OBJECTIVES:The aim of the study was to compare cardiac and respiratory function at rest in participants with early-onset type 2 diabetes and a control group without diabetes, matched for age, sex, and body mass index (BMI). METHODS:This study included 18 participants with early-onset type 2 diabetes (12 men and 6 women, age 34.9±6 years, diabetes duration 3.1±3.0 years) and 14 control participants without diabetes, matched for age, sex, and BMI (9 men and 5 women, age 32.9±5.2 years). Participants underwent resting echocardiography and pulmonary function tests. Fasting blood samples were analyzed for glycated hemoglobin, glucose, C-reactive protein, insulin, free fatty acids, and N-terminal pro-B-type natriuretic peptide. RESULTS:Significant differences between groups were observed in left ventricular diastolic function at rest. Compared with controls, the group with early-onset type 2 diabetes had lower E/A (ratio between early [E] and late [A] ventricular filling velocity) (p=0.002), higher E/e' (representing left ventricular filling pressure) (p=0.017), lower e' (early myocardial relaxation velocity) (p<0.001), and lower diffusing capacity of the lung for carbon monoxide (p=0.003). CONCLUSIONS:Subclinical left ventricular diastolic dysfunction and lower lung diffusing capacity were detected in participants with early-onset type 2 diabetes when compared with matched controls.

BACKGROUND AND AIMS:The experience of outpatient care may differ for select patient groups. This prospective study evaluates the adult patient experience of multidisciplinary outpatient cystic fibrosis (CF) care with videoconferencing through telehealth compared with face-to-face care the year prior. METHODS:People with CF without a lung transplant were recruited. Patient-reported outcomes were obtained at commencement and 12 months into the study, reflecting both their face-to-face and telehealth through videoconferencing experience, respectively. Three patient cohorts were analysed: (i) participants with a regional residence, (ii) participants with a nonregional including metropolitan residence and (iii) participants with colonised multiresistant microbiota. RESULTS:Seventy-four patients were enrolled in the study (mean age, 37 ± 11 years; 50% male; mean forced expiratory volume in the first second of expiration, 60% [standard deviation, 23]) between February 2020 and May 2021. No differences between models were observed in the participants' rating of the health care team, general and mental health rating, and their confidence in handling treatment plans at home. No between-group differences in the Cystic Fibrosis Questionnaire - Revised (CFQ-R) were observed. Travel duration and the cost of attending a clinic was significantly reduced, particularly for the regional group (4 h, AU$108 per clinic; P < 0.05). A total of 93% respondents preferred to continue with a hybrid approach. CONCLUSION:In this pilot study, participants' experience of care and quality of life were no different with face-to-face and virtual care between the groups. Time and cost-savings, particularly for patients living in regional areas, were observed. Most participants preferred to continue with a hybrid model for outpatient care.

The experience of outpatient care may differ for selected patient groups. This prospective, observational study evaluates the patient experience of multidisciplinary outpatient Cystic Fibrosis (CF) care via telehealth compared with face-to-face care the year prior, by place of residence and presence of multi-resistant microbiota.

Spirometry is usually performed under the supervision of a trained respiratory scientist to ensure acceptability and repeatability of results. To evaluate the quality of spirometry performance by adult cystic fibrosis (CF) patients with and without observation by a trained respiratory scientist, an observational, single centre study was conducted between February to December 2020. 74 adults were recruited and instructed to perform spirometry without supervision within 24 h of their remote CF clinic consultation. Spirometry was repeated at their consultation, supervised by a respiratory scientist using video conferencing. The majority of patients achieved grade A (excellent) or B (very good) spirometry quality with (95%) and without supervision (93%) independent of lung function severity. Similarly, forced expiratory volume in 1 second demonstrated no significant differences with paired spirometry performed within a 24 hour period. For a large proportion of adult CF patients, unsupervised portable spirometry produces acceptable and repeatable results. (c) 2021 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are the standard treatment for selected patients with peritoneal malignancy. The optimal means of assessing risk prior to these complex operations is not known. This study explored the associations between preoperative cardiopulmonary exercise testing (CPET) variables and postoperative outcomes following elective CRS and HIPEC. This study included patients who underwent routine preoperative CPET prior to elective CRS and HIPEC at Royal Prince Alfred Hospital in Sydney between July 2017 and July 2020. CPET was performed using a cycle ergometer and measured peak oxygen uptake (VO2 peak) and anaerobic threshold (AT). Outcomes included in-hospital morbidity, length of intensive care unit (ICU) stay and hospital stay. The associations between preoperative CPET variables and postoperative morbidity were assessed using univariate and multivariate analyses. A total of 129 patients were included. Mean age was 56 years (standard deviation (SD) 12.5 years), and colorectal cancer was the most common indication for CRS and HIPEC. The overall complication rate was 69%, and two (1.6%) patients died in hospital. Patients who did not develop any postoperative complication had slightly higher preoperative AT and VO2 peak and shorter length of hospital stay. Data in this study support the role of CPET prior to CRS and HIPEC as an adjunct to improve risk assessment.

