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)
OP1: Prediabetes Remission and Long-Term Risk of Cardiovascular Death, Heart Failure Hospitalization, and All-Cause Mortality
Elsa Vazquez Arreola, Qiuhong Gong, Robert L. Hanson, Jinping Wang, Leontine Sandforth, Siyao He, Xin Qian, Stefan R. Bornstein, Andreas Fritsche, Norbert Stefan, Hubert Preissl, Edward W. Gregg, Nikolaus Marx, Reiner Jumpertz von Schwartzenberg, Guangwei Li, Andreas L. Birkenfeld
Tübingen, Germany
Background and Aims: Prediabetes confers elevated risks of cardiovascular disease (CVD) and heart failure (HF). Multifactorial lifestyle interventions (LI) – diet and physical activity targeting weight loss – are recommended, but their long-term cardiovascular impact is uncertain. We previously showed that restoring normal glucose regulation (NGR) in prediabetes markedly lowers incident type 2 diabetes, additive to weight loss and persisting beyond LI. We hypothesized that achieving prediabetes remission (to NGR) is associated with lower risk of cardiovascular death or HF hospitalization, with a lasting legacy effect.
Materials and Methods: We conducted post hoc analyses of two landmark diabetes-prevention cohorts: the U. S. Diabetes Prevention Program Outcomes Study (DPPOS; n = 2,402) and the Chinese DaQing Diabetes Prevention Outcomes Study (DaQingDPOS; n = 540). Remission to NGR was assessed at 1 year (DPPOS) and 6 years (DaQingDPOS) after LI. The primary endpoint was cardiovascular death or HF hospitalization over ~20 years (DPPOS) and ~30 years (DaQingDPOS). DPPOS estimates used inverse probability of treatment weighting to adjust for baseline differences. A fixed-effects meta-analysis pooled study-level hazard ratios (HRs).
Results: In DPPOS, over a median 20 years, event rates were 1.74 (95 % CI, 0.87 – 3.48) vs 4.19 (95 % CI, 3.56 – 4.92) per 1,000 person-years for participants with vs without remission (p = 0.013), with an adjusted HR 0.42 (95 % CI, 0.20 – 0.88; p = 0.021). Findings were concordant in DaQingDPOS (HR 0.49; 95 % CI, 0.28 – 0.84; p = 0.010). The pooled HR was 0.48 (95 % CI, 0.31 – 0.74; p = 0.0008). Results were consistent when defining exposure as achieving remission at least once during follow-up (HR 0.43; 95 % CI, 0.29 – 0.63; p < 0.0001). All-cause mortality was also lower with remission (HR 0.62; 95 % CI, 0.47 – 0.82; p = 0.0009).
Conclusion: Achieving prediabetes remission to NGR is associated with ~50 % lower risk of cardiovascular death or HF hospitalization, with a decades-long legacy effect, across diverse U. S. and Chinese cohorts. Targeting remission may represent a pragmatic, high-impact strategy for cardiometabolic prevention.
OP2: Clinical Association of Diabetes Mellitus and Heart Failure with Metabolic Dysfunction–Associated Steatotic Liver Disease
Kateryna Pivtorak, Oleksandr Ivanchuk, Tatiana Shevchuk, Natalia Pivtorak, Iryna Fedzhaga, Natalia Shevchuk
Vinnytsia, Ukraine
Background and Aims: Over the past decade, the importance of metabolic dysfunction–associated steatotic liver disease (MASLD) has been increasingly recognized, as it not only determines the severity of liver injury but is also linked to the progression of cardiovascular disease, the onset of type 2 diabetes mellitus (T2DM), and other systemic complications. Here, we set out to evaluate the association between MASLD and heart failure.
Materials and Methods: The study included 134 patients with MASLD (normal weight, overweight, and obese) without T2DM, and 62 patients with MASLD (normal weight, overweight, and obese) with T2DM. Anthropometric measurements were performed, and serum levels of liver enzymes AST, ALT, and GGT were assessed. Liver fibrosis was evaluated using elastography (FibroScan). Cardiac assessment included ECG and echocardiography. Cardiovascular (CV) risk stratification was conducted using the SCORE scale for high-risk countries. Inflammatory mediators (TNF-α, IL-1, IL-6), biomarkers (C-reactive protein [CRP], fibrinogen), endothelin-1 (ET-1), von Willebrand factor (vWF) activity, intima-media thickness (IMT), presence of atherosclerotic plaques and carotid artery stenosis, and the HOMA-IR insulin resistance index were measured in all participants.
Results: Both groups demonstrated left ventricular diastolic dysfunction and QT interval prolongation in MASLD patients with T2DM, which correlated with disease severity. Most obese MASLD patients exhibited reduced endothelium-dependent vasodilation, indicating endothelial dysfunction. Plasma concentrations of pro-inflammatory cytokines TNF-α and IL-6 in MASLD patients were 3,6 – 6,7 times higher than in patients with a similar degree of obesity but without MASLD. ET-1 concentration strongly correlated with cardiovascular risk scores. Multiple inflammatory mediators (TNF-α, IL-1, IL-6) and biomarkers (CRP, fibrinogen) showed significant correlations with obesity degree, ET-1 concentration, vWF levels, and markers of insulin resistance, all of which are predictors of increased CV risk.
Conclusion: The presence of left ventricular diastolic dysfunction and heart failure, impaired endothelium-dependent vasodilation, elevated ET-1 levels, systemic inflammatory mediators, increased IMT, and higher incidence of cardiac arrhythmias are strongly associated with elevated cardiovascular risk in MASLD patients. These findings support the necessity of routine cardiovascular screening in individuals with MASLD.
OP3: Relationship between Undiagnosed Diabetes, Cardiovascular Events and Mortality in Acute Coronary Syndrome Patients Enrolled in the STRONG-MI Registry
Faisal Aziz, Christoph Strohhofer, Friederike von Lewinski, Miriam Meister, Andreas Kainz, Dirk von-Lewinski, Harald Sourij
Graz, Austria
Background and Aims: Diabetes significantly elevates the risk of subsequent cardiovascular events and mortality following acute coronary events. However, the contribution of prediabetes and undiagnosed diabetes towards this risk is not well explored. This study investigated the association of glycated hemoglobin (HbA1c), prediabetes and undiagnosed diabetes with all-cause mortality and major adverse cardiovascular events (MACE) in patients hospitalized for acute coronary syndrome (ACS) in Styria, Austria.
Materials and Methods: A total of 3,612 individuals without previously confirmed diagnosis of diabetes who presented with ACS and underwent coronary catherization between 2007 and 2016 were analysed from the STRONG-MI cohort. Prediabetes was defined as admission HbA1c of 5.7 – 6.4 % and diabetes as HbA1c ≥ 6.5 %. Outcomes were defined as all-cause mortality, composite MACE, myocardial infarction, stroke and cardiovascular death. The Cox regression was used to assess the association of continuous HbA1c (1-SD change) and diabetes with outcomes.
Results: Prediabetes and undiagnosed diabetes were present in 42 % and 7 % of patients with ACS, respectively. All-cause mortality rate (per 1000 person-years) was 27.4 in individuals with non-diabetes, 36.9 in prediabetes and 47.6 in undiagnosed diabetes. The rate of cardiovascular death was 11.5 in non-diabetes, 17.4 in prediabetes and 22.2 in undiagnosed diabetes. Rise in HbA1c by 1-SD (0.68 %) increased the risk of all-cause mortality by 20 % (p = 0.004) and cardiovascular mortality by 23 % (p = 0.019). Compared to individuals without diabetes, the risk of all-cause mortality was 6 % (p = 0.344) higher in those with prediabetes and 36 % (p = 0.005) higher in those with undiagnosed diabetes. The risk of cardiovascular death was 18 % higher in prediabetes (p = 0.082) and 40 % higher in undiagnosed diabetes (p = 0.028) compared to no diabetes.
Conclusion: Prediabetes and undiagnosed diabetes at the time of ACS are associated with an increased risk of all-cause and cardiovascular death. Systematic screening and early intensive management of glycemia may improve post-ACS adverse outcomes.
OP4: Influence of Diabetes Mellitus on Thrombosis in Branch Retinal Vein Occlusion
Marianne Shahsuvaryan
Yerevan, Armenia
Background and Aims: The global epidemic of diabetes mellitus highlights a need to assess its role as a risk factor and comorbidity for branch retinal vein occlusion (BRVO) so that visual loss from both diabetic eye disease and BRVO can be slowed or better controlled.
Materials and Methods: The study was a clinic-based case-control study of 158 patients with a clinical diagnosis of BRVO and 566 controls, all aged 21 years and older. Persons with severe myopia, vasoproliferative retinopathy and intermediate or posterior intraocular inflammatory disease were excluded from case and control groups. Patients with corneal disorders or cataract among controls were eligible if the fundus could be explored and was considered normal despite anterior segment problems. A commercially available statistical software package was used for tabulations and statistical analyses.
Results: It was found that diabetes was significantly more common among cases than controls. An increased risk of BRVO was revealed in persons with diabetes (odds ratio (OR) = 13.57, 95 % confidence interval (CI): 4.57 – 45.27). Risk of BRVO increased in association with hyperglycemia, but odds ratios were greater for moderate hyperglycemia (OR = 5.32, 95 % CI: 2.4 – 12.17) vs. severe (OR = 4.99, 95 % CI: 1.26 – 23.01). A greater prevalence of higher glucose level was found in patients with BRVO and systemic hypertension.
Conclusion: The results suggest a relationship between BRVO and diabetes as a risk factor. The findings reinforce recommendations to carefully evaluate patients with thrombosis of the branch retinal vein for diabetes mellitus, and also support the potential value of its medical treatment in preventing occurrence of BRVO. Enhancing vigilant awareness of medical professionals should open new insights into preventive measures.
OP5: A Time In Range of 70% -Attenuates the Senescence-Inducing and Pro-Inflammatory Effects of Hyperglycemia
Rosalba La Grotta, Valeria Pellegrini, Francesca Carreras, Cesare Celeste Berra, Karolina Mužina, Barbara Jenko Bizjan, Klemen Dovc, Francesco Prattichizzo, Tadej Battelino, Antonio Ceriello
Milan, Italy
Background and Aims: The Time In Range (TIR) represents the amount of time spent by a given individual in the range close to normoglycemia, i.e. 70 – 180mg/dl. On the basis of studies demonstrating an association of TIR with the incidence of diabetes complications, guidelines recommend a target of at least 70% of TIR for most people with diabetes. However, no study has explored the effect of variable degrees of TIR on molecular mechanisms relevant for the development of diabetes complications.
