108秋季會(嘉長)

目

錄

理監事名單 ........................................................................................3 會場交通資訊 .....................................................................................4 會場平面圖 ........................................................................................4 歡迎詞 ...............................................................................................5 理事長致詞 ........................................................................................6 節目表 ................................................................................................8 演講摘要 ...........................................................................................10 論文口頭報告 ...................................................................................27

1

社團法人中華民國內分泌暨糖尿病學會理監事名單 社團法人中華民國內分泌學會

第十四屆理監事名單

理 事 長

曾芬郁

常務理事

王佩文、蔡克嵩

理

王治元、李亭儀、施翔蓉、陳思達、陳涵栩 劉鳳炫、歐弘毅、簡銘男

事

常務監事

張慶忠

監

林仁德、林宏達

事

候補監事

林怡君

秘 書 長

吳婉禎

副秘書長

王舒儀、周振凱、林志弘、邱偉益、陳思綺 張鈞鎧、蘇登煌

社團法人中華民國糖尿病學會

第十四屆理監事名單

理 事 長

黃建寧

常務理事

陳榮福、杜思德、蔡世澤、楊偉勛

理

胡啟民、陳清助、李弘元、曾慶孝、裴 馰 林時逸、朱志勳、洪乙仁、蘇景傑、林慶齡

事

常務監事

許惠恒

監

莊立民、何橈通、戴東原、葉振聲

事

秘 書 長

張恬君

副秘書長

李建興、林嘉鴻、楊宜瑱、王俊興、田凱仁 林昆德

2

會場交通及平面圖資訊 長庚醫療社團 法 人 - 嘉 義 長 庚 紀 念 醫 院 地址 ： 嘉義縣 朴 子 市 嘉 朴 路 西 段 6 號 電話 ：（ 05 ） 3 6 2 -1 0 0 0

嘉義長庚紀念醫院位置圖

自行前往交通資訊

◎高鐵： A 、 學會接駁公車於 2 號出口集合 。 B 、 快捷公車 7211 ： 高鐵嘉義站 - 崙仔頂站 - 東勢寮站 - 縣政府站 - 長庚醫院 （ 頭班車 06 ： 00 約 20 分鐘一車次 ） ◎嘉義縣公車處： ◎嘉義客運： 嘉義―水上―太保―長庚 朴子―大糠榔―長庚 （ 頭班車 5 ： 50 約 30 分鐘一車次 ） （ 頭班車 7 ： 00 約 30 分鐘一車次 ） 朴子―大糠榔―長庚 布袋―朴子―長庚 頭班車 6 10 約 30 分鐘一車次 （ ： ） （ 頭班車 7 ： 30 約 60 分鐘一車次 ） 布袋―朴子―長庚 塭港―朴子―長庚 頭班車 6 20 約 60 分鐘一車次 （ ： ） （ 頭班車 7 ： 00 約 60 分鐘一車次 ）） 嘉義―蒜頭―雙溪口―長庚 （ 頭班車 8 ： 45 嘉義市發車 ） ◎停車場：西側停車場、綜合大樓地下停車場、北側停車場。

請於報到時向工作人員索取 " 停車優惠劵 " 3

4

嘉義長庚紀念醫院

院長歡迎詞

首先感謝各位先進來到嘉義長庚，參加中華民國內分泌暨糖尿病學會 2019 年秋季會。本人很榮幸以開會場地嘉義長庚身分，歡迎大家來此共聚一堂，希望 敝院相關的準備跟設施，能為大家提供舒適的會議環境及服務。 貴學會成立至今 39 年，聯繫國內各相關領域專家，促進內分泌及糖尿病之 學術發展及應用，期間學術交流活動除提升國內醫療水準，更積極與世界尖端接 軌，走向國際。對提升國人內分泌及糖尿病相關疾病提供優質診療及照護。 嘉義長庚紀念醫院位於嘉義縣朴子市與太保市交界處，鄰近嘉義縣政府與台 灣高鐵嘉義站，自 2002 年 1 月起，開始為雲嘉南地區民眾提供優質的門診、急 診與住院醫療服務。目前 1,369 床的醫療服務量肩負民眾健康照護之責任。嘉義 縣老年人口比率 19.42 ％優冠全國，對內分泌暨糖尿病相關醫療照護之殷切需求， 不言可喻。 此次貴學會於嘉義長庚舉辦 2019 年秋季會暨學術研討會，提供頂尖優質學 術交流，將新知在嘉義點燃薪火，擴大本區醫學視野。期許貴學會在理事長睿智 領導下，內分泌暨糖尿病照護能在嘉義深耕生根。 最後祝福各位先進先賢身體健康，大會圓滿成功。

院長

敬上

中華民國 108 年 9 月 29 日 5

社團法人中華民國內分泌學會 理事長致詞

中華民國內分泌學會及糖尿病學會 108 年秋季會由內分泌學會主辦。因應會 員希望增加南部學術活動比重的需求，今年的秋季會活動有許多創新，我們將過 往星期六下午半天的學術活動 (15 學分 ) 拉長為星期日接近一天的課程 (20 學分 )。 感謝嘉義長庚紀念醫院林志鴻院長及何正主任的協助與支持，我們得以有設備新 穎且舒適的會議場所。我們精心安排學術活動，內分泌學會邀請高雄長庚王佩文 教授主講「Mitochondria and Diabetes」、成大鄭凱比醫師主講「Immunotherapy induced endocrinopathy」、 台 大 張 晉 誠 醫 師 主 講「Interventional Radiology in Endocrinology」、台大楊偉勛教授主講 「Cross talk between fat and bone」、台大 施翔蓉醫師主講「Tumor induced osteomalacia」，糖尿病學會黃建寧理事長邀請 林口長庚林嘉鴻醫師主講「Artificial pancreas」、中山附醫羅仕昌醫師主講「糖尿 病神經病變綜論」、台北榮總胡啟民教授主講「糖尿病神經病變的篩檢與診斷」。 中國附醫張慶忠教授、林口長庚劉鳳炫醫師、林口長庚陳思達主任、嘉義長庚何 正主任、遠東診所蔡克嵩教授、台北榮總林宏達教授、中國附醫陳清助主任、台 大張恬君醫師分別擔任各場演講的主持人。感謝演講者與主持人的付出，讓本次 學術內容充實豐富。為鼓勵年輕會員，本次活動也安排有口頭論文競賽。除了學 術饗宴外，本次秋季會精心規劃員眷旅遊，會員在接受學術將近一天的學術洗禮 後，也可以輕鬆的與員眷共遊故宮南院。感謝會員的積極參予，讓本次秋季會充 滿具學術氣息的溫馨互動。感謝吳婉禎秘書長帶領邱偉益、蘇登煌、林志弘、陳 思綺、張鈞鎧、王舒儀、周振凱副秘書長及黃璿如、陳佩嬅秘書，安排此次活動， 讓會員們在輕鬆交流中有更多分享與學習。謹此感謝所有協助與支持本次活動的 好朋友們。謝謝大家 !

