. In regard to the first point, the WG-CGM suggests a transparent distribution that encompasses all clinically pertinent scenarios during testing. The possible sample types are capillary, venous and arterialized venous blood. All samples have their respective advantages and disadvantages; however capillary samples are recommended. The reference measurement procedure should ensure traceability and accuracy of the used reference device. In addition, reporting of results should be standardized to allow comparison and interpretation.Conclusion: By establishing a common foundation for CGM performance evaluation and reporting, including standardized reference procedures, manufacturers will be encouraged to align CGM readings better, as they are aiming for the same target. As a result, CGM systems will become more comparable, ultimately leading to consistent treatment adjustments across systems. Similarly, the standardization of HbA1c measurement a few years ago has achieved harmonization of results among different analyzers.
Grant/Support Information: This work was supported by the Diabetes Center Berne, Switzerland.
OP 08: Age is No Barrier to Diabetes Technology: Improvements in Glycemia in Older People with Type 2 Diabetes Mirror Engagement Levels with the OneTouch Reveal® Mobile Diabetes Management App
Elizabeth Holt, Stuart Phillips, Mike Grady ; Malvern, PA, USA
Background and Aims: Despite an increasing number of older people with type 2 diabetes (PwT2D), the majority of reports and studies evaluating diabetes-related technology do not focus on this population. While technology can ease the burden of self-care and provide a sense of security in older adults, age-related comorbidities, especially cognitive and physical decline, may present barriers to its effective use. The OneTouch Verio (OTV) Flex® blood glucose meter (BGM) provides a color range indicator and the OTV Reflect® BGM provides a dynamic color range indicator and Blood Sugar Mentor® feature. Both BGMs are complemented by connectivity to the OneTouch Reveal® (OTR) app. We sought to provide real-world evidence that these systems foster improvements in diabetes management in older PwT2D without raising exposure to hypoglycemia.
Materials and Methods: Anonymized glucose and app analytics were extracted from the LifeScan server for 133,817 PwT2D (78,167 <65 and 55,650 ≥65 years of age). Data from their first 14 days using the OTR app with either the OTV Flex or the OTV Reflect BGM was compared to the 14 days prior to a 6-month timepoint using paired within-subject differences.
Results: Glucose readings in-range (RIR, 70-180 mg/dl) in PwT2D performing >1 app session per week improved by +11.6 percentage points (%pts) at 6 months (to 75.7% from a baseline of 64.2%) in those <65 compared to +7.2 %pts (to 75.5% from a higher baseline of 68.2%) in those ≥65 years of age. Engaging in more app sessions (or time spent on the app) per week steadily improved RIR, with those performing >10 app sessions per week improving by +18.5 %pts in those <65 and by +11.2 %pts in those ≥65 years of age (see Fig 1). The majority of users were highly engaged with the app, with 60.4% of those <65 and 62.9% of those ≥65 performing >4 app sessions every week on average over the 6 months. In terms of time spent in app sessions, 50.0% of those <65 and 52.8% of those ≥65 spent >20 minutes viewing app insights each week over 6 months. Importantly, improvements in RIR with higher app engagement did not come at the expense of clinically meaningful or increased levels of hypoglycemic readings (<70 mg/dL) in older or younger people. Improvements in mean blood glucose (BG) mirrored trends of increasing app engagement. Those <65 years who performed >2 to 4 app sessions per week lowered mean BG by -25.5 mg/dL (169.3 to 143.7 mg/dL) at 6 months compared to -13.2 mg/dL (159.1 to 145.9 mg/dL) for those ≥65 years of age. The frequency of BG checking in each category of app engagement was similar in older and younger PwT2D, ranging from 2.3 to 2.8 checks per day in those <65 performing <1 up to >10 sessions per day and from 2.4 to 2.5 per day in those ≥ 65 years of age, without an increase in check frequency over time.
Conclusion: Real-world evidence confirmed older people with diabetes are highly engaged with the OneTouch Reveal® diabetes management app, attaining meaningful improvements in readings in range without increasing hypoglycemic readings.
Grant/Support Information: The study data collection, analysis and abstract creation were funded by LifeScan Inc.Population-wide screening for cardiovascular, renal and metabolic risk
Population-wide screening for cardiovascular, renal and metabolic risk
P 01: Lifestyle-Related and Metabolic Diseases in Children and Adolescents in Haryana: Our Experience
Simmi Kharb, Anjali Verma; Rohtak, India
Background and Aims: The prevalence of lifestyle-related and metabolic diseases in children and adolescents is rising globally, with India, including the state of Haryana, witnessing significant increases due to rapid lifestyle changes. The objectives of this study were: (1) to determine the prevalence of endocrine disorders among pediatric patients visiting the endocrine clinic in our hospital; (2) to differentiate the spectrum of disorders by gender and age group; and (3) to evaluate the impact of associated disorders and major risk factors in the pediatric age group.This study aimed to provide an overview of lifestyle and metabolic diseasesin children and adolescents in Haryana, drawing on clinical experience and regional data to highlight key trends, challenges, and potential interventions.
Materials and Methods: The study is based on a retrospective analysis of clinical data collected from pediatric and adolescent patients presenting with lifestyle and metabolic disorders at the Lifestyle and Metabolic Research clinic run by a Multidisciplinary Research Unit, Paediatrics Department of PGIMS, Rohtak, Haryana, over the past five years. Patients were enrolled from 2019 to 2024 under the Lifestyle and Metabolic Research Clinic, and data on age, gender, socioeconomic status, anthropometric indices, clinical features, investigations, diagnosis, and outcomes were extracted.
Results: The analysis revealed a rising incidence of obesity, Type 2 diabetes mellitus (T2DM), dyslipidemia, hypertension, short stature and hypothyroidism among children and adolescents in Haryana, driven by unhealthy dietary habits, physical inactivity, increased screen time, and socio-economic factors.
Conclusion: The increasing prevalence of lifestyle and metabolic diseases in Haryana’s youth is alarming, necessitating urgent public health interventions, early identification, lifestyle modification programs, and community-based initiatives to curb this trend and promote healthier habits.
P 02: Screening for Chronic Kidney Disease among Algerian Young Adults: a Pilot Study
Adel Gouri, C Hakimi, MM Mimouni, S Chine, A Dekaken, S Banharkat; Annaba, Algeria
Background and Aims: Renal failure has emerged as a major public health issue in Algeria. The rising prevalence is partly due to the lack of early detection of the preclinical stages of the disease and the associated risk factors. This pilot study was conducted to determine the prevalence of chronic kidney disease and its associated risk factors among Algerian young adults.
