109秋季會

56

57

58

目 錄

目

錄

理事長致詞 ........................................................................................2 會場平面圖 ........................................................................................4 節目表 ................................................................................................5 主持人介紹 .........................................................................................7 演講者摘要 .......................................................................................18 論文口頭發表摘要 ............................................................................32 Lunch symposium 摘要 ......................................................................41

1

理事長致詞

各位會員大家好： 學會年度重要的秋季會因疫情的關係首次改為冬季會。承襲以往傳統的 精彩節目，兩會此次也均安排了豐富的內容供會員參考學習，其中針對疫情， 特 別 涵 蓋 了 有 關 COVID-19 與 DM，COVID-19 與 Endocrine Disorders 的 課 程。其他部分還包括了 SGLT2-i 的新知，Brain-gut axis in obesity ，Advanced medullary thyroid cancer 及 Cushing disease 的治療等，相當值得期待。 另外，今年也舉辦了年輕學者研究成果的口頭發表，共有 4 位年輕醫師 入選，也請會員前輩們給予鼓勵與指導。 延續 40 週年慶系列活動，學會也籌劃過去相關活動的歷史照片展覽， 敬請會員們仔細觀賞、回顧與展望。 祝福大家在台中有充實美好的一天。

社團法人中華民國糖尿病學會 理事長

敬上

中華民國 109 年 12 月 13 日

2

理事長致詞

因應 COVID-19 疫情，社團法人中華民國內分泌暨糖尿病學會 109 年年 會改至 9 月份舉辦，以往每年 9 月份舉辦的秋季會也因此而順延成 12 月的 冬季會。冬季會由糖尿病學會主辦，感謝黃建寧理事長、張恬君秘書長精心 規劃，安排了許多精彩的學術節目，包括與 COVID-19 相關的糖尿病內分泌 疾病新知以及糖尿病、甲狀腺髓質癌、庫欣氏症、肥胖等治療的新進展。演 講者與主持人都是學養豐富的專家，內容精彩可期。 感謝中山醫學大學提供會議場地、主持人及演講者的協助、秘書處同仁 的付出、全體會員的支持，讓冬季會順利圓滿。 祝大家身體健康，平安喜樂 !

社團法人中華民國內分泌學會 理事長

敬上

中華民國 109 年 12 月 13 日

3

會場平面圖

中山醫學大學 正心樓 1 樓 會場平面

4

Program 社團法人中華民國內分泌暨糖尿病學會

冬季學術研討會

日 期：109 年 12 月 13 日（星期日）09:00-17:30 地 點：中山醫學大學 正心樓 1 樓 0112 室（臺中市南區建國北路一段 110 號） 備 註：進入會議室內請戴口罩 時間

主 題

演講者

9:00-9:30 9:30-9:40 9:40-10:10

主持人

報到 致詞 ( 黃建寧理事長、曾芬郁理事長 ) 「良程及時，控糖腎心安」治療選擇衛教輔助工具競賽 頒獎 ( 黃建寧理事長 ) COVID-19 and diabetes

楊宜瑱醫師

陳榮福主任

醫學新知 (AZ) 10:10-10:40 New Era of CKD Management in Diabetes: 廖國盟醫師 Evolving Role of SGLT-2i

胡啟民醫師

10:40-10:50 Q/A

胡啟民醫師

10:40-11:00 11:00-11:30

大合照 / Break Management of advanced medullary thyroid cancer

11:30-12:00 Medical treatment for Cushing disease

周振凱醫師

王佩文教授

陳思綺醫師

施翔蓉醫師

12:00-12:10 Q/A 12:10-13:10

施翔蓉醫師

Lunch symposium 台田 (221 室 ) Sanofi(222 室 ) MSD(223 室 ) Novartis(225 室 )

13:10-13:40 COVID-19 and endocrine disorders

王舒儀醫師

蔡克嵩教授

13:40-14:10 Brain-gut axis in obesity

洪晧彰醫師

林時逸醫師

14:10-14:20 Q/A

林時逸醫師 OP (young researchers)

Serum Angiopoietin-like Protein 6, Risk

14:20-14:30 of Type 2 Diabetes, and Response to

范綱志醫師

14:30-14:40 glucose and advanced DKD

王威傑醫師

Hyperglycemia: A Prospective Cohort Study

張恬君醫師 陳清助主任

Association of Hemorrhoids With Hashimoto's 徐盛邦醫師 14:40-14:50 Thyroiditis and Associated Comorbidities: A Nationwide Population-Based Cohort Study

14:50-15:00

Adrenal Tumor Mimicking Non-Classic Congenital Adrenal Hyperplasia

蔡文瑄醫師

15:00-15:10

Closing remarks ( 黃建寧理事長、曾芬郁理事長 )

15:10-17:30

輕旅行程 ( 台灣文學館搭配道禾六藝館 ) 5

Program

時間

主 題

演講者

主持人

杜思德院長

張淳堆醫師

Lunch symposium (12:10-13:10) 台田 (221 室 ) Sanofi (222 室 ) MSD (223 室 ) Novartis (225 室 )

6

Cardio-Renal Protection of SGLT2i for DKD Patients

Beyond the status quo: Addressing the need for intensification in T2D patients with 黃兆山醫師 high HbA1C and helping them get to goal.

A Rising Star in OAD Treatment for Patient with T2DM - Complementary Mechanism 朱志勳主任 with Ertugliflozin and Sitagliptin Combination

周振凱醫師

陳清助主任

VERIFY the role of early combination: The 曾耀賢醫師 黃建寧理事長 importance of Beta cell preservation

Moderator 黃建寧 理事長

黃 建 寧 理事長 現職 Current Position 中華民國糖尿病學會

理事長

中山醫學大學

校長室

校長

中山醫學大學

醫學系 / 醫研所

教授

中山醫學大學附設醫院

內科部

主治醫師

國際醫療衛生促進協會

理事

臺中市醫師公會

理事

學歷 Education 私立中山醫學大學

醫學研究所

醫學博士

私立中山醫學院

醫學研究所

碩士

私立中山醫學院

醫學系

醫學士

經歷 Positions and Employment 中山醫學大學附設醫院

院長室

總院長

中山醫學大學

校長室

副校長

中山醫學大學

醫學研究所

所長

中山醫學大學附設醫院

醫學研究部

副院長

中山醫學大學附設醫院

內科部

主任

台灣大學醫學院附設醫院

代謝內分泌科

研究員

7

Moderator 曾芬郁 理事長

曾 芬 郁 理事長 現任 中華民國內分泌學會理事長 台大醫學院醫學系兼任內科教授 台大醫院內科部兼任主治醫師 台東基督教醫院教學部主任

學歷 國立台灣大學醫學系

醫學士

美國哈佛大學公共衛生學院公共衛生

碩士

國立台灣大學公共衛生學院公共衛生

博士

國立台灣大學管理學院商學

碩士

經歷 美國德州貝勒醫學院內分泌科研究員 省立台北醫院

家庭醫學科主任

署立台北醫院

內科部主任

臺大醫院

內科部副主任、代理主任

臺大醫學院醫學系副主任、代理主任 中華民國內分泌學會秘書長、理事

8

Moderator 陳榮福 主任

陳 榮 福 主任 曾任 高雄長庚醫院一般內科主任 高雄長庚醫院營養治療科主任 高雄長庚醫院健康診療科主任 高雄長庚醫院內科部副部長 高雄長庚醫院內分泌暨新陳代謝科主任 中華民國骨質疏鬆症學會理事長 中華民國骨質疏鬆症學會理事 中華民國糖尿病學會理事 中華民國糖尿病衛教學會理事 財團法人醫院評鑑暨醫療品質策進會健康檢查品質認證委員

現任 高雄長庚醫院糖尿病中心主任 中華民國骨質疏鬆症學會常務理事

(2011 年起 )

中華民國糖尿病學會常務理事

(2010 年起 )

中華民國糖尿病學會降血糖工作小組召委

(2018 年起 )

中華民國糖尿病衛教學會常務理事

(2017 年起 )

中華民國糖尿病衛教學會學術委員會總召

(2017 年起 )

中華民國血脂及動脈硬化學會理事

(2011 年起 )

台灣骨鬆肌少關節防治學會常務理事

(2016 年起 )

台灣骨鬆肌少關節防治學會學術委員會

(2016 年起 )

台灣腦下垂體學會理事

(2017 年起 )

財團法人醫院評鑑暨醫療品質策進會 糖尿病疾病照護品質認證委員

(2020 年起 )

科技部研究計畫審查委員

(2005 年起 )

高雄長庚醫院研究計畫審查委員

(2000 年起 )

高雄長庚醫院醫學教育委員會委員

(2015 年起 )

高雄長庚醫院醫療品質暨病人安全委員會委員

(2019 年起 )

高雄長庚醫院院區醫師資格審查委員會委員

(2019 年起 )