Materials and Methods: We exposed endothelial cells and monocytes to increasing percentages of TIR, i.e. 50%, 70%, 85%, as well as to constant normoglycemia and hyperglycemia, evaluating the development of senescence and of the associated pro-inflammatory response. We then assessed the expression of a plethora of markers of senescence and inflammation at the mRNA level in peripheral blood mononuclear cells (PBMCs) derived from individuals with early (i.e. 1-year post-diagnosis) type 1 diabetes (T1D, n=37), categorized according to the TIR (< or >70%) observed in the previous 14 days, comparing the two groups through ANCOVA adjusted for HbA1c. Correlations between TIR values and the expression of the same markers was also tested through linear regression.
Results: Constant hyperglycemia promoted the development of senescence in endothelial cells and induced inflammatory responses in both endothelial cells and monocytes. A TIR of 70%, but not of 50%, suppressed these effects while a TIR of 85% did not provide additional benefit. Data from people with T1D mirrored such results, as demonstrated by the higher expression of p16, a marker of senescence, and of IL-6, MCP-1, and CXCL1, three inflammatory mediators, in PBMCs from individuals with TIR < 70% and compared with those with TIR >70%, independently of HbA1c. When considered as a continuous variable, TIR showed a correlation with p16, IL-6, and CXCL1.
Conclusion: A TIR above 70% is associated with attenuated pro-senescence and pro-inflammatory effects of hyperglycemia. These molecular results support the TIR target currently recommended by guidelines.
OP6: Monitoring Ketone Levels Continuously During a 7-Day Fast
Nina Jendrike, Delia Waldenmaier, Manuela Link, Sükrü Öter, Lorena Morent, Manuel Eichenlaub, Cornelia Haug, Guido Freckmann
Ulm, Germany
Background and Aims: Ketone bodies are an alternative energy source the body produces from fatty acids during fasting or very low-carbohydrate diets. Although considered dangerous in the context of diabetic ketoacidosis, ketone bodies can have beneficial effects on neurological, cognitive, and cardiac functions. A ketogenic diet is a potentially promising therapy for epilepsy and psychiatric disorders. The availability of a device that measures ketone bodies, specifically β-hydroxybutyrate, continuously in the subcutaneous tissue, opens up many new possibilities for use as well as for basic research on ketone metabolism.
Materials and Methods: In this study, which included 18 participants but no individuals with type 1 diabetes, ketone levels were monitored over 7 days of fasting according to the Buchinger protocol (consisting solely of broth and diluted vegetable juices). The continuous ketone monitoring (CKM) system SiBio Ketone Sensor KS1 (SiBio Technology Limited) and a continuous glucose monitoring system (FreeStyle Libre 3 Plus, Abbott Diabetes Care Ltd.) were used. Additionally, capillary ketone levels were regularly measured with FreeStyle Precision β-ketone test strips (Abbott Diagnostics GmbH).
Results: All 18 participants (12 female, average age 39.1 ± 12.1 years, BMI 28.3 ± 5.8 kg/m2) completed the 7-day fasting program. CKM levels increased above 0.5 mmol/l after 4 to 64 hours. The maximum CKM levels ranged from 2.3 to >8.0 mmol/l and were reached after 5 to 7 days. A good agreement was observed between CKM readings and blood β-hydroxybutyrate levels. Daily average glucose levels reached 54 to 71 mg/dl after 2 to 3 days. After breaking fast with an apple, ketone levels decreased but did not return to baseline within the next 4 hours for most participants.
Conclusion: This study provided insights into the dynamics of ketone levels during fasting. Additionally, it offers evidence of significant variation both between and within individuals, even in a controlled and supervised study environment. If CKM is incorporated into therapy guidelines for different diseases in the future, this variability will need to be taken into account, especially when defining target or threshold levels.
OP7: Routine Biopsychosocial Care Is Practical and Achievable
Katharine Barnard-Kelly, Ryan Kelly, Ethan Barnard, Caitlin Woombs, Daniel Chernavvsky
Fareham, United Kingdom
Background and Aims: Chronic disease care was designed for acute conditions. Patients often struggle to express their psychosocial challenges and providers don’t have time or resources to address them. Spotlight-AQ, the AI powered clinical tool identifies those hidden needs, giving a 360 degree view of patient needs. The aim of this study was to assess feasibility and acceptability in routine care by providers and patients with diabetes or obesity.
Materials and Methods: Completion rates were calculated and priorities identified; 1:1 interviews were held with n = 40 patients and n = 12 providers to assess acceptability and perceived impact.
Results: The completion rate was 92 % across UK and US primary and specialist care (70 – 100 %, median 94 %). Psychological burden was the most frequently cited priority concern, US (UK) 47 % (50 %), followed by skills gaps 27 % (42 %), social challenges 23 % (4 %) and therapy issues 8 % (4 %). Interview data showed high acceptability from patients and providers, with positive impact report by both groups on visits (e. g. ‘it was good because it made me think of my total diabetes treatment plan, beyond the insulin pump’ and ‘it helped prompt me to ask some questions and brought up some questions and topics that I hadn’t thought able to ask’. Providers reported ‘one of the values is the patients can think about what else they can bring up’ and ‘it was interesting and helpful. I made more emphasis on what they [patients] were worried about’ and ‘it‘s helping identify some of the barriers for diabetes control’.
Conclusion: The intervention was acceptable in routine care and improved visits by including psychosocial aspects alongside physical aspects of health. Completion rates were very high and integration was seamless within the work process.
OP8: Pharmacist-Led Consultations for Continuous Glucose Monitoring Users: Knowledge, Confidence, and Opportunities to Support Diabetes Management and Outcomes
Anastasija Levkina, Kasparas Zdancius, Irena Zukauskaite, Indre Treciokiene, Jurate Gudonyte
Vilnius, Lithuania
Background and Aims: Diabetes outcomes depend heavily on good glycemic control and the quality of care. Continuous glucose monitoring systems (CGMs) are increasingly used in diabetes management and are becoming more accessible through community pharmacies. Pharmacist-led consultations for CGM users have been associated with improved outcomes. This study aimed to evaluate community pharmacists’ (CPs) knowledge, confidence, and attitudes towards CGM use and consultations.
Materials and Methods: This pilot cross-sectional study was conducted among 153 CPs in community pharmacies across Lithuania. CPs completed a 5-point Likert scale questionnaire on their knowledge, confidence, and attitudes towards CGM use and patient consultations. Data were analyzed using descriptive statistics, Pearson’s and Spearman’s correlation tests, and t-tests.
Results: CPs reported good knowledge of sensor placement (mean >4.0), interpretation of CGM data (4.03 ± 0.83), high confidence in providing recommendations based on CGM results (4.24 ± 0.64). Lower scores were observed in technical aspects, including CGM app synchronization (3.42 ± 0.99), app navigation (3.38 ± 0.77), and actions if CGM/app stopped working (2.72 ± 1.02). Older age was negatively associated with technical problem-solving ability (ρ = -0.30, p < 0.001). Better knowledge of potential technical issues correlated positively with awareness of their frequency in patients’ practice (ρ = 0.35, p < 0.001; r = 0.35, p < 0.001). Higher confidence in CGM knowledge was associated with higher readiness to consult patients (ρ = 0.33, p < 0.001; r = 0.35, p < 0.001). Higher confidence in CGM knowledge and in interpreting and integrating CGM results into daily life was found among CPs who referred that they had received CGM-related training (p = 0.04 and p = 0.003). Overall, CPs expressed willingness to participate in further CGM-related training (4.19 ± 0.71).
Conclusion: CPs reported good baseline knowledge of CGM use and confidence in providing recommendations; however, gaps remain in technical problem-solving, particularly among older CPs. As CGMs become increasingly available through community pharmacies, structured training is important to strengthen professional confidence, consultation skills, and patient care. Enhanced competence may translate into better patient support, including improved understanding of CGM data, greater confidence in self-management, and potentially better diabetes outcomes.
Dyslipidemia – Epidemiology, Biomarkers and Management
P01: Verification of Lipid Profile Reference Intervals in an Algerian Adult Population Following CLSI EP28-A3c Guidelines
Adel Gouri, Amani Benlassel, Aya Hamida, Younes Benchaar, Saddek Benharkat
Annaba, Algeria
Background and Aims: Reference intervals (RIs) are fundamental tools for the clinical interpretation of laboratory test results, enabling the distinction between physiological and pathological values. According to the Clinical and Laboratory Standards Institute (CLSI) EP28-A3c and International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) recommendations, each clinical laboratory should verify the applicability of manufacturer-provided RIs according to its own patient population, taking into account potential geographical, ethnic, dietary and methodological variations. This study aimed to verify the reference intervals for lipid profile parameters (total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG)) in a healthy adult population from Annaba, Algeria.
Materials and Methods: An analytical cross-sectional study was conducted between January and April 2025 in the Department of Medical Biochemistry, Ibn Rochd University Hospital, Annaba. A total of 40 apparently healthy adults (≥18 years) were recruited after medical screening to exclude underlying conditions affecting lipid metabolism. Venous blood samples were collected in the morning after a 12-hour overnight fast. Biochemical measurements were performed using Roche Cobas INTEGRA analyzers with manufacturer-recommended reagents and quality control procedures. Outlier detection was carried out using Tukey’s method, and the 90 % confidence intervals (CIs) for the sample medians were compared to the manufacturer’s RIs, in accordance with CLSI EP28-A3c verification criteria.
Results: After exclusion of extreme values, the lipid profile data from the study population showed 90 % CIs for TC, LDL-C, HDL-C, and TG that fell entirely within the manufacturer’s reference intervals. No statistically significant deviations were observed, confirming the validity of the provided RIs for all four parameters in this population.
Conclusion: The manufacturer-provided reference intervals for lipid profile parameters were successfully verified for the studied healthy adult population using the CLSI EP28-A3c protocol. This verification reinforces the reliability of lipid profile interpretation in clinical practice at the given institution, ensuring accurate decision-making and harmonization with international standards.
P02: ISAP-PROTECT: Nationwide Expert Consensus on the Role of Icosapent Ethyl in Triglyceride Management and Cardiovascular Protection
PK Sahoo, PK Hazra, J P. Sawhney, Vikas Agarwal, Arindam Pande, Arun Ranganathan, Sunil Sathe, Mala Dharmalingam, B V. Kumar, Vaishali Deshmukh
Bhubneshwar, India
Background and Aims: This expert consensus aimed to evaluate the clinical utility of Icosapent Ethyl (IPE) in triglyceride management and cardiovascular risk reduction, highlighting key therapeutic benefits and aligning expert perspectives through structured perception mapping.