Aims: To identify biomarkers of cardiomyopathy in patients with type 2 diabetes mellitus (T2DM) using cardiovascular magnetic resonance (CMR) and to identify associations between functional status, metabolomic profile and myocardial fibrosis. Methods: In this prospective case control study, patients (n = 49) with T2DM without significant coronary artery disease, and matched controls (n = 18) underwent CMR, cardiopulmonary exercise testing, and plasma metabolomic analyses. Results: Patients with T2DM (n = 49, median [interquartile range] age 61 [56-63] years, 61% male, diabetes duration 11 [7-20] years), historical HbA1c 7.6% (60 mmol/mol) (6.9-8.6) and matched controls (n = 18) were examined. Study patients had increased myocardial extracellular volume (ECV) (26.9 [23.8-30.0] vs 23.4 [22.4-25.5) %, p < 0.001). Increased ECV was associated with male sex (p = 0.04), time with T2DM (p = 0.02), reduced peak VO2 (R2 = 0.48, p = 0.01), increased circulating choline (p = 0.002) and cysteamine (p = 0.002) both of which were also associated with reduced peak VO2 (p < 0.025 and 0.014 respectively). Conclusions: Patients with well-controlled T2DM without significant coronary disease exhibit focal and diffuse myocardial fibrosis and diffuse myocardial fibrosis is associated with reduced exercise tolerance and metabolites. Plasma metabolites may provide mechanistic insights into diffuse myocardial fibrosis, and cardiopulmonary fitness.

RATIONALE: In Chronic Obstructive Pulmonary Disease (COPD), expiratory flow limitation and gas trapping cause an increase in FRC, known as hyperinflation. Hyperinflation impedes diaphragm function, causes breathlessness and reduces exercise capacity. In healthy people, elastic chest compression reduced FRC. Therefore, we investigated whether elastic chest compression could reduce hyperinflation in patients with COPD. METHODS: Eight patients with COPD and gas trapping (RV > 120% predicted) performed body plethysmography at baseline and with elastic chest compression placed at the Xiphisternum and over the abdomen. Participants then underwent two magnetic resonance imaging scans of the thorax without and with elastic chest compression to measure the height, length and angle of the diaphragm at FRC. Data are presented as mean ± SD. RESULTS: COPD participants were 66±7.9 years old with moderate to severe airflow obstruction (FEV 1 = 48.2±19% predicted). Elastic chest compression reduced FRC (148.7±25 vs 138.9±22% predicted, p = 0.002) but did not alter TLC or RV (p = 0.25 and 0.58, respectively). This led to an increase in inspiratory capacity with elastic

Background: The prevalence of early-onset type 2 diabetes (EOT2D, diagnosed with T2DM under the age 40) is increasing. There is limited research on the perceptions and knowledge about diabetes and its management. The aim of the study was to explore the insights on diabetes and exercise among this cohort. Method: Twelve participants who underwent an 8-week, supervised, high-intensity intermittent training (HIIT) program were invited to participate in a semi-structured interview. The interview explored exercise history, perception of EOT2D, knowledge of EOT2D management and complications, feedback on HIIT, and barriers and facilitators to regular exercise. Inductive thematic analysis was used. Results: Eight males and four females aged between 20-44 years were interviewed. Four themes emerged from analysis: (i) The diagnosis of T2DM was often unexpected. Participants reported the sense of “loss control” at diagnosis. This motivated people to exercise, but regular and structured exercise was rarely maintained: “didn’t continue after a few months.” (ii) Participants had varying