9

Moderator 胡啟民 醫師

胡 啟 民 醫師 Present Appointment Since 2019 Member of Executive Board, Chinese Taipei Diabetes Association Since 2012

Member, Institutional Review Board, Taipei Veterans General Hospital

Since 2009 Attending Physician, Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan Since 2003 Associate Professor, Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

Education 1981-1988

MB Department of Medicine, National Yang-Ming Medical College Internship: 1986-1988 at Taipei Veterans General Hospital

Appointments Held

10

2013-2019

Editor-in-Chief, Formosan Journal of Endocrinology and Metabolism

2013-2016

Member of Executive Board, Chinese Taipei Diabetes Association

1997-2009

Attending Physician, Section of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

2001-2002

Postgraduate Research Scholar, Division of Clinical Epidemiology and Preventive Medicine, UCLA

1996-2003

Lecturer, Department of Medicine,National Yang-Ming University School of Medicine, Taipei, Taiwan

Moderator 王佩文 教授

王 佩 文 教授 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, Shen FC, Chang YH, Lian WH, Hsieh CH, Chuang JH, Lin TK, Liou CW, Chang CS, Lin CY, Su YJ, Wang PW: Abrogation of toll-like receptor 4 mitigates obesity-induced oxidative stress, proinflammation, and insulin resistance through metabolic reprogramming of mitochondria in adipose tissue. Antioxid Redox Signal, 2020. 33(2): 66-86.

2. Yang YT, Chen JF, Tung SC, Kuo MC, Weng SW, Chou CK, Shen FC, Chang CM, Tsai CJ, Taso CF, Wang PW: Long-term outcome and prognostic factors of singledose Radioiodine Therapy in patients with Graves' disease. J Formos Med Assoc, 2020; 119:925-932.

3. 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: 7514383. doi: 10.1155/2018/7514383

11

Moderator 施翔蓉 醫師

施 翔 蓉 醫師 Employment Attending physician, Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital Associated Professor, Department of Internal Medicine, National Taiwan University School of Medicine Education College of Medicine, National Taiwan University, M.D. Institute of Biomedical Engineering, National Taiwan University, Ph.D.

Publication(5 important publications – latest sequence) 1. 1. Yang WP, Chang HH, Li HY, Lai YC, Huang TY, Tsai KS, Lin KH, Lin DT, Jou ST, Lu MY, Yang YL, Chou SW, Shih SR. Iron Overload Associated Endocrine Dysfunction Leading to Lower Bone Mineral Density in Thalassemia Major. The Journal of Clinical Endocrinology and Metabolism. 2020 Jan 7. pii: dgz309. doi: 10.1210/clinem/dgz309.

[Epub ahead of print].

2. Shih SR, Liao SL, Shih CW, Wei YH, Lu TX, Chou CH, Yen EY, Chang YC, Lin CC, Chi YC, Yang WS, Tsai FC. Fibroblast Growth Factor Receptor Inhibitors Reduce Adipogenesis of Orbital Fibroblasts and Enhance Myofibroblastic Differentiation in Graves' Orbitopathy. Ocular Immunology and Inflammation. 2019 Oct 28:1-10. doi: 10.1080/09273948.2019.1672196. [Epub ahead of print] 3. Shih SR, Jan IS, Chen KY, Chuang WY, Wang CY, Hsiao YL, Chang TC, Chen A. Computerized Cytological Features for Papillary Thyroid Cancer Diagnosis-Preliminary Report. Cancers (Basel). 2019 Oct 25;11(11). pii: E1645. doi: 10.3390/cancers11111645.

4. 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. Osteoporosis International. 2019 Nov;30(11):22892297. doi: 10.1007/s00198-019-05116-1. Epub 2019 Aug 5. PMID: 31384956 5. Lin LC, Ko BS, Chu TS, Tsai SL, Sheng WH, Yen CJ, Chang CH, Wu CH, Shih SR, Chiu WY, Pan SC, Chen WP, Chang PY, Tseng FY. Immediate knowledge improvement and longterm teaching confidence after General Medicine Faculty Training Program. Journal of the Formosan Medical Association. 2019 Aug 16. pii: S0929-6646(19)30238-4. doi: 10.1016/ j.jfma.2019.08.001. [Epub ahead of print]

12

Moderator 張淳堆 醫師

張 淳堆 醫師 新陳代謝科 糖尿病衛教中心 張淳堆醫師曾任美國加州洛山磯 加州大學 內分泌新陳代謝科研究員。張醫師 擅長於糖尿病以及一些內分泌疾病的飲食 ( 嚴格素食 ) 或中草藥調理。張醫師 診治的專長領域包括 – 1 甲狀腺、副甲狀腺疾病或腫瘤； 2 一般內分泌性疾病 3 高血脂症 4 甲狀腺超音波檢查判讀

13

Moderator 蔡克嵩 教授

蔡 克 嵩 教授 經歷

1984~2016 2010~2015 2016~

台大醫院內科及檢驗醫學部 台大醫院北護分院 遠東聯合診所

主治醫師 院長 所長

研究領域

1. 內分泌與代謝學 2. 檢醫醫學與臨床生化 3. 骨病學與骨質疏鬆症

論文 (5 important publications – latest sequence) 1. You Y.S., Lin C.Y., Liang H.J., Lee S.H., Tsai K.S., Chiou J.M, Chen Y.C., Tsao C.K., Chen J.H., 2014: Association between the metabolome and low bone mineral density in Taiwanese women determined by (1) h NMR spectroscopy. J Bone Miner Res. 29(1):21222.

2. Chen JH, Chen YC, Mao CL, Chiou JM, Tsao CK, Tsai KS., 2014: Association between Secreted Phosphoprotein-1 (SPP1) Polymorphisms and Low Bone Mineral Density in Women. PLoS One. 9(5):e97428.

3. Chiu W.Y., Chien J.Y., Yang W.S., Juang J.M., Lee J.J., Tsai K.S., 2014: The risk of osteonecrosis of the jaws in Taiwanese osteoporotic patients treated with oral alendronate or raloxifene. J Clin Endocrinol Metab. 99(8):2729-35.

4. Lee J.C., Jeng Y.M., Su S.Y., Wu C.T., Tsai K.S., Lee C.H., Lin C.Y., Carter J.M., Huang J.W., Chen S.H., Shih S.R., Mariño-Enríquez A, Chen C.C., Folpe A.L., Chang Y.L., Liang C.W.,2015 : Identification of a novel FN1-FGFR1 genetic fusion as a frequent event in phosphaturic mesenchymal tumour. J Pathol. 2015 Mar;235(4):539-45. (SCI), IF=7.429 5. Lee J.C., Su S.Y., Changou C., Yang R.S., Tsai K.S., Collins M., Orwoll E., Lin C.Y., Chen S.H., Shih S.R., Lee C.H., Oda Y., Billings S., Li C.F., Nielsen G. P., Konishi E., Petersson F., Carpenter T., Sittampalam K., Huang H.Y., and Folpe A., 2016: Characterization of FN1-FGFR1 and Novel FN1-FGF1 Fusion Genes in a Large Series of Phosphaturic Mesenchymal Tumors in Modern Pathology

14

Moderator 林時逸 醫師

林 時逸 醫師 學 歷 國立陽明醫學院醫學系第九屆畢業 國立陽明大學臨床醫學研究所博士班畢業

經 歷 台北榮總新陳代謝科住院總醫師 台中榮民總醫院新陳代謝科住院總醫師 台中榮民總醫院新陳代謝科主治醫師 台中榮民總醫院新陳代謝科主任醫師 中華民國糖尿病學會秘書長 ( 民國 102 年 5 月起 ) - ( 民國 108 年 3 月 )

現 職

台中榮民總醫院高齡醫學中心主任醫師 ( 民國 104 年 11 月起 ) - 迄今 中華民國糖尿病學會理事 ( 民國 108 年 4 月起 )

專科證書 中華民國內科專科醫師 中華民國內分泌新陳代謝專科醫師 中華民國糖尿病衛教師 臺灣老年醫學專科醫師

專科學會 中華民國內科學會 中華民國內分泌學會 中華民國糖尿病學會 中華民國糖尿病衛教學會 台灣老年學暨老年醫學會

15

Moderator 張恬君 醫師

張 恬 君 醫師 現 任

2002/7 迄今 2016/8 迄今 2019/5 迄今

台大醫院內科部 台大醫學院內科臨床 中華民國糖尿病學會

主治醫師 副教授 秘書長

學 歷 高雄醫學大學

學士

國立台灣大學醫學院臨床醫學研究所

博士

經 歷 1994/7 ~ 1997/6 1997/7 ~ 1999/6 1999/7 ~ 2002/6 2000/2 ~ 2005/7 2005/8 ~ 2010/7 2007/1 ~ 2007/12