Materials and Methods: The ISAP-PROTECT consensus involved 116 dyslipidaemia management experts with 3500+ cumulative clinical experience years. Participants rated 12 IPE-related clinical statements via a 5-point Likert scale. Data were analyzed using GraphPad v10.3.0, with strong consensus defined as a weighted agreement score exceeding 100.
Results: The perception mapping exercise highlighted a strong expert consensus on the therapeutic role of IPE in triglyceride management and cardiovascular protection. IPE was highly rated for reducing cardiovascular events in high-risk patients with elevated triglycerides (score: 127.4), including diabetics and those with residual risk despite statin therapy (score: 125.1). Its evidence from the REDUCE-IT trial was strongly endorsed (score: 124.3), along with its anti-inflammatory and plaque-stabilizing properties (score: 122.8). The panel also agreed on IPE’s favorable safety and tolerability (score: 121.6), and its role in reducing hospitalization for cardiovascular causes (score: 120.9). Experts emphasized its relevance for long-term secondary prevention strategies (score: 119.4), positioning IPE as a key adjunct to statins in comprehensive lipid management. The overall mean response scores were: strongly agree: 61 ± 23 (95 % CI 46 to 76), agree: 56 ± 22 (95 % CI 42 to 71), p < 0.0001.
Conclusion: The expert consensus affirms IPE’s vital role in cardiovascular risk reduction and triglyceride management, supporting its integration into clinical practice as a key adjunct to statin therapy.
P03: The Impact of Night Shift Work on the Lipid Profile of Healthcare Professionals: A Cross-Sectional Study
Rima Laskri, Younes Benchaar, Adel Gouri, Samia Mélais, Amel Bahmed, Samia Chaib, Saddek Benharkat
Annaba, Algeria
Background and Aims: The hospital work environment exposes healthcare professionals to chronic occupational stress stemming from high workload, irregular schedules, and the demanding nature of patient care. Such stress is a postulated risk factor for metabolic disturbances, including dyslipidaemia, which may accelerate atherosclerosis and increase the risk of cardiovascular disease. This study aimed to evaluate the impact of hospital work patterns on the lipid profile of healthcare staff.
Materials and Methods: A cross-sectional study was conducted in 2024 involving 51 healthcare workers at the Dorban unit of Annaba University Hospital. Data on work schedule, professional role, departmental affiliation, and years of service were collected. Venous blood samples were analysed to measure total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides using an end-point colorimetric method on a Roche INTEGRA 400+ automated system. Atherogenic indices (Total Cholesterol/HDL-C and LDL-C/HDL-C ratios) and residual cholesterol were calculated. Data was analysed using SPSS software (version 25.0) with appropriate statistical tests.
Results: The mean age of participants was 45.3 ± 9.3 years. The majority were employed in the otorhinolaryngology (39.2 %) and haematology (17.6 %) departments, with nurses (45.7 %) and medical assistants (41.3 %) comprising the largest professional groups. A high atherogenic risk was identified in 23.2 % of participants based on the Total Cholesterol/HDL-C index. Comparative analysis revealed that night-shift workers exhibited significantly elevated levels of total cholesterol (5.57 ± 1.04 mmol/l) and LDL-C (3.38 ± 1.12 mmol/l) compared to day-shift workers (4.67 ± 0.83 mmol/l and 2.71 ± 0.86 mmol/l, respectively; p < 0.05). No significant associations were found between lipid parameters and professional role, department, or seniority.
Conclusion: These findings indicate that night-shift work is significantly associated with an adverse lipid profile, characterised by elevated total cholesterol and LDL-C, suggesting an increased cardiometabolic risk among hospital staff. The implementation of targeted preventive strategies, including regular lipid screening and workplace wellness programs promoting lifestyle choices, is warranted to mitigate the cardiovascular risks associated with the organisational demands of hospital work.
P04: Contribution of Non-HDL Cholesterol in the Management of Dyslipidemia in Type 2 Diabetes: An Algerian Cross-Sectional Study
Adel Gouri, Sarra Belfendes, Saddek Benharkat
Annaba, Algeria
Background and Aims: Type 2 diabetes mellitus (T2DM) is frequently associated with dyslipidemia, a major cardiovascular risk factor. While LDL cholesterol (LDL-C) remains the primary lipid target, non-HDL cholesterol (non-HDL-C) encompasses all atherogenic ApoB-containing lipoproteins and may better reflect residual cardiovascular risk. This study aimed to evaluate the utility of non-HDL-C in the management of dyslipidemia in T2DM patients.
Materials and Methods: A descriptive cross-sectional study was conducted from November 2019 to April 2020 at the Endocrinology Department (CHU Ibn Sina) and Medical Biochemistry Laboratory (CHU Dorban), Annaba. Fifteen adult T2DM patients, with or without lipid-lowering therapy, were included. Data collected included demographic, clinical, and biochemical parameters: fasting glucose, HbA1c, triglycerides, total cholesterol, HDL-C, LDL-C (Friedewald formula), and non-HDL-C (total cholesterol – HDL-C). Dyslipidemia was defined according to ESC/EAS guidelines, with therapeutic targets adapted to cardiovascular risk level.
Results: The mean age was 59.1±8.7 years, with female predominance (67%). Obesity or overweight was present in 87%, and 60% had ≥3 associated cardiovascular risk factors. Dyslipidemia was highly prevalent: decreased HDL-C in all patients, elevated LDL-C in 60%, and elevated non-HDL-C in 67%. Among patients on statins (47%), 28% achieved LDL-C targets, yet half of these still had elevated non-HDL-C, indicating persistent residual risk. Among untreated patients (53%), 75% had elevated LDL-C and non-HDL-C. A discordance between LDL-C and non-HDL-C values was observed, with some patients having optimal LDL-C but elevated non-HDL-C.
Conclusion: Non-HDL-C is a valuable marker for assessing residual cardiovascular risk in T2DM patients, particularly when LDL-C targets are achieved. Its routine inclusion in lipid profiles could improve dyslipidemia management and cardiovascular prevention in this high-risk population.
P05: Indian Consensus on Optimizing Statin Therapy: Clinical Evidence, Practice Gaps, and Future Directions
BRJ Kannan, Gopal C. Ghosh, Dinesh Gautam, Nitin Tiwari, Soumik Chaudhuri, Snehil V. Mishra, Gyatso Wangchuk, Rajat Sharma, Rockey Katheriya, J. V. Balasubramaniyan
Madurai, India
Background and Aims: Statin therapy remains the cornerstone of lipid management for primary and secondary prevention of cardiovascular disease. Despite robust global evidence, clinical adoption in India often lags due to variability in practice patterns, physician inertia, and perceived uncertainties regarding newer lipid-lowering agents. To address this gap, a structured consensus was developed to capture expert opinion on statins, rosuvastatin optimization, and adjunct therapies, particularly in the Indian context.
Materials and Methods: A structured 17-item questionnaire covering statin eligibility, efficacy, tolerability, and adjunctive therapies was administered to a representative panel of Indian cardiologists and lipid specialists (STRATIFY 4 Study Group). Respondents rated each statement on a 5-point Likert scale (strongly disagree to strongly agree). Weighted scores were computed, with a threshold of >100 considered indicative of consensus agreement.
Results: Consensus was achieved on most statements. High agreement was observed for the continuation of dual antiplatelet therapy beyond 12 months (weighted score 123.1), improving physician education and access to lipid-lowering therapies (124.0), and rosuvastatin co-treatment in type 2 diabetes to reduce atherogenic biomarkers (121.3). Strong endorsement was also noted for universal LDL-C, hsCRP, and Lp(a) screening in asymptomatic Indian adults (118.2) and cumulative exposure to LDL-C as a key driver of atherosclerotic CVD (111.9). Areas of relative uncertainty included statin use in chronic liver disease (78.2) and long shelf-life of rosuvastatin as a therapeutic determinant (101.7). Importantly, statements addressing emerging therapies such as bempedoic acid and inclisiran reflected moderate agreement, highlighting evolving perceptions in clinical practice. The overall mean response scores were: agree: 60 ± 11 (95 % CI 54 to 65), strongly agree: 37 ± 12 (95 % CI 31 to 43), p < 0.0001
Conclusion: This consensus highlights strong national endorsement for statins, particularly rosuvastatin, as a first-line therapy in CVD prevention, with added value in high-risk groups such as type 2 diabetes. The findings reinforce guideline-concordant practices, emphasize the importance of physician education and early risk stratification, and recognize the role of adjunctive therapies in specific patient subsets. Variability in agreement on newer agents highlights the need for further long-term outcome data. Collectively, these insights support statins as the benchmark therapy for dyslipidemia management in India.
SGLT2 & GLP-1 Therapies: Real-World Use, Mechanisms and Safety
P06: Dapagliflozin Therapy: Effects on Glycemic Control, Weight Loss, and Cardiovascular Health in Diabetic and Non-Diabetic Patients
Liana Jashi, Tamar Peshkova, Koba Kamashidze, Tamar Shervashidze, Eter Margalitadze, Nino Gorgiladze, Irina kokoladze, Inga Abesadze, Ana Abashidze
T‘bilisi, Georgia
Background and Aims: This study aimed to evaluate the effects of dapagliflozin on metabolic and cardiovascular parameters in patients with and without diabetes, with a particular focus on gender-related differences. The primary outcomes of interest included changes in fasting glucose, postprandial glucose, HbA1c, body mass index (BMI), heart ejection fraction, and weight after three months of dapagliflozin therapy.
Materials and Methods: A total of 39 patients (20 with diabetes and 19 without) from Adjara, Georgia, were enrolled in this prospective study. Data were collected at baseline and after a 3-month treatment period. Parameters assessed included fasting glucose, postprandial glucose, HbA1c, heart ejection fraction, BMI, and weight loss. Gender differences were analyzed within both groups.
Results: In patients with diabetes (n = 20): Fasting glucose decreased significantly by 31.3 %, (from 9.6 mmol/l to 6.6 mmol/l). Postprandial glucose dropped by 46.6 % (from 14.6 mmol/l to 7.8 mmol/l). HbA1c decreased by 0.8 % (from 7.93 % to 7.13 %). Heart ejection fraction improved by 16.7 % (from 42 % to 49 %). BMI reduced by 6.7 % (from 27.1 kg/m² to 25.3 kg/m²). Weight loss averaged 4.3 %.In patients without diabetes (n = 19): Fasting glucose decreased by 3.9 %, (from 4.9 mmol/l to 4.7 mmol/l). Postprandial glucose showed a 5.2 % reduction (from 5.6 mmol/l to 5.3 mmol/l). HbA1c decreased by 0.09 % (from 5.03 % to 4.94 %). Heart ejection fraction improved by 20.5 % (from 39 % to 47 %). BMI decreased by 2.3 % (from 26.4 kg/m² to 25.8 kg/m²). Weight loss averaged 2.8 %.Gender Differences: In patients with diabetes, males showed more significant reductions in fasting glucose (33.5 %) and more significant improvements in heart ejection fraction (49 %), while females had better reductions in HbA1c (0.9 %) and BMI (7.3 %). Among patients without diabetes, males exhibited a more substantial reduction in BMI (2.8 %) and greater weight loss (3.2 %), while females showed a higher improvement in heart ejection fraction (48 %).
