Endocrine Abstracts

Background and Aims: When alcohol abuse and diabetes are combined, the consequences can be unpredictable and cause a double whammy, since both conditions cause similar pathological effects, in particular negative effects on the cardiovascular system.

Methods: The patient is 49 years old, male. Height 175 cm, weight 95 kg. BMI 31.02 kg/m². T2D was diagnosed 10 years ago. At the beginning of the disease, he took oral hypoglycemic drugs (can’t remember their names). For 5 years, he has been taking medium- and short-acting human insulin. Poor control glycemia and bread units. BP has been increasing for 5 years and at the time of examination, he took Telmisartan 80 mg once daily. Diagnosed with type 2 diabetes mellitus in the decompensation stage. Complication: Diabetic nephropathy, CKD 1. Hypertension, stage 1 arterial hypertension. In addition to routine tests to diagnose CKD, we performed carotid-femoral sphygmography (SphygmoCor XCEL, AtCor) to assess pulse wave velocity (PWV) and Myocardial perfusion imaging using SPECT - AnyScan® SC - Mediso with technetium-99m sestamibi before and after 6-month follow-up. To evaluate summed score of perfusion during rest (SRS), computer software is used to evaluate perfusion isotope activity in each segment compared to the volume of radiopharmaceutical accumulation, set as 100%, in 17 segments of the polar map. the decrease in the accumulation of the radiopharmaceutical was translated into a point scale: 0 points - 70% and more, 1 point - 69-50%, 2 points - 49-30%, 3 points - 29-10%, 4 points - 9 and below%.

Results: Results of first laboratory examination: HbA1C - 11.2%, fasting blood sugar - 10.8 mmol/l. Instrumental examination ECG unchanged. PWV 14,70 m/s. SRS - 0 points, average perfusion indicator (API) - 84.95±7.3%. The patient was prescribed to take dapagliflozin 10 mg 1 tablet once daily for 6months. During the re-appointment the patient complained of general weakness. Body weight 96 kg, TVI 31.34 kg/m². HbA1C - 9.4%, fasting blood sugar - 13.4 mmol/l. The patient underwent re- sphygmography and SPECT examination. PWV 14,70 m/s. SRS –9 points, API - 74.0±23.2%. Despite the decrease in vascular stiffness according to the results of Sphygmocore, a decrease in myocardial perfusion was noted. The patient admitted that he had been abusing alcohol for the past few months and had frequent nocturnal hypoglycemia

Conclusion: Despite a decrease in vascular stiffness during treatment with dapagliflozin, a decrease in myocardial perfusion was noted due to alcohol-induced hypoglycemic conditions.