2008/3 ~ 2013/3 2010/8 ~ 2016/7

台大醫院內科部 財團法人恩主公醫院內科部 臺大醫院新陳代謝暨 內分泌內科 財團法人恩主公醫院內科部 台大醫院內科部 台大醫學院內科 台大醫學院內科 Strelitz Diabetes Institute, Eastern Virginia Medical school, Norfolk, Virginia, U.S.A. (Mentor: Prof. Aaron Vinik.) 中華民國糖尿病學會 台大醫學院內科臨床

住院醫師 總醫師 臨床研究員 主治醫師 兼任主治醫師 兼任講師 臨床講師 博士後研究員

副秘書長 助理教授

專 長 內科學、代謝與內分泌學、分子生物學、基因體學、 胰島細胞生理學與藥理學

Honors and Awards

2005 中華民國衛生署臨床研究獎 2009 中華民國糖尿病學會研究獎助 2010 中華民國糖尿病學會暨中華民國內分泌學會 98 年度優秀論文獎 2010 第 2 屆亞太拜耳華人糖尿病論壇青年研究獎 2016 中華民國糖尿病學會暨中華民國內分泌學會 105 年度優秀論文獎

16

Moderator 陳清助 主任

陳 清助 主任 現 任 1. 中國醫藥大學附設醫院 內科部 內分泌代謝科 主任 2. 中國醫藥大學 內科學 副教授

學 歷 中國醫藥學院中醫學系畢業

經 歷 1. 中國醫藥大學附設醫院 內科部 住院醫師、總醫師、主治醫師 2. 台北榮民總醫院 新陳代謝科 研究員 3. 美國 University of Louisville 新陳代謝科 研究員 4. 中華民國糖尿病學會理事 (2007-2010; 2016 迄今 ) 5. 台中市糖尿病共同照護學會理事 (2002-2012; 2017 迄今 ) 6. 台中市糖尿病共同照護學會理事長 (2013-2017)

榮譽事蹟 1.

2.

3.

4.

5.

6.

7.

1999 年中華民國糖尿病學會研究論文獎 2000 年中華民國內分泌暨糖尿病學會年會優秀論文之一 2003 年中華民國糖尿病學會糖尿病傑出研究獎 2009 年中華民國糖尿病學會優秀論文獎 2011 年中華民國糖尿病衛教學會論文獎第三名 1992, 1996, 2000, 2005 年中國醫藥大學附設醫院優良醫師 2009 年中國醫藥大學院級優良導師

Reviewer Diabetes Care, Diabetic Medicine, Diabetes Research and Clinical Practice, Act Pharmacologica Sinica, Journal of Human Nutrition and Dietetics, Canadian Medical Association Journal, BMC Endocrine Disorder, Crdiovascular diabetology, 高雄醫學大學雜誌 , 中華醫學雜誌 , 內科學誌

研究興趣 1. 胰島素抗性 (insulin resistance)

2. 脂肪細胞激素 (adipocytokines)

研究論文 SCI 論文約 90 餘篇

17

Speaker 楊宜瑱 醫師

楊 宜 瑱 醫師 現職 Current Position 中山醫學大學附設醫院 內科部 內分泌新陳代謝科 主任

學歷 Education 中山醫學大學醫學系

1991/09 至 1998/06

中山醫學大學醫學研究所碩士

2005/09 至 2007/06

中山醫學大學醫學研究所博士

2007/09 至 2014/07

中山醫學大學醫學系助理教授

2015-07~

經歷 Positions and Employment 中山醫學大學附設醫院 內科部 住院醫師

1998/07/01 至 2002/06/31

中山醫學大學附設醫院 內科部 住院總醫師

2002/07/01 至 2003/06/31

國立台灣大學醫學院附設醫院 內科部 內分泌新陳代謝科 臨床研究師

2003 /07/01 至 2005/06/31

國立台灣大學醫學院附設醫院 內科部 老人醫學臨 床研究醫師

2003 /07/01 至 2005/06/31

中山醫學大學附設醫院 內科部 一般內科

2006/7/1 至 2013/06/31

中山醫學大學附設醫院 內科部 內分泌新陳代謝科 主治醫師

2005/07~

中山醫學大學附設醫院 內科部 內分泌 新陳代謝科 主任

2013/07~

專科部分 內科專科 內分泌新陳代謝科專科 老人醫學專科

研究部分 臨床基礎研究 : 糖尿病血管病變

臨床研究 糖尿病衛教研究 , 包括團體衛教、血糖監測、衛教工具等

18

Speaker 楊宜瑱 醫師

COVID-19 and diabetes 楊宜瑱醫師 Underlying diabetes mellitus and cardiovascular diseases are considered risk factors for increased coronavirus disease 2019 (COVID-19) disease severity and worse outcomes, including higher mortality.Potential pathogenetic links between COVID-19 and diabetes mellitus include effects on glucose homeostasis, inflammation, altered immune status and activation of the renin–angiotensin–aldosterone system (RAAS).During the COVID-19 pandemic, tight control of glucose levels and prevention of diabetes complications might be crucial in patients with diabetes mellitus to keep susceptibility low and to prevent severe courses of COVID-19.Evidence suggests that insulin and dipeptidyl peptidase 4 inhibitors can be used safely in patients with diabetes mellitus and COVID-19; metformin and sodium–glucose cotransporter 2 inhibitors might need to be withdrawn in patients at high risk of severe disease.Pharmacological agents under investigation for the treatment of COVID-19 can affect glucose metabolism, particularly in patients with diabetes mellitus; therefore, frequent blood glucose monitoring and personalized adjustment of medications are required.As COVID-19 lacks definitive treatment so far, patients with diabetes mellitus should follow general preventive rules strictly and monitor glucose levels more frequently, engage in physical activity, eat healthily and control other risk factors.

19

Speaker 廖國盟 醫師

廖國盟 醫師 Current Position Attending physician, Endocrinology and Metabolism, Taipei City Hospital, Zongxiao branch

Education 2002-2020 1995-2002 1987-1994

Attending physician, Taipei City Hospital, Zongxiao branch/ Endocrinology and Metabolism Doctor student, Graduate Institute of Epidemiology, College of Public Health, National Taiwan University Medical Student, Medical College, National Taiwan University

Research Interests 1.Endocrinology and metabolism 2.Epidemiology 3.Biostatics

Publications 1. Kuo‐Meng Liao1 Chi‐Wei Chang2 Sheng‐Hung Wang2 Yi‐Ting Chang3 Ying‐Chun Chen1 Gin‐Chung Wang4 (2019, Oct). Assessment of cardiovascular risk in type 2 diabetes patients by insight into radial pulse wave harmonic index . Acta Physiologica, .

2019;00:e13398. (SCI, 2018:8/81 (Physiology)).

2. Kuo-Meng Liao1,* , Chi-Wei Chang2,* , Sheng-Hung Wang2, Yi-Ting Chang3, YingChun Chen1 & Gin-Chung Wang4 (2019, Sep). Risk assessment of macrovascular and microvascular events in patients with type 2 diabetes by analyzing the amplitude variation of the fourth harmonic component of radial pulse wave . Physiological Report, Physiol Rep, 7 (19), 2019, e14252,. (SCI).

3. Kuo-MengLiao a,1, Chi-Wei Chang b,1, Sheng-Hung Wang b , Yi-Ting Chang c , YingChun Chen a , Gin-ChungWang d (2019, Aug). The first harmonic of radial pulse wave predicts major adverse cardiovascular and microvascular events in patients with type 2 diabetes . Journal of Diabetes and Its Complications, https://doi.org/10.1016/ j.jdiacomp.2019.107420 . (SCI).

4. Chi-Wei Chang, Kuo-meng Liao, Yi-Ting Chang, Sheng-Hung Wang, Ying-chun Chen, Gin-Chung Wang (2019, Apr). Fourth harmonic of radial pulse wave predicts adverse cardiac events in asymptomatic patients with type 2 diabetes .Journal of Diabetes and Its Complications , Volume 33, Issue 6,2019,Pages 413-416. (SCI). 共同第一作者 5. Chi-Wei Chang ,1 Kuo-meng Liao,2 Yi-Ting Chang,3 Sheng-Hung Wang,4 Ying-chun Chen,2 and Gin-Chung Wang5Chi-Wei Chang and Kuo-meng Liao contributed equally to this work. (2018, Oct). The First Harmonic of Radial Pulse as an Early Predictor of Silent Coronary Artery Disease and Adverse Cardiac Events in Type 2 Diabetic Patients.