Conclusion: Dapagliflozin demonstrated beneficial effects on glycemic control, cardiovascular health, and weight management in both patients with and without diabetes. Gender-specific differences were evident, with males generally showing more significant improvements in cardiovascular outcomes and weight loss, while females showed greater reductions in glycemic parameters and BMI. These findings highlight the importance of considering gender when tailoring dapagliflozin therapy to optimize treatment outcomes.
P07: Safety Profile of GLP-1 Receptor Agonists
Inna Doroshkevych, Alla Zhamba
Vinnytsya, Ukraine
Background and Aims: GLP-1 receptor agonists (GLP1-RAs) have great therapeutic potential for treating diabetes and obesity, preserving cardiovascular, cerebrovascular, and renal function, reversing MAFLD, and potentially slowing the progression of dementia. While GLP1-RAs have notable benefits in improving glycemic control and promoting weight loss, their adverse effects should not be overlooked.
Materials and Methods: An analysis of studies from various databases, including Scopus, Web of Science, PubMed, SpringerLink, Reprotox, Medline (from 2019 – 2025) was conducted on the effects of long-term use of semaglutide on muscle mass and function in obese patients, and predictors of muscle tissue loss and possibilities for its prevention were studied.
Results: A 24-month retrospective cohort study involved 220 patients treated with semaglutide and 212 control subjects. The prevalence of sarcopenia among participants was 27.7 %. Semaglutide treatment significantly reduced both body mass index and muscle mass compared to controls. Notably, divergent patterns emerged in functional measures. Grip strength initially improved but then declined in men, while it continued to decrease in women. Gait speed significantly reduced in both genders. Multivariable analysis identified semaglutide dosage, baseline ASMI, and gait speed as independent predictors of muscle loss. Semaglutide initially improved muscle function, although in female participants this improvement only manifested as an upward trend. This effect may be mediated through the reduction of intramuscular fat infiltration, which is characteristically elevated in obese individuals. The accumulation of lipids and their metabolic byproducts within and between muscle cells can lead to mitochondrial dysfunction and subsequent declines in muscle strength and function. Previous studies have confirmed that GLP-1RA treatment significantly reduces this pathological fat infiltration. However, it was demonstrated that long-term administration results in gradual muscle mass loss, which cancels out the initial positive changes. Regression analysis identified baseline ASMI and gait speed as independent predictors of muscle loss, without significant gender or age differences. This suggests that reduced physical activity, resulting from declining muscle function, may create a vicious cycle of further muscle deterioration.
Conclusion: Despite the metabolic benefits in the pharmacotherapy of obesity and type 2 diabetes, long-term use of semaglutide may have a side effect in the form of muscle loss, especially in patients with initial signs of sarcopenia and the elderly. To minimize these risks, it is advisable to: carefully select patients for therapy; use individualized dosing, especially in the elderly; regularly monitor muscle mass and function; combine pharmacotherapy with moderate strength training and an optimized protein diet to prevent muscle loss.
P08: Effect of Sodium-Glucose Cotransporter-2 Inhibitors on Telomeres Length in Patients with Type 2 Diabetes Mellitus with and without Chronic Kidney Disease
Yanina Rebrova, Yanina Saienko, Dmytro Krasnienkov, Boris Mankovsky
Kyiv, Ukraine
Background and Aims: Telomeres are protective DNA structures at chromosome ends acting as a "biological clock." Their shortening accelerates aging and increases chronic disease risk. In type 2 diabetes mellitus (T2DM), attrition is faster, especially with chronic kidney disease (CKD), making telomere length a marker of biological age and prognosis. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are effective nephroprotective agents and may also slow cellular aging by reducing oxidative stress and inflammation. However, the effect of SGLT-2 inhibitors on the telomeres length in patients with T2DM and CKD was not fully investigated. Therefore, the aim was to evaluate the effect of SGLT2 inhibitors therapy on telomere length in patients with T2DM with and without CKD.
Materials and Methods: This study included 100 patients with T2DM divided into 2 groups – with CKD (n = 50) and without CKD (n = 50). In each group, half of the patients received SGLT2 inhibitors therapy. Quantitative variables are presented as median [25th; 75th percentile], categorical — as n (%). Clinical and epidemiological data was determined for both groups. Telomere length in whole blood was measured using monochrome multiplex quantitative PCR with the calculation of the telomere-to-single-copy gene ratio (T/S ratio). To adjust for the effect of age, residual telomere length (ΔT/S) was calculated based on a regression model. Pathologically short telomeres were defined as ΔT/S with Z-score < -1. Statistical analysis included Mann–Whitney U test, χ² test, Pearson correlation, and multiple linear regression.
Results: Patients with CKD were older (71 [65 – 78] vs 52 [47 – 56] years), had longer diabetes duration (6 [2 – 15] vs 3 [2 – 5] years), higher HbA1c (6.7 [6.1 – 7.7] % vs 6.1 [5.6 – 7.5] %), and lower eGFR (46 [36 – 53] vs 80 [73 – 89] ml/min/1.73 m²). Albuminuria was higher in CKD (28 [7.2 – 56] vs 5.4 [2.7 – 11.1] mg/l). BMI was comparable (32.8 [28.7 – 36.2] vs 32.5 [26.9 – 36.7] kg/m²). Cardiovascular disease was more prevalent in CKD (60 % vs 34 %). Both groups had equal sex distribution (40 % women, 60 % men). Patients with CKD had significantly lower ΔT/S values compared with those without CKD (p = 0,035). Pathologically short telomeres were observed in 20.8 % of CKD patients versus 2.1 % without CKD (p = 0,0076). SGLT2 use was associated with significantly longer telomere length in both the CKD group (r = 0,50; p < 0,01) and the non-CKD group (r = 0,60; p < 0,01). In a multivariate model, SGLT2 inhibitors therapy was the only independent predictor of longer telomere length (p < 0,001; R² = 0.51).
Conclusion: CKD is associated with the shortening of telomeres in patients with T2DM. SGLT2 inhibitors therapy in patients with T2DM with and without CKD is associated with longer residual telomere length (ΔT/S), which may indicate a slowdown of cellular aging. These findings highlight the potential role of SGLT2 inhibitors as geroprotective agents in clinical practice.
P09: Is There a Link between GLP-1 Receptor Agonists and The Risk of Pancreatitis?
Inna Doroshkevych, Alla Zhamba, Sviatoslav Semenenko
Vinnytsya, Ukraine
Background and Aims: GLP-1 receptor agonists are widely used to treat type 2 diabetes and obesity. Despite their effectiveness in reducing weight and improving glycemic control, there are concerns about a potential increased risk of acute pancreatitis. Given the prevalence of these diseases, elucidating the true association between GLP-1 agonist therapy and the risk of pancreatitis is clinically important.
Materials and Methods: An analysis of studies from various databases, including Scopus, Web of Science, PubMed, SpringerLink, reprotox, Medline, PubMed, for the years 2019 – 2025 on the effect of GLP-1 receptor agonists on the exocrine function of the pancreas and a possible connection with acute pancreatitis was conducted.
Results: The results of in vitro studies, prospective randomized clinical trials (LEADER, SCALE), epidemiological observations and meta-analyses on the use of GLP-1 agonists (liraglutide, semaglutide, tirzepatide) in patients with diabetes, obesity or overweight were analysed. GLP-1 receptors are found in the exocrine pancreas, but their activation does not directly stimulate the release of digestive enzymes; perhaps an adaptive cellular response occurs. Experimental studies have not revealed a direct stimulatory effect of GLP-1 on amylase or lipase secretion. During liraglutide therapy, a moderate (7 – 31 %) increase in their levels was observed, which normalized after discontinuation of treatment and was not associated with clinical pancreatitis. Clinical trials of liraglutide have not shown a significant increase in the incidence of pancreatitis. In the LEADER study (liraglutide, 1.8 mg, in patients with type 2 diabetes), the incidence of pancreatitis was not different from placebo (0.4 % vs. 0.5 %). In the SCALE study (liraglutide, 3.0 mg, in patients without diabetes), a slightly higher risk was found (0.4 % vs. < 0.1 %). The time to development of pancreatitis (after 5 – 12 months) correlates more with weight loss than with the drug itself. Semaglutide and tirzepatide were also not associated with a significant increase in the risk of pancreatitis in meta-analyses. A correlation was found between the degree and rate of weight loss and the risk of pancreatitis, regardless of the drug. The increase in amylase/lipase was transient, not associated with clinical manifestations of pancreatitis.
Conclusion: Currently, there is no reliable connection between the use of GLP-1 receptor agonists and an increased risk of acute pancreatitis. A moderate increase in amylase and lipase levels is a biochemical adaptation, not a marker of a pathological process. Similarly, the risk of pancreatitis is more likely to be associated with rapid weight loss due to the action of the drug than with the GLP-1 agonist itself. The use of GLP-1 agonists should not be limited in patients with a history of pancreatitis without an individual risk assessment. Further monitoring of patients with risk factors is necessary in the first 2 – 3 months of therapy.
P10: An Analysis of Sodium-Glucose Cotransporter-2 inhibitors‘ Usage Amongst Old-Aged Individuals
Muhammad Shoaib Zaidi
Riyadh, Saudi Arabia
Background and Aims: The aim of the study was to analyse the benefits and side effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) amongst the cross section of the elderly home care patients of our hospital in Riyadh, Saudi Arabia.
Materials and Methods: In this observational study, online data of home care old aged patients was randomly searched. A total of twenty four patients on SGLT2i were selected. The searched variables included patients’ ages, genders, comorbidities, indications and duration of usage of SGLT2is and other diabetes mellitus medications. The HbA1c, serum potassium, creatinine, urinary albumin/creatinine, hemoglobin & hematocrit, before and after SGLT2i intake, were also recorded. Co-medications such as angiotensin-converting-enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), and diuretics, were equally noted. The indications for which the SGLT2i had been prescribed included heart failure (with preserved, mildly reduced or reduced ejection fraction), atherosclerotic cardiovascular disease (ASCVD), high ASCVD risk, and chronic kidney disease (CKD) with and without proteinuria.