Materials and Methods: This was a cross-sectional analytical study conducted in 150 young subjects. Participants were screened for urinary protein using the morning protein-to-creatinine ratio (PCR) and urine dipsticks. Serum creatinine, fasting glucose, urea, and uric acid levels were determined, while the glomerular filtration rate (GFR) was estimated using the 4-variable MDRD formula based on serum creatinine.
Results: The mean age of the studied population was 23.8 ± 3.0 years. Hypertension was observed in 4% of the study participants, while 14% had hyperglycemia. The prevalence of overweight and obesity was 25.33% and 11.33%, respectively. The prevalence of chronic kidney disease (CKD) was 12.67%. Age, female gender, BMI, waist circumference, smoking, and a family history of hypertension were identified as predictive factors for chronic kidney disease in this study.
Conclusion: The prevalence of kidney disease and associated risk factors is high in the young Algerian population. These findings support the need for early screening and appropriate management of the main risk factors.
P 03: Ensuring Heart Health in Young Athletes: Findings from a Screening Study in Batumi (Georgia)
Miranda Shervashidze, Ana Chikhradze, Tamar Bakhtadze, Khatia Dolidze; Batumi, Georgia
Background and Aims: Sports offer significant benefits for children and adolescents, including discipline, teamwork, and physical health. However, it’s essential to ensure that physical activity is safe, especially in preventing sudden cardiac death (SCD). Sudden cardiac arrest in young athletes is a rare but serious event. While there is no specific data for Georgia, about 100 cases occur annually in high school athletes in the US. The incidence in US athletes is estimated at 1:200,000, with primary causes being heart rhythm disorders like prolonged QT syndrome, Brugada syndrome, and hypertrophic cardiomyopathy (HCM). Ensuring safety involves assessing both heart rhythm and anatomy, as well as identifying asymptomatic cardiovascular conditions that could pose risks during sports activities.
Materials and Methods: We conducted a retrospective study of 252 athletes aged 6 to 17, performing echocardiographic assessments and 12-lead ECG monitoring. Participants were divided by age group and sport, with the majority being football players (167), followed by rugby (35), basketball (20), tennis (16), judo (6), gymnastics (5), and skating (3). Most athletes showed no symptoms of heart disease, but screening focused on identifying undiagnosed conditions. Out of 252 athletes, 25 (9.9%) had underlying cardiovascular diseases, and body mass index (BMI) issues were identified in rugby and judo players.
Results: Our screening detected a variety of heart conditions, including mitral valve prolapse (10 cases), mitral regurgitation (7), atrial septal defect (4), aortic valve insufficiency (2), hypertrophic cardiomyopathy (1), and Wolff-Parkinson-White syndrome (1). Notably, two athletes required lifestyle changes to prevent sudden cardiac death. One with WPW syndrome underwent successful ablation and resumed sports, while the athlete with HCM was advised to limit competitive activity and undergo regular check-ups.
Conclusion: Early detection of asymptomatic cardiovascular diseases through regular heart screenings can significantly reduce the risk of sudden cardiac death in young athletes. Although screening cannot prevent all cases, it plays a critical role in minimizing risk and ensuring safer participation in sports. Regular evaluations, especially for high-risk individuals, are vital for long-term heart health.
P 04: Evaluation of Urinary Measurement of TSH and Free Thyroxine (FT4) in the Assessment of Thyroid Function: a Pilot Study
Younes Benchaar, A Gouri, W Taayat, MC Rahim, R Laskri, S Benharkat; Annaba, Algeria
Background and Aims: Thyroid function tests remain one of the most frequently requested endocrine examinations in clinical practice. However, repeated blood sampling for these tests can be invasive and sometimes uncomfortable for patients. Therefore, the assessment of thyroid hormones in urine could represent a promising alternative. The main objective of this study was to analyse the correlation between thyroid hormone levels measured in serum and urine in apparently euthyroid subjects.
Materials and Methods: This study was conducted on a sample of 43 presumably healthy and euthyroid subjects recruited between December 2023 and May 2024 at the Laboratory of Clinical Biochemistry, Ibn Rochd University Hospital, Annaba, Algeria. Thyroxine (T4) and thyroid stimulating hormone (TSH) levels were measured in the blood and urine of the participants. The assays were performed by immunometric methods, using a sandwich-type method for TSH and an immuno-competition method for T4, conducted on the Roche E411 automated system.
Results: The mean age of the participants was 25.0 years (range 19-35 years), with a female predominance of 66%. The mean concentration of thyroid-stimulating hormone (TSH) was 2.08 ± 0.84 mIU/L in serum and 601 ± 0.3 mIU/L in urine, while that of free thyroxine (FT4) was 13.70 ± 1.55 pmol/L in serum and 602 ± 115.8 pmol/g of albuminuria. A weak, non-significant positive correlation was observed between blood and urine FT4 concentrations (r=0.25, p=0.14), whereas a significant positive correlation was found between blood and urine TSH concentrations (r=0.34, p=0.038).
Conclusion: These findings suggest that urinary TSH measurement may serve as a reliable non-invasive alternative for assessing thyroid function. However, further research is needed to improve the reliability of urinary FT4 measurements in subjects with thyroid disorders.
P 05: Characteristics of Older Adults with Diabetes and an Insufficient Level of Physical Activity
Younes Benchaar, A Gouri, W Taayat, MC Rahim, R Laskri, S Benharkat; Annaba, Algeria
Background and Aims: Physical Activity (PA) plays an important role in the treatment of diabetes (DM), but older adults may face challenges in maintaining it at an appropriate level. Therefore, the coexistence of these two variables—advanced age and diabetes—poses a special challenge for the practicing physician, who should assist their patients in maintaining a ‘sufficient’ level of PA. The greatest challenge, due to the often short duration of visits and the lack of quick tests to assess PA levels in this population, is identifying individuals whose PA level is insufficient. The aim of the study was to identify variables that would allow to identify a senior patient most likely to have insufficient PA.
Materials and Methods: Patients over 64 years old with DM from one diabetes center were surveyed (January-June 2024) using the International Physical Activity Questionnaire (IPAQ) to assess PA level and the Accompanying Survey (AS), which included epidemiological (diseases) and demographic data (age, gender, education, etc.), and questions about daily barriers to engaging in PA. The exclusion criterion was the inability to complete the questionnaires or difficulties outlined in the original IPAQ document. The correlations between the most significant selected variables were initially assessed using generalized principal component analysis (PCA). This model was estimated using the NIPALS iterative algorithm. The convergence criterion was set at 0.00001, with the maximum number of iterations equal to 50. The number of components was determined through the maximum predictive ability of Q^2 using the V-fold cross-check method. The resulting optimal PCA model was reduced to 2 principal components. Correlations between the IPAQ variable, categorized into a dichotomous variable, and the results of the AS were analyzed using the meta-analysis model for the effects of the variables, using the OR with a 95% CI.
