22nd Brazilian Diabetes Society Congress

Abstract

Oral presentations

O1 A randomized controlled trial to compare the glycemic effects of dapagliflozin, a sodium glucose cotransporter 2 inhibitor, and gliclazide modified release, a sulphonylurea, assessed by CGMS

André Gustavo Daher Vianna, Claudio Silva de Lacerda, Luciana Muniz Pechmann, Michelle Garcia Polesel, Kleber Ramos Marques, Emerson Cestari Marino, Josiane Melchioretto Detsch, Claudia Pinheiro Sanches

Centro de Diabetes Curitiba, Curitiba, Brazil

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O1

Introduction: A reduced number of trials evaluated the effects of SGLT2 inhibitors on glucose pattern by CGM, but neither compared these effects with other class of antidiabetics. This is the first prospective and randomized study to compare the effects of dapagliflozin and an active comparator (gliclazide MR) on GV and glycemic control through the use of CGM parameters in patients with type 2 diabetes mellitus treatment naïve or not controlled on a stable dose of metformin.

Objective: This study aims to evaluate whether there is a difference between the effects of dapagliflozin and gliclazide MR (modified release) on glycemic variability (GV) and control, as assessed by continuous glucose monitoring (CGM), in individuals with uncontrolled type 2 diabetes (T2DM).

Methods: An open-label, randomized study was conducted in uncontrolled T2DM individuals drug naïve or on steady-dose metformin monotherapy which were treated with 10 mg dapagliflozin once daily or 60 to 120 mg of gliclazide MR once daily. CGM and GV indices calculation were performed at baseline and after 12 weeks.

Results: In total, 97 patients (age: 57.9 ± 8.7 years, male sex: 50.5%, baseline glycated hemoglobin (HbA1c): 7.9 ± 0.9) were randomized and 94 completed the 12-week protocol. Per protocol analysis demonstrated that the reduction of GV, as measured by the mean amplitude of glycemic excursions (MAGE), was superior in the dapagliflozin versus gliclazide MR group (− 17.8 ± 33.3 vs. − 3.3 ± 42.9 mg/dL, mean ± SD, p = 0.037). The improvement of GV, as measured by the coefficient of variation (CV) and the standard deviation (SD) was also superior in the dapagliflozin group (p = 0.021 and 0.024, respectively). Moreover, dapagliflozin increased the time in range (TIR, between 70 and 180 mg/dL) by 28.6 ± 24.4% vs. 19.8 ± 33.1% (p = 0.041). The intention-to-treat (ITT) analysis was also performed and did not alter the significance of the results.

Conclusions: Dapagliflozin reduced glycemic variability and increased the TIR more efficiently than gliclazide MR in individuals with T2DM after 12 weeks of treatment as demonstrated by continuous glucose monitoring evaluation.

Financial support: AstraZeneca do Brasil.

O2 Association between pre-gestational BMI and adverse obstetric outcomes

Filipe Dias de Souza, Patricia Medici Dualib, Rosiane Mattar, Sergio Atala Dib, Bianca de Almeida Pititto

Universidade Federal de São Paulo, São Paulo, Brazil

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O2

Introduction: Previous studies have shown a higher incidence of obstetric complications in patients with increased body mass index (BMI). However, few studies provide details about the relation between obstetric complications and obesity degree.

Objectives: To compare occurrence of adverse obstetric outcomes in pregnant women with gestational diabetes mellitus (GDM) according to pre-gestational BMI.

Methods: 788 patients with GDM (IADPSG criteria) from a high-risk prenatal service between 2007 and 2019, were divided into five groups according to BMI: normal weight (18.5 to 24.5 kg/m²), overweight (25.0 to 29.9 kg/m²), grade I obesity (30.0 to 34.9 kg/m²), grade II obesity (35.0 to 39.9 kg/m²) and grade III obesity (≥ 40.0 kg/m²). Metabolic profile and occurrence of obstetric outcomes were compared between BMI groups using ANOVA or Chi square test. Obstetric outcomes included gestational hypertension (GHP), preeclampsia, c-section and others (hypothyroidism, pseudotumor cerebri, psychiatric disorders, thromboembolic events, HIV infection, dyslipidemia). Logistic regression was performed—preeclampsia and GHP as dependent variables.

Results: Mean age of the sample was 33.4 years and did not differ between BMI groups (p = 0.257). HbA1c levels increased (p = 0.006), while weight gain during pregnancy decreased (p < 0.001) progressively across the BMI degrees. Frequencies of previous GDM/macrosomia or preeclampsia were not different between groups (p = 0.51), but higher frequencies of prior hypertension were observed according to the increase in BMI (p < 0.001). Increase in frequencies of GHP (0.6 vs. 2.1 vs. 3.4 vs. 0 vs. 9.8%, p = 0.004) and preeclampsia (0.6 vs. 1.7 vs. 6.3 vs. 1.2 vs. 12.2, p < 0.001) were observed according to the progression of BMI degrees, respectively normal, overweight, GI, GII and GIII, while no difference was seen in occurrence of hypothyroidism, cesarean delivery or other maternal complication between groups. In logistic regression, BMI—used as independent variable as a continuous variable—was associated with preeclampsia (OR 1.12, 95% CI 1.04–1.20), adjusted for prior hypertension and weight gain during pregnancy, and GHP (OR 1.08, 95% CI 1.002–1.16) adjusted for weight gain during pregnancy.

Conclusions: Gestational hypertension and preeclampsia is positively associated with pre-gestational BMI in women with GDM independent of weight gain and metabolic profile.

Financial support: CAPES.

O3 Bean consumption improves biochemical parameters and antioxidant capacity in female rats

Josilene Lopes de Oliveira¹, Luiz Antônio Alves de Menezes Júnior², Jonathas Assis de Oliveira², Alice Helena de Souza Paulino², Mayara Medeiros de Freitas Carvalho², Ana Maria Fernandes Viana², Joyce Ferreira da Costa², Maria Lucia Pedrosa²

¹Universidade Estadual de Campinas, Campinas, Brazil; ²Universidade Federal de Ouro Preto, Ouro Preto, Brazil

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O3

Introduction: Oxidative damage caused by overproduction of reactive species is related to the pathogenesis of several diseases, such as diabetes, cardiovascular disease. The beans have shown numerous benefits beyond the supply of macro and micronutrients, highlighting the antioxidant activity.

Objective: To determine the in vitro antioxidant capacity of the three most consumed beans in Brazil and to verify if this effect is confirmed in vivo.

Methodology: The antioxidant capacity of carioca (C), black (B) and red (R) beans was determined by the DPPH method, the polyphenols by the Folin-Ciocalteu method. In the in vivo analysis, 32 wistar rats were used, divided into 4 groups: C (control), CB (C + 10% bean), H (hyperlipidic) and HB (H + 10% bean), they consumed the diets for 6 weeks. The blood and liver were used for dosing.