Results: Out of twenty-four patients, 58.3 % were female and 41.7 % male. Their ages ranged from 64 – 90 years. The duration range of the SGLT2i use was between 0.4 – 31 months. 41.7 % of individuals taking the medications had type 2 diabetes, hypertension, dyslipidemia and other comorbidities. The major indications for which the SGLT2i were used included ASCVD (20.8 %, cumulative 70.8 %), atherosclerotic heart disease and systolic heart failure (together 20.8 %). Other indications included HFpEF, high ASCVD risk, CKD and proteinuria. The other diabetes medications were insulin (16.7 %), metformin, a DPP-4 inhibitor and insulin (together 12.5 %). The glycosylated hemoglobin values before and after were similar. The urinary albumin creatinine ratios got improved in 5 of 24 patients (20.8 %), maximum up to 75.36 mg/g, and worsened in 4 of 24 (16.7 %) patients. The maximum ACR rise seen was 152.3 mg/g (nearly 500 % increase). The corresponding serum creatinine levels and the creatinine clearances of those patients did not indicate any worsening. There were no patients demonstrating a remarkable change in their serum potassium levels. The highest achieved hemoglobin and hematocrit were 16.3 g/l and 50.1 %, respectively. The urinary tract infection was manifested in 16.6 % of the patients.
Conclusion: Although the study was observational and the sample size was small, it was able to demonstrate that SGLT2i were well tolerated and had infrequent minor side-effects only.
Obesity Across the Lifespan: From Metabolic Signatures to Associated Risks
P11: Impact of Obesity on Myocardial Structure and the Development of Heart Failure
Ivanna Zubovych, Yevhen Marushko, Yanina Saienko, Oleksandr Halchenko, Borys Mankovsky
Kyiv, Ukraine
Background and Aims: Obesity is a global issue, and its impact on cardiac function remains insufficiently studied, particularly in the early stages without concomitant cardiovascular diseases. The study evaluated the systolic function of the left ventricle, using global longitudinal strain (GLS) and the extracellular volume (ECV) in 39 patients with obesity but without cardiovascular diseases.
Materials and Methods: We included 39 obese patients without cardiovascular disease: 16 men and 23 women, aged 57.3 ± 9.43 years, BMI = 34.8 ± 4.5kg/m2. The control group consisted of 33 healthy individuals (19 men and 14 women), aged 57.3 ± 5.7 years, BMI = 25.9 ± 3.2 kg/m2. ECV was assessed using magnetic resonance imaging of the heart on a 3T MR scanner. Segmental myocardial contractility was assessed by the method of GLS during strain echocardiography according to a 17-segment scheme.
Results: The left ventricular ejection fraction according to MRI data in patients of both groups was almost the same (56.9 ± 9.3 % and 59.5 ± 5.7 % in obese patients and control group, respectively, p > 0.05). The mean value of NT-proBNP in obese patients was 84.7 ± 40.9 pg/ml, which indicated the absence of laboratory signs of HF. It was found that the ECV in obese patients was significantly higher than in the control group (36.6 ± 4.9 % vs. 27.6 ± 3.2 %, respectively, p < 0.001). The mean value of left ventricular GLS in obese patients was higher compared with the control group (-13.3 ± 5.6 % vs. -20.0 ± 1.8 %, p < 0.01). The correlation analysis showed a moderate positive relationship between BMI and ECV (r = 0.45, p < 0.05) and also revealed a moderate inverse relationship between BMI and GLS (r = -0.45). This relationship is statistically significant (p < 0.05).
Conclusion: It was found that there was a significant increase in extracellular heart volume and a decrease in segmental myocardial contractility in obese patients compared with the control group, as determined by the method of global longitudinal deformation. This may indicate the development of metabolic cardiomyopathy, with a high probability of obesity association. The pathogenesis of the detected myocardial abnormalities is influenced to a greater extent by the level of BMI and the degree of obesity. The detected subclinical myocardial systolic dysfunction in obese patients without concomitant cardiovascular diseases can be considered as a sign of obesity-associated cardiomyopathy.
P12: Metabolic Signatures of Obesity in Children: Insights from HOMA-IR, Insulin, and Metabolic Syndrome Phenotypes
Simmi Kharb, Spoorthi Deshmukh, Akashdeep Bhardwaj, Lungsao Naomi, Anjali Verma
Rohtak, India
Background and Aims: Childhood obesity is a growing global health challenge, associated not only with adverse physical outcomes and reduced quality of life but also with a heightened risk of endocrine, metabolic, and cardiovascular complications in later life. Recent focus has shifted towards identifying distinct metabolic phenotypes within the obese pediatric population. Some obese children, despite excess weight, do not show typical cardiometabolic abnormalities and are classified as Metabolically Healthy Obese (MHO), while others exhibit metabolic dysfunction and are designated as Metabolically Unhealthy Obese (MUO) or progress to Metabolic Syndrome (MS). Additionally, normal-weight children may also show metabolic impairment, forming the Metabolically Unhealthy Normal Weight (MUNW) group. However, limited data exists on these phenotypes in Indian children. This study aimed to characterize the metabolic profiles of MHO, MUO, and MS children and compare them with healthy controls – both Metabolically Healthy Normal Weight (MHNW) and MUNW – using fasting insulin and HOMA-IR as markers of insulin resistance.
Materials and Methods: A total of 40 obese children (6 – 14 years) attending a pediatric endocrinology clinic were enrolled and classified into phenotypes using criteria such as blood pressure, triglycerides, HDL-C, and fasting glucose. Age- and sex-matched 40 healthy controls were also studied. Fasting insulin and HOMA-IR were calculated, and intergroup comparisons were made.
Results: Among obese children, 18 % were MHO (n = 8) and 82 % were MUO (n = 32). Within the MUO group, 6 children (19 %) met criteria for MS, with clustering of ≥3 metabolic abnormalities. MHO children had near-normal metabolic parameters: insulin 10.2 ± 2.8 µIU/ml, HOMA-IR 1.9 ± 0.5, TG 115 ± 35 mg/dl, HDL-C 42 ± 5 mg/dl, and normal blood pressure. MUO children had significantly worse profiles: insulin 18.6 ± 4.2 µIU/ml, HOMA-IR 3.7 ± 0.9, TG 196 ± 92 mg/dl, HDL-C 35 ± 6 mg/dl, with 40 % showing elevated blood pressure. Among controls, 52.5 % were MHNW (n = 21) and 47.5 % were MUNW (n = 19). MUNW children had elevated insulin (12.4 ± 4.2 µIU/ml), HOMA-IR (2.7 ± 0.7), TG (155 ± 45 mg/dl), and reduced HDL-C (48 ± 7 mg/dl), with raised blood pressure, unlike MHNW children, who had largely normal profiles.
Conclusion: Childhood obesity is metabolically heterogeneous. BMI alone is insufficient for risk stratification. MUO and MUNW children, often missed by standard screenings, represent high-risk groups. Incorporating fasting insulin and HOMA-IR into routine assessments enables early identification and targeted interventions, potentially mitigating long-term cardiometabolic risks.
P13: Bariatric Surgery as a Strategy to Improve Fertility and Pregnancy Outcomes in Women with Obesity and Type 2 Diabetes: A Case Report
Tamar Shervashidze, David Abuladze, Rusudan Kvanchakhadze, Liana Jashi, Miranda Shervashidze, Khatuna Chakvetadze
Tbilisi, Georgia
Background and Aims: Women with overweight or obesity face an increased risk of miscarriage, while type 2 diabetes mellitus (T2DM) further raises the likelihood of adverse maternal and neonatal outcomes. These complications are more common in women with pregestational diabetes than in those with gestational diabetes. Obesity, through its metabolic and hormonal disturbances, can significantly impair reproductive health. Good glycemic control before conception is essential to reduce these risks. Bariatric surgery, although primarily intended for substantial weight reduction, has also been shown to exert beneficial metabolic effects that may improve fertility.
Materials and Methods: We present the case of a female patient with type 2 diabetes mellitus (T2DM), diagnosed at the age of 29. Clinical data were collected across multiple pregnancies, diabetes management strategies, bariatric surgery and subsequent fertility treatment. Both of her early pregnancies were managed with insulin therapy. At the age of 40, the patient underwent bariatric surgery, after which she was followed for metabolic and reproductive outcomes. Four years later, she underwent in vitro fertilization (IVF) due to secondary infertility, with insulin therapy continued throughout the pregnancy.
Results: The patient was diagnosed with type 2 diabetes mellitus (T2DM) at the age of 29. At 33, she experienced intrauterine fetal death at 7 months of gestation, complicated by fetal hydrocephalus, with a BMI of 50 kg/m². Her second pregnancy at 38 ended in spontaneous abortion at 7 weeks (BMI 52.1 kg/m²), with a pre-pregnancy HbA1c >7.5 %. Both pregnancies were managed with insulin, and glycemic control was achieved during gestation. At the age of 40, she underwent bariatric surgery (BMI 53.3 kg/m²), achieving significant weight loss. Four years later, her BMI had decreased to 33.3 kg/m², and HbA1c was <6.5 %. Despite secondary infertility, a twin pregnancy was achieved through in vitro fertilization. Diabetes was managed with insulin throughout the pregnancy, and two healthy infants were delivered by cesarean section at 34 weeks.
Conclusion: The weight reduction was associated with improved fertility, better outcomes in fertility treatment and a reduced risk of diabetes and cardiovascular-related complications. Hence, women should receive preconception counseling about the risks of obesity and its impact on early pregnancy loss. Optimal diabetes control before conception is essential, as poor glycemic management significantly increases the risk of congenital anomalies, miscarriage and adverse maternal outcomes. Current European Society of Human Reproduction and Embryology (ESHRE) recommendations suggest that couples with obesity and a history of recurrent pregnancy loss aim to achieve a normal BMI (20 – 25 kg/m² in caucasian individuals) before conception. Reaching a healthy BMI, together with well-controlled diabetes, may offer significant benefits for both maternal and neonatal health.
Neuropathy and Cardiac Autonomic Dysfunction in Diabetes
P14: Rethinking Peripheral Neuropathy Through a Vascular Lens: Insights from the NEUROPA Study
Austeja Simkute, Irena Zukauskaite, Arunas Vaitkevicius, Jurate Gudonyte
Vilnius, Lithuania
Background and Aims: Peripheral neuropathy is often associated with vascular dysfunction, which complicates its clinical evaluation. The aim of the study is to evaluate the significance of varicose vein symptoms in the management of peripheral sensory nerve current perception threshold (CPT) disorders.