Results: Data from 156 individuals was analyzed (women 65,4%). The median age was 72 years (range: 65–83) and BMI was 28.7 kg/m² (range: 18.6–49.7). The PCA grouped data from basic descriptives related to the value of insufficient (IPAQ=0) and et least sufficient (IPAQ= 1 or 2) level of PA. The variables most strongly associated with insufficient PA levels were: female sex, age >75 years, BMI >33, being single, and living with no more than one person. The meta-analysis did not reveal any diseases more or less associated with achieving a score of 0 in the IPAQ.
Conclusion: We identified characteristics of older adults with DM who are highly likely to have an insufficient level of PA: woman over 75 years with obesity being single and living alone or with one other person. In daily practice, this profile will enable quicker identification of individuals who particularly need support in maintaining PA for as long as possible. Diagnosis and Treatment of Kidney Diseases
P 06: Characteristics of Older Adults with Diabetes and an Insufficient Level of Physical Activity
Adel Gouri, W Taayat, MC Rahim, A Dekaken, S Banharkat; Annaba, Algeria
Background and Aims: To date, no biomarker is sufficiently sensitive and specific for early detection of chronic kidney disease, particularly in young adults. This study aimed to identify the most relevant early biomarker between estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR), as well as evaluating the correlation between these two parameters.
Materials and Methods: This cross-sectional study involved 50 young adults aged 18 to 35 years, residing in the northeastern region of Algeria (Annaba, Guelma, El Taref, and Skikda). Participants were recruited from the clinical biochemistry department of CHU Ibn Rochd in Annaba. Blood and urine biochemical parameters relevant to the screening of chronic kidney disease (CKD) were measured in the participants. The urinary albumin-to-creatinine ratio (ACR) and the protein-to-creatinine ratio (PCR) were calculated. The estimated glomerular filtration rate (eGFR) was determined using the 4-variable MDRD formula.
Results: The mean age of the studied population was 25.0 ± 4.0 years, with a female predominance of 66%. The estimation of eGFR revealed that 8% of participants had mild renal insufficiency and 4% had moderate insufficiency. The calculation of ACR showed that 16% of the population had pathological albuminuria. No significant correlation was found between eGFR and ACR (r=-0.07, p=0.62). However, the combination of these two parameters allowed for the re-stratification of chronic kidney disease (CKD) risk in 11% of the population initially classified as having no kidney disease according to eGFR; these patients were reclassified into categories G1A2 (moderate risk) and G1A3 (high risk). Additionally, 7% of the subjects initially presenting with mild renal insufficiency according to eGFR were reclassified into category G2A1 (no risk).
Conclusion: Our study demonstrated the effectiveness of re-stratifying chronic kidney disease risk in young subjects by integrating eGFR and ACR.
P 07: Proteinuria in Diabetes: A Case for Caution and Biopsy
Muhammad Shoaib Zaidi; Riyadh, Saudi Arabia
Background and Aims: The commonest etiology for chronic kidney disease and end-stage renal disease, universally, is diabetes. Although kidney histology is the gold standard for diagnosing diabetic kidney disease, in common practice it is usually diagnosed through laboratory testing.
Materials and Methods: Clinical Case: 43 yrs old Saudi house-wife was admitted on the 7th of February, 2024 with a 5 months history of progressive pitting pedal edema, facial puffiness, followed by dyspnea (NYHA-III), orthopnea, paroxysmal nocturnal dyspnea and frothy urine for 1 month, prior to the admission. She had a past medical history of long-term Type 2 Diabetes (T2D) and chronic liver disease (HBV+). Systemic review-weight gain and anorexia. Family history unremarkable. She also developed acute diarrhea during the admission.
On evaluation, the patient was found to have the following issues: (1) Diabetic kidney disease (anasarca with moderate ascites+, hypoalbuminemia [serum albumin 26 (39.7-49.4g/l)], serum creatinine 140 (45-84) umol/l, albuminuria (Albumin/Creatinine 2541 (0-30) mg/g, CBC (Hb% 95 (12-16) g/l, MCV 86.6fl, TLC and PLTs normal, HbA1c 8.7%, US abdomen (normal liver, spleen, portal vein & kidneys, moderate ascites and right pleural effusion), ascitic tap (serum-ascitic albumin gradient 0.8g/l) and renal biopsy showed Class III DM nephropathy (classification 2010), with secondary focal segmental glomerulosclerosis. (2) Right renal vein thrombosis with poor right renal perfusion (US proven). (3) Clostridium-difficile colitis (toxin+ on stool testing).
Other important investigations: Hepatitis B core and e Abs+, HBV PCR 159IU/ml, Auto-immune workup negative. Serum immune electrophoresis-polyclonal gammopathy, transthoracic echo mild concentric left ventricular hypertrophy with normal LV systolic function, moderate pericardial and left pleural effusions, US pelvis anterior sub-serosal fibroid (2.7 x 2.9 cms).
Results: The patient was managed with moderate protein intake, diuretics, oxygen, fluid restriction, therapeutic abdominal paracentesis, apixaban, angiotensin receptor and calcium channel blockers, atorvastatin, dapagliflozin, linagliptin and basal-bolus insulin.Her condition got stabilized and was advised follow-ups in nephrology, hepatology and gynecology clinics. It was planned in the follow-up visit to add finerenone.
Conclusion: Our case taught us that one should never assume the heavy proteinuria in diabetes to be related to diabetic nephropathy, until the secondary causes have been ruled out. The value of tissue biopsy in arriving at the precise diagnosis cannot be overemphasized.
P 08: Dapagliflozin as a Renal Protector: a Case Study of Contrast-Induced Nephropathy in a Diabetic Patient Following Post-Coronary Interventions
Tamar Peshkova, Liana Jashi; Batumi, Georgia
Background and Aims: Coronary artery disease (CAD) is prevalent in diabetic patients, often necessitating percutaneous coronary intervention (PCI) for significant stenosis. Diabetic patients are at increased risk of contrast-induced nephropathy (CIN), potentially leading to acute kidney injury (AKI). Sodium-glucose cotransporter-2 (SGLT2) inhibitors like dapagliflozin have demonstrated renoprotective effects, particularly in patients with chronic kidney disease (CKD). This case reports a diabetic patient who developed hypercreatinemia after coronary procedures, with improved renal function following dapagliflozin initiation.
Materials and Methods: A 73-year-old male with type 2 diabetes for 9 years, managed with metformin and sitagliptin, presented with chest pain. His medical history included hypertension and dyslipidemia. A CT coronary angiogram revealed 90% stenosis of the left anterior descending (LAD) artery. After an unsuccessful PCI, he was transferred to a specialized clinic where stenting of the LAD was performed. The patient received three contrast injections. Forty-eight hours post-procedure, his serum creatinine rose to 1.53 mg/dL, with GFR dropping to 48 mL/min/1.73 m², indicating CIN. Sitagliptin was discontinued, and dapagliflozin was started alongside metformin for diabetes management and renal protection.