Results: Regarding antioxidant capacity, “C” (51%) presented lower value, when compared to “R” (81%) and “B” (87%), in the polyphenol quantification there was a direct correlation with antioxidant capacity. We attribute this result to the fact that “R” and “B” beans have a colored peel, the phenolic compounds, important exogenous antioxidants, are responsible for this coloration. Knowing the important antioxidant capacity of beans, we evaluated whether this profile results in antioxidant effect in vivo, since the in vitro study does not take into account the bioavailability of these compounds, their metabolism, tissue retention and cellular activity. In vivo, superoxide dismutase and catalase had a reduction in “HB” (3.8/138.5) when compared to “H” (5.4/195.6), suggesting that these enzymes were less likely to have had bean components contributing to antioxidant defenses, it is known that the activity of these enzymes is increased under oxidative stress. The bean also had a hypocholesterolemic effect, the “HB” group had a 40% decrease in serum cholesterol when compared to “H” among the possible mechanisms, we may mention the presence of soluble fibers, tannins, proteins and saponins. This legume also has a hypoglycemic effect, the “HB” (6.9) group presented lower glycemia in “H” (10.6) and may be associated with the presence of saponins and phytates. Or the presence of phaseolamin, which inhibits alpha-amylase, a starch glucose converting enzyme.

Conclusion: In addition to providing various nutrients, beans also have exogenous antioxidant function and can reduce cholesterol and blood glucose.

Financial support: CAPES.

O4 Beneficial effect of using carbohydrate counting in type 1 diabetic patients stature: data from the largest Brazilian multicenter study of type 1 diabetes mellitus

Luana Matos de Souza¹, Natasha Vasconcelos Albuquerque¹, Milena Silva Sousa¹, Ana Paula Dias Rangel Montenegro², Virgínia Oliveira Fernandes², Carlos Antônio Negrato³, Marília de Brito Gomes⁴, Renan Magalhães Montenegro Junior²

¹Programa de Pós Graduação em Saúde Pública-PPGSP/UFC, Fortaleza, Brazil; ²Universidade Federal do Ceará-UFC, Fortaleza, Brazil; ³Sociedade Brasileira de Diabetes-SBD, São Paulo, Brazil ⁴Universidade Estadual do Rio de Janeiro-UERJ, Rio de Janeiro, Brazil

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O4

Introduction: Inadequate glycemic control in children and adolescents with type 1 diabetes mellitus (T1DM) may interfere with growth. Thus, nutritional strategies that contribute to good control, such as carbohydrate counting, may be associated with adequate growth in this population.

Objective: To verify the impact of carbohydrate counting on the height of patients with T1DM.

Methods: This is a cross-sectional study, approved by the Ethics Committee (CPEA: 2.521.547), with participants from the Brazilian Type 1 Diabetes Study Group (BrazDiab1), conducted from 2008 to 2010. Participants aged < 19 years and with at least 12 months of follow-up in specialized services, were selected. Patients were categorized into two groups according to the use or no use of carbohydrate counting. For height analysis, the data were transformed into height-for-age Z score (Z H/A). Individuals with Z H/A < 0 were considered below average in relation to the general population. The glycated hemoglobin (HbA1c) collection method was defined according to the American Diabetes Association (2015) recommendations and considered as adequate glycemic control with HbA1c < 7.5%. Multiple logistic regression was performed to estimate odds ratios (OR) and 95% confidence interval (95% CI), with the Z H/A < 0 as the dependent variable, while the independent variable of interest was type of diet (use or no use of carbohydrate counting).

Results: A total of 1,441 participants were selected, from which 56% (807) were female, mean age was 12.1 ± 4.0 years and disease duration 5.0 ± 3.7 years. Only 34.6% (499) of the participants performed the carbohydrate counting technique. Regarding height, the mean Z H/A was 0.15 ± 1.21 in those who did carbohydrate counting and 0.02 ± 1.29 in those who did not (p = 0.39). Although both groups presented HbA1c values above the cutoff point, those who executed the technique, compared to those who did not, had significantly lower HbA1c values (9.1 ± 2.3 vs 9.5 ± 2.6, p = 0.00). In addition, there was a beneficial association between carbohydrate counting and Z H/A. Once, when the dependent variable was Z H/A < 0, it was found that individuals who performed the technique had a protection factor of 0.77 (95% CI: 0.60–0.97) in relation to the other participants.

Conclusions: Patients who performed carbohydrate counting had better glycemic control and lower chances of Z H/A < 0, suggesting a possible beneficial association between the technique and height in this population.

O5 Chemotherapy treatment increases insulin resistance in breast cancer women

Jordana Carolina Marques Godinho Mota¹, João Felipe Mota², Raquel Machado Schincaglia², Leonardo Ribeiro Soares¹, Larissa Vaz Gonçalves¹, Karine Anusca Martins¹, Ruffo Freitas-Júnior¹

¹Centro Avançado de Diagnóstico da Mama, Hospital das Clínicas, Federal University of Goiás, Goiânia, Brazil; ²Clinical and Sports Nutrition Research Laboratory (Labince), Federal University of Goiás, Goiânia, Brazil

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O5

Introduction: Chemotherapy is a type of systemic treatment commonly used in breast cancer with different adverse effects related to nutritional status. However, the side effects of chemotherapy on glycemic profile, according to the menopausal status and type of chemotherapy treatment still need to be better investigated.

Objective: To evaluate the impact of chemotherapy on glycemic profile of women with breast cancer according to the menopausal stage and type of chemotherapy.

Methods: This is a longitudinal study that included 99 newly diagnosed women in stage I to III of breast cancer during adjuvant or neoadjuvant chemotherapy. Glycemic profile was assessed in the first month and after the end of the last chemotherapy session by fasting glucose and insulin, homeostasis model assessment (HOMA) indexes, and quantitative insulin sensitivity check index (QUICKI).

Results: After chemotherapy, fasting insulin (9.62 ± 4.06 vs 13.37 ± 6.92 μU/mL, p < 0.001), HOMA-IR (2.37 ± 1.20 vs 2.83 ± 1.36, p = 0.01), and HOMA-B (136.05 ± 70.56 vs 162.34 ± 77.76, p = 0.01) were higher compared to the baseline. The quicki index decreased after the treatment (0.34 ± 0.03 vs 0.32 ± 0.02, p < 0.001). The adjuvant chemotherapeutic treatment was associated with greater increases in glycemia (9.82 95% CI: 3.27–16.37; p < 0.01). No differences were observed between women in pre and post-menopausal stage.

Conclusions: The chemotherapy treatment increased insulin resistance in women with breast cancer. The adjuvant chemotherapy has higher positive association with glycemia.