Materials and Methods: A cross-sectional study of 257 neurology outpatients measured CPT in both legs using the Neurometer® at 2000 Hz, 250 Hz, and 5 Hz. Neurometric measurements were categorized into three groups based on the frequencies: group 1 – impaired results (hyperesthesia/hypoesthesia) in both legs (117), group 2 – impaired results in one leg (80), and group 3 – normal results (normoesthesia) in both legs (60). All groups were statistically comparable in terms of age and sex. Smoking history, information on nutrition and physical activity, and the Varicose Veins Symptoms Questionnaire (VVSymQ) were collected.
Results: Among 257 patients (mean age 52.8 ± 15.5 years), the prevalence of leg heaviness varied significantly across groups: 39.3 % in group 1, 36.3 % in group 2, and 20 % in group 3 (p = 0.032). Also, both impaired groups showed higher percentage of leg achiness compared with group 3 (29.9 % vs. 36.3 % vs. 13.3 %, p = 0.01). A significantly higher proportion of patients in group 1 reported leg swelling (22.2 %) compared with group 2 (10 %) and group 3 (11.7 %) (p = 0.041). 17.1 % of group 1 and 22.5 % of group 2 patients indicated leg itching, as opposed to 6.7 % in group 3 (p = 0.041). Additionally, a significantly higher proportion of daily smokers was found in group 1 (13.8 %), followed by group 2 (7.6 %) and group 3 (3.4 %) (p = 0.011). Meanwhile, no statistically significant differences were observed between the groups regarding regular physical activity (75.7 % vs. 87.3 % vs. 83.3 %, p = 0.109) or daily fruit consumption (56.4 %, 62 %, and 70 %, respectively; p = 0.211).
Conclusion: Peripheral sensory impairment, particularly bilateral, showed significant associations with varicose vein symptoms and daily smoking, highlighting the relevance of vascular dysfunction and behavior-related risk factors in the development of peripheral neuropathy. These results support a more integrated, symptom-oriented approach to neuropathy assessment.
P15: Heart Rate Variability and Chronic Low-Grade Inflammation Metrics in Internally Displaced Persons with Type 2 Diabetes and Subclinical Cardiac Autonomic Neuropathy
Victoria Serhiyenko, Alexandr Serhiyenko, Volodymyr Segin
Lviv, Ukraine
Background and Aims: Internally displaced persons (IDPs) exhibit emotional responses to psychosocial stress that disturb the autonomic nervous system. The objective of the study was to examine the distinctions between short-term heart rate variability (HRV) and chronic low-grade inflammation (LGI) in IDPs with T2D and subclinical cardiac autonomic neuropathy (CAN).
Materials and Methods: Sixteen healthy individuals (group 1, control) were examined, alongside sixteen patients from Lviv diagnosed with T2D and asymptomatic CAN (group 2), as well as sixteen IDPs with T2D and subclinical CAN (group 3). There were no significant differences in age, sex, duration of T2D, BMI, and HbA1c (p > 0.05). Subclinical CAN was detected using routine cardiovascular reflex testing and the Composite Autonomic Symptom Score-31 (COMPASS-31). We evaluated the short-term HRV outcomes, which persisted for 5 minutes. Assay systems were used to find the amounts of immunoreactive insulin, hsCRP, tumor necrosis factor (TNF-α), interleukin (IL)-1β, IL-6, and IL-10 in the blood. The Homeostatic Model Assessment for IR (HOMA-IR) and TNF-α/IL-10 were calculated. We used the nonparametric Mann-Whitney test to compare the obtained data, focusing on the median (Me) and interquartile range (Q25 – Q75). Statistical significance at the level of p < 0.05.
Results: In group 3, the heart rate (HR) of patients increased dramatically, although the median RR intervals (mRR) and the proportion of consecutive NN intervals differing by more than 50 ms (pNN50%) decreased. In comparison to the second group, we noted a substantial rise in HR among IDPs: 86.19 ± 82.3 [69.0; 121.0] bpm (p < 0.05); decrease of root mean square of successive differences (RMSSD): 17.56 ± 9.06 [5.0; 41.0] ms (p < 0.05); pNN50%: 2.56 ± 4.66 [0; 17] % (p < 0.05); high-frequency power (HF): 143.81 ± 111.68 [10.0; 363.0] ms² (p < 0.01); percentage of high frequency in the overall spectrum (HF%): 10.44 ± 8.15 [2.0; 26.0] (p < 0.01), with the increase of the normalized low frequency unit (LFnorm): 79.81 ± 1. The highest HOMA-IR scores were observed in IDPs with T2D and subclinical CAN (5.2 ± 1.7 [2.8; 8.1]; p < 0.05). The evaluated patients exhibited an elevation in hsCRP levels, notably in group 3, with a mean of 9.9 ± 4.9 [2.1; 18.7] mg/l (p < 0.05). The concentrations of TNF-α and the TNF-α/IL-10 ratio exhibited the most significant increase in IDPs, measuring 17 ± 4.9 pg/ml [2.8; 21.6] (p < 0.001) and 3.0 ± 2.9 [0.2; 9.9] (p < 0.05), respectively.
Conclusion: IDPs with T2D and subclinical CAN demonstrate the most pronounced IR and a significant increase in certain chronic LGI markers. A decrease in overall HRV power and a pronounced preponderance of the sympathetic component were observed in IDPs with T2DM and preclinical CAN. The findings may serve as a foundation for the development of effective preventive strategies for T2D as well as for the creation of innovative approaches to the timely diagnosis and management.
P16: Identification of Risk Factors for Cardiovascular Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus and Cardiovascular Diseases based on Patient Phenotype Examination and Insulin Production
Olha Monashnenko, Boris Mankovsky
Kyiv, Ukraine
Background and Aims: Cardiovascular autonomic neuropathy (CAN) is a serious complication of type 2 diabetes mellitus (T2DM) that significantly worsens patient prognosis. The aim of this study was to evaluate the relationship between clinical and laboratory parameters, particularly insulin secretion, and the development of CAN in patients with T2DM and concomitant cardiovascular diseases (CVD).
Materials and Methods: We included 82 patients diagnosed with T2DM and CVD. Based on the presence of cardiovascular autonomic neuropathy, patients were divided into two groups: a main group with existing CAN (n = 66) and a control group without CAN (n = 16). All participants underwent a detailed examination, including medical history, anthropometry, and laboratory tests. C-peptide levels were used as a key marker of endogenous insulin production. For statistical analysis, the Student’s t-test and χ² test were used, and the significance level was set at p < 0.05.
Results: A comparative analysis showed that patients with CAN were significantly older (67.1 ± 8.4 vs. 62.3 ± 9.1 years, p < 0.05) and had a longer duration of T2DM (12.8 ± 6.1 vs. 8.5 ± 5.2 years, p < 0.01) compared to the control group. The CAN group also had a significantly lower glomerular filtration rate (72.5 ± 18.0 vs. 84.2 ± 15.1, p < 0.05) and a markedly lower C-peptide level (2.1 ± 0.9 vs. 2.9 ± 1.1 ng/ml, p < 0.01). A strong negative correlation was found between C-peptide levels and the duration of diabetes (r = -0.65, p < 0.01), indicating the depletion of insulin secretion over time.
Conclusion: The key risk factors for the development of CAN in patients with T2DM and CVD are older age, a longer duration of diabetes, reduced kidney function, and decreased endogenous insulin secretion. Impaired insulin production, confirmed by low C-peptide levels, is an independent and statistically significant risk factor for the development of CAN in this patient population. C-peptide assessment may serve as a useful tool for risk stratification and identifying patients who require more careful monitoring and preventive measures.
P17: Prevalence and Correlates of Peripheral Neuropathy in Type 2 Diabetes Mellitus: The Impact of Metabolic Control and the Association with Heart Failure in a Romanian Cohort
Florin Gabriel Panculescu, Catrinoiu Doina, Suliman Ioana Livia
Constanta, Romania
Background and Aims: Diabetic neuropathy (DN) is one of the most frequent and disabling complications of type 2 diabetes mellitus (T2DM). Its development is influenced by metabolic control, disease duration, and age, and it often coexists with cardiovascular disease. Heart failure (HF), a frequent comorbidity in T2DM, shares common pathophysiological pathways with DN, but the triangular relationship between diabetes, neuropathy, and HF remains underexplored, particularly in Eastern Europe. The aim of this study was to evaluate the prevalence of DN in patients with T2DM, assess its association with metabolic control, and investigate the relationship between DN and HF.
Materials and Methods: We conducted a descriptive, prospective study (January – July 2025) at the County Emergency Clinical Hospital "Sf. Apostol Andrei," Constanța, Romania. A total of 302 outpatients with T2DM (aged 17 – 72 years) were included. Data collected included demographics, diabetes duration, HbA1c, NT-proBNP, BMI, treatment type, and presence of DN and HF. Statistical analyses assessed associations and independent predictors of DN and HF.
Results: DN was diagnosed in 100 patients (33.1 %), with higher prevalence in men (58 %). Prevalence increased with age (40 % in >60 years) and disease duration (>10 years: 66 %). DN patients had significantly higher HbA1c (mean 9.2 % vs 7.4 % in non-DN); 96 % had HbA1c >7 %. Among DN patients, 71 % were treated with insulin, who also showed poorer glycaemic control than those on oral agents. HF was documented in 79 patients (26.1 %); of these, 52 (65.8 %) also had DN. Patients with both DN and HF were older (mean 67 years) and had longer diabetes duration (mean 13.6 years). DN prevalence was significantly higher in HF patients than in those without HF (65.8 % vs 24.7 %, p < 0.001). Logistic regression identified poor glycaemic control, longer diabetes duration, and HF as independent predictors of DN; DN itself was a predictor of HF when combined with poor metabolic control and hypertension.
Conclusion: In this Romanian cohort, one-third of T2DM patients had DN, strongly associated with poor metabolic control, longer diabetes duration, older age, and male gender. HF was present in over one-quarter of patients and showed a significant overlap with DN, suggesting shared pathophysiological mechanisms. These findings underscore the need for integrated, multidisciplinary management of diabetic patients to prevent or delay both neuropathic and cardiovascular complications.
Interventional Cardiology: Risk, Cohorts & Consensus
P18: Comprehensive Analysis of Risk Factors, Clinical Correlations, and Therapeutic Strategies in Heart Failure: Insights from a Cohort of 44,992 Patients
Navanil Biswas, Manish Ganguly, Subrata Barai, Darshan B. S, Chidananda G. C, Srikanth Nakka, Panchanan Sahoo, Sashankha Chunduri, Sanjeeb Roy, Avradip Santra
Kolkata, India
Background and Aims: Heart failure is a major global health concern, causing significant morbidity and mortality. This study aimed to identify demographic and clinical factors influencing heart failure, assess correlations among clinical parameters, and evaluate treatment patterns, particularly focusing on beta-blockers like metoprolol.