Results: Over three months, the patient’s serum creatinine decreased to 1.2 mg/dL, and GFR improved to 58 mL/min/1.73 m². No further cardiovascular or renal complications occurred, and glycemic control remained stable with dapagliflozin and metformin.
Conclusion: This case highlights the renal protective effects of dapagliflozin in a diabetic patient who developed CIN after coronary interventions. The switch from sitagliptin to dapagliflozin led to improved renal function, suggesting potential benefits for patients at risk for CIN. Further studies are needed to confirm these findings.
P 09: The Influence of Finerenone on Kidney Function in Patients with Chronic Kidney Disease with and without Type 2 Diabetes
Yanina Rebrova, Y. Saienko, Y. Marushko, B. Mankovsky; Kyiv, Ukraine
Background and Aims: Chronic kidney disease develops in approximately 40% of patients with type 2 diabetes mellitus (T2DM) and significantly increases the risk of mortality and cardiovascular morbidity. Finerenone, a novel nonsteroidal mineralocorticoid receptor antagonist, has demonstrated a significant impact on renal function by reducing proteinuria and preserving glomerular filtration rate in patients with chronic kidney disease. However, the influence of finerenone on kidney function in different patient populations requires further investigation. Therefore, the aim of our study was to investigate the influence of treatment with finerenone on kidney function in patients with chronic kidney disease (CKD) with and without T2DM.
Materials and Methods: Two groups of patients were examined. The first group included 45 patients with T2DM who were taking finerenone (age 63,0 ± 6,0 years, duration of diabetes 7,0 ± 4,0 years, HbA1c 7,6 ± 2,2%, creatinine level 115,6 ± 3,8 µmol/L, estimated glomerular filtration rate (eGFR) 51,0 ± 1,6 ml/min/1.73m², and urinary albumin-to-creatinine ratio (UACR) 43,1 ± 10,8 mg/g; data are presented as mean ± SD). The second group consisted of 40 patients without T2DM but with CKD who were taking finerenone (age 54,0 ± 4,0 years, HbA1c 5,1 ± 0,9%, creatinine level 84,7 ± 2,0 µmol/L, eGFR 83,6 ± 1,9 ml/min/1.73m², and UACR 25,1 ± 4,2 mg/g).To compare the effect of finerenone on eGFR and UACR, we used one-way analysis of variance (ANOVA) and Student’s t-test.
Results: In patients with diabetes, the reduction in creatinine under the influence of finerenone is significantly greater than in the group without diabetes (p<0,05). The increase in eGFR under the influence of finerenone does not significantly differ between the groups with and without diabetes (54,4 ± 1,8 ml/min/1.73m²; 86,8 ± 1,7 ml/min/1.73m², p>0,05). The reduction in UACR does not significantly differ between the groups with and without diabetes, but there is a tendency towards a more pronounced effect in patients without diabetes (42,4 ± 10,7 mg/g; 21,3 ±4,4 mg/g, p>0,05).
Conclusion: We found that finerenone positively affects kidney function in patients with and without T2M. The administration of finerenone has been associated with a decrease in urinary albumin excretion and a slowing of the progression of kidney disease, highlighting its potential as a therapeutic option for managing renal complications.Risk Stratification in Metabolic Diseases.
Risk Stratification in Metabolic Diseases
P 10: The Usefulness of Cardiac Enzyme Biomarkers for Predicting Cardiovascular Risk in Individuals with Overweight
Younes Benchaàr, Rima Laskri, Adel Gouri, Djaouida Kerbi, Samia Benyahia, Saddek Benharkat; Annaba, Algeria
Background and Aims: Screening and assessing cardiovascular risk is crucial in people with overweight, which is an independent risk factor for coronary disease. This study aims to evaluate the cardiac enzyme biomarkers (CPK, LDH, ASAT, and ALAT) in relation to BMI and to investigate their correlation with the reference marker CRPus.
Materials and Methods: Sixty-two subjects were included in a cross-sectional pilot study with an analytical focus, divided into two groups based on BMI. The first group consisted of overweight subjects (BMI ≥ 25 kg/m²), and the second group comprised normo-weight volunteers (18.5 ≤ BMI < 25 kg/m²). Analysis of CPK, LDH, ASAT, ALAT, and Lp(a) was conducted for the entire study population, along with CRPus.
Results: The levels of cardiac enzyme markers LDH (p<0.001) and CPK (p=0.001) were significantly higher in subjects with overweight compared to normo-weight individuals. Lp(a) levels were elevated in subjects with obesity. The evaluation of cardiovascular risk based on CRPus revealed that 81.2% of subjects with overweight had a moderate to high atherogenic risk, while 45.2% had a high risk according to IA. Considering Lp(a) levels, 35.5% of individuals with overweight and 33.3% of those with normal weight were at high risk. CRPus showed a positive and significant correlation with ASAT (r=0.36, p=0.046) and LDH (r=0.37, p=0.037).
Conclusion: LDH levels differed significantly by BMI and correlated positively with CRPus. These findings suggest that LDH may be a promising indicator in the evaluation of cardiovascular risk in individuals with overweight.
P 11: Characteristics of Arterial Hypertension in the Cardiovascular Manifestation of Diabetic Autonomic Neuropathy
Jamolkhon Kayumov; Fergana, Uzbekistan
Background and Aims: Cardiovascular autonomic neuropathy is a common form of neuropathy, causing abnormalities in heart rate control and central and peripheral vascular dynamics. We explored the association between hypertension and the cardiovascular form of diabetic autonomic neuropathy in subjects with T2DM.
Materials and Methods: The study involved 50 patients with type 2 diabetes aged 54.3 ± 3.2 years and 10 healthy people aged 56.6 ± 2.7 years as a control group. All patients underwent standard cardiovascular tests (ITC) to detect cardiovascular forms of diabetic autonomic neuropathy (DAN). Based on the presence or absence of DAN, patients were divided into two groups (DAN+ and DAN-). During the study, a survey was conducted along with an ECG study of heart rate variability and the dispersion of the duration of electrical ventricular systole.