O6 Comparison between the 2010 and 2018 EWGOP sarcopenia criteria in elderly with type 2 diabetes

Paula de Campos Calassara, Ana Luiza Nicoletti Dias, Paulo Sergio Chagas Gomes, Luciane Pires da Costa, Jefersson Teixeira, Roselee Pozzan, Lucianne Righetti Monteiro Tannus, Roberta Arnoldi Cobas

Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O6

Introduction: The loss of muscle mass and strength/function related to aging, sarcopenia, represents a diagnostic challenge.

Objectives: the first purpose of the study was to compare sarcopenia prevalence in a sample of elderly subjects with type 2 diabetes, based on two different criteria of the European Working Group in Older People: EWGSOP—2010 and EWGSOP2—2018. The second purpose was to describe the clinical differences of patients classified according the each criterion.

Methods: a cross-sectional sample including elderly subjects with T2DM were submitted to the following testing protocol: muscle strength/function (sit-to-stand chair, get up and go, gait speed, handgrip strength, “Short Physical Performance Battery”), body composition (bioimpedance), clinical features, cognition and depression. The EWGSOP 2010 and 2018 (severe sarcopenia) criteria were applied and compared.

Results: A total of 77 patients were included, 46 (63%) women, age 73.8 ± 6.8 years, duration of diabetes 19.5 [10–25] years, glycohemoglobin (%) 7.9 ± 1.3%, BMI (kg/m²) 27.8 ± 4.6. Of the total, 37% did not meet any criteria for sarcopenia (subgroup 1), 38.4% only 2010 (subgroup 2), 9.6% only 2018 (subgroup 3) and 15.2% both criteria (subgroup 4). The 2018 criteria did not diagnose sarcopenia in men. Differences were observed when subgroups 1, 2, 3 and 4 were compared: Body mass index (kg/m²) = 29.6 ± 5.1 vs 27.4 ± 4.2 vs 29.5 ± 3.7 vs. 23.9 ± 2.8, p = 0.004); abdominal circumference (cm) = 100.9 ± 11.6 vs 101.4 ± 12 vs 103 ± 7.92 vs 89.95 ± 8.94, p = 0.023; glomerular filtration rate (CKD-EPI ml min⁻¹ 1.73 m⁻²) 60.5 ± 16.6 vs 50.4 ± 18.7 vs 70.9 ± 16.8 vs. 59.4 ± 14.2, p = 0.013); presence of peripheral neuropathy (%) = 29.2 vs 73.1 vs 42.9 vs 20, p = 0.004; history of bone fracture (%) = 4 vs 14.8 vs 28.9 vs 45.5, p = 0.019; history of cardiovascular event (%) = 7.4 vs 10.7 vs 0 vs 45.5, p = 0.009; possible dementia (%) = 65.4 vs 63 vs 57.1 vs. 18.2, p = 0.049). There was no difference regarding age, duration of diabetes, A1c, blood pressure, retinopathy, history of fall and depression.

Conclusion: The EWGSOP 2018 criterion diagnosed sarcopenia in fewer patients compared to the 2010 version. The criteria compared were able to detect sarcopenia in patients, but with somewhat different clinical characteristics.

O7 Comparison of glycated hemoglobin levels in type 1 diabetic patients with diabulimia

Luiza Costa Monteiro Hadler¹, Raquel Oliveira Gomes¹, Andreia Ribeiro de Carvalho Cavalcante¹, Maria Claret Costa Monteiro Hadler², André Neves Mascarenhas³, Isabela Fernandes Araujo³, Iago Barbosa Pinto Rodrigues³, Amanda Cristine Amador de Moura³

¹Unidade de Endocrinologia e Diabetes do Hospital Regional de Taguatinga (HRT), SES/DF, Brasília, Brazil; ²Universidade Federal de Goiás (UFG), Goiânia, Brazil; ³Escola Superior de Ciências da Saúde (ESCS), SES/DF, Brasília, Brazil

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O7

Introduction: Diabulimia is a specific diabetes eating disorder (ED) whose main feature is limiting and/or skipping insulin dosing and it is more likely to be presented among women with type 1 diabetes (T1DM). Worse metabolic control requiring hospitalization and higher risk to develop microvascular complications are frequent clinical issues related to those with ED compare to those without it. Moreover, the hypothesis that T1DM patients with diabulimia have divergent HbA1c levels compared to patients without ED has not yet been tested.

Objective: To compare the glycated hemoglobin (HbA1C) levels between T1DM patients who omitted insulin and those who did not.

Methods: A cross-sectional, observational and analytical study involving all patients diagnosed with T1DM1 who have been followed up at an Endocrinology and Diabetes United (UENDO) at a secondary level hospital, during 2 years (2016 to 2017).

A questionnaire was developed in order to evaluate socio-epidemiological information. Questionnaire included a question about omitted insulin doses focusing weight loss. The Mann–Whitney test was applied to compare medians among HbA1C levels between those who omitted insulin and those who did not. All data were analyzed with the SPSS—Statistical Package for Social Science version 18.0. Protocol was approved by local Ethics Committee.

Results: Original sample involved 138 eligible individuals, 26 refused to participate. Thus, final sample was 112 subjects aged 16 to 54 years (29.94 ± 9.30 years), there were 51 males, mean age 31.45 ± 10.05 years and 61 females (28.67 ± 8.5 years). Among those who answered the question about insulin omission (n = 110), 9.1% of patients reported omitting insulin doses for the purpose of weight loss, mainly were female (90%). Concerning median HbA1c, no difference between groups who omitted insulin and those who did not was found (p = 0.757).

Conclusions: The prevalence of diabulimia reported in the study was high, especially among female patients, a common previous finding. However, HbA1c levels were not higher in patients with diabulimia, despite ED patients have worse metabolic control. Other features need to be evaluated to clarify the present finding.

O8 Diabetes and transplantation: what is the relationship to the gravity of peripheral neuropathy?

Geyse Gomes de Oliveira¹, Emanuel Davi Simões dos Santos², Edson Bruno Vidal de Sousa², Camylla Bandeira Miranda², Cristiany Azevedo Martins¹, Hortência Diniz Teixeira², Taciana Benevides Rocha¹, Daniela Gardano Bucharles Mont’Alverne²

¹Hospital Universitário Walter Cantídio | Universidade Federal do Ceará, Fortaleza, Brazil; ²Universidade Federal do Ceará, Fortaleza, Brazil

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O8

Introduction: Posttransplant diabetes mellitus (DM) has been attributed to corticosteroid therapy. However, studies do not talk about the behavior of patients who were already diabetic before transplantation (TX). Does this population, when undergoing therapy after TX, worsen their condition, when compared with those who develop DM only after TX?

Objective: To compare, in patients with previous diabetes and in diabetic patients after transplantation, the incidence and severity of peripheral neuropathy.

Methods: A cross-sectional quantitative approach study was conducted in people with kidney or liver TX, regardless of sex and over 18 years old. All participants were evaluated for age, gender, time of TX, time since diagnosis of DM, last HbA1c value. The presence of diabetic peripheral neuropathy (DPN) was assessed by the Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS) in the lower limbs and the prayer sign test in the upper limbs. Results were expressed as mean ± standard deviation and/or percentage. For the comparisons, the t-test was used, being considered as statistically significant when p less than or equal to 0.05.