理事長

敬上

中華民國 108 年 9 月 29 日

6

社團法人中華民國糖尿病學會 理事長致詞

此次秋季會輪由內分泌學會主辦，特別選在靠近故宮南院的嘉義長庚 醫院舉行，一方面回應會員需求，顧及南北平衡，二方面在學分授予方面 也提高了份量。 糖尿病學會計畫三個課程，其一是林嘉鴻醫師的 Artificial pancreas， 近年來此新科技進展迅速，希望能提供會員們了解並加以應用；其二 是 由 羅 仕 昌 醫 師 報 告 他 於 2018 年 10 月 至 Sheffield University UK, Royal Hallamshire Hospital 跟隨 Prof. Solomon Tesfaye 學習有關糖尿病神經病變的 心得新知，最後是請胡啟民醫師分享糖尿病神經病變的臨床實務。以上安 排，再加上內分泌學會曾理事長的精心策劃，各項節目精彩可期，非常值 得大家踴躍參與。

理事長

敬上

中華民國 108 年 9 月 29 日

7

社團法人中華民國內分泌暨糖尿病學會 108 年度秋季學術研討會 日期：108 年 9 月 29 日（星期日）09:00-15:30 地點：嘉義長庚紀念醫院 ( B1 第一國際會議廳 )

Program 時間

主 題

演講者

09:00~09:30

報到

09:30~09:35

內分泌學會 理事長致詞

09:35~09:40

嘉義長庚紀念醫院 盧勝男 副院長致詞

09:40~10:10 Mitochondria and Diabetes 10:10-10:40 Immunotherapy induced endocrinopathy 10:40~10:45

大合照

10:45~11:00

Break

11:00~11:30 Interventional Radiology in Endocrinology 11:30~12:00 Artificial pancreas 人工胰臟

主持人

高雄長庚醫院 王佩文 教授 成大醫院 鄭凱比 醫師

中國附醫 張慶忠 教授 林口長庚 劉鳳炫 醫師

台大醫院 張晉誠 醫師 林口長庚 林嘉鴻 醫師

林口長庚 陳思達 主任 嘉義長庚 何 正 主任

Lunch symposium

12:00~13:00 13:00~13:30 Cross talk between fat and bone 13:30~14:00 Tumor induced osteomalacia

台大醫院 楊偉勛 教授 台大醫院 施翔蓉 醫師

遠東診所 蔡克嵩 教授 台北榮總 林宏達 教授

中山附醫 羅仕昌 醫師 台北榮總 胡啟民 教授

中國附醫 陳清助 主任 台大醫院 張恬君 醫師

Break

14:00~14:15 14:15~14:45 糖尿病神經病變綜論 14:45~15:15 糖尿病神經病變的篩檢與診斷 15:15~15:30

糖尿病學會理事長致詞 ( 頒獎 )

15:30~18:30

故宮南院參訪

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社團法人中華民國內分泌暨糖尿病學會 108 年度秋季學術研討會 ( 論文口頭報告 ) 日期：108 年 9 月 29 日（星期日）14:15 - 15:00 地點：嘉義長庚紀念醫院 ( B1 簡報室 )

Program 時間

論文題目

14:15 – 14:20

報告者

主持人

論文口頭報告規則簡介

A Better Quality of Diabetes 14:20 – 14:30 Care Based on A Specialist of Endocrinology and Metabolism

草屯療養院 楊晉州 醫師

Targeting PLKs as a Therapeutic 14:30 – 14:40 Approach to Well-differentiated Thyroid Cancer

林口長庚 林樹福 醫師

Fixed-dose Combination of Linagliptin and Metformin for The 14:40 – 14:50 Treatment of People Whose Type 2 Diabetes Is Uncontrolled in Realworld Clinical Practice

中山附醫 楊宜瑱 醫師

The Effects of Nursing Rehabilitation 14:50 – 15:00 and Education Projects for Type 2 Diabetic Patients Project

備註：報告 7 分鐘，討論 3 分鐘

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王治元 林嘉鴻 歐弘毅

陽大附醫 楊文菊 護理師

王佩文 Pei-Wen Wang 學歷 1969-1976

Medical Degree, National Taiwan University, Taiwan

經歷 1981-1984 1984-1985 1996-1997 1985-present 2004-present

Attending Physician, Department of Internal Medicine & Nuclear Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan Research fellow, McGill University and Montreal General Hospital, Canada Research fellow, General Clinic Research Center, Stanford University School of Medicine, U.S.A Attending Physician, Department of Internal Medicine & Nuclear Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan Professor, Chang Gung University, Taipei, Taiwan

現職 Attending Physician/Professor Department of Internal Medicine & Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.

研究領域 Mitochondrial dysfunction in diabetes、Thyroid cancer、Nuclear Endocrinology

研究著作 1. Lin HY, Weng SW,Chang YH, Su YJ,Chang CM, Tsai CJ, Shen FC, Chuang JH, Lin TK, Liou CW, Lin CY, Wang PW: The causal role of mitochondrial dynamics in regulating insulin resistance in diabetes: Link through itochondrial reactive oxygen species. Oxid Med Cell Longev. 2018 Sep 30;2018:7514383.

2. Shen FC, Weng SW, Tsao CF, Lin HY, Chang CS, Lin CY, Lian WS, Chuang JH, Lin TK, Liou CW, Wang PW: Early intervention of N-acetylcysteine better improves insulin resistance in diet-induced obesity mice. Free Radic Res. 2018 Dec;52(11-12):1296-1310.