Materials and Methods: A retrospective cohort study was conducted on 44,992 heart failure patients. Collected data included demographics (age, gender, lifestyle), vital signs (blood pressure, BMI, pulse), and biochemical markers (cholesterol, serum creatinine, eGFR, uric acid). Risk factors such as hypertension and diabetes, and therapeutic use of beta-blockers, diuretics, and angiotensin converting enzyme (ACE) inhibitors were recorded. Correlation analyses were used to explore parameter relationships. NYHA class was applied to assess symptom severity.
Results: In this cohort, a strong positive correlation between age and pulse rate was observed (r=0.98). Renal markers demonstrated a moderate positive correlation between serum creatinine and uric acid (r=0.45), while eGFR showed a slight inverse association with triglycerides (r=-0.09). Systolic blood pressure rose progressively across age strata, from a mean of 141.8mmHg in patients <40 years to 148.8mmHg in those >80 years, and total cholesterol similarly increased with age, peaking at 211.7mg/dl in the >80-year group. Hypertension was detected in 4,334 participants, and 3,133 patients had both hypertension and diabetes. Lifestyle factors such as tobacco and alcohol use were also common. Regarding pharmacotherapy, metoprolol was the most frequently prescribed beta-blocker (n=5,550). Among diuretics, spironolactone was used in 345 patients, with torsemide and furosemide also commonly prescribed. Functional status was predominantly NYHA class II (n=7,531), indicating mild symptoms, while 761 patients were classified as NYHA class IV.
Conclusion: Older patients showed higher pulse, blood pressure, and cholesterol, emphasizing age as a key factor in heart failure severity. Kidney dysfunction correlated with metabolic changes such as elevated triglycerides. Hypertension and diabetes were the most prevalent risk factors. Metoprolol was widely used across NYHA classes, highlighting its clinical utility. Spironolactone and torsemide were central in fluid management. These findings support the need for personalized treatment strategies considering age, comorbidities, and renal function to improve outcomes in heart failure patients.
P19: High Stakes, High Pressure: The Overlooked Cardiovascular Risks of Youth Athletes
Miranda Shervashidze, Ana Chikhradze, Tamar Bakhtadze, Khatia Dolidze, Tamar Shervashidze
Batumi, Georgia
Background and Aims: Childhood obesity remains one of the most urgent global health challenges of the 21st century. According to the World Health Organization, over 390 million children and adolescents are now overweight or obese, with prevalence rates nearly tripling since the 1970s. Excess adiposity in youth is a major predictor of adult obesity – carrying up to a tenfold increased risk of persisting into later life – and is closely linked to early-onset hypertension, dyslipidemia, insulin resistance, and cardiovascular disease. Elevated blood pressure (BP) during childhood is increasingly recognised as a precursor of adult hypertension and a driver of coronary artery disease, stroke, and heart failure. Importantly, pediatric athletes engaged in high-mass, strength-based sports such as rugby and judo may face unique cardiometabolic risks due to body mass optimization, intense training, and dietary practices, despite the common perception that athletic participation confers protection against obesity-related disease.
Materials and Methods: We performed a cross-sectional study of 305 athletes aged 8 – 17 years from regional sports academies. Assessments included anthropometrics, echocardiography, 12-lead ECG, and standardized BP measurement across three clinic visits. Body mass index (BMI) was categorised according to Centers for Disease Control and Prevention (CDC) growth charts (<75th, 75th – 89th, 90th – 94th, ≥95th percentiles). A focused analysis was conducted in 63 strength-based athletes (rugby, judo, and similar disciplines), given their higher rates of overweight/obesity. Statistical methods included Chi-square, ANOVA/t-tests, and multivariable logistic regression adjusting for sport type, age, and sex.
Results: Among rugby and judo athletes (mean age 13.4 ± 2.1 years; 82 % male), the prevalence of sustained elevated BP was 38 %, which is far above the 3 – 5 % typically reported in the general pediatric population. White-coat hypertension accounted for only 12 % of cases. BMI distribution showed 33 % ranging in the ≥90th percentile, with 15 % meeting obesity criteria. Elevated BP was strongly BMI-dependent: 62 % in ≥95th percentile, 41 % in 90th – 94th, 29 % in 75th – 89th, and 10 % in <75th (p < 0.001). Logistic regression confirmed a 6.2-fold risk of hypertension in athletes with obesity (95 % CI: 2.1 – 14.9; p < 0.001). No independent effect of sport type was observed once BMI was considered.
Conclusion: Our findings reveal a strikingly high prevalence of hypertension among youth athletes in weight-intensive sports, challenging the assumption that athletic training protects against obesity-related cardiovascular risk. The dose-response relationship between BMI and BP highlights the urgent need for systematic cardiovascular screening, even in competitive young athletes. Preventive strategies – including early detection, family-centered nutrition support, and careful training oversight – are critical to halt the trajectory toward adult cardiovascular disease.
P20: Nationwide Expert Consensus of 800 Cardiologists on the Evolving Role of Nicorandil in STEMI, PCI, and FFR-Driven Interventional Cardiology
Gojanur Shetty, Prashant Sahoo, Sanjay Porwal, Naveen Garg, Anupam Goel, Rahul Gupta, Girish Kawthekar Manish Saha, Purnanand Aila, B. S. Ayyappan
Bangalore, India
Background and Aims: The AngioStat initiative aimed to build nationwide expert consensus on the evolving role of nicorandil in interventional cardiology, focusing on its clinical utility across PCI, STEMI, and FFR-related outcomes.
Materials and Methods: The AngioStat consensus engaged 800 cardiovascular disease experts, collectively contributing over 25,000 years of clinical experience. Participants assessed eight evidence-based clinical statements on nicorandil using a 5-point Likert scale. Statistical analysis was conducted using GraphPad v10.3.0, with strong consensus defined as a weighted agreement score above 100.
Results: The perception mapping revealed strong expert consensus on nicorandil’s cardioprotective role in PCI settings. Highest agreement was seen for its real-world benefit in STEMI patients aligning with the CHANGE trial (score: 11.4) and its ability to reduce reperfusion injury during primary PCI (score: 106.5). Nicorandil as a hyperemia agent alternative for FFR (score: 103.3) and long-term outcome benefits post-PCI (score: 100.8) also achieved consensus. While the ischemia-centric paradigm shift scored marginally above threshold (score: 100.6), efficacy in contrast nephropathy prevention received lower endorsement (score: 81.9). The overall mean response scores were: agree: 74 ± 10 (95 % CI 66 to 83), strongly agree: 18 ± 10 (95 % CI 9.5 to 27), p < 0.0001.
Conclusion: The expert consensus affirms nicorandil’s evolving role in interventional cardiology, particularly for STEMI and primary PCI. Its benefits in reperfusion injury reduction, long-term outcomes, and FFR support broaden its clinical utility beyond traditional uses.
P21: Expert Consensus on Optimizing Antiplatelet Therapy in Chronic Coronary Syndrome: Insights from 3,650 Man-Years of Clinical Experience and a Focus on Clopidogrel for Improved Outcomes
Saumitra Ray, Chandrashekhar Kashinath Ponde, Jagdish Hiremath, Manish Bansal, A. George Koshy, Devanu Roy, Arnab Dutta, Johann Christopher, Ezhilan J, Kiron Varghese, Aditya Kapoor, Tarun Dave, Prasant Kumar Sahoo, Arvind Kumar, Deepak Saha
Kolkata, India
Background and Aims: Chronic Coronary Syndrome (CCS) requires careful balancing of efficacy and safety in antiplatelet therapy. The DIDEPT (Dissemination on De-escalation and Escalation of Antiplatelet Therapy in CCS) initiative aimed to establish expert consensus and practical recommendations for optimal management.
Materials and Methods: DIDEPT convened six meetings with 30 cardiovascular experts and 145 active participants, amassing 3,650 man-years of clinical experience. Among 19,998 registered clinicians, 4,660 attended webinars to evaluate 13 clinical statements using a 5-point Likert scale. A strong consensus was defined as a weighted score >75.
Results: Strong consensus was achieved for 11 of the 13 statements. The highest weighted score (101.3) was attributed to the 2024 ESC Guidelines, emphasizing a patient-centered approach. Key agreements included de-escalation to clopidogrel for high bleeding risk (100.0), combination therapy with statins to reduce recurrent cardiovascular events (94.6), and abbreviated DAPT for high bleeding risk (93.0). Clopidogrel was strongly endorsed as the ‘new aspirin’ for monotherapy (92.6) and a cornerstone therapy post-PCI in combination with aspirin (91.8). Escalating therapy from aspirin to clopidogrel (91.5) and the Risk Factor-Weighted Clinical Likelihood model for CAD prediction (89.0) also received significant support. Overall, clopidogrel monotherapy’s superiority to aspirin was highlighted (87.5). The findings underscore the importance of personalized, evidence-based strategies for high bleeding risk patients, with overall mean response scores: agree: 52 ± 8.4, strongly agree: 45 ± 12, p < 0.0001.
Conclusion: The DIDEPT findings highlight clopidogrel as a highly efficacious approach as compared to aspirin, reinforcing clopidogrel as a cornerstone therapy in CCS. Clopidogrel demonstrates a favorable safety profile, particularly in high bleeding risk scenarios, making it a reliable option for both efficacy and safety in long-term patient care. Aligning practices with updated guidelines that prioritize clopidogrel can optimize long-term outcomes through personalized strategies.
P22: Reducing Door to Balloon Time in a Himalayan Capital – Barriers in Private Cardiac Care in Kathmandu, Nepal
Shivaji Bikram Silwal, S Chaulagain, U Panta
Banepa, Nepal
Background and Aims: Primary percutaneous coronary intervention (PCI) is the gold standard for ST-elevation myocardial infarction (STEMI) management, with international guidelines recommending a door to balloon (DB) time of <90 minutes. However, in Kathmandu, Nepal, achieving this benchmark is challenging due to systemic inefficiencies, infrastructural constraints, and logistical barriers. Most private catheterization laboratories (cath lab) are located within Kathmandu’s Ring Road, with over 75 % of STEMI cases referred from other hospitals. Traffic congestion, limited cath lab availability, and inconsistent referral pathways further delay treatment, particularly during peak hours. This study identifies key barriers to reducing DB time in Kathmandu’s private cath labs and proposes context specific strategies for optimizing STEMI care in this resource limited urban setting.
Materials and Methods: A prospective observational study was conducted over one year in high-volume private hospitals, enrolling 124 STEMI patients undergoing primary PCI. DB time was analysed, with delays categorized into four phases: pre-hospital, triage, ECG to cath lab transfer, and cath lab activation to balloon inflation. In depth interviews with healthcare providers and administrators explored systemic and logistical challenges.