Results: One hundred and fifteen individuals who underwent liver or renal TX were evaluated, 53 of whom had DM before TX and 62 developed DM after TX. There was no statistical difference regarding gender (p = 0.325) and age (p = 0.120), and of the total, most were men (n = 64–55.7%) with a mean age of 57.8 ± 10.4 years old. When comparing the time since diagnosis of DM, a statistically significant difference was observed between the groups (p = 0.0001; 16.1 ± 7.8 years and 5.7 ± 3.6 years) and time since diagnosis of TX, being the group that developed DM after TX with the longest years of surgery (p = 0.001; 4.6 ± 4.4 years and 9.3 ± 5.9 years). There was also a difference regarding the NDS, and the group with previous DM had higher mean scores (p = 0.0001). When assessing the severity of DPN, it was found that patients who already had DM before TX had higher severity of DPN (p = 0.043), and 25% of them had a risk of ulceration while no patient in the DM group after TX had this risk. As for the sign of prayer, there was no difference between the two groups (p = 0.418).

Conclusions: A high incidence of DPN was observed in all participants, however people who had DM before TX had higher neuropathy disability score. This impairment was greater in the lower limbs than in the upper limbs.

O9 Effects of aerobic, strength and combined training on expression of diabetic mice heart contractible proteins

Jonathan Nícolas dos Santos Ribeiro, Patricia Luana Barbosa da Silva Ribeiro, Bruno de Melo Carvalho, Stéfani Mendes da Silva, Fátima Lúcia Rodrigues Guimarães, Ruy Bandeira de Vasconcelos Júnior, Amanda Mota Vieira, Denise Maria Martins Vancea

Universidade de Pernambuco, Recife, Brazil

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O9

Introduction: Diabetic cardiomyopathy is characterized by ventricular diastolic/systolic dysfunction resulting from a malfunction of the proteins responsible for maintaining calcium (SERCA2a, PLP, FKBP 12.6) thus reducing the contractile performance of the heart, and physical exercise is one of the methods to reduce the progress of cardiomyopathy in diabetes.

Objective: To analyze the effects of aerobic, strength and combined training on the expression of contractile proteins in the heart of diabetic mice.

Methods: The study was approved by the Animal Use and Ethics Committee (No. 002/2018) and conducted with 22 male Swiss mice randomly randomized into five groups: Sedentary Normoglycemic Group (SNG, n = 5), Sedentary Diabetic Group (SDG, n = 5), Diabetic Aerobic Group (DAG, n = 4), Diabetic Strength Group (DSG, n = 4) and the Diabetic Combined Group (DCG, n = 4). Induction of type 1 diabetes mellitus in the SDG, DAG, DSG and DCG groups was performed by intraperitoneal administration of streptozotocin (40 mg/kg). Exercise protocols were performed three times a week for 8 weeks. The Aerobic Training (AT) was performed in mouse specific pools, with weight overload of 1% to 3% of the animals body weight. The Strength Training (ST) was performed in a rodent climbing apparatus, with weights attached in the syrup, with progressive overload from 50% to 100% of the maximum climbing. The combined training used the TA system plus the characteristics of the TF. Cardiac proteins: FKBP 12.6, SERCA2a, PLB; were obtained by extraction of the heart still in contraction and later analyzed by western blotting. Statistical analysis was performed using the one way ANOVA test together with their respective Bonferroni post hoc test and the paired student t test, always adopting the significance level of p ≤ 0.05.

Results: The analysis of protein expression of FKBP 12.6 (DGA = 9.5%/DSG = 32% and DCG = 33%) and PLB (DGA = 21.9%/DSG = 38.3% and DCG = 77.0%) showed significant increases (p = 0.00) for the use of combined training. The total concentration of SERCA2a showed a significant increase (p = 0.00) in DGA (40.714 ± 1206) when compared to DSG (14.746 ± 4158) and DCG (22506 ± 1542).

Conclusions: Aerobic, strength and combined training were effective in the modulation of cardiac proteins in diabetic mice, with PLB and FKBP 12.6 proteins being more expressed in combined training and SERCA2a presenting a greater expression in aerobic training.

O10 Epigenetic regulation by micrornas in pathophysiology of diabetic cardiomyopathy

Mariana Borges Lopes¹, Renata Caroline Costa de Freitas², Flávio Santos Silva³, Bento José Abreu⁴, Adriana Augusto de Rezende¹, Gabriela Placoná Diniz⁵, Raul Hernandes Bortolin², André Ducati Luchessi¹

¹Department of Clinical and Toxicological Analyzes, UFRN, Natal, Brazil; ²Department of Clinical and Toxicological Analyzes, USP, São Paulo, Brazil; ³Department of Health Sciences, UFERSA, Mossoró, Brazil; ⁴Life Science Center, Morphology department, UFRN, Natal, Brazil; ⁵Institute of Biomedical Sciences, Anatomy department, São Paulo, Brazil

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O10

Introduction: Diabetic cardiomyopathy (DCM), a recognized disease that affects cardiomyocytes, is a complication caused by chronic hyperglycemia and has high rates of mortality and morbidity in diabetic patients. However, despite medical advances in DCM, the molecular basis of this complication is not fully elucidated. In this context, the present study intends to validate the prediction regarding messenger RNAs (mRNAs) and their possible regulatory miRNAs with the molecular mechanisms involved in development of DCM through in vitro and in vivo approaches.

Methods: Myoblast lineage was cultivated under normoglycemic (NG, 5.5 mmol/L of glucose) and hyperglycemic (HG, 25 mmol/L of glucose) conditions for 24 h, after was performed total RNA extraction by Trizol reagent and gene expression analyzes using real time PCR (RTqPCR). Wistar rats used in in vivo model had diabetes pharmacologically induced by streptozotocin (40 mg/kg, i.v.; n = 7) than was compared with control group (citrate buffer, n = 7), after 30 days from induction the animals was euthanized, the DCM was characterized and their left ventricles was used for total RNA extraction by Trizol Reagent, mRNA and miRNA expression was analyzed by RTqPCR. The protocols used in this study were approved by the ethics committee at the Federal University of Rio Grande do Norte (017/2009).

Results: Pla2g2a expression was upregulated on the online datasets evaluated in our previous study using in silico strategies to predict gene expression in DCM, it result was also observed in the H9c2 cell culture under hyperglycemic conditions (3-fold increased, p-value = 0.043) and in left ventricles of diabetic rats from the in vivo study (3-fold increased, p-value = 0.004). miR-214 was reduced in the databases analysis and also in the in vitro (p-value = 0.043) and in vivo (p = 0.025) studies. Furthermore, there was a tendency for decreased expression of Hk2 in H9c2 cell culture under hyperglycemic conditions, and significant decrease in diabetic rats compared to their respective controls (p-value = 0.010). miR-187 increased 3-fold in diabetic rats as well as in the H9c2 culture (p-value = 0.028 and p-value = 0.019, respectively) and miR-17 was decreased (p-value = 0.015).