Results: Presence of DAN was associated with a significant decrease in heart rate variability (p<0.01), a longer QT interval (p<0.001), and increased QT dispersion (p<0.001). The absence of BP lowering at night is a clinically significant disorder as it is associated with the development of left ventricular hypertrophy and an increased risk of cardiovascular complications (CVC). An increase in SBP of 10 mmHg at night increases cardiovascular risk by 31%. Among the surveyed patients, 3 out of 30 (10%) were dippers, 10 (33.3%) were non-dippers, and 17 (56.7%) were night-pickers in SBP. In patients with DAN, the mean daytime SBP was 143 ± 8.7 mmHg, and nighttime SBP was 136.8 ± 8.3 mmHg. The mean daytime DBP was 90.3 ± 5.5 mmHg and nighttime DBP was 81.7 ± 5.0 mmHg. Among 30 patients with type 2 diabetes, 10 (33.3%) showed an SBP pattern as dippers, 8 (26.7%) as non-dippers, and 12 (40%) as night-pickers.
Conclusion: In patients with type 2 diabetes and DAN, hypertension was observed in 30% of non-dippers and 48.4% of night-pickers. The course of hypertension with a night-picker pattern increases the risk of cardiovascular complications in patients with cardiovascular autonomic neuropathy.
P 12: Length of Telomeres in Patients with Type 2 Diabetes Mellitus and Chronic Kidney Disease, with and without Diabetic Neuropathy
Olha Monashnenko, Yanina Saienko, Yanina Rebrova, Dmytro Krasnienkov, Veronika Korcheva, Midlovets Kostiantyn, Boris Mankovsky; Kyiv, Ukraine
Background and Aims: Telomeres are protective "caps" of repetitive 5’-TTAGGG-3’ sequences at the ends of each chromosome. As telomeres shorten under oxidative stress and with cell replication in most somatic cells, telomere length is inversely related to biological age. As a biomarker of biological aging, Leukocyte telomere length (LTL) is associated with diabetes prevalence and complications. The aim of this study was to investigate the associations between the length of telomeres in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) with and without diabetic neuropathy (DN).
Materials and Methods: We examined 197 subjects divided into four groups. The first group included 71 patients with T2DM and concomitant CKD and DN (age 58.2 ± 11.8 years, BMI 33.3 ± 6.6, diabetes duration 10.8 ± 8.5 years, HbA1c 7.6 ± 1.6; data are presented as mean ± SD). The second group included 23 patients with T2DM and concomitant CKD without DN (age 61.0 ± 9.3 years, BMI 33.6 ± 5.4, diabetes duration 7.9 ± 4.5 years, HbA1c 7.8 ± 2.1%). The third group included 58 patients with T2DM and without CKD and DN (age 48.2 ± 8.2 years, BMI 33.2 ± 6.5, diabetes duration 4.4 ± 4.0 years, HbA1c 7.6 ± 2.0 %). The fourth group included 45 patients without T2DM, CKD and DN as controls (age 51 ± 3.8 years, BMI 31 ± 7.1, HbA1c 5.4 ± 0.3%).CKD was diagnosed by serum creatinine, eGFR and albumin to creatinine ratio (ACR). DN was diagnosed by assessment of clinical symptoms and the standard battery of tests and scales. Telomere length was measured in whole blood by monochrome multiplex quantitative polymerase chain reaction (PCR) by adjusting the telomere to single copygene (T/S ratio). Statistical analysis was performed using the Kruskal-Wallis test.
Results: We found that the T/S ratio, which reflects the length of telomeres, differed significantly between controls and the three groups of patients with T2DM with or without CKD and DN (p=0.01). Therefore, it can be concluded that the change in telomere length has a statistically significant association with the development of T2DM complications.
Conclusion: We found that telomere length is altered in T2DM patients with CKD and DN. The pathogenetic and prognostic role of telomere alterations in patients with T2DM requires further investigation.
P 13: Mitochondrial DNA Copy Number among Patients with Type 2 Diabetes Mellitus and Chronic Kidney Disease
Yanina Saienko, Yanina Rebrova, Olha Monashnenko, Dmytro Krasnenkov, Boris Mankovsky; Kyiv, Ukraine
Background and Aims: Mitochondrial DNA copy number (mtDNA-CN) is an indirect measure of mitochondrial dysfunction and is associated with type 2 diabetes mellitus (T2DM); however, whether mtDNA-CN can predict the risk of developing chronic kidney disease (CKD) is not well-known. The aim of our study was to measure human blood mtDNA-CN in the context of chronic kidney disease (CKD), and to evaluate its potential as a clinical biomarker of kidney disease.
Materials and Methods: We examined 105 subjects divided into three groups. The first group included 65 patients with T2DM and CKD (age 70.9 ± 8.0 years, diabetes duration 5.9 ± 2.5 years, HbA1c 7.1 ± 1.7%, serum creatinine 145.0 ± 87.0 µmol/L, estimated glomerular filtration rate (eGFR) 44.0 ± 11.0 ml/min/1.73m², albumin/creatinine ratio (ACR) 36.0 ± 74.0 mg/g; data are presented as mean ± SD). The second group included 25 patients with T2DM without CKD (age 53.2 ± 6.8 years, diabetes duration 3.7 ± 2.2 years, HbA1c 7.6 ± 2.2%, serum creatinine 89.6 ± 14.9 µmol/L, eGFR 81.3 ± 12.2 mL/min/1.73m², ACR 18.0 ± 9.7 mg/g). The third group included 15 patients without T2DM or CKD (age 50.3 ± 3.8 years, HbA1c 5.45 ± 0.3%, serum creatinine 100.7 ± 22.5 µmol/L, eGFR 83.0 ± 22.8 mL/min/1.73m², ACR 11.0 ± 4.4 mg/g).Data were compared using Student’s t-test. Association with eGFR, ACR and mtDNA-CN in these three groups was determined by correlation analysis.
Results: We did not find significantly different mtDNA-CN in patients with T2DM with and without CKD compared to the control group (1.23 ± 0.452 in patients with T2DM and CKD, 1.30 ± 0.365 in those with T2DM without CKD, and 1.28 ± 596 in the control subjects). There was no statistically significant correlation between mtDNA-CN and eGFR in any of the three groups studied. Also, there was no statistically significant correlation between mtDNA-CN and ACR in any of the three groups.
Conclusion: We can conclude that mtDNA-CN is not associated with CKD in our groups of patients with T2DM. Further investigation is needed to explore the pathogenesis and prognostic significance of mtDNA-CN in patients with T2DM and CKD.Cardio-Hepatic Diseases and Protection
P 14: Hypoxic Preconditioning Improves Mitochondrial Health in Rats with Insulin Resistance
Mariia Kozlovska, MO Zavhorodniy, KV Rozova, MG Dubova, MI Vasylenko, AG Portnychenko; Kyiv, Ukraine
Background and Aims: Hypoxic preconditioning (HP) is aimed at preventing various types of damage and increasing the functional reserves of the body. Mitochondria provide ATP energy to cardiomyocytes to maintain normal cardiac function. Insulin resistance (IR) significantly complicates the course of cardiovascular diseases and is becoming increasingly common. However, the functions and state of myocardial mitochondria in HP and IR require further investigation. The aim of this study was to investigate the effect of hypoxic preconditioning on mitochondrial function and myocardial damage in insulin resistant rats.