3. Shen FC, Hsieh CJ, Huang IC, Chang YH, Wang PW: Dynamic risk estimates of outcome in Chinese patients with well-differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation. Thyroid. 2017 Apr;27(4):531-536.

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Mitochondria and Diabetes 粒線體與糖尿病 Pei-Wen Wang 王佩文 Division of Endo/Metab, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan 長庚大學醫學院暨高雄長庚醫院內科部新陳代謝科

Insulin resistance (IR) and chronic low-grade inflammation play essential roles in the pathogenesis of type 2 diabetes (T2DM). Mitochondria, in addition to its bioenergetic function, have an independent role in the pathogenesis of IR and are increasingly recognized as a central hub triggering metaflammation through provoked innate immunity.

We studied the genetic effect of mitochondria on IR by trans-mitochondrial cybrids, because the cybrid models have the same nuclear genomic background. Cybrids derived from 143B osteosarcoma cell line and different mitochondrial haplogroups, including B4 (the major diabetes-susceptible haplogroup in Chinese population), D4 (the major diabetes-resistant haplogroup in Chinese population) were developed in vitro. The cells were cultured in medium containing different concentration of glucose and saturated fatty acid, and stimulated with insulin. Expression level of proteins related to insulin signaling, mitochondrial dynamics, pro-inflammation, and innate immunity were determined using Western blotting.

Upon insulin treatment, cybrid D4 showed greater translocation of cytoplasmic GLUT1/GLUT4 to the cell membrane than cybrid B4. On the contrary, the activation of p-P38, p-JNK and p-NF-κB was higher in cybrid B4 than cybrid D4. Higher levels of intra-cellular and mitochondrial ROS (mtROS) were observed in cybrid B4, and pretreatment with N-acetyl-L-cysteine (NAC) could increase insulin-induced GLUT1/ GLUT4 translocation and reduce the pro-inflammation signals.

Under nutrients excess, cybrid B4, as compared with cybrid D4, presented increased mitochondrial pro-fission profiles, enhanced chronic inflammation markers (RIG-I, MDA5, MAVS, IRF3) and inflammasome (NLRP3, Caspase-1, IL-1β). Manipulating mitochondrial dynamic proteins can alter mtROS expression and the insulin signaling pathway.

In the diet-induced obesity mouse model with C57B/L6 mice, we found high-fat high-sucrose diet (HFD) fed mice showed significantly increased body weight and body fat, decreased motor activity, impaired intraperitoneal glucose tolerance test (IPGTT) and insulin tolerance test (IPITT), together with increased mitochondrial and intracellular ROS expression, DNA and protein oxidative damage, and adipose tissue inflammation. Antioxidant NAC treatment significantly improved IPGTT and IPITT, and decreased the oxidative damage and chronic inflammation. Furthermore, the protective effect of NAC is better expressed through early intervention (since 1st month) than late intervention (since 3rd month) in the 6-month HFD treatment course.

We concluded that mitochondria have an independent role in pathogenesis of diabetes. Early therapy to reduce mtROS can better improve IR and development of T2DM 11

鄭凱比 Kai Pi Cheng 學歷 2002-2009

國立成功大學醫學系學士

經歷 2010-2013 2013-2015

成大醫院內科部住院醫師 成大醫院內分泌暨新陳代謝科總醫師

2015-present

成大醫院內分泌暨新陳代謝科主治醫師

現職 成大醫院內科部內分泌暨新陳代謝科主治醫師

研究著作 1. Cheng KP, Ou HY, Hung HC, Lin CH, Fan KC, Wu JS, Wu HT, Chang CJ. Unsaturated Fatty Acids Increase the Expression of Hepassocin through a Signal Transducer and Activator of Transcription 3-Dependent Pathway in HepG2 Cells.

Lipids. 2018 Sep;53(9):863-869.

2. Cheng KP, Yang YJ, Hung HC, Lin CH, Wu CT, Hung MH, Sheu BS, Ou HY. Helicobacter pylori eradication improves glycemic control in type 2 diabetic patients with asymptomatic active Helicobacter pylori infection. J Diabetes Investig. 2019 Jul;10(4):1092-1101.

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Immunotherapy induced endocrinopathy 免疫治療所誘發的內分泌疾病 Kai Pi Cheng 鄭凱比 Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital 成大醫院內科部內分泌暨新陳代謝科

Immune checkpoints are the proteins on T lymphocyte which play an important role in regulating immune response. Among them, cytotoxic T lymphocyte antigen 4 (CTLA-4) and programmed cell death protein 1 (PD-1) are the most common targets in immunotherapy. Monoclonal antibodies binding to CLTA-4 and PD-1 (and its ligand PD-L1) have been shown to improve the clinical outcomes of some advanced cancers by enhancing anti-tumor response. However, various kinds of endocrinopathies have been reported as the side effects of this novel therapy.

Thyroid dysfunction is the most common endocrine adverse event of immune checkpoint inhibitors (ICIs). According to a meta-analysis, the overall prevalence of ICIs-induced hypothyroidism and thyrotoxicosis were estimated to be 6.6% and 2.9%, respectively. Regarding the pathophysiology of ICIs-induced thyroid dysfunction, thyroiditis is the cornerstone. Most patients have an asymptomatic thyrotoxic phase followed by the hypothyroidism that is likely permanent and hormone replacement therapy-dependent.

Hypophysitis is another ICIs-induced endocrinopathy which the clinicians need to pay attention on. Once it happens, central adrenal insufficiency, central hypothyroidism and hypogonadotropic hypogonadism are the most affected hormone axes. Among them, central adrenal insufficiency is an urgent and possible lethal complication if unrecognized. A timely therapy with glucocorticoid is essential in that situation.

Insulin dependent diabetes, although rare, is a noteworthy side effect of immunotherapy as well. Patients often suffered from a rapid loss of beta cell function accompanied by the acute progression to hyperglycemia. What’s more, approximately sixty percent of patients present with diabetic ketoacidosis, which is a life-threatening condition.