Conclusions: The experimental data performed in this study, validate the result of our in silico study previously published, as well as ratify prediction of these genes to participate in the pathophysiology of DCM.

Financial support: CAPES, CNPQ, FAPESP.

O11 Evaluation of insulin application by diabetic patients

Marielle De Araújo Melo, Dandara Sampaio Leão De Carvalho, Isabella Carvalho Oliveira, Raíssa Carneiro Rezende, Guilherme Borges De Andrade, Daniela Espindola Antunes, Estela Muszkat Jatene, Daniela Pultrini Pereira De Oliveira Viggiano

Universidade Federal de Goiás – UFG, Goiânia, Brazil

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O11

Introduction: Insulin application is the therapy used in patients with Type 1 Mellitus Diabetes and a lot of attention is needed when it is used. The inadequate use and insecurities in the insulin auto-application can interfere in an adequate disease control.

Objective: To evaluate insulin application by patients and the connection with glycemic control.

Methodology: A cross-sectional study with 95 individuals with T1MD accompanied by the Endocrinology department in a university hospital. The data was collected between April and September in 2018 with the application of a standard questionnaire according to the Brazilian Diabetes Society published in 2017. The variables used were age, gender, schooling, the application object, knowledge on how to apply it, storage, expiration date, complications when applying it and glycated hemoglobin.

Results: From the 95 patients, 62.1% were women, 36.8% were in high school with 28.4% aged between 21 and 30 years old. From the sample, 67.4% were using the insulin pen. In this group, 40.6% showed number of application errors bigger then 7, while the percentage was higher in the disposable syringe (74.2%; p = 0.008). Most of the patients using the pen (89.6%) and syringe (93.5%) made the application in different parts of the body, properly. When it comes to sanitation, the patients that were using the pen showed the worst habit: 57.8% wash their hands, 25% clean the insulin bottles and 29.7% clean the skin versus 93.5%, 51.6% and 61.3% from those who used the syringe, respectively. About the storage of the insulin and the patients who were using the pen: 79.7% knew the ideal temperature for the insulin bottle, 73.4% knew the right place to store it but only 54.7% knew the expiration date when the insulin bottle is opened versus 90.3%; 80.6% and 51.6% from those who were using the syringe, respectively. In relation with complications like lipodystrophy, hypoglycemia and hyperglycemia, the proportion for the use of the pens was 57.8%, 56.4% and 42.2% versus 48.4%; 71% and 41.9% in syringes, respectively. The needles reutilization for more than 5 times was verified in 32.8% of the patients who used the pen and 31% with the syringe, with a bigger risk association of lipodystrophy (p = 0.014). The results didn’t show a statistical significance with glycated hemoglobin.

Conclusion: The results showed the importance of an intensive and continued education in diabetes for the conduction of a safe treatment and complications reductions.

O12 HLA in patients with type 1 diabetes from an admixed population: a nationwide study in Brazil

Deborah Conte Santos¹, Marcela Haas Pizarro¹, Bianca Senger Vasconcelos Barros¹, Laura Gomes Nunes de Melo¹, Luiza Harcar Muniz¹, LuisCristovão Porto², Dayse Aparecida Silva³, Marilia Brito Gomes¹

¹Universidade do Estado do Rio de Janeiro, Departamento de Medicina Interna, Diabetes, Rio de Janeiro, Brazil; ²Universidade do Estado do Rio de Janeiro, Laboratorio de Histocompatibilidade e Criopreservação (HLA), Rio de Janeiro, Brazil; ³Universidade do Estado do Rio de Janeiro, Laboratorio de Diagnostico DNA (LDD), Rio de Janeiro, Brazil

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O12

Introduction: HLA region on chromosome 6p21 is known to be responsible for almost 50% of the genetic risk and it has been studied for decades. The highest prevalence of T1D is observed on Caucasian population and most of the studies are concentrated on populations with small degrees of miscegenation. However, previous data show that the frequency of HLA haplotypes, and their effects on T1D risk or protection varies among populations. There is scarcity of data on the genetics of T1D population in Brazil.

Objective: In this study, we aimed to evaluate the HLA class II genetic profile of T1D patients from all the five regions of the country.

Methods: This was a nationwide multicenter cross-sectional study conducted between August 2011 and August 2014 in 14 public clinics located in 10 Brazilian cities in five geographical regions (North, Northeast, Midwest, Southeast and South). For the present study, we included 1019 type 1 diabetes patients and 5116 controls pared for region of birth and self-reported color/race. Control individuals belonged to the bone marrow transplant donor’s bank of Brazil (REDOME), which is the largest HLA data repository in the country. The study was approved by each center’s local ethics committee. HLA-class II alleles (DRB1, DQA1 and DQB1) were genotyped using the SSO and NGS method.

Results: The most frequently risk haplotype found in our population were DRB1*03:01 ~ DQA1*05:01 g ~ DQB1*02:01 (OR 5.8, p < 0.00001), DRB1*04:05 ~ DQA1*03:01 g ~ DQB1*03:02 (OR 5.34, p < 0.00001), DRB1*04:02 ~ DQA1*03:01 g ~ DQB1*03:02 (OR 3.43, p < 0.00001). Most prevalent protection haplotypes were DRB1*07:01 ~ DQA1*02:01 ~ DQB1*02:02 (OR 0.54, p < 0.0001), DRB1*13:01 ~ DQA1*01:03 ~ DQB1*06:03 (OR 0.30, p < 0.00001) and DRB1*01:02 ~ DQA1*01:01 g ~ DQB1*05:01(OR 0.45, p < 0.00001). The HLA-DR3/DR4 genotype presented the greatest risk (OR 12.1, p < 0.0001) in 23.6% of the patients, followed by –DR3/DR3 (OR 10.6, p < 0.0001) in 9.8% and –DR3/DR9 (9.01, p < 0.0001) in 2.7%.

Conclusion: Regarding the most prevalent risk alleles, such as DR3, DR4, our findings are in accordance with previous studies both in European and in admixed population. It is important to notice that DR7 allele which is usually protective only in European population showed to be protective also in our population. This fact could be explained by the higher proportions of European ancestry, compared to African ancestry proportions in type 1 diabetes Brazilian patients demonstrated in previous studies from our group.

O13 Impact of the use of the flash glucose monitoring system as diagnostic tool for patients with type 1 diabetes mellitus

Leticia Bernardes Cunha, Luiza Macedo Travalloni, Julia Bruno Vieira, Pedro Felisberto dos Santos Neto, Isabella Sued Leão, Joana Rodrigues Dantas, Lenita Zajdenverg, Melanie Rodacki

Departamento de Clínica Médica-Serviço de Nutrologia-Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O13

Introduction: Glycemic control reduces the risk of micro and macrovascular complications in patients with type 1 diabetes (T1D), but it is still a big challenge. Flash glucose monitoring system for intermittent continuous glucose monitoring (iCGM) may detect hyperglycemic and hypoglycemic episodes not perceived by capillary blood glucose monitoring, which could be helpful for these patients, especially those with labile glucose control.