Cardiology Research and Practice, DOI: 10.1155/2018/5128626. (SCI). 共同第一作者

20

Speaker 廖國盟 醫師

New Era of CKD Management in Diabetes: Evolving Role of SGLT-2i 廖國盟醫師 台灣 2019 年健保費用支出的十大疾病，首位為慢性腎臟病，花費了 533 億， 透析人數也與日俱增，從前年的 9 萬人增加到了去年 9.2 萬人，台灣透析無論發生 率還是盛行率都是世界之冠，因而被稱為洗腎王國，是台灣政府及醫療體系急需解 決的一大問題。導致 ESRD 的主因為糖尿病，佔 38%，而糖尿病同時也是健保十大 花費疾病的第二名。糖尿病患約 30-40% 合併有腎病，糖尿病腎病變初期 eGFR 反 而上升，呈現 hyperfiltration 的狀態，此時的腎絲球高壓及高過濾率帶給腎元極大 的傷害，待腎元持續受損，eGFR 開始下降時，腎元已損害約 50% 以上，蛋白尿也 開始出現，因此，及早介入為糖尿病腎病管理最好的方式。在已經合併有腎病的糖 尿病，上一個實證證明有效的藥物 ACEI, ARB 距今已 20 年，現今終於出現了第二 個能夠降低腎臟硬終點 (eGFR decline, ESRD, renal death) 的治療藥物。DAPA-CKD 試驗在今年 9 月發表，不但發現 Dapagliflozin 在糖尿病合併 CKD 病患能降低 36% 腎臟硬終點，更發現在沒有糖尿病的 CKD 病患也能降低 50% 腎臟硬終點，ESRD 風險顯著降低 36%，全死因死亡風險更是降低 31%，為人類醫療史上 CKD 治療的 重大突破。

21

Speaker 周振凱 醫師

周振凱 醫師 現職 高雄長庚醫院 新陳代謝科主治醫師

教育經歷 民國 84 年 9 月 ~ 91 年 6 月

高雄醫學大學醫學系畢業

民國 96 年 9 月 ~ 105 年 8 月

長庚大學臨床醫學研究所博士班畢業

民國 107 年 03 月 ~ 迄今

長庚醫學大學部定助理教授

工作經歷 91 年 08 月 ~ 94 年 06 月

高雄長庚內科住院醫師

94 年 07 月 ~ 96 年 08 月

高雄長庚醫院新陳代謝科總醫師

96 年 09 月 ~ 迄今

高雄長庚新陳代謝科主治醫師

107 年 08 月 ~ 109 年 06 月

高雄長庚新陳代謝科副主任

109 年 07 月 ~ 迄今

高雄長庚新陳代謝科主任

執照 1. 醫師證書 : 醫字第 034512 號 2. 內科專科證書 : 第 7335 號 3. 內分泌新陳代謝專科醫師證書 : 第 480 號

學術著作 1. Aberrant Expression of Androgen Receptor Associated with High Cancer Risk and Extrathyroidal Extension in Papillary Thyroid Carcinoma.Chen-Kai Chou,Shun-Yu Chi,Fong-Fu Chou,Shun-Chen Huang,Jia-He Wang,Chueh-Chen Chen and Hong-Yo Kang.

Cancers 2020, 12(5), 1109; https://doi.org/10.3390/cancers12051109 2. Analysis of overall survival in differentiated thyroid cancer patients with double primary malignancy. Shu-Ting Wu, Chen-Kai Chou Kaohsiung J Med Sci. 2020;1– 9 3. MicroRNA-146b: A Novel Biomarker and Therapeutic Target for Human Papillary Thyroid Cancer. Chen-Kai Chou, Rue-Tsuan Liu, and Hong-Yo Kang, Int J Mol Sci. 2017 Mar; 18(3): 636. Published online 2017 Mar 15. doi: 10.3390/ijms18030636 4. IRAK1, a Target of miR-146b, Reduces Cell Aggressiveness of Human Papillary Thyroid Carcinoma. Chen-Kai Chou, Chou FF, Huang CC, Kang HY, Liu RT. J Clin Endocrinol Metab. 2016 Aug 17:jc20162276.

22

5. Prognostic Implications of miR-146b Expression and Its Functional Role in Papillary Thyroid Carcinoma. Chen-Kai Chou, Yang KD, Chou FF, Huang CC, Lan YW, Lee YF, Kang HY, Liu RT. The Journal of Clinical Endocrinology & MetabolismFebruary 1, 2013 vol. 98 no. 2E196-E205

Speaker 周振凱 醫師

Management of advanced medullary thyroid cancer 周振凱醫師 Medullary thyroid cancer (MTC) is a form of thyroid carcinoma which originates from the parafollicular cells (C cells), which produce the hormone calcitonin. MTC is the third most common of all thyroid cancers and together make up about 3% of all thyroid cancer cases. Demonstration of calcitonin expression is mandatory for the diagnosis.

Approximately 25% of medullary thyroid cancer cases are genetic in nature, caused by a mutation in the RET proto-oncogene. RET mutations may occur sporadically, or can be inherited as germline events associated with familial MTC or the multiple endocrine neoplasia syndromes type 2A and 2B (MEN2A and MEN2B). All patients with MTC should thus be offered genetic counselling and be screened for germline RET mutations.

The vast majority (91.4%) of sporadic MTCs with distant metastases harbour such mutations, in most cases is RET M918T (93.8%).

Calcitonin and CEA are valuable diagnostic, prognostic and predictive markers for use with MTC. Their serum concentrations are directly related to the C-cell mass.

Preoperative screening for pheochromocytoma and hyperparathyroidismis highly recommended for all patients with MTC. Surgery and radiation therapy have been the major treatments for medullary thyroid carcinoma. The initial approach will depend on preoperative serum calcitonin levels and neck imaging findings.

Tyrosine kinase inhibitors (TKIs) are used in patients with advanced MTC. Cabozantinib and vandetanib are the first-line systemic therapy for patients with progressive, metastatic MTC. In patients with RETM918T or RAS-mutant MTCs, cabozantinib offers significant PFS and OS advantages over wild-type MTCs. Vandetanib is an oral agent targeting VEGFRs, RET, and EGFR. It has been shown to be effective in a randomized phase III trial (the ZETA trial) in patients with locally advanced or metastatic MTC. There is little evidence to support the use of either chemotherapy or radionuclide therapy in patients with MTC, although either might be considered when TKIs are contraindicated

23

Speaker 陳思綺 醫師

陳思綺 醫師 學歷 2001/7-2008/6 台北醫學大學醫學系 學士

經歷 2008/07-2011/06 台大醫院內科部 住院醫師 2011/07-2013/06 台大醫院內分泌暨新陳代謝科 總醫師 2013/08-2017/09: 新北市立聯合醫院內分泌新陳代謝科主治醫師 2017/10-2020/03: 天主教天主教新店耕莘醫院內分泌新陳代謝科主治醫師 2020/04 至今 : 台北市立聯合醫院仁愛院區內分泌新陳代謝科主治醫師

現職 台北市立聯合醫院仁愛院區內分泌新陳代謝科主治醫師

研究著作 1. Wu HT, Chen SC (equal contribution), Fan KC, Kuo CH, Lin SY, Wang SH, Chang CJ, Li HY. FASEB J. 2020 Feb;34(2):2958-2967.

2. Wu WC, Wei JN, Chen SC, Fan KC, Lin CH, Yang CY, Lin MS, Shih SR, Hua CH, Hsein YC, Chuang LM, Li HY. Progression of insulin resistance: A link between risk factors and the incidence of diabetes. Diabetes Res Clin Pract. 2020 Mar;161:108050.

3. Yen IW, Lee CN, Lin MW, Fan KC, Wei JN, Chen KY, Chen SC, Tai YY, Kuo CH, Lin CH, Hsu CY, Chuang LM, Lin SY, Li HY. Overweight and obesity are associated with clustering of metabolic risk factors in early pregnancy and the risk of GDM. PLoS One. 2019 Dec 3;14(12):e0225978 4. Chen SC, Wei JN, Lin MS,Shih SR, Hua CH, Hsein YC,Su CC, Li HY/Risk of Incident Diabetes among Individuals with Prediabetes in Taiwan. Formos J Endocrinol Metab 9: 0109, 2018.

5. Kuo CH, Chen SC, Fang CT, Nien FJ, Wu ET, Lin SY, Chuang LM, Lee CN, Li HY. Screening gestational diabetes mellitus: The role of maternal age. PLoS One. 2017 Mar 15;12(3):e0173049.

24

Speaker 陳思綺 醫師

Medical treatment for Cushing disease 陳思綺 醫師 Cushing disease is caused by adrenocorticotropin-producing pituitary tumor inducing uncontrolled hypercortisolism. It accounts for 70 % of cases of Cushing syndrome. Transsphenoidal surgery is the first-line option, and the remission rates are 70% to 90% for microadenomas and 50% for macroadenomas. However, some patients will not be cured after initial surgery, and the recurrence rate for patients in remission after surgery is up to 30%. The treatment of persistent or recurrent Cushing disease involves a consideration of repeat pituitary surgery, radiotherapy, medical therapies, and bilateral adrenectomy. In this section, we will focus on the pharmacologic treatments for Cushing disease.