Overall incidence of endocrinopathies is around ten percent of patients on checkpoint inhibitors. With a variety of ICIs approved for treating more and more kinds of cancer, the clinicians have to be cautious with these adverse events and develop related treatment strategies.

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張晉誠 Chin-Chen Chang 學歷 1997-2004 2009-2018

M.D., Chung Shan Medical University Ph.D., Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University

經歷 2003-2004 2004-2009 2009-present

Rotating Intern, National Taiwan University Hospital Residency, Department of Medical Imaging, National Taiwan University Hospital Attending Physician, Department of Medical Imaging, National Taiwan University Hospital

現職 台大醫院影像醫學部 主治醫師

研究領域 Imaging diagnosis in abdomen and pelvis Interventional radiology in abdomen and pelvis

研究著作 1. Chang CC, Lee BC, Liu KL, Chang YC, Wu VC, Huang KH, Wu TH; The influence of the peripheral cortisol fluctuation on the success rate of adrenal venous sampling. Sci Rep. 2018 Feb 8;8(1):2664.

2. Guo JC, Chang CC, Yang CY, Liao BC, Liau JY, Chang CH, Yeh KH. Computed tomographic characteristics for patients with unresectable gastric cancer harboring lowvolume peritoneal carcinomatosis. Med Oncol. 2017 Aug;34(8):143.

3. Chang CC, Lee BC, Chang YC, Wu VC, Huang KH, Liu KL; TAIPAI Study Group.

Comparison of C-arm computed tomography and on-site quick cortisol assay for adrenal venous sampling: A retrospective study of 178 patients. Eur Radiol. 2017 Jul 4.

4. Chang CC, Chen HH, Chang YC, Yang MY, Lo CM, Ko WC, Lee YF, Liu KL, Chang RF. Computer-aided diagnosis of liver tumors on computed tomography images. Comput Methods Programs Biomed. 2017 Jul;145:45-51.

5. C h a n g C C , L e e B C , L i u K L , C h a n g Y C , Wu V C , H u a n g K H . N o n - s t i m u l a t e d adrenal venous sampling using Dyna computed tomography in patients with primary aldosteronism. Sci Rep. 2016 Nov 23;6:37143.

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Interventional Radiology in Endocrinology 介入性放射線診療於內分泌學的應用 Chin-Chen Chang 張晉誠 Department of Medical Imaging, National Taiwan University Hospital, Taiwan. 台大醫院 影像醫學部

Adrenal venous sampling (AVS) was introduced in late 1960s as a test to distinguish unilateral from bilateral primary aldosteronism (PA). AVS is held to be the “gold standard” diagnostic procedure for assessing lateralization of aldosterone secretion and thereby identifying the surgically curable forms of primary aldosteronism.

The successful cannulation of both adrenal veins continues to be challenging clinical issues. Adequate adrenal sampling is based on higher cortisol concentration compared with peripheral sampling. Dyna-CT and on-site quick cortisol assay could be helpful to improve the successful rate.

Furthermore, CT-guided ablation could be applied to treat PA. This treatment has advantages of less invasiveness and safety. Besides medical treatment and surgical resection, tumor ablation becomes another choice, especially for patients with surgical contraindication or unwilling to surgery.

Cortisol hypersecretion is not uncommon condition in patients with PA. Conventional criteria for lateralization could be challenged due to underestimated lateralization index in AVS. Adjusted criteria should be considered.

AVS could be applied for lateralization of the adrenal gland with autonomous cortisol secretion and ACTH-independent Cushing’s syndrome.

Selective arterial calcium stimulation with hepatic venous sampling is useful in differentiating insulinoma from nesidioblastosis with high specificity in patients with hyperinsulinemic hypoglycemia and negative or inconclusive noninvasive imaging

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林嘉鴻 Chia-Hung Lin 學歷 1993-2000 2004-2009

M.D., Medical college, National Taiwan University, Taipei,Taiwan Ph.D., Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan

經歷 2000-2003 2003-2005 2005-present 2012-present

Residency: Internal Medicine, Lin-Ko medical center, CGMH Fellowship: Division of Metabolism and Endocrinology, Department of Internal Medicine, CGMH Attending physician, Division of Metabolism and Endocrinology, Department of Internal Medicine, CGMH Lecturer, Chang Gung University and Chang Gung Memorial Hospital

現職 Attending physician, Division of Metabolism and Endocrinology, Department of Internal Medicine, Chang Gung Memorial Hospital Assistant Professor, Chang Gung University and Chang Gung Memorial Hospital

研究領域 1. The clinical assessment of continuous subcutaneous insulin injection (CSII) and continuous glucose monitoring (CGM) therapy in intensive insulin care 2. Diabetic education 3. Gestational diabetes mellitus (GDM)

研究著作 1. Chia-Hung Lin, Feng-Ju Hsieh, Yang-Hau Van, and Fu-Sung Lo. Polymorphic Basal Rates of Continuous Subcutaneous Insulin Infusion among Taiwanese Children with Type 1 Diabetes. Biomed Res Int. 2015;2015:250656. doi: 10.1155/2015/250656.

2. Yin-Chun Chen, Yu-Yao Huang, Hung-Yuan Li, Shih-Wei Liu, Sheng-Hwu Hsieh, Chia-Hung Lin. Professional Continuous Glucose Monitoring for the Identification of Type 1 Diabetes Mellitus Among Subjects with Insulin Therapy. Medicine. 2015 Jan;94(3):e421 3. Chia-Hung Lin, Yun-Shien Lee, Yu-Yao Huang, Sheng-Hwu Hsieh, Zih-Syuan Chen, Chi-Neu Tsai.

Polymorphisms of GLP-1 Receptor Gene and Response to GLP-1 Analogue in Patients with Poorly Controlled Type 2 Diabetes. J Diabetes Res. 2015;2015:176949 4. Fei-Ling Wu, Jyuhn-Huarng Juang, Chia-Hung Lin. Development and validation of the hypoglycaemia problem-solving scale for people with diabetes mellitus. J Int Med Res. 2016 Jun;44(3):592-604 5. Lin CW, Hsu BR, Tsai JS, Yang HM, Lin JR, Lin CH, Huang CH, Hung SY, Huang YY. Effect of limb preservation status and body mass index on the survival of patients with limb-threatening diabetic foot ulcers.