Objectives: (1) To identify, through iCGM, hyperglycemic peaks and hypoglycemic episodes not identified by capillary blood glucose monitoring in patients with T1D, labile glucose control but adherent to treatment; (2) To identify if there is improvement in 14 days in time in glucose range (between 70 and 180 mg/dL; TIR), time in hypoglycemia and hyperglycemia, and estimated glycated hemoglobin after intervention in insulin therapy based on data obtained from iCGM.

Methods: In this prospective study, adults with T1D used Flash monitoring system for 14 days as a diagnostic tool. After this period, insulin was titrated and each patient underwent more 14 days of iCGM. TIR, time in hyperglycemia and hypoglycemia and estimated HbA1c were recorded before and after the alteration.

Results: The study included 40 individuals (19 men and 21 women), with a mean age of 25.6 ± 7.2 years old and a mean duration of diabetes of 15.3 ± 7.8 years. Their mean HbA1c was 7.8 ± 1.3. All patients were on basal-bolus insulin therapy (9 used NPH and 31 used long-acting analogs; 6 used Regular insulin and 34 used ultra-rapid insulin analogs). 9 had HbA1c < 7%. In the first 14-days iCGM evaluation, only 3 patients had TIR > 70% and 50% subjects had TIR < 50%. Patients with HbA1c < 7% did not have superior TIR than others (p = 0.058). There were no differences in TIR (52% vs 53%; p 0.027), percentage of hypoglycemia (22% vs 21%; p 0.018) and of hyperglycemia (25% vs 25%; p 0.33) between the first and second evaluation.

Conclusions: The use of iCGM for 14 days as a diagnostic tool detected significant hyper and hypoglycemic episodes in individuals with T1D and labile glycemic control despite good adhesion to treatment. Only one medical intervention after 14-days iCGM was not sufficient to improve patients’ glycemic control over the next 14 days in these individuals. It is possible that a longer follow-up and further titration would enable significant changes.

O14 Posttransplant diabetes mellitus impact on kidney transplantation related outcomes

Luisa Penso Farenza¹, Thizá Massaia Londero Gai², Roberto Ceratti Manfro¹, Cristiane Bauermann Leitão¹, Andrea Carla Bauer¹

¹Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; ²Universidade Federal de Santa Maria, Santa Maria, Brazil

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O14

Introduction and objective: Posttransplant diabetes mellitus (PTDM) is a frequent complication after solid organs transplantation, occurring in 10–50% of kidney transplanted patients. This study’s objective is to determine the impact of different glycemic status at transplantation on death and graft loss in kidney recipients.

Methods: 1167 patients received a kidney graft between January 2000 and December 2013 at a southern Brazilian reference center and were included in this cohort study. Recipients were classified in three categories regarding glycemic status: PTDM, non-PTDM and pre-transplantation DM. PTDM diagnosis was adjudicated according to the 2014 International Consensus. Evaluated variables included sex, ethnicity, type of donor and recipients’ age at transplantation. Effect of these variables on death after transplantation and kidney graft loss was assessed by regression analysis. Survival analysis was also performed. Data were collected by electronic medical record review and the study was approved by the hospital’s ethical committee.

Results: From 1167 patients, 160 (15.3%) developed PTDM and 142 (13.6%) were diagnosed with pre-transplantation DM. On multivariate regression analysis, death incidence was higher in patients with PTDM (OR 3.23, CI 1.35–7.61, p = 0.008) and in patients with pre-transplantation DM (OR 4.27, CI 1.73–10.48, p = 0.001), compared to NPTDM. Death risk was also higher in older patients and those who received graft from deceased donor. Only pre-transplantation DM was associated to higher incidence of kidney graft loss (OR 3.48, CI 1.36–9.04, p = 0.009). Patients with PTDM did not present higher risk of kidney graft loss (OR 1.47, CI 0.69–2.89, p = 0.28). On Kaplan–Meier analysis, pre-transplantation DM recipients died earlier (991 (357–1626) days) than PTDM (p = 0.006) and non-PTDM (p = 0.02) patients. Time until graft loss also was earlier only in pre-transplantation DM group (p = 0.04).

Conclusions: After 167 months of follow-up (mean time since transplantation, 123 ± 47 months) in this kidney recipients’ cohort, PTDM does not impact in precocious mortality nor in early graft loss. PTDM seems to be a death risk factor, but it seems to be not due to kidney graft loss or events immediately related to the transplantation, as occurs in pre-transplantation DM group. PTDM could be associated to later death after transplantation related to chronic-metabolic and cardiovascular disease.

O15 Preliminary performance of a new patch biosensor (LIVSEN^®) for glucose monitoring

Monike Lourenço Dias Rodrigues, João Otávio Sedovski Garcia, David Evangelista da Silveira Junior, Aécio Marques Teixeira, CleytonLouredo Xavier, Raul Hilário Amaral, Larisse Silva Dalla Libera, Nelson Rassi

Hauttis Health Technology, Goiânia, Brazil

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O15

Introduction: A new patch sensor for sweat glucose detection was recently developed (Livsen^®). After glucose-oxidase enzymatic reaction, continuous ruptures in a specific metal substrate are produced, and amperometric interference in radio signals by timely ruptures in the metal substrate are reflected by sensor´s built-in antenna to cell phone. Each glucose reading is based on radio signal interpretation by Near-Field-communication (NFC) technology and the corresponding app for iPhone.

Objective: The present study aimed to investigate the clinical performance of this sensor.

Methods: Nineteen patients (11 women) with diabetes (13 Type 1 DM, 6 Type 2 DM), aged 19–71 years (mean 42 years), were tested. Patients had the sensor attached to left forearm, during a 4-h test, during three consecutive days. Each patient returned to the test room in the same period (morning or afternoon). Sensor warm—up was 60 min, after an initial calibration with capillary blood glucose. After sensor warm-up in the first day, patients were guided to a room with stable temperature (23^o C), and stood seated during most part of the test. Two controlled meals were allowed during the 4-h test, and blood glucose calibration was not again performed. Fasting measurements, than postprandial measurements were obtained in 15 min intervals during 120 min, than hourly (180 and 240 min). Each measurement was a simultaneous assessment of capillary blood glucose in 2 glucometers (Accu-Chek Guide^®, Roche and Freestyle Lite ^®, Abbott) and a sensor reading by Livsen App for Iphone with NFC technology.