Medical therapy options for Cushing disease include centrally acting agents, steroidogenesis inhibitors, and glucocorticoid receptor antagonists. Currently, there are three FDA-approved treatments for Cushing disease. Pasireotide and pasireotide longacting release are somatostatin receptor agonists which act on tumorous corticotrophs to decrease ACTH secretion. Hyperglycemia is a common side effect of pasireotide.

Mifepristone, a glucocorticoid receptor antagonist, was approved by the FDA for use in patients with hyperglycemia with Cushing syndrome (including those with Cushing disease). Adverse effects of Mifepristone include hypoadrenalism, hypokalemia, and excessive vaginal bleeding. Osilodrostat is an oral steroidogenesis inhibitor which blocks 11-beta-hydroxylase to prevents cortisol synthesis. In a study included 137 adults with persistent Cushing disease, more patients taking osilodrostat (86%) had normal urinary cortisol levels compared to placebo-receiving patients (29%). The most common side effects included adrenal insufficiency, headache, vomiting, nausea, fatigue and edema.

The FDA has approved osilodrostat to treat adults with Cushing disease who either cannot undergo pituitary gland surgery or have undergone the surgery but still have the disease in March, 2020. Some steroidogenesis inhibitors and cabergoline are also used as “off label＂ in the treatment of Cushing disease. Combination therapy is an additional strategy that aims to increase treatment efficacy.

25

Speaker 王舒儀 醫師

王舒儀 醫師 現職 彰化基督教醫院內分泌新陳代謝科主任 彰化基督教醫院臨床試驗中心副主任

學歷 1992 ~1999

高雄醫學大學醫學系學士

2013 ~2015

中山醫學大學臨床醫學研究所碩士

經歷 1999/08 ~ 2003/06

彰化基督教醫院內科部住院醫師

2003/07 ~ 2004/12

彰化基督教醫院內分泌新陳代謝科臨床研究醫師

2005/01 ~ 迄今

彰化基督教醫院內分泌新陳代謝科主治醫師

研究領域 糖尿病 甲狀腺疾病

26

Speaker 王舒儀 醫師

COVID-19 and endocrine disorders 王舒儀 醫師 Different endocrine glands that can be affected by COVID19. (1) Pituitary: possible hypothalamic-pituitary disfunction and alterations in antidiuretic hormone metabolism.

(2) Thyroid: sick euthyroid syndrome; (3) Adrenal: probable higher susceptibility to COVID-19 in adrenal insufficiency and Cushing＇s syndrome; (4) Bone. Low vitamin D may be linked to more severe disease Increased risk of hypocalcemia. (5) Testicle: Higher susceptibility and worse outcomes have been reported in men; (6) Diabetes. Worse outcomes in diabetic patients; (7) Obesity: Worse prognosis in obese patients.

Endocrinologists, as any other healthcare worker under the current COVID-19 outbreak, will need to self-protect from this viral disease. Avoid unnecessary routine appointments in person. Adequate supplementation of vitamin D is recommended particularly in areas with large known prevalence of hypovitaminosis D and due to the decreased sun exposure. COVID-19 patients＇ outcome is expected to improve with nutritional support. New possible endocrinological targets of COVID-19 have been recently described and warrant a full study in the next future.

27

Speaker 洪晧彰 醫師

現任

洪晧彰 醫師

成大醫院內分泌新陳代謝科主治醫師 成功大學醫學院醫學系臨床助理教授 社團法人中華民國糖尿病衛教學會副秘書長

學歷 台北醫學大學醫學系畢業 成功大學基礎醫學研究所博士班畢業

經歷 成大醫院內科部住院醫師 成大醫院內分泌新陳代謝科總醫師、研究醫師

證書 內科專科醫師 中華民國內分泌暨新陳代謝科專科醫師 肥胖專科醫師 合格糖尿病衛教人員

個人網站：hunghc.com 研究著作 1. Hung HC. Sodium-glucose cotransporter-2 inhibitors for heart failure. Formo J Endocrinol Metabl. 11:1-3, 2020.

2. Lin AC†, Hung HC†, Chen YW, Cheng KP, Li CH, Lin CH, Chang CJ, Wu HT, Ou HY. Elevated Hedgehog-Interacting Protein Levels in Subjects with Prediabetes and Type 2 Diabetes. J Clin Med. 2019 Oct 6;8(10). (†equal contribution) 3. Lin CC, Cheng KP, Hung HC, Li CH, Lin CH, Chang CJ, Hu CY, Wu HT, Ou HY. Serum secretogranin III concentrations were increased in subjects with metabolic syndrome and independently associated with fasting plasma glucose levels. J. Clin. Med. 2019, 8(9), 1436.

4. 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 diabetes patients with asymptomatic active Helicobacter pylori infection. J Diabetes Investig. 2019 Jul;10(4):1092-1101.

5. Cheng KP, Ou HY, Hung HC, Li 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.

28

Speaker 洪晧彰 醫師

Brain-gut axis in obesity 洪晧彰 醫師 Obesity has a complex and multifactorial etiology. A growing body of studies support the concept of bidirectional signaling within the brain–gut axis in the pathophysiology of obesity. Signaling from the brain through the autonomic nervous system and the hypothalamic–pituitary–adrenal axis influences many gastrointestinal processes, including motility and transit, fluid and mucus secretion, immune activation, intestinal permeability and relative gut microbial abundance, as well gene expression patterns in certain gut microorganisms. Conversely, the gut microbiota can communicate with the brain via hundreds of metabolites, which are sensed by specialized cells in the gut, including enteroendocrine cells, enterochromaffin cells and primary or secondary afferent nerve endings. Perturbations at any level of the brain-gut axis, resulting in compromised inhibitory mechanisms that normally regulate food intake, can bias ingestive behaviors towards predominantly hedonic-driven eating behaviors, cravings and overeating. A particular type of eating behavior, which has been termed ｀food addiction＇, plays an important part in the pathophysiology of obesity. Food addiction is the continued consumption of highly palatable foods even after energy requirements have been met and despite known negative physical and psychological consequences in response to uncontrolled food ingestion. Previous work on obesity and food addiction crosses multiple fields of research, which shows the close interactions between diet and gut microbial signals, the effect of these signals on satiety and inflammatory mediators from the gut, and their disruptive effect on homeostatic mechanisms in the brain, leads to a shift towards a greater influence of hedonic reward mechanisms and a reduction in inhibitory control.

29

30

14:20-15:00 Lunch symposium

31

Speaker 范綱志 醫師

范 綱 志 醫師 現任 國立台灣大學醫學院附設醫院新竹分院內分泌新陳代謝科主治醫師 國立台灣大學醫學院附設醫院內科部主治醫師

學歷 國立台灣大學醫學院臨床醫學研究所碩士畢業 輔仁大學醫學院醫學系畢業

經歷 國立台灣大學醫學院附設醫院內分泌新陳代謝科研修醫師 國立台灣大學醫學院附設醫院內科部教學總醫師代表 國立台灣大學醫學院附設醫院內科部住院醫師 國立台灣大學醫學院附設醫院年度最佳實習醫師

專長 三高整合照護 ( 糖尿病、高血壓、高血脂 ) 甲狀腺及副甲狀腺疾病、甲狀腺超音波及甲狀腺穿刺檢查 肥胖及代謝症候群 高尿酸及痛風 血鈣異常、骨質疏鬆症 腦下垂體及腎上腺疾患 性腺功能異常

證照 中華民國考試院醫師考試及格及醫師證書 台灣內科專科醫師證書 中華民國內分泌暨糖尿病專科醫師證書

參與學會 台灣內科醫學會會員 中華民國內分泌暨糖尿病學會會員 中華民國糖尿病衛教學會會員 中華民國醫用超音波學會會員 中華民國血脂及動脈硬化學會會員 32

OP-01 范綱志 醫師

Serum Angiopoietin-like Protein 6, Risk of Type 2 Diabetes, and Response to Hyperglycemia: A Prospective Cohort Study 范綱志 醫師 Context: Angiopoietin-like protein 6 (ANGPTL6) is a hepatokine that improves insulin sensitivity in animals. However, serum ANGPTL6 concentration was found to be higher in human participants with diabetes or metabolic syndrome in cross-sectional studies, implying that ANGPTL6 may be induced to counteract hyperglycemia.

Objective: To investigate whether serum ANGPTL6 can predict incident diabetes and explore whether glucose or insulin can regulate ANGPTL6 expression and secretion.

Design: This cohort study included adults without diabetes at baseline who were followed every 2 years for incident diabetes. Serum ANGPTL6 concentrations were measured at baseline and during oral glucose tolerance tests (OGTTs). A hepatic cell line, HepG2, and diet-induced obesity mouse model were used to evaluate the response of ANGPTL6 expression and secretion to hyperglycemia and the metabolic syndrome.