J Diabetes Complications. 2017 Jan;31(1):180-18 6. Ching-Chien Yang†, Chia-Hung Lin†, Nan-Kai Wang, Chi-Chun Lai, Fu-Sung Lo, and the Chang Gung Juvenile Diabetes Eye Study Group (†Co-first authors). Risk Factors Associated With the Development of Nephropathy 10 Years After Diagnosis in Taiwanese Children With Juvenile-Onset Type 1 Diabetes—A Cohort Study From the CGJDES. Front Endocrinol (Lausanne). 2018 Aug 3;9:429

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The Artificial Pancreas 人工胰臟 Chia-Hung Lin 林嘉鴻 Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Taipei, Taiwan. 林口長庚紀念醫院 內分泌暨新陳代謝科

Insulin pump therapy is the promising paradigm for intensive therapies in diabetes (DM). Through the so called continuous subcutaneous insulin infusion (CSII), the basal insulin is supplied in the form of a continuous infusion (comprising between 40 and 60 percent of the total daily dose) with pre-meal bolus doses given to minimize postprandial glucose excursions.

Most patients with diabetes mellitus who want to maintain good glycemic control need to measure their blood glucose concentrations often. Real-time continuous blood glucose monitoring (CGM) is the device to make a difference view in glucose monitoring. CGM measure the glucose content of interstitial fluid using an electrochemical enzymatic sensor. Interstitial fluid is accessed by a needle sensor inserted subcutaneously. Fluctuation in blood glucose, identified by continuous glucose monitoring, is the new information about DM management besides A1C levels. CGM offers a good way to investigate blood sugars and possible new methods to solve difficult problems in DM management.

The latest sensor-augmented pump therapy composed of CSII and real-time CGM is the perfect paradigm to cure not only type 1 but type 2 diabetes. The suspension of insulin before low blood glucose and automatic increase in basal insulin delivery are the main characteristics of this smart-guarded insulin pump. Further automatic basal insulin adjustment and bolus infusion corresponding to high glucose are well developed recently. Manipulating the connections between CSII and real-time CGM well is the path to the upcoming artificial pancreas in the near future.

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楊偉勛 Wei-Shiung Yang 學歷 1978-1985 1991-1997

臺大醫學院醫學系學士 華盛頓大學遺傳學博士

經歷 2019-present 2015-present 2014-present 2008-present 1999-present

臺大醫院醫學研究部主任 臺大醫學院臨床醫學研究所所長 臺灣大學特聘教授 臺大醫學院臨床醫學研究所暨醫學系教授 臺大醫院內科部內分泌新陳代謝科主治醫師

現職 臺大醫學院臨床醫學研究所教授兼所長 臺大醫院內科部代謝內分泌科主治醫師 臺大醫院醫學研究部主任

研究領域 代謝症候群及其他內分泌疾病之臨床、遺傳及分子醫學研究

研究著作 1. Wang YT, Tseng PH, Chen CL, Han DS, Chi YC, Tseng FY, Yang WS. Human serum RNase-L level is inversely associated with metabolic syndrome and age. Cardiovasc Diabetol. 2017 Apr 11;16(1):46.

2. Wang YT, Chiang HH, Huang YS, Hsu CL, Yang PJ, Juan HF, Yang WS.* A link between adipogenesis and innate immunity: RNase-L promotes 3T3-L1 adipogenesis by destabilizing Pref-1 mRNA. Cell Death Dis. 2016 Nov 10;7(11):e2458.

3. Chen PL, Shih SR, Wang PW, Lin YC, Chu CC, Lin JH, Chen SC, Chang CC, Huang TS, Tsai KS, Tseng FY, Wang CY, Lu JY, Chiu WY, Chang CC, Chen YH, Chen YT, Fann CS*, Yang WS*, Chang TC*. Genetic determinants of antithyroid drug-induced agranulocytosis by human leukocyte antigen genotyping and genome-wide association study. Nat Commun. 2015 Jul 7;6:7633.

4. Yang WS, Jeng CY, Wu TJ, Tanaka S, Funahashi T, Matsuzawa Y, Wang JP, Chen CL, Tai TY, Chuang LM. Synthetic peroxisome proliferator-activated receptor-gamma agonist, rosiglitazone, increases plasma levels of adiponectin in type 2 diabetic patients. Diabetes Care. 2002 Feb;25(2):376-80.

5. Yang WS, Lee WJ, Funahashi T, Tanaka S, Matsuzawa Y, Chao CL, Chen CL, Tai TY, Chuang LM: Weight reduction increases plasma levels of an adipose-derived antiinflammatory protein adiponectin. J Clin Endocrinol Metab. 2001 Aug;86(8):3815-9.

Erratum in: J Clin Endocrinol Metab 2002 Apr;87(4):1626.

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Cross Talk between Fat and Bone 脂肪與骨骼的對話 Wei-Shiung Yang 楊偉勛 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. 台大醫院 內科

In embryonic development, adipose tissues and bone are partially derived from the same origin. Therefore, the interactions between the adipose tissues and bones are inevitable in various physiological and pathological conditions. Although obesity is commonly found to positively associate with increased bone mineral density, there is growing evidence that the fracture risk at various skeletal sites may be increased in obesity, especially severe obesity. Many factors, including nutritional, mechanical, systemic inflammation and altered adipokine actions may play a role in bone fragility.

Specifically, the adiposity in bone marrow may affect osteoclasts/osteoblasts activity via the actions of paracrine factors. On the other hand, bone-derived hormones (osteokines), such as osteocalcin may have endocrine actions on various tissues beyond the skeletal system.