Results: The DB time was 124 minutes, with only 28 % of patients achieving the <90-minute target. The main sources of delay were the pre-cath lab phase (58 %, due to late or misinterpreted ECGs and prolonged triage at referring centers), cath lab activation (22 %, related to financial clearance, consent procedures, and team mobilization), infrastructural constraints (12 %, including limited cath lab availability, competition with elective cases, and lack of 24/7 staffing), and referral/transport factors (8 %, including poor inter-hospital coordination and traffic-related ambulance delays).
Conslusion: DB time delays in Kathmandu’s private cath labs arise from pre-hospital, institutional and logistical barriers. Key strategies to reduce delays include implementing STEMI fast-track protocols with staff training, enabling pre-hospital ECG transmission and advance referrals, streamlining financial and consent procedures, ensuring dedicated cath lab access, and establishing an integrated regional STEMI network with designated PCI hubs and efficient transfer systems.
Evidence, Comorbidity and Engagement in Cardiometabolic Care
P23: Hypothyroidism in Algerian Adults with Nephrotic Syndrome: A Cross-Sectional Study
Adel Gouri, Nihed Benchetah, Saddek Benharkat
Annaba, Algeria
Background and Aims: Nephrotic syndrome (NS) is associated with massive urinary protein loss, including thyroid hormones and their binding proteins, potentially leading to hypothyroidism. The prevalence, type, and determinants of thyroid dysfunction in NS remain insufficiently studied. This study aimed to evaluate the frequency and characteristics of hypothyroidism among adult NS patients and identify associated clinical and biological factors.
Materials and Methods: We conducted a descriptive cross-sectional analytical study from January 2020 to April 2022 at the Medical Biochemistry Laboratory of Ibn Rochd University Hospital, Annaba, in collaboration with the Nephrology and Hematology departments. Thirty adult patients (≥18 years) with confirmed NS (proteinuria ≥3 g/24 h for ≥1 year) were included after applying exclusion criteria (pre-existing thyroid disease, autoimmune secondary NS, or interfering treatments). Data collection covered demographics, clinical features, renal parameters, and thyroid function tests (TSH, FT4). Hypothyroidism was classified as clinical (TSH >4.2 mUI/l with low FT4) or subclinical (TSH > 4.2 mUI/l with normal FT4). Statistical analyses included descriptive statistics, Student’s t-test, Chi-square, and Pearson correlation (p < 0.05).
Results: Participants had a mean age of 48.2 ± 13.9 years, with a male-to-female ratio of 1.3. Most cases were secondary NS (52 %), predominantly due to multiple myeloma, amyloidosis, and diabetes. Impure forms accounted for 87 % of NS cases. Hypothyroidism was present in 27 % of patients (n = 8), of which 62 % were clinical and 38 % subclinical. Compared to euthyroid patients, hypothyroid patients had higher proteinuria and lower serum albumin levels (p < 0.05), while renal function parameters showed non-significant differences. Strong positive correlations were found between TSH and proteinuria (r = 0.691, p < 0.05) and strong negative correlations between TSH and albuminemia (r = -0.75, p < 0.05). FT4 showed inverse correlations with proteinuria (r = -0.621) and direct correlations with albumin (r = 0.656), both statistically significant.
Conclusion: Hypothyroidism is a frequent complication in adult NS patients, particularly in those with massive proteinuria and severe hypoalbuminemia. Systematic screening of thyroid function in NS is recommended, especially in long-standing, secondary, or impure forms, to enable early diagnosis and management.
P24: National Consensus on Olmesartan in Hypertension: Clinical Perspectives from Indian Experts
Ashok Pancholia, Pramod Mundra, Satrajit Samanta, Chetan Shah, Vikrant Vijan, Nagraj Desai, Sunil Kumar, S. N. Routray, Arun Gopi, Ritankur Barkotoky, Bhupesh Shah, Siddhant Trehan, Chandra Bhan Meena, Aziz Khan, Vickram Vignesh, Pranav Sheth
Indore, India
Background and Aims: Olmesartan, an angiotensin II receptor blocker (ARB), has been validated globally through landmark clinical trials and remains a cornerstone in hypertension management. This mapping exercise aimed to evaluate expert consensus on various clinical dimensions of olmesartan therapy using a structured Likert-scale questionnaire.
Materials and Methods: The Olmesartan Measure (OLMEASURE) Study Group conducted a structured consensus exercise in involving 300 specialists in hypertension care. A structured 17-item questionnaire was utilised among clinicians, addressing olmesartan’s efficacy, safety, tolerability, and broader clinical applications. Respondents rated statements on a five-point Likert scale (strongly disagree to strongly agree). Weighted scores were calculated to quantify consensus, with scores >100 considered strong consensus agreement.
Results: The survey demonstrated consistently high levels of agreement on key attributes of olmesartan. Weighted scores exceeded 110 for several domains, including benefits of long-lasting blood pressure control (117.8), smooth 24-hour control with combination therapy (116.3), and additional clinical benefits beyond blood pressure reduction (118.1). The highest consensus (119.1) was observed for olmesartan’s role in delaying microalbuminuria onset in type 2 diabetes, supported by landmark evidence. Strong support was also recorded for its efficacy as monotherapy or in combination (117.4) and early blood pressure reduction within the first week (114.6). Overall, 15 of 17 statements achieved weighted scores >100, reflecting widespread expert endorsement. The overall mean response scores were: agree: 73 ± 19 (95 % CI 64 to 82), strongly agree: 20 ± 12 (95 % CI 14 to 26), p < 0.0001
Conclusion: This consensus exercise highlights olmesartan’s validated efficacy, long-term safety, and pleiotropic benefits in hypertension management, including compelling evidence in diabetic patients. High levels of physician agreement reinforce its benefit in hypertension management.
P25: Gamification to Deliver Diabetes Education: DiaFight Novel Card Games
Ryan Kelly, Mark Clements, Ethan Barnard, Caitlin Woombs, Sarah Tutton, Daniel Chedrnavvsky and Katharine Barnard-Kelly
Fareham, United Kingdom
Background and Aims: Evidence-based, theory-driven education is crucial to support the acquisition of diabetes skills. Alongside supporting optimal glycemia-related behaviors, a focus on positive psychosocial adjustment is also necessary. There is a need for fun and engaging ways to share learning for families, schools and broader communities. DiaFight are novel card games for children and adults aged 7+ consisting of a fantasy world of different Dia Characters. Together they address a broad range of real lived experiences faced by children, families and adults with T1D across physical, mental and social wellbeing issues.The aim was to assess acceptability, relevance and playability of the DiaFight card games with families and adults living with type 1 diabetes.
Materials and Methods: Following co-design development of the card game with people living with diabetes and healthcare professionals (HCPs); a series of focus groups were held to assess acceptability, relevance, educational impact, stigma impact and playability. Patient participants were given a games pack and invited to explore and play the game during 3-hour sessions. Both participants and HCPs provided feedback on potential impact.
Results: Patient participants were n = 16 adults (23 – 62 yrs, 9 male) and n = 8 children (3 – 16 yrs). Gaming experience was beginner (n = 7), moderate (n = 4) and expert (n = 3). Diabetes knowledge was reported as low (n = 2), moderate (n = 9) and expert (n = 3). Fifteen HCPs provided feedback. All said the game was a good educational tool that made talking about diabetes easier, it would help them communicate to others the demands of diabetes and how they could be more supportive.
Conclusion: The intervention was effective as an evidence-based, theory-driven educational tool to support teamwork, improve awareness of the psychosocial aspects of real lived experience of diabetes and reduce associated stigma.
P26: Pharmacokinetic and Clinical Relevance of the Medoxomil Moiety in Olmesartan: A Scoping Review
Ashok Pancholia, Ashwani Mehta, Rohit Kapoor, Pranab Jyoti Bhattacharyya, Bharat Bhusan Kukreja, Varesh Nagrath, Prabhat Agarwal, Chetan Shah, Bhupesh Shah
Indore, India
Background and Aims: Medoxomil is a pharmacologically inert promoiety used in the synthesis of several prodrugs, most notably olmesartan medoxomil, an angiotensin II receptor blocker (ARB) indicated for hypertension. Its utility lies in enhancing the oral bioavailability of poorly absorbed parent drugs by increasing lipophilicity and enabling transporter-mediated uptake. After oral administration, olmesartan medoxomil undergoes rapid enzymatic hydrolysis to release active olmesartan. This review synthesizes current evidence regarding the pharmacokinetics, metabolism, and clinical implications of the medoxomil moiety in olmesartan formulations.
Materials and Methods: A scoping review was conducted using literature published from 2000 to 2025 across PubMed, Scopus, and regulatory sources. Search terms included "olmesartan medoxomil," "medoxomil prodrug," "carboxymethylenebutenolidase (CMBL)," and "bioavailability." Inclusion criteria encompassed original pharmacokinetic studies, clinical trials, formulation studies, and pharmacovigilance data pertaining to the medoxomil moiety’s absorption, metabolism, or clinical relevance.
Results: The results of in vitro studies, prospective randomized clinical trials (LEADER, SCALE), Olmesartan medoxomil is enzymatically hydrolyzed in the proximal small intestine primarily by CMBL, with minor roles from paraoxonase-1 and chemical hydrolysis. The intact prodrug is undetectable systemically, and the medoxomil group is rapidly degraded into non-toxic metabolites. The absolute bioavailability of olmesartan is ~26 %, with a Tmax of 1 – 2 hours. The prodrug facilitates OATP2B1-mediated uptake, improving systemic exposure. Bile acid sequestrants and OATP2B1 inhibitors can impair absorption, while food has minimal effect. Novel delivery systems such as nanocrystals and Self-Microemulsifying Drug Delivery System (SMEDDS) have demonstrated enhanced absorption in preclinical studies. No significant safety or pharmacological concerns have been identified for the medoxomil moiety in recent pharmacovigilance reports.
Conclusion: The medoxomil moiety is essential for the pharmacological success of olmesartan by enabling effective gastrointestinal absorption and systemic availability of the active drug. Its rapid and complete hydrolysis, coupled with lack of systemic exposure or toxicity, highlights its value as a safe and effective prodrug strategy. In special populations, including pediatrics, and malnourished individuals, variability in hydrolytic enzyme expression may necessitate tailored dosing. Clinicians should consider timing of administration with interacting agents, but overall, the medoxomil-based design of olmesartan remains a clinically sound and biopharmaceutically rational approach.
Erschienen in: Diabetes, Stoffwechsel und Herz, 2026; 35 (1) Seite 37-52