Results: We recruited 1103 participants without diabetes at baseline. During the 4.22-year follow-up, 113 (10.2%) participants developed incident diabetes. Serum ANGPTL6 was negatively associated with the incidence of diabetes (adjusted hazard ratio, 0.77; p = 0.042). However, serum ANGPTL6 level was higher in participants with prediabetes (p = 0.018) and was elevated during OGTT. In HepG2 cells, treatment with glucose, but not insulin, induced ANGPTL6 expression. Hepatic ANGPTL6 expression and serum ANGPTL6 concentrations were significantly higher in mice fed with a high-fat diet than in those fed with a standard chow (both p < 0.05).

Conclusion: A high serum ANGPTL6 level is associated with a low incidence of diabetes in humans. ANGPTL6 is expressed and secreted in response to hyperglycemia to maintain glucose homeostasis. (J Clin Endocrinol Metab 105: e1949–e1957, 2020)

33

Speaker 王威傑 醫師

現任

王威傑 醫師

中山醫學大學助理教授

2019/8 迄今

中山醫學大學附設醫院內科部主治醫師

2013/2 迄今

學歷 中山醫學大學醫學系

2000/09~2007/06

醫學士

中山醫學大學博士

2015/6~2018/6

醫學博士

經歷 中山醫學大學附設醫院內科部總醫師

2010-2013

中山醫學大學附設醫院內科部住院醫師

2007/08 至 2010/7

SCI 期刊論文發表 1. Epidemiology and factors associated with mortality of thyroid storm in Taiwan: a nationwide population-based study. Kornelius E, Chang KL, Yang YS, Huang JY, Ku MS, Lee KY, Ho SW. Intern Emerg Med. 2020 Jul 16. doi: 10.1007/s11739-020-02445-6 2. Two alcoholic liver cirrhosis patients developed diabetic ketoacidosis after SGLT2 inhibitors-prescription. Chao HY, Kornelius E. J Formos Med Assoc. 2020 Jul 17:S09296646(20)30324-7. doi: 10.1016/j.jfma.2020.07.013.

3. The risk of thyroid cancer in patients with thyroid nodule 3 cm or larger. Kornelius E, Lo SC, Huang CN, Yang YS. Endocr Pract. 2020 Jul 13. doi: 10.4158/EP-2020-0136 4. Kornelius E, Lo SC, Huang CN, Wang YH, Yang YS. Association of blood glucose and renal end points in advanced diabetic kidney disease. Diabetes Res Clin Pract. 2020 Mar;161:108011. doi: 10.1016/j.diabres.2020.108011 5. L o S C , Ya n g Y S , K o r n e l i u s E , H u a n g J Y, L a i Y R , H u a n g C N , C h i o u J Y. E a r l y cardiovascular risk and all-cause mortality following an incident of severe hypoglycaemia: A population-based cohort study. Diabetes Obes Metab. 2019 Aug;21(8):1878-1885

34

OP-02 王威傑 醫師

Association of blood glucose and renal end points in advanced diabetic kidney disease 王威傑 醫師 Aims: The association of blood glucose in advanced diabetic kidney disease (DKD) is unclear. This study investigated the association between blood glucose and renal endpoints in DKD patients.

Methods: This retrospective cohort study enrolled type 2 diabetic patients with advanced DKD with an estimated glomerular filtration rate (eGFR) between 30 and 90 ml/ min/1.73 m2 and urine albumin-to-creatinine ratio (UACR) of 300–5000 mg/g. We classified patients into 2 groups according to their 1-year average HbA1c: <7% and >7%. We followed up the patients until the occurrence of primary renal endpoints.

Results: A total of 345 patients were included in the analysis for the period 2012–2018.

Mean baseline eGFR was 58 ml/min/1.73 m2 and mean albuminuria levels were 1146 and 1313 mg/g, respectively. Median study duration was 3 years. The risk of primary renal endpoints was not decreased in patients with HbA1c less than 7% with an adjusted hazard ratio (aHR) of 0.62, 95% CI 0.26–1.45. The risks of persistent eGFR lower than 15 ml/ min/1.73 m2 and doubling of serum creatinine level were similar between 2 group with aHR of 0.58 (95% CI 0.19–1.83) and 0.61 (95% CI 0.26–1.44), respectively.

Conclusions: Intensive blood sugar control did not prevent renal failure in advanced DKD

35

Speaker 徐盛邦 醫師

徐 盛 邦 醫師 學 歷 中山醫學大學醫學士

經 歷 中華民國內科專科醫師 中華民國內分泌暨新陳代謝科專科醫師 台北新光醫院內科部住院醫師 台北新光醫院內分泌暨新陳代謝科總醫師 台北新光醫院內分泌暨新陳代謝科主治醫師 台中慈濟醫院內分泌暨新陳代謝科主治醫師 中國醫藥大學附設醫院 新陳代謝科主治醫師 台中長安醫院內分泌暨新陳代謝科主治醫師

36

2009-2012 2012-2014 2014 2014-2018 2018 ~2020 2020- 迄今

OP-03 徐盛邦 醫師

Association of Hemorrhoids With Hashimoto’s Thyroiditis and Associated Comorbidities: A Nationwide Population-Based Cohort Study 徐盛邦 醫師 Methods: Using Taiwan＇ s Longitudinal Health Insurance Database, we compared the incident risk of HT between the study cohort (comprising patients with hemorrhoids) and the comparison cohort (comprising patients without hemorrhoids). Both cohorts were followed from index date until the date of HT diagnosis, withdrawal from the National Health Insurance program, or the end of 2015.

Results: The study cohort and comparison cohort comprised 6,486 patients with hemorrhoids and 25,944 patients without, respectively. The mean follow-up time was _3years. The incidence rate of HT in the study cohort was 5.37 per 1,000 person-years, which was higher than that of the control cohort (2.46 per 1,000 person-years). The risk of developing HT in the study cohort was 2.06 times (95%confidence interval [CI] = 1.02, 4.19) higher than that in the comparison cohort.

Conclusion: In our study, patients with hemorrhoids could be at increased risk of HT compared with patients with other comorbidities of HT, such as cardiovascular disease.

37

Speaker 蔡文瑄 醫師

蔡 文 瑄 醫師 現職 Resident, Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital

學歷 Bachelor´s degree, School of Medicine, China Medical University

經歷 2019 till now, Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital; 2016-2019, Department of Internal Medicine, National Taiwan University Hospital

SCI 期刊論文發表 1. Tsai W-H, Wong C-H, Dai S-H, Tsai C-H and Zeng Y-H (2020) Adrenal Tumor Mimicking Non-Classic Congenital Adrenal Hyperplasia. Front. Endocrinol. 11:526287. doi: 10.3389/ fendo.2020.526287

38

OP-04 蔡文瑄 醫師

Adrenal tumor mimicking non-classic congenital adrenal hyperplasia 蔡文瑄 醫師 Elevated 17-hydroxyprogesterone may be caused by congenital adrenal hyperplasia, ovarian or adrenal tumors. A positive cosyntropin stimulation test result for 17-hydroxyprogesterone may be found in functional or non-functional tumors and be related to tumour size. Here, we present a case of a 36-year-old woman with a 4-year history of infertility. Laboratory test results revealed elevated progesterone and 17-hydroxyprogesterone, with normal luteinizing hormone, follicle-stimulating hormone, oestrogen, testosterone, dehydroepiandrosterone sulphate, and anti-Mullerian hormone levels. The 250-μg cosyntropin stimulation test revealed a 17-hydroxyprogesterone level of 11.3 ng/mL (34.3 nmol/L) and 31.8 ng/mL (96.2 nmol/L) at 0 min and 60 min, respectively. Non-classic congenital adrenal hyperplasia was diagnosed initially; however, genetic testing revealed no 21-hydroxylase deficiency. She received dexamethasone but progesterone and 17-hydroxyprogesterone levels remained high.

Abdominal computed tomography found a 4.5 × 4.8-cm left adrenal tumor. Subsequent pathological report was compatible with an adrenal cortical adenoma. Progesterone and 17-hydroxyprogesterone levels returned to the normal range postoperatively and the 250μg cosyntropin stimulation test of 17-hydroxyprogesterone showed a normal response.

When biochemically diagnosed NCCAH demonstrate no typical features and show poor response to steroid, the patient should undergo gene mutation analysis and receive adrenal or ovarian imaging. For women suffering from infertility, adrenalectomy of 17-OHP secreting adrenal tumor may improve fertility outcome.