Results: The mean value of glucometers readings was compared to Livsen readings; 600 valid pairs of measurements were obtained (183, 210 and 207 in first (D1), second (D2) and third days (D3), respectively). The mean average relative difference (MARD) between mean glucometer values and Livsen readings was 11.1%. Mard of D1 was 8.7%, D2 was 11.86% and D3 was 12.36%, with ANOVA testing showing statistical difference between D1 MARD and D3 MARD. (Tukey multiple comparisons, p = 0.00078, IC = 95%). Clarke error grid analysis showed 98.6% of measurements in Clarke Zones A and B in D1, 98.8% in D2 and 98.2% in D3.

Conclusion: The new patch Livsen sensor showed adequate MARD and Clarke error grid Zone performance overall. The study will be extended to a greater sample, and the MARD difference among days 1 to 3 can be minimized with repeated calibrations.

O16 Suboptimal glycaemic control in adults with type 1 diabetes in Latin America: characteristics, glycaemic control, hypoglycaemia and disease management. Results from sage analyses

Andre Gustavo Daher Vianna¹, Balduíno Tschiedel², Jose Fernando Botero³, Maurício Aguiar de Paula⁴, Juan Jose Gagliardino⁵

¹Centro de Diabetes de Curitiba, Curitiba, Brazil; ²Instituto da Criança com Diabetes - Grupo Hospitalar Conceição, Porto Alegre, Brazil; ³Universidad Pontificia Bolivariana, Medellín, Colombia; ⁴Sanofi, São Paulo, Brazil, ⁵CENEXA. Centro de Endocrinología Experimental y Aplicada, La Plata, Argentina

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O15

Introduction: Although achievement of glycaemic target effectively prevents the development/progression of diabetes complications, many people with type 1 diabetes (T1D) do not achieve their goal. SAGE study evaluated the glycaemic control in adults with T1D in LatAmcountries.

Methods: SAGE was a multinational, observational, cross-sectional study of patients aged ≥ 26 years with T1D for ≥ 1 year. Primary endpoint: percentage of participants in predefined age groups (26–44; 45–64; ≥ 65 years old) achieving HbA1c < 7%. Secondary endpoints: other glycaemic outcomes, hypoglycaemia, therapeutic management and diabetes technology use.

Results: SAGE included 488 eligible patients from Argentina, Brazil, Chile and Colombia; 61.5% female, mean (SD) age 45.6 (13.8) years, BMI 25.5 (4.2) kg/m² and ≥ 10 years T1D duration was found in 83%. Hypertension or dyslipidaemia were present in 24.1% and hypothyroidism in 15.1%. Mean (SD) HbA1c was 8.15 (1.64) %. Only 23.8% achieved HbA1c < 7.0%; this proportion was higher (27.9%) in the older subgroup. Mean (SD) FPG and PPG was 152.0 (77.59) and 168.3 (70.27) mg/dL, respectively. Mean (SD) total insulin dose was 49.5 (25.5) U/day (0.71 (0.34) U/kg/day) and 68.9% were on a basal-bolus regimen. Only 34.9% titrated basal insulin at least once a week. Insulin devices used were injections/pens (84.6%) or insulin pump (15.2%). 14.0% had at least one severe hypoglycemia within 6 months and 82.8% had one symptomatic hypoglycemia within the last 3 months. Incidence of diabetic ketoacidosis was 4.5% mainly related to infection (27.3%) and missing insulin dose (22.7%). 96.9% of patients were in use of finger-stick blood glucose meter and 77.6% used it at least once daily in the last 7 days; 21.1% were using continuous glucose meter and only 4.1% blood ketone meter.

Conclusion: Despite guidelines recommendations, glycaemic control is suboptimal in adults with T1D in LatAm, irrespective of age groups. The low and infrequent insulin titration may partly explain the lack of glycaemic control. Further action is required globally including training of physicians and patients for appropriate insulin titration and carbohydrate counting. Use of new technologies and advanced insulin formulations may benefit HbA1c target achievement in this population.

Study sponsored by Sanofi.

O17 Teleophthalmology screening for diabetic retinopathy in São Paulo metropolitan area, Brazil: economic assessment

Fernando Korn Malerbi¹, Rubens Belfort Junior¹, Olimpio J. Nogueira V. Bittar², Paulo Henrique Morales¹

¹Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil; ²Health State Secretary São Paulo, São Paulo, Brazil

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O17

Introduction and objectives: Diagnosis and timely treatment of diabetic retinopathy are the mainstay for diabetic blindness prevention; however, proper screening is limited by several barriers. Ampliation of access to retina examination is a global challenge. Brazil has the fourth largest diabetic population in the world, with increasing demand for diabetic retinopathy screening. The objectives of this study are: (1) to evaluate the rate of detected cases in a telemedicine program for diabetic retinopathy screening, and (2) to compare costs for such screening with those of a conventional program.

Methods: Retrospective study which assessed the outcomes of a diabetic retinopathy screening program undertaken at peripheral areas of Sao Paulo city and its Metropolitan Area, with a protocol that combined fundus photographs and telemedicine. Fixed costs for telemedicine screening were calculated, as well as the costs for conventional screening. Direct and indirect costs were taken into account; the former comprised diagnostic expenditures and the latter considered travel costs and lost working days. Different scenarios, depending on the resolutivity and the presence of a local ophthalmologist, were evaluated.

Results: A total of 28,842 patients were evaluated; treatment was indicated in 18.99%: cataract surgery (10.84%) or diabetic retinopathy treatment—laser photocoagulation (6.93%) or vitrectomy (1.21%). The remaining 81.01% were non-referrable patients who could be followed at the primary care setting; such protocol prevented unnecessary travel and consultation expenses, as well as less lost working days. The cost per case detected would be 2.65 to 5.35 higher if conventional screening protocols were used, the variables being the presence of a local ophthalmologist and the resolutivity of the service.

Conclusion: The present data indicate that diabetic retinopathy screening with telemedicine is feasible in Brazil, and such strategy addresses important barriers such as cost and availability of the specialist. Telemedicine screening has a good cost-effectivity profile for the public health system as it delivers a lower cost per case detected, mainly in areas lacking specialists. The present results encourage the implementation of such protocols in underserved areas, provided that treatment can be offered to the detected cases.

O18 The effect of transcranial direct current stimulation associated with hypocaloric diet on food intake and weight loss in overweight or obesity: a double-blind, randomized clinical trial

Carina de Araujo¹, Raquel Crespo Fitz¹, Daniela Albugeri Nogara¹, Amanda Farias Osório³, Gabriella Richter da Natividade¹, Paula Nunes Merello³, Pedro Schestatsky², Fernando Gerchman¹

¹Endocrine and Metabolic Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; ²Neurology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; ³Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O18

Introduction: The dorsolateral prefrontal cortex (DLPFC) plays an important role in appetite and food intake regulation and may be a target for transcranial direct current stimulation (tDCS), a treatment modality that has shown to reduce food craving and calorie intake. Thus, we tested the effect of active tDCS associated with a hypocaloric diet (HD) on weight loss and food consumption in overweight or obese adults.