Materials and Methods: Experiments were performed on adult male Wistar and spontaneously hypertensive rats (SHR) with myocardial hypertrophy. IR was induced by a high-fat diet (HFD) for 2 weeks (58% kcal from fat) and confirmed by an insulin tolerance test. HP was reproduced by "ascending" to an altitude of 5600 m for 3 hours in a barocamp. Myocardial damage was assessed by electron microscopy.
Results: The number of subsarcolemmal and intramyofibrillar mitochondria in the myocardium was found to be 1.7 and 2 times higher in the hearts of SHR rats than in Wistar rats, respectively. HP increased the level of mitochondrial damage in Wistar rats by 12.1% compared with controls (p<0.05), but the hypertrophied myocardium was characterized by a smaller number of structurally altered organelles and the absence of swelling, which may indicate better structural protection of mitochondria. In the myocardium of animals with IR of both strains, a quantitative increase in both subpopulations of mitochondria, preservation of their function, and activation of intracellular connections with other organelles were observed. The improvement of the mitochondrial apparatus may be associated with the transition of these organelles to the use of lipid substrates, as evidenced by the presence of lipid infiltration of cardiomyocytes under HFD. The effect of HP on animals with IR was characterized by activation of the myocardial mitochondrial apparatus (increased number of normal mitochondria and decreased number of structurally altered mitochondria compared with controls, p<0.005), energy metabolism and absence of mitochondrial dysfunction in Wistar rats and to a lesser extent in SHR.Conclusion: Thus, hypoxic preconditioning caused favorable changes in mitochondrial functional activity in Wistar and spontaneously hypertensive rats with insulin resistance. Better structural protection of mitochondria was found in hypertrophied myocardium. However, the protective effect of preconditioning was partially lost in the presence of insulin resistance.
Grant/Support Information: This work was supported by the budget program "Research work of young scientists of the National Academy of Sciences of Ukraine 2023-2024".
P 15: Insulin Resistance, Pancreatic Steatosis and Atherosclerosis
Kateryna Pivtorak, OV Ivanchuk, IV Fedzhaga, NA Pivtorak; Vinnytsia, Ukraine
Background and Aims: Insulin resistance is a process closely related to hepatic and pancreatic steatosis. It is often accompanied by dyslipidemia and progression of atherosclerosis. The mechanisms by which this pathogenetic process is initiated are not fully understood. One of the hypotheses suggests an increase in the synthesis of pro-inflammatory cytokines and the formation of a chronic inflammatory process in the pancreas. The purpose of this study was to determine the characteristics of indicators of carbohydrate and lipid metabolism in patients with pancreatic steatosis.
Materials and Methods: 96 patients with pancreatic steatosis were examined. Criteria for the diagnosis of steatosis were a decrease in densitometric parameters of pancreatic tissue (<30 hu), obtained by computed tomography of the abdominal cavity. Blood lipid profile of cholesterol and triglycerides, low density lipoprotein cholesterol, very low density, high density and atherogenicity index were evaluated. Glucose, insulin, and C-peptide levels were determined in the fasting state and two hours after ingestion of 75 g glucose dissolved in 250-300 ml water for 5 minutes. Insulin resistance was determined by the level of the HOMA index. We examined the level of inflammatory mediators (TNF-α, IL-1, IL-6), markers (C-reactive protein, fibrinogen), intima-media thickness, and presence of atherosclerotic plaques and stenosis of carotid arteries in all enrolled patients.
Results: An inverse correlation was found between body mass index (BMI) and densitometric parameters of pancreatic tissue. Among individuals with pancreatic steatosis, those with overweight and obesity had elevated (p<0.05) levels of triglycerides (1.51 ± 1.26 mmol/l) and LDL cholesterol (1.48 ± 1.19 mmol/l). The level of total cholesterol was elevated in 22 patients. The average level of total cholesterol in the serum of patients was 5.2 ± 0.6 mmol/l. Most patients had decreased HDL cholesterol and increased LDL cholesterol levels. There was a frequent combination of pancreatic steatosis with hepatic steatosis, gallbladder cholesterol, gastroesophageal reflux disease and coronary heart disease. 51 patients were diagnosed with fasting hyperglycemia and impaired glucose tolerance, and type 2 diabetes mellitus was diagnosed in 14 patients. In 31 patients, laboratory tests showed an increase in the HOMA index, the average values of which exceeded the norm by more than 2 times. In 42 patients there was an increase in insulin and C-peptide. The analysis of the quality of life of patients with pancreatic steatosis revealed a decrease in the levels of physical and psychological components.
Conclusion: Pancreatic steatosis was characterized by proatherogenic abnormalities of lipid levels, mainly hypertriglyceridemia, and carbohydrate metabolism in the form of type 2 diabetes, impaired glucose tolerance or hyperglycemia in a fasting state. Our results suggest an association between atherogenicity and signs of pancreatic lesions.
P 16: Clinical Case of a Physician with Metabolic Dysfunction-Associated Steatotic Liver Disease
Muhammad Shoaib Zaidi; Riyadh, Saudi Arabia
Background and Aims: Pre-diabetes or diabetes can be one of the five diagnostic criteria of metabolic dysfunction-associated steatotic liver disease (MASLD).
Materials and Methods: Clinical case: A 54 yrs old internist presented to the clinic, with three months history of altered bowel habits, bloating, malaise, bilateral discomfort in both thighs. He had an erratic sleep and a sedentary lifestyle. Rest of the systemic review unremarkable. No addictions or allergies. He had migraine, dyslipidemia, cervical and lumbar spondylosis. History includes iron and B12 deficiencies. Upper and lower GI endoscopies normal, 2 yrs back. Family history of type 2 diabetes, hypertension, dyslipidemia, osteoporosis and coronary heart disease. On valproic acid, amitriptyline, sumatriptan, galcanezumab, naproxen, pantoprazole, and vitamin D.BP 160/100 mmHg, Pulse 120/m, regular, afebrile, RR 20/m, O2 saturation 100% on room air. BMI 26.7 kg/m².