39

PP-09 李昂澤 醫師

40

論文口頭發表注意事項 論文壁報發表注意事項

12:10-13:10 Lunch symposium

41

Speaker 杜思德 院長

杜 思 德 院長 學歷 學士

1979.09~1986.07

彰化基督教醫院內分泌新陳代謝科

主治醫師

1992.07~ 迄今

鹿港基督教醫院內分泌新陳代謝科

主治醫師

2005.07~ 迄今

鹿港基督教醫院

院長

2005~2017

中華民國糖尿病衛教學會第八屆

理事長

2017.07 ~ 迄今

中華民國骨質疏鬆學會第十一屆

理事

2017.10~ 迄今

彰化基督教醫院糖尿病健康 e 院

院長

2018.10~ 迄今

漢銘醫院內分泌新陳代謝科

主治醫師

2019.04~ 迄今

中華民國糖尿病學會第十四屆

常務理事

2019~ 迄今

中國醫藥大學中醫學系

經歷

科技專長 糖尿病、甲狀腺疾病、 腦下垂體疾病、 腎上腺疾病、 副甲狀腺疾病 性腺疾病等

期刊論文 (2019) 1. CH Wu1, YF Chang2,CH Chen 3,EM Lewiecki4, C Wüster5, I Reid 6, KS Tsai7, T Matsumoto8, LB Mercado-Asis9, DC Chan10, JS Hwang11, CL Cheung12,K Saag13, JK LEE14,ST Tu15,W Xia16,W YU17,YS Chung18,P Ebeling 19, A Mithal20, SL Ferrari21, C Cooper 22, GT Lin23, RS Yang24.Consensus Statement on the Use of Bone Turnover Markers for Short-Term Monitoring of Osteoporosis Treatment in the Asia-Pacific Region. J Clin Densitom. 2019 Mar 20.

2. PC Cheng1,SR Hsu1,JC Li2,CP Chen2, SC Chien2, ST Tu1,YC Cheng3,YH Liu4,JF Kuo1.lasma Low-Density Lipoprotein Cholesterol Correlates With Heart Function in Individuals With Type 2 Diabetes Mellitus: A Cross-Sectional Study. Front Endocrinol (Lausanne). 2019 Apr 11;10:234.

3. CH His, ST Tu, WH Sheu 2019 Diabetes Atlas: Achievements and challenges in diabetes care in Taiwan. J Formos Med Assoc. 2019 Nov(11).130-134 4. CH Chu 1, CC Hsu 2, SY Lin 3, LM Chuang 4,JS Liu 2, ST Tu 5.Trends in antidiabetic medical treatment from 2005 to 2014 in Taiwan. J Formos Med Assoc.2019 Nov;118 Suppl 2:S74-S82.

5. HK Sia1,2, ST Tu1, PY Liao1, KH Lin2, CT Kor3, LL Yeh4 A convenient diagnostic tool for discriminating adult-onset glutamic acid decarboxylase antibody-positive autoimmune diabetes from type 2 diabetes: a retrospective study. PeerJ. 2020 Feb.

42

台田(221室)

Cardio-Renal Protection of SGLT2i for DKD Patients 杜思德 院長 Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. In CREDENCE trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically.

At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P = 0.00001).

The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P = 0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P = 0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture.

From weeks 3 to 130, there was a 66% difference in the mean rate of eGFR decline with canagliflozin versus placebo (mean slopes,21.30 versus 23.83ml/min per 1.73m2 per year; difference,22.54 ml/min per 1.73m2 per year; 95% confidence interval [CI], 0.90 to 4.17). Effects of canagliflozin on kidney, cardiovascular, and mortality outcomes were consistent for those with eGFR ,30 and $30 ml/min per 1.73 m2 (all P interaction .0.20).

The estimate for kidney failure in participants with eGFR ,30 ml/min per 1.73m2 (hazard ratio, 0.67; 95% CI, 0.35 to 1.27) was similar to those with eGFR $30 ml/min per 1.73 m2 (hazard ratio, 0.70; 95% CI, 0.54 to 0.91; P interaction50.80). There was no imbalance in the rate of kidney-related adverse events or AKI associated with canagliflozin between participants with eGFR ,30 and $30 ml/min per 1.73 m2 (all P interaction .0.12). This post hoc analysis suggests canagliflozin slowed progression of kidney disease, without increasing AKI, even in participants with eGFR ,30 ml/min per 1.73 m2.

In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years. Canagliflozin safely reduced the risk of renal and cardiovascular events, with consistent results across eGFR subgroups, including the subgroup initiating treatment with an eGFR of 30 to 45 ml/min per 1.73 m2. Absolute benefits for renal outcomes were greatest in subgroups with lower eGFR. 43

Speaker 黃兆山 醫師

黃 兆 山 醫師 Employment Record Aug 1993 - June 1996

Resident in Department of Internal Medicine Chang Gung Memorial Hospital, Taipei, Taiwan

July 1996 - June 1998

Fellowship in Section of Division of Endocrinology and Metabolis Chang Gung Memorial Hospital, Taipei, Taiwan

July 1998 -

Attending in Section of Division of Endocrinology and Metabolism Chang Gung Memorial Hospital, Taipei, Taiwan

Education Sep 1985 - June 1992 China Medical College, Tai-Chung Board Certification: 1993, Board of Medicine, R.O.C., No.: 25658 1995, Board of Internist, R.O.C., No.4447 1999, Board of Endocrinologist, R.O.C. No.887 1999, Board of Metabolist, R.O.C. No.933 Professional Affiliation: Endocrinology Society, R.O.C. Diabetes Association, R.O.C. Society of Internal Medicine, R.O.C Taiwanese Osteoporosis Association, R.O.C International Society for Clinical Densitometry, U.S.A European Association for the Study of Diabetes Research Interest: Osteoporosis Diabetic foot ulcer and complications Peripheral arterial occlusive disease Metabolic syndrome Hyperlipidemia 44

Sanofi(222室)

Beyond the status quo: Addressing the need for intensification in T2D patients with high HbA1C and helping them get to goal 黃兆山 醫師 Diabetes mellitus (DM) in adults is a global health problem, despite advances in therapy for T2D, many people with T2D are not achieving their glycemic goals and a lack of control may lead to complications. Research suggested that early achievement of sustained glycemic control is a key component of effective management of T2D and a paradigm shift toward personalized, early intensification with combination therapy could help people with T2D achieve glycemic targets. New treatment option like FRC (Fixed Ratio combination) combining the pharmacological properties of basal insulin and GLP-1 RA can help to optimize management of T2D, particularly in cases of high HbA1c,real-world evidence and indirect comparison analyses have shown the need for combination therapy and its advantages versus single injectable therapy, especially in patients poorly controlled on OADs (HbA1c ≥9%)

45

Speaker 朱志勳 主任

朱 志 勳 醫師 現 職 高雄榮民總醫院內科部新陳代謝科

主任

2014/9 至今

中華民國糖尿病衛教學會

理事

2017 至今

中華民國糖尿病學會

理事

2019 至今

國立中山大學生物科學 研究所碩士在職專班

碩士

2003/9 至 2006/1

中國醫藥學院醫學系 26 屆

醫學士

1983/9 至 1990/7

學 歷

經 歷 中華民國糖尿病學會

副秘書長 2013 至 2019

高雄榮民總醫院內科部新陳代謝科

主治醫師 1999/7 至 2014/9

高雄榮民總醫院內科部新陳代謝科

總住院醫師

1998/7 至 1999/6

高雄榮民總醫院內科部新陳代謝科

代總住院醫師

1997/7 至 1998/6

高雄榮民總醫院內科部

住院醫師 1994/6 至 1997/6

龍泉榮民醫院

住院醫師 1992/6 至 1994/6

專業證書 1997: 中華民國內科專科醫師證書 1999: 中華民國內分泌暨新陳代謝科專科醫師證書 2002: 糖尿病衛教人員合格證書 2001: 教育部部定講師證書 2007: 教育部部定助理教授證書 2020: 教育部部定副教授證書

專科學會會員 中華民國內科醫學會 中華民國內分泌暨糖尿病學會 中華民國糖尿病衛教學會

46

MSD(223室)

A Rising Star in OAD Treatment for Patient with T2DM Complementary Mechanism with Ertugliflozin and Sitagliptin Combination 朱志勳 醫師 Current guidelines recommend that a single agent be added to treatment in patients with inadequate glycemic control with metformin monotherapy. Although some patients achieve glycemic control with dual therapy, many, especially those starting at higher HbA1c levels, may not. Further, patients who achieve glycemic control with dual therapy may experience progressive deterioration of glycemic control. In some cases, it may be appropriate to consider addition of a combination of two anti-hyperglycemic agents (AHAs) with complementary mechanisms of action, favorable safety profiles and without pharmacokinetic interaction, such as a sodium-glucose cotransporter 2 (SGLT2) and dipeptidyl peptidase-4 (DPP-4) inhibitors.2 This may provide a more robust and sustained anti-hyperglycemic effect, resulting in more patients achieving and maintaining glycemic goals, and could become a useful alternative to the single stepwise antihyperglycemic approach. Ertugliflozin is an inhibitor of SGLT2, with high selectivity relative to SGLT1, Ertugliflozin as monotherapy or as add-on to metformin or metformin and sitagliptin improved glycemic control and reduced body weight, with a safety profile consistent with that of other SGLT2 inhibitors. Sitagliptin is a DPP-4 inhibitor indicated for treatment of type 2 diabetes. Sitagliptin as monotherapy, or as part of dual or triple therapy for patients with type 2 diabetes, provides clinically meaningful reductions in blood glucose.