Methods: In this randomized, placebo-controlled, double-blind study, overweight or obese adults were selected to completed a 4-wk (20 sessions; 5 weekdays) of fixed-dose tDCS (2 mA, 20 min) delivered over the right DLPFC associated whit a HD. Subjects were randomly assigned (1:1) and stratified by sex to active tDCS + HD (AG), or sham tDCS + HD (SG). The primary outcomes were weight loss and the secondary outcome were changes in food intake and in desire to eat. Body weight was assessed weekly at baseline (t₀), and at days 5 (t₅), 10 (t₁₀), 15 (t₁₅), 20 (t₂₀), and at the end of the study (t_F). Habitual food intake was assessed at t₀, t₁₀ and t₂₀ using a 3-day weighed dietary records. A 100-mm visual analog scale was used to assess desire to eat something sweet, salty, savory, or fatty at t₀ and t_F. All analyses were performed in intention-to-treat (ITT) using generalized estimating equations. All participants provided written informed consent. ClinicalTrials.gov (NCT02683902).

Results: 28 individuals were randomized and included in the ITT (mean age, 37.6 ± 5.8 years; BMI, 31.5 ± 2.4 kg/m²); 23 received all 20 planned sessions. Although there was a greater weight loss in the AG than in the SG at t_F (− 4.5 kg [95% CI: − 9.4, 0.5] vs. − 2.3 kg [95% CI: − 5.0, 0.3]), this difference was not statistically significant. The energy intake was not statistically different between groups at t₀, t₁₀ and t₂₀. There was a significant interaction in the desire to eat sweet foods (p = 0.005). The AG showed a significant 23.7 percentage points reduction (95% CI: − 40.2, − 7.1) in the desire for sweets over the study, whereas the SG had a non-significant 1.0 percentage point increased (95% CI: − 13.3, 15.2).

Conclusions: Although we might not show that repetitive active tDCS is able to optimize weight loss and decrease calorie intake, it was able to reduce the desire to eat sweet foods. These findings open a new perspective for this therapeutic modality as a potential strategy for the treatment of food craving and metabolic disorders related to carbohydrates consumption. FIPE 15-0119.

O19 Translation, cultural adaptation and validation of IDSRQ to Brazilian Portuguese

Raquel Cristina Lopes Assis Coelho¹, Adriana Silvino Pagano², Aleida Nazareth Soares¹, Janice Sepulveda Reis¹

¹Instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, Belo Horizonte, Brazil; ²faculdade de Letras, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O19

Introduction: The Insulin Delivery System Rating Questionnaire (IDSRQ) is a measure of health-related quality of life (HRQOL) and treatment preference for insulin delivery systems in persons with type 1 (T1DM) and type 2 diabetes mellitus (T2DM). The aim of the study was to translate and cross-culturally adapt the IDSRQ for Brazilian users as well as evaluate the validation of selected psychometric aspects.

Materials and methods: methodological study carried out in the following stages: forward translation, synthesis, back-translation, assessment by Judge Committee, pre-test and validation. International guidelines for translation and cross-cultural adaptation of measurement tools were followed. The validation provided information about the reliability (internal consistency, test–retest) and the construct validity of the studied tool.

Results: Regarding content validation, the instrument performed well in the Judges’ assessment with a mean Content Validity Index of 0.87 (± 0.2). Pre-test step involved 30 T1DM in face to face discussions. The IDSRQ validation study involved 113 T1DM patients, 46% male, mean age 32.61 (± 12.59) years and mean age at diagnosis of diabetes of 17.51 (± 12.41). 27.4% were using vial and syringe; 61.1% using pen and 11.5% using insulin pump. 76.5% of the patients administer insulin > 5 times daily. NPH was the most used basal insulin (39.8%), followed by glargine U100 (34.5%). Lispro was the most used fast insulin, by 60.2% of the patients. The scale presented acceptable internal consistency (Cronbach’s alpha = 0.785).

Conclusions: The translated and cross-culturally adapted Brazilian Portuguese version may be used to assess HRQoL and treatment preferences for insulin delivery systems in T1DM Brazilian patients.

Keywords: Diabetes mellitus; Type 1; Quality of life; Insulin

O20 Triglycerides levels could be a marker of large for gestational age in gestational diabetes?

Micaela Frasson Montero, Filipe Dias de Souza, Rosiane Mattar, Sergio Abbud Dib, Patrícia Medici Dualib, Bianca de Almeida Pititto

Escola Paulista de Medicina - Universidade Federal de São Paulo, São Paulo, Brazil

Diabetology & Metabolic Syndrome 2019, 11(Suppl 1):O20

Introduction: One of the complications of gestational diabetes (GDM) is the higher frequencies of elevated birth weight, which has also been associated with mother’s previous body mass index and weight gain during pregnancy. Recent studies have shown a positive association between triglyceride (TG) levels at late pregnancy and birth weight of newborns in pregnant women without gestational diabetes (GDM), but there is lack of knowledge regarding the relation of TG and birth weight in GDM.

Objective: The aim of the study was to evaluate the association of birth weight with levels of triglycerides (TG) in the third trimester of gestational diabetes (GDM).

Methods: The study included 645 pregnant women with GDM in follow-up at DM and Gestation service, from 2008 to April/2019 and data were collected from the participants’ medical records. Participants were stratified by median of TG (median = 173.0 mg/dL). Metabolic characteristics and birth weight were presented as mean (standard deviation) and compared by Student’s t-test; and the frequency of large for gestational age (LGA, weight > 90th percentile at birth) was presented as percentage(n) and compared using Chi Square test, p < 0.05.

Results: The sample had mean age of 34 (5) years, body mass index of 29.9 (9.5) kg/m², HbA1c of 5.6 (0.6)% and weight gain during pregnancy of 9.5 (5.9) kg, that did not differ between groups. Both groups had also similar frequency in using insulin during pregnancy, 38% in the group above and 41% in the group below the median. Women with TG above de median had greater levels of total cholesterol [233 (45) vs. 202 (39) mg/dL, p < 0.001], LDL-cholesterol [126 (42) vs. 109 (34) mg/dL, p < 0.001] and lower levels of HDL-cholesterol [61 (14) vs. 67 (15) mg/dL, p < 0.001] comparing to the group with TG below the median; while birth weight of the newborn did not differ [3.2 (0.5) vs. 3.1 (0.5) kg, p = 0.29] between groups. Pearson correlation was also not significant between birth weight and TG. There was a borderline significance for the comparison of frequency of LGA [10% (32) vs. 6% (19), p = 0.056] considering the groups above and below the median of TG respectively.

Conclusions: In this homogeneous group of GDM women regarding age, BMI, weight gain and use of insulin during pregnancy, higher TG was associated with greater frequency of LGA. We hypothesize that TG might be representing a higher insulin resistance and could be a biomarker to consider preventive strategies against LGA in GDM.