Results: CBC-normal. ALT 137.8 IU/l [0-41], AST 60.7 IU/l [0-40], GGT 80 IU/l [8-61]. Albumin, ALP, Bilirubin, CPK, Coagulation and thyroid function normal. Creatinine 117 umol/l [59-104]. HbA1c 6%, corrected calcium 2.36 mmol/l [2.1-2.55], phosphorus 0.77 mmol/l [0.81-1.45], Vitamin D 47 nmol/l [>75], PTH 7.22 pmol/l [1.6-6.9]. Total cholesterol 6.96 mmol/l [<5.2], LDL 4.09 mmol/l [ ≤4], TGs 4.76 mmol/l [0.55-1.9], HDL 0.71 mmol/l [>1.5]. Celiac antibodies and HBV/HCV serology negative. US abdomen: mild hepatomegaly with diffuse fatty infiltration. Rest unremarkable. Fibro-scan-E 6.3 kPa (IQR 0.6 - IQR/med 10%), CAP 400 dB/m, Fibrosis 0-1. His 10 yrs CVD risk was 6.3% and lifetime risk was 57.5% (U-Prevent Life CVD model).The patient was advised to have a healthy and active lifestyle, appropriate sleep, angiotensin receptor blocker and a high intensity statin. A follow-up in hepatology clinic was given.
Conclusion: Metabolic dysfunction-associated steatotic liver disease itself has many cardiovascular risk factors and was linked to arrhythmias, atherosclerotic heart disease and heart failure, in some studies.
P 17: Hypoxic Preconditioning Exerts Cardioprotective Effect in Ischemic Injury Against Insulin Resistance and Myocardial Hypertrophy in Rats
Mariia Kozlovska, MO Zavhorodniy, MI Vasylenko, KV Rozova, MG Dubova, AG Portnychenko; Kyiv, Ukraine
Background and Aims: Insulin resistance (IR) significantly worsens the course of cardiovascular diseases, which is accompanied by myocardial ischemia. However, the protective effects of hypoxic preconditioning (HP), especially in myocardial hypertrophy, are not well understood. The aim of this study was to evaluate the effect of hypoxic preconditioning on the ultrastructure of normal and hypertrophied myocardium in ischemic injury and insulin resistance in rats.
Materials and Methods: Experiments were performed on adult male Wistar rats and spontaneously hypertensive rats (SHR) fed a high-fat diet (HFD) for 2 weeks. SHR had left ventricular myocardial hypertrophy. IR was confirmed by insulin tolerance test. HP was reproduced by "ascending" to an altitude of 5600 m for 3 hours in a barocamp the day before ischemia/reperfusion (I/R), which was followed by an analysis of the hearts using the Langendorff isolated heart method. Myocardial ultrastructure was studied by electron microscopy.
Results: Electron microscopy revealed that the hearts of SHR differ from Wistar rats in left ventricular hypertrophy and the presence of certain manifestations of myofibrillar swelling and destruction. Endothelial and sarcolemmal dysfunction developed in the myocardium of animals with IR of both lines. The I/R injury was accompanied by the development of edematous and destructive processes in the myocardium of rats of both strains, but in SHR these changes were more pronounced and muscle fiber lesions were more prominent. The I/R injury was accompanied by significant mitochondrial damage and dysfunction in the myocardium of Wistar rats, but changes in mitochondrial ultrastructure were less pronounced in SHR. In rats with IR, a favorable effect of HFD on the prevention of mitochondrial dysfunction during I/R was observed. HP limited edematous-destructive processes in the myocardium and reduced the level of muscle fiber damage. However, in SHR, the protective effect of HP on I/R injury was less pronounced than in Wistar animals. HP had a significant effect on I/R-induced mitochondrial damage in rats with IR, reducing it by 60.7% in Wistar rats vs. controls (p<0.005) and less pronounced in SHR by 25.5% vs. controls (p<0.005).
Conclusion: Thus, hypoxic preconditioning and a high-fat diet for 2 weeks improved the ultrastructural state of cardiomyocytes during ischemia/reperfusion. However, in the presence of myocardial hypertrophy in rats, the cardioprotective effect was partially lost.
Grant/Support Information: This work was supported by the budget program "Research work of young scientists of the National Academy of Sciences of Ukraine 2023-2024".Stress, Isolation, and COVID-19 - Implications for Diabetes and Kidney Function
Stress, Isolation, and COVID-19 - Implications for Diabetes and Kidney Function
P 18: Assessing the Effects of Habitual Changes on Diabetes Outcomes During Social Isolation
Liana Jashi, Tamar Peshkova, Tamar Shervashidze, Ana Kotorashvili, Eter Margalitadze, Nino Gorgiladze, Maia Kobuladze; Batumi, Georgia
Background and Aims: COVID-19-related social isolation led to significant lifestyle changes, potentially impacting diabetes progression and complications. This study aimed to evaluate how these behavioral changes affected diabetic patients.
Materials and Methods: A cross-sectional, prospective-retrospective study was conducted using specialized questionnaires for 742 diabetic patients and 276 doctors. Data were analyzed using SPSS 27, with descriptive statistics, chi-square tests, Pearson correlation, and binomial/polynomial regressions to assess risk factors and outcomes (95% confidence, p=0.05).
Results: The study revealed that 39.4% of patients reported no sleep disturbances, while 33.8% experienced insomnia and 28.8% reported increased drowsiness. Physical activity levels dropped, with 38.3% of patients reporting no exercise, and 37.4% considering housework to be sufficient physical activity. Dietary habits also shifted, with 25.7% of patients increasing their intake of sweets, 23.3% consuming more fatty foods, and 15.1% increasing protein consumption. Despite these changes, 35.9% of patients reported no significant dietary changes. Weight fluctuations were notable, as 59.2% gained weight, 19.7% lost weight, and 21.1% experienced no change.
Smoking habits showed a mixed trend: 41.5% of patients did not smoke, while 16.8% reduced smoking and 17.6% quit altogether. Alcohol consumption remained stable in 59.9% of cases, while 12.6% reported increased intake and 12.2% reduced their consumption. Emotional well-being was also affected, with 53.5% of patients reporting anxiety and 2.2% experiencing suicidal thoughts during isolation.Gender differences emerged in the study, with men more likely to report increased tobacco and alcohol consumption. Chi-square analysis showed significant associations between gender and physical activity, with men reporting higher levels of inactivity. Lack of physical activity significantly increased the likelihood of hospitalization for diabetic foot complications. Poor dietary habits, such as increased intake of fatty and sweet foods, raised the risk of stroke and heart disease. However, engaging in 4-6 hours of exercise per week reduced the likelihood of heart procedures, and increased protein intake was associated with a decreased risk of hospitalization for heart-related issues. Tobacco use during isolation also heightened the risk of diabetic foot complications.
Conclusion: Social isolation during the COVID-19 pandemic led to unhealthy lifestyle changes in diabetic patients, worsening physical and emotional health and increasing hospitalizations for complications like stroke, heart disease, and diabetic foot. Continuous monitoring, support, and patient education are essential to mitigate these risks, especially during crises.