The primary objective was to determine whether coadministration of ertugliflozin with sitagliptin provides better glycemic benefit for patients with type 2 diabetes who were inadequately controlled with metformin. An updated data of VERTIS-CV adds additional understanding of Ertugliflozin on HF & Renal understanding.

47

Speaker 曾耀賢 醫師

曾 耀 賢 醫師 現 職 童綜合醫院新陳代謝科 主任 自 2019/09 迄今 台中榮總埔里分院新陳代謝科／老年醫學科主任 自 2007 / 10 ～ 2017

學 歷 台灣大學公衛學院職業醫學研究所 中國醫藥大學醫務管理所 中山醫學大學醫學系

博士 碩士 醫學士

自 2013/9 迄今 自 2009 / 09 至 2011/07 自 1995 / 07 至 2002/ 06

經 歷 台中榮民總醫院新陳代謝科 經歷：台中榮民總醫院內科

總醫師 自 2005 / 7 至 2007 / 10 住院醫師 自 2002 / 07 至 2005 / 6

專 長 1. 臨床醫學 2. 內分泌學 3. 老年醫學 4. 大數據分析

期刊論文 (2019) 1: Tseng YH, Tsan YT, Chan WC, Sheu WH, Chen PC. Use of an α-Glucosidase Inhibitor and the Risk of Colorectal Cancer in Patients with Diabetes: A Nationwide, Population-Based Cohort Study. Diabetes Care. 2015 Nov;38(11):2068-74 2: Wei-Che Chiu, Yao-Hsien Tseng, Pau-Chung Chen. Progress of Diabetic Severity and Risk of Dementia.: J Clin Endocrinol Metab. 2015 Aug;100(8):2899-908.

Response to the letter 3: Chen PH, Tsai YT, Wang JS, Lin SD, Lee WJ, Su SL, Lee IT, Tu ST, Tseng YH, Sheu WH, Lin SY. Post-meal β-cell function predicts the efficacy of glycemic control in patients with type 2 diabetes inadequately controlled by metformin monotherapy after addition of glibenclamide or acarbose. Diabetol Metab Syndr.

2014 May 31;6:68. doi: 10.1186/1758-5996-6-68. eCollection 2014.

4: Tseng LN, Tseng YH, Jiang YD, Chang CH, Chung CH, Lin BJ, Chuang LM, Tai TY, Sheu WH. Prevalence of hypertension and dyslipidemia and their associations with micro- and macrovascular diseases in patients with diabetes in Taiwan: an analysis of nationwide data for 2000-2009. J Formos Med Assoc. 2012 Nov;111(11):625-36.

5: Wang JS, Lin SD, Lee WJ, Su SL, Lee IT, Tu ST, Tseng YH, Lin SY, Sheu WH. Effects of acarbose versus glibenclamide on glycemic excursion and oxidative stress in type 2 diabetic patients inadequately controlled by metformin: a 24week, randomized, open-label, parallel-group comparison. Clin Ther. 2011 48 Dec;33(12):1932-42.

Novartis (225室)

VERIFY the role of early combination: The importance of Beta cell preservation 曾耀賢 醫師 Type 2 diabetes mellitus (T2DM) develops as a consequence of progressive β-cell dysfunction in the presence of insulin resistance. Strategies to minimize β-cell loss and to increase their function and regeneration will ultimately lead to therapy for 2 diabetes.

DPP-4 inhibitors may restore the deranged islet-cell balance in T2DM, by stimulating meal-related insulin secretion and by decreasing postprandial glucagon levels. Moreover, in rodent studies, DPP-4 inhibitors demonstrated beneficial effects on (functional) β-cell mass and pancreatic insulin content.

Latest evidence from VERIFY study shows the early combination with Metformin and Vildagliptin improve in beta cell function compare with initial monotherapy.

49

MEMO

50

1. 諾華

北市衛藥廣字第108120061號

台北市中山區民生東路三段2號8樓 電話：(02)2322-7777 傳真：(02)2322-7328

51

免費諮詢專線：0800-880-870 TW1811919990

1. 諾華

52

1. 諾華封底裏

處方資 訊 摘 要 得安穩 Diovan ® Film-Coated Tablets 80 mg、160 mg 衛署藥輸字第 023373 號 衛署藥輸字第 023374 號 適應症：高血壓、心衰竭( NYHA 二到四級 )、心肌梗塞後左心室功能異常。 劑量&使用方法：單日劑量80 mg- 320 mg，用法依適應症不同調整。 禁忌：已知對 Diovan 中任何成份過敏者及孕婦。 合併使用本品及含 aliskiren 成分藥品於糖尿病患或腎功能不全患者 (GFR < 60 ml/ min/ 1.73 m 2 )。 警語：對於出現血管性水腫的病人，應立即停用 Diovan。Diovan 不建議使用於腎絲球過濾率 < 30 mL/ min/ 1.73 m 2 以及接受透析的兒童病患。對於肝功能受損的病患，valsartan 的劑量不應超過每日 80 mg。副作用：暈眩、姿勢性暈眩、低血壓、姿勢性低血壓、腎臟衰竭與腎功能不全。 可得安穩 CoDiovan ® Film-Coated Tablets 80 / 12.5 mg、160 / 12.5 mg 衛署藥輸字第 023109 號 衛署藥輸字第 023220 號 適應症：單一療法無法控制的高血壓，作為第二線用藥。 劑量&使用方法： Valsartan 之使用劑量為 80 毫克至 320 毫克，一天服用一次。 Hydrochlorothiazide 之有效使用劑量為 12.5 毫克至 50 毫克，一天服用一次。 禁忌：嚴重的肝功能不全、膽道性肝硬化、膽汁鬱積、無尿、嚴重腎功能不全( 肌酐酸清除率 < 30 毫升/ 分鐘)、無法治療之低血鉀、低血鈉、高血鈣及有症狀之高尿酸血症。 警語：對於出現血管性水腫的病人，應立即停用 Co-Diovan。 Hydrochlorothiazide 會引起特異體質反應，導致急性短暫近視與急性隅角閉鎖型青光眼。隨著長期使用，NMSC 的風險似乎會增加。 副作用：低血鎂症、高尿酸血症、低血鈉症、食慾下降、姿勢性低血壓、陽萎、蕁麻疹、輕度噁心及嘔吐。 易安穩 Exforge ® Film-coated tablets 5 / 80 mg、5 / 160 mg 衛署藥輸字第 024824 號 衛署藥輸字第 025072 號 適應症：Exforge ( amlodipine 和 valsartan ) 適用於治療高血壓，此複方藥品不適合用於起始治療。 劑量&使用方法：每日服用一劑 5 mg- 10 mg 之 Amlodipine，可有效治療高血壓，而 valsartan 的 有效劑量為 80 mg- 160 mg。 禁忌：禁用於無尿症或對磺胺類衍生藥物過敏之病人。合併使用本品及含 aliskiren 成分藥品於糖尿病患或腎功能不全患者 ( GFR < 60 ml/ min/ 1.73 m 2 )。 警語：妊娠 安全分類 D。目前並無嚴重腎功能不全病人( 血清肌酸酐清除率 < 10ml/ min ) 之數據。對於出現血管性水腫的病人，應立即停用。 副作用：暈眩、水腫、頭痛、消化不良、疲勞、肌肉痙攣、背痛、噁心。 力安穩 Exforge HCT® Film-coated tablets 5 / 160 / 12.5 mg 衛署藥輸字第 025419 號 適應症：本品適用於以 Amlodipine、Valsartan、Hydrochlorothiazide 其中兩種成分合併治療，仍無法有效控制血壓之高血壓病人。 劑量&使用方法：每日用藥一次。劑量可在兩週後增加。Exforge HCT 最高建議劑量為 10/ 320/ 25 毫克。 禁忌：禁用於無尿症或對磺胺類衍生藥物過敏之病人。合併使用本品及含 aliskiren 成分藥品於糖尿病患或腎功能不全患者 ( GFR < 60 ml/ min/ 1.73 m 2 )。 警語：妊娠安全分類 D。目前未有腎臟移植病人使用 Exforge HCT 的臨床經驗。對於出現血管性水腫的病人，應立即停用。 Hydrochlorothiazide 會引起特異體質反應，導致急性短暫近視與急性 隅角閉鎖型青光眼。隨著長期使用，NMSC 的風險似乎會增加。 副作用：暈眩、水腫、頭痛、消化不良、疲勞、肌肉痙攣、背痛、噁心。

台灣諾華股份有限公司 104台北市中山區民生東路三段2號8樓 www.novartis.com.tw

電話：(02) 2322-7777 傳真：(02) 2322-7328 免費諮詢專線：0800-880-870

詳細資料處方備索 使用前請詳閱說明書警語及注意事項 僅限專業醫療人士參閱

TW1909730249

54