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施翔蓉 Shyang-Rong Shih 學歷 1993-2000 2009-2012

臺大醫學院醫學系學士 臺灣大學醫工所博士

經歷 2000-2005 2005-2008 2008-present 2014-present 2017-present 2019-present

臺大醫院內科部住院醫師 臺大雲林分院代謝內分泌科主治醫師 臺大醫院代謝內分泌科主治醫師 臺大醫學院醫學系助理教授 台灣腦下垂體學會理事 中華民國內分泌學會理事

現職 台大醫學院醫學系助理教授 臺大醫院代謝內分泌科主治醫師

研究領域 甲狀腺疾病，腦下垂體疾病，代謝性骨疾病

研究著作 1. Lin CH, Chang CK, Shih CW, Li HY, Chen KY, Yang WS, Tsai KS, Wang CY, Shih SR. Serum fibroblast growth factor 23 and mineral metabolism in patients with euthyroid Graves' diseases: a case-control study. Osteoporos Int. 2019 Aug 5. doi: 10.1007/s00198-019-05116-1.

2. Lin CH, Chen KH, Chen KY, Shih SR, Lu JY. Immune checkpoint inhibitor therapy-induced hypophysitis a case series of Taiwanese patients. J Formos Med Assoc. 2019 Jan;118(1 Pt 3):524-529. Shih SR and Lu JY are corresponding authors 3. Jan IS, Lee YT, Wang CM, Cheng TY, Wang CY, Chang TC, Shih SR. The surgery and repeat aspiration outcomes of atypia of undetermined significance category in The Bethesda System for Reporting Thyroid Cytopatholog. Asian J Surg. 2019 Jan;42(1):144-147.

4. Chun-Heng Kuo, Shyang-Rong Shih, Hung-Yuan Li, Szu-Chi Chen, Po-Ju Hung, Fen-Yu Tseng, Tien-Chun Chang. Adrenocorticotropic hormone levels before treatment predict recurrence of Cushing's disease. The first two authors are co-first authors. J Formos Med Assoc. 2017 Jun;116(6):441-447.

5. Pei-Lung Chen, Shyang-Rong Shih, Pei-Wen Wang, Ying-Chao Lin, Chen-Chung Chu, JungHsin Lin, Szu-Chi Chen, Ching-Chung Chang, Tien-Shang Huang, Keh Sung Tsai, Fen-Yu Tseng, Chih-Yuan Wang, Jin-Ying Lu, Wei-Yih Chiu, Chien-Ching Chang, Yu-Hsuan Chen, Yuan-Tsong Chen, Cathy Shen-Jang Fann, Wei-Shiung Yang and Tien-Chun Chang. Genetic determinants of antithyroid drug-induced agranulocytosis by human leukocyte antigen genotyping and genomewide association study. Nat Commun. 2015 Jul 7;6:7633. Chen PL and Shih SR contributed equally to this study.

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Tumor Induced Osteomalacia 腫瘤引起的軟骨病 Shyang-Rong Shih 施翔蓉 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei, Taiwan. 台大醫學院醫學系內科 臺大醫院代謝內分泌科

Tumor induced osteomalacia (TIO) is a rare paraneoplastic disorder caused by fibroblast growth factor 23 (FGF23) secreted by tumors. FGF23 decreases renal reabsorption of phosphate, increases phosphaturia, and results in hypophosphatemia and osteomalacia.

Symptoms often include fragility fractures, bone pain and muscle weakness.

Diagnosis relies on the hypophosphatemia, decreased renal phosphate reabsorption rate, and elevated FGF23. Localization of the offending tumors can be difficult since the tumors are often small and benign with slow growing nature, and can be anywhere in the body. Scintigraphy based on somatostatin receptor may be of help.

Surgical removal of the tumors is the only definitive treatment. Medical treatment with phosphate salts or active vitamin D is necessary if tumor cannot be located or complete surgical resection is not possible. One of the most promising emerging medication is anti-FGF23 monoclonal antibody KRN23.

In conclusion, tumor induced osteomalacia is one of the differential diagnosis of fragility fracture and is worthy of investigation in patients with hypophosphatemia.

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羅仕昌 Lo, Shihchang 學歷 2004-2011 2017-2019

中山醫學大學醫學系學士 中山醫學大學醫學研究所碩士

經歷 2012-2015 2015-2017 2018-present

中山醫學大學附設醫院內科部住院醫師 中山醫學大學附設醫院內分泌科研究醫師 中山醫學大學附設醫院內分泌科主治醫師

現職 中山醫學大學附設醫院內分泌科主治醫師

研究領域 糖尿病、甲狀腺疾病

研究著作 1. Lo SC, Yang YS, Kornelius E, Huang JY, Lai YR, Huang CN, Chiou JY: Early cardiovascular risk and all-cause mortality following an incident of severe hypoglycaemia: A population-based cohort study. Diabetes, obesity & metabolism 2019;21:1878-1885.

2. Kornelius E, Yang YS, Lo SC, Peng CH, Lai YR, Chiou JY, Huang CN: Progress of diabetes severity associated with severe hypoglycemia in Taiwan. Am J Manag Care 2018;24:e99-e106 3. Ya n g Y S , K o r n e l i u s E , C h i o u J Y, L a i Y R , L o S C , P e n g C H , H u a n g C N : L o w Dose Aspirin Reduces Breast Cancer Risk in Women with Diabetes: A Nationwide Retrospective Cohort Study in Taiwan. Journal of women's health (2002) 2017;26:12781284.

4. Kornelius E, Chiou JY, Yang YS, Lo SC, Peng CH, Lai YR, Huang CN: Iodinated Contrast Media-Induced Thyroid Dysfunction in Euthyroid Nodular Goiter Patients.

Thyroid : official journal of the American Thyroid Association 2016;26:1030-1038.

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Pathophysiology of DSPN: from peripheral to central DSPN的病生理學：從周邊到中樞 Shih-Chang Lo 羅仕昌 Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital, Taichung, Taiwan. 中山醫學大學附設醫院 新陳代謝科

The global epidemic of diabetes continues to increase, with its world-wide prevalence set to rise to an estimated 629 million people by 2045. Chronic complications of diabetes are one of the most important issues in patient care. Of all complications, distal symmetric polyneuropathy (DSPN) is the most prevalent, but it is often overlooked in clinical care. DSPN can place a huge burden on patients’ lives, increasing rates of unemployment, mental health disorders and physical comorbidities.

Over time, up to 50% of patients with diabetes develop DSPN. DSPN has two major clinical manifestations, including insensitivity to trauma resulting in foot ulcerations and neuropathic pain that can be extremely distressing, the latter accounts for about 20-25% of DSPN. Unfortunately, painful-DSPN is marked under-diagnosed and hence undertreated in clinical practice. In Taiwan, patients often can’t clearly describe the symptom of neuropathic pain, leading to delays in diagnosis.