P 19: Association between Post-Traumatic Stress Disorder and Glycemic Control
Alexander Serhiyenko, Volodymyr Segin, Olexandr Kruk, Marta Hotsko, Victoria Serhiyenko; Lviv, Ukraine
Background and Aims: Post-traumatic stress disorder (PTSD) is a clinically diagnosed condition that occurs in individuals who experience or witness a traumatic event that involves the actual or possible threat of death, violence, or serious injury. It occurs in about 20% of individuals who experience or witness a traumatic event. The incidence of PTSD is increasing due to the war in Ukraine. This study aimed to analyze the results of the questionnaire, clinical and paraclinical manifestations of PTSD, and to identify the parameters to discover simple and relevant biomarkers for future interventions.
Materials and Methods: We have screened 264 individuals, and 101 males were involved into the study. Screened patients underwent detailed psychiatric examinations in order to identify patients with overt PTSD and patients with no signs of PTSD. The following questionnaire were completed: Post traumatic stress disorder screening questionnaire Breslay 1999; Mississippi Scale for Combat-Related PTSD (M-PTSD) for DSM-III; Generalised Anxiety Disorder Assessment (GAD-7); The Patient Health Questionnaire (PHQ-9). Heart rate variability was investigated by short-time ECG records (5 minutes in supine position and 6 minutes in orthostatic test) were recorded by "CARDIOLAB" (Kharkiv, Ukraine). Glycated hemoglobin A1c, glucose, immunoreactive insulin levels, and the homeostasis model assessment IR (HOMA-IR) were measured.
Results: According to Post traumatic stress disorder screening questionnaire Breslay 1999, 32 persons were diagnosed with high risk of PTSD, mean was 2,94 ± 0,9. The mean of M-PTSD was 80,4 ± 1,9, 58,4% at low risk, 11,9% at middle and 29,7% of persons were at high risk of PTSD. According to GAD-7, a moderate level of anxiety disorder was diagnosed among 21,8%, medium among 20,8% and high among 25,7%. PHQ-9 moderate depression grade was diagnosed among 11,9%, moderately severe among 15,8% and severe among 12,9%. The pattern of HRV changes indicates suppression of parasympathetic activity HF (-11,7%; р<0,05), low overall spectral power and increase of LF/HF ratio (+7,1 %; р<0,05).The development of PTSD was associated with an increase in HOMA-IR (3.0 ± 3.0 vs 1.47 ± 0.72, p<0.05). New onset type 2 diabetes mellitus (T2D) was diagnosed in 4 previously healthy patients. Their data were excluded from the analysis.
Conclusion: PTSD is a common condition and occurs in 30% of all individuals who experience or witness a traumatic event. It is characterized by altered heart rate variability, increased sympathetic activity of the autonomic nervous system and increased insulin resistance parameters all of which contribute to an elevated risk of T2D development.
P 20: The Relationship between Diabetes Distress and Cardiac Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus
Victoria Serhiyenko, Ludmila Serhiyenko, Volodymyr Segin, Olexandr Kruk, Alexandr Serhiyenko; Lviv, Ukraine
Background and Aims: Diabetic cardiac autonomic neuropathy (CAN) is a severe complication of diabetes associated with diabetic distress (DD). DD is an often unrecognized emotional burden that occurs during the treatment of the disease, that is often combined with depression and anxiety.This work was aimed to study the psycho-emotional state of patients with type 2 diabetes mellitus (T2D), including patients with CAN and internally displaced persons from the military (combat) zone.
Materials and Methods: The cohort comprised 40 patients diagnosed with T2D. Patients were divided into two groups: with T2D (Group A) and internally displaced persons from the military (combat) zone with T2D (Group B). Patients had overweight and were aged between 40 and 60 years. Diagnosis of CAN was based on cardiovascular reflex tests (CART). To assess the degree of DD, the following scales were used: T2DDAT: Identifying the Core Level of Distress (T2DDAT-CORE) and T2DDAT: Identifying the Sources of Distress (T2DDAT-SOURCES).
Results: It was found that the diagnosis of CAN was more frequent among persons in Group B (80% vs 25%). The majority of patients with CAN in Group A were diagnosed in the subclinical stage (60%), while patients from Group B were mainly diagnosed with moderate (50%) and partly severe stages (25%) of the disease.Increased DD according to the T2DDAT-CORE scale was observed in 55% of patients in Group A, and 60% in the subgroup with CAN. Similar indicators in Group B were 80% and 93.8%, respectively. The most frequent concerns reported by patients (according to the T2DDAT-SOURCES scale) were fear of serious diabetes complications (35% in Group A and 90% in Group B); the feeling of being left alone with the disease (40% in Group A and 85% in Group B); the feeling of not being heard or understood by their healthcare provider (30% in Group A and 80% in Group B); and the feeling of not being recognised as a person by their healthcare provider (35% in Group A and 95% in Group B). Among persons in Group B, increased levels of anxiety and restlessness were found in 95% of cases, low mood in 80%, sleep disturbances in 95%, fears in 70%, and general weakness and fatigue in 65%.
Conclusion: The prevalence of diabetic distress in patients with T2D and CAN, especially among internally displaced persons from military (combat) zones, was significantly increased. The results indicate the need to consider the psycho-emotional state of patients with T2D and CAN, especially internally displaced persons, when developing a comprehensive treatment plan.
P 21: Are COVID Positive Pediatric Patients More at Risk for Acute Kidney Injury than Adult Patients?
MacKenzie Brogan, William Gehrhardt, Deborah Mallon, Corey Siragusa, Ellen Miller; Chicago, USA
Background and Aims: Pediatric patients may experience a rare condition, multisystem inflammatory syndrome in children (MIS-C), when infected with COVID-19. We evaluated whether children infected with COVID-19 are at increased risk for Acute Kidney Injury (AKI) compared to adults infected.
Materials and Methods: We evaluated 29,219 total pediatric discharges, 482 (1.6%) were COVID positive and 434,460 adult discharges, of whom 38,558 (8.9%) were COVID positive at a 21 hospital urban/suburban academic health system for the period of January 1, 2020 to December 31, 2021. The incidence of AKI in COVID positive children and adults was evaluated using the International Society of Nephrology KIDGO criteria for diagnosing AKI.
Results: The relative risk of AKI in COVID positive children was 3.12 (95% confidence interval 1.96-4.97) and the relative risk of AKI in COVID positive adults was 1.88 (95% confidence interval 1.85-1.91). Pediatric patients with AKI had a significantly longer length (LOS) than non-AKI pediatric patients (19.9 days versus 4.6, p=0.02) while adult AKI patients had a nonsignificant increase in LOS (10.8 days versus 5.7, p=0.24).
Conclusion: Pediatric patients are at greater risk for AKI when infected with COVID compared to adults and experience a significantly increased length of stay.
Erschienen in: Diabetes, Stoffwechsel und Herz, 2025; 34 (1) Seite 23-37