Although our understanding of diabetic neuropathy has substantially evolved over the past decade, the distinct mechanisms underlying neuropathy in painless DPSN and painful DSPN remains unknown. Recent studies examining the pathophysiology of painful-DSPN have identified maladaptive alterations in both the peripheral and central nervous systems. The recent advances in skin biopsy immunohistochemistry and neuroimaging, which have the potential to further our understanding of the pathophysiology, and identify new mechanism-based therapies.

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胡啟民 Chii-Min Hwu 學歷 1981-1988

國立陽明醫學院醫學系學士

經歷 2003-2006 1997-2009

國立陽明大學 醫學系 專任副教授 臺北榮民總醫院 內科部健診科 主治醫師

現職 臺北榮民總醫院內科部內分泌新陳代謝科主治醫師 國立陽明大學 醫學院 內科副教授

研究領域 糖尿病學、內分泌學

研究著作 1. Wang JS, Wu YL, Shin SJ, Tien KJ, Chin MC, Hwu CM. Hospitalization in patients with type 2 diabetes mellitus in Taiwan: A nationwide population-based observational study. J Formos Med Assoc. 2019 Jul 9. pii: S0929-6646(19)30349-3.

2. Yen FS, Chen W, Wei JC, Hsu CC, Hwu CM. Effects of metformin use on total mortality in patients with type 2 diabetes and chronic obstructive pulmonary disease: A matchedsubject design. PLoS One. 2018 Oct 4;13(10):e0204859 3. Hwu CM, Liou HH, Lee CJ, Hsu BG. A positive association between Interleukin-1 receptor antagonist and insulin resistance in postmenopausal women. Gynecol Endocrinol. 2018 Jul;34(7):574-578.

4. Hwu CM, Lin YC, Lin KH. β-Cell function in postmenopausal women with isolated post-challenge hyperglycemia. J Diabetes. 2018 Feb;10(2):158-165.

5. Hwu CM, Lin YC, Lin MW. High levels of C-reactive protein are positively associated with isolated postchallenge hyperglycemia in postmenopausal women. Metab Syndr Relat Disord. 2016 Sep;14(7):334-9.

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Screening and Diagnosis of Diabetic Neuropathy 糖尿病神經病變的篩檢與診斷 Chii-Min Hwu 胡啟民 Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan 臺北榮民總醫院 內科部 內分泌新陳代謝科

Diabetic neuropathy is the most common chronic complication of diabetes mellitus and appears early during the natural course of diabetes. Diabetes mellitus may cause a broad spectrum of neuropathic complications, including acute and chronic forms affecting each level of peripheral nerves, from nerve root to distal axon. Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain and numbness in legs and feet to problems with digestive system, urinary tract, blood vessels and heart.

Some people have mild symptoms. But, for others, diabetic neuropathy can be painful and disabling.

Despite a long history of research in diabetic neuropathy, we are only starting to understand the pathophysiology of the disease. It is generally accepted that diabetic neuropathy is a multifactorial process. Development of symptoms depends on many factors, such as total hyperglycemic exposure and other risk factors such as elevated lipids, blood pressure, smoking, and high exposure to other potentially neurotoxic agents such as ethanol. Genetic factors may also play a role. Elevated blood glucose levels, elevated triglycerides, high body mass index, smoking and hypertension are risk factors for neuropathy. However, early diagnosis of diabetic neuropathy is difficult because multiple tests are required for diagnosis and the examination methods are complicated and time consuming. Furthermore, diabetic neuropathy can be asymptomatic in up to 50% of cases.

In December 2017, the American Diabetes Association (ADA) released an updated position statement on the prevention, detection, and management of diabetic neuropathies. The position statement underscores the following recommendations for screening and diagnosis of diabetic neuropathy: • Consider screening patients with prediabetes who have symptoms of peripheral neuropathy.

• All patients should be assessed for distal symmetric polyneuropathy starting at diagnosis of type 2 diabetes and 5 years after the diagnosis of type 1 diabetes and at least annually thereafter.

• Assessment should include a careful history and either temperature or pinprick sensation (small- fiber function) and vibration sensation using a 128-Hztuning fork(large-fiber function).

• All patients should have an annual 10-g mono fi lament testing to assess for feet at risk for ulceration and amputation.

• lectrophysiological testing or referral to a neurologist is rarely needed for screening, except in situations where the clinical features are atypical.

In summary, although diabetic neuropathy is a common complication in diabetic patients, it is often neglected in routine clinical diabetes practice. There has been an evolution in our understanding of the pathophysiology, the screening and diagnosis, and the management of diabetic polyneuropathy over the past decade. We highlight these new perspectives and provide updates from the past decade of research.

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口頭發表注意事項 論文口頭發表注意事項： 發表時間：108 年 9 月 29 日 ( 星期日 ) 14:15 - 15:00 地

點：嘉義長庚紀念醫院 (B1 簡報室 )

說

明：

1. 每題 7 分鐘報告 +3 分鐘討論 請把握報告時間，為維持節目順暢，第 1 次響鈴時間為 7 分鐘， 第 2 次響鈴為 10 分鐘，請隨即結束演講。 2. 投影片檔案格式，請使用 Microsoft PowerPoint 2003 版本。 3. 報告投影片請於 108 年 9 月 29 日 ( 星期日 ) 14:15 前，交於大講 堂內講台前方工作人員。 4. 若要更換報告者，請提早告知學會，謝謝。

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Oral-01

A BETTER QUALITY OF DIABETES CARE BASED ON A SPECIALIST OF ENDOCRINOLOGY AND METABOLISM CHIN-CHOU YANG Division of General Medicine, Department of General Psychiatry, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan

Background: Metabolic disorders such as metabolic syndrome, hyperglycemia, and hyperlipidemia are common in patients with psychiatric disorders. Type 2 diabetes, one of the most important public health issues of the twenty-first century, is an important clinical and pathological condition in individuals with schizophrenia. The purpose of our study is to examine the effectiveness of treatment of diabetes in schizophrenia patients with a long-term-care team based on a specialist of endocrinology and metabolism.

Methods: Our retrospective study included 56 schizophrenia patients with type 2 diabetes admitted in a psychiatric long-term-care center. Before 2018, these patients accepted treatment for diabetes in general clinics near the center. Instead, a full-time specialist of endocrinology and metabolism was involved since January 1, 2018, and the treatment was based on opinions of the specialist then. Paired t-test was used to understanding the effectiveness of this health promotion intervention, by comparing the results of glycemic control between 2017 and 2018.

Results: The average hemoglobin A1c level (HbA1c) of 2017 and 2018 were 6.5 ± 0.86 and 6.3 ± 0.76, respectively. A significant decrease of HbA1c level was noted. (p0.05) Conclusions: To our best knowledge, this is the first study comparing the effectiveness of treatment of diabetes in schizophrenia patients, whether or not, with a full-time specialist of endocrinology and metabolism. The results revealed significant improvement of both HbA1c and pre-prandial glucose levels after accept treatment of the specialist. The remarkable benefits of this health promotion intervention should be continued and further research might provide more complete information to help us controlling diabetes in schizophrenia patients.

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Oral-02

TARGETING PLKS AS A THERAPEUTIC APPROACH TO WELL-DIFFERENTIATED THYROID CANCER 1

SHU-FU LIN, 1JEN-DER LIN, 2CHUN-NAN YEH, 3YU-TUNG HUANG, 4

TING-CHAO CHOU, 5RICHARD WONG

1

Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang

Gung Memorial Hospital, Taiwan, R.O.C.;2Department of General Surgery, Chang Gung Memorial Hospital, Taiwan, R.O.C.;3Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taoyuan, Taiwan, R.O.C.;4Laboratory of Preclinical Pharmacology Core, Memorial Sloan-Kettering Cancer Center, New York, New York, USA;5Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

Background: Polo-like kinases (PLKs) are pivotal regulators of cell proliferation and cell survival; therefore, PLKs may be potential targets in the treatment of malignancy. The therapeutic effects of volasertib, a PLKs inhibitor for papillary and follicular thyroid cancer (known as well-differentiated thyroid cancer (WDTC)), were evaluated in this study.

Methods: Four cell lines originating from two pathologic types of thyroid cancer (papillary and follicular) were studied. The cytotoxicity of volasertib was measured using a lactate dehydrogenase assay. The expression of protein was assessed using Western blot analysis (PCNA and cleaved caspase-3) and immunofluorescence microscopy (cleaved caspase-3). Cell cycle distribution was measured by flow cytometry and immunofluorescence microscopy. Apoptosis and caspase-3 activity were measured by flow cytometry and fluorometric assay. Mice bearing flank WDTC were treated with oral gavage of drugs.

Results: Volasertib inhibited cell proliferation in two papillary and two follicular thyroid cancer cell lines in a dose-dependent manner. Volasertib treatment reduced cells in the S phase and increased cells in the G2/M phase. Volasertib activated caspase-3 activity and induced apoptosis. Drug combinations of volasertib and sorafenib showed mostly synergism in four well-differentiated thyroid carcinoma cell lines in vitro.

Volasertib treatment in vivo retarded the growth of a papillary thyroid tumor model.

Furthermore, the combination of volasertib with sorafenib was more effective than a single treatment of either in a follicular thyroid cancer xenograft model. Promising safety profiles appeared in animals treated with either volasertib alone or volasertib and sorafenib combination therapy.

Conclusions: Our findings support volasertib as a potential drug for the treatment of patients with WDTC. 28

Oral-03

FIXED-DOSE COMBINATION OF LINAGLIPTIN AND METFORMIN FOR THE TREATMENT OF PEOPLE WHOSE TYPE 2 DIABETES IS UNCONTROLLED IN REAL-WORLD CLINICAL PRACTICE 1

YI-SUN YANG

1

Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital, Taiwan, R.O.C.

Methods: Using a hospital-based electronic medical record database, a total of 831 patients were enrolled. The primary endpoint was to measure the change of fasting plasma glucose (FPG) and HbA1c from baseline at 3, 6, and 12 month. The change between visit intervals of renal function, bodyweight & body mass index (BMI) were also collected.

Results: After adding on linagliptin/metformin FDC, the mean HbA1c levels decreased by 0.72% from baseline to 3 months and the efficacy maintained through 12 months.

Linagliptin/metformin FDC lowering HbA1ceffect is regardless of age, renal function, background anti-diabetic drugs, body weight or BMI. Conclusions: Linagliptin/metformin FDC may be considered as a safe and effective treatment option, which could improve glycemic control in all kinds of type 2 diabetes already on treatment with insulin or other OAD. Linagliptin/metformin FDC therapies would significantly simplify the therapeutic regimen and maximize patients' adherence to treatment.

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Oral-04

THE EFFECTS OF NURSING REHABILITATION AND EDUCATION PROJECTS FOR TYPE 2 DIABETIC PATIENTS PROJECT 1

WEN-CHE YANG, 1PEI-YING LIN, 1WAN-HSUN CHIEN

1

Department of Nursing, National Yang-Ming University Hospital

Background: The type 2 diabetes is a common chronic disease and a major cause of mortality in Taiwan, and the evidence literature review suggests that a policy of prevention could be more effective than the early detection and treatment of diabetes.

Methods: The purpose of this study was to investigate the effects of using nursing rehabilitation and health education projects on blood sugar control for type 2 diabetes patients. Methods: The study was a pretest- posttest control group design. From March 1st 2019 to August 30th 2019, Type 2 diabetes patients were recruited from clinics of diabetes.

Results: The research sampling was included 61 patients receiving the nursing rehabilitation and health education projects. The average glycated hemoglobin decreased to 7.69 ± 1.6%, and the average LDL decreased to 79.57 ± 44.5 mg/dl, which was significant.

Conclusions: The impact of using the nursing rehabilitation and health education projects was significantly of diabetes clinic patients. However, the nursing rehabilitation and health education projects were an active role in sharing knowledge and raising awareness among peers and patients. The nursing rehabilitation and health education projects offer a new choice among multiple ways of education.

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MEMO

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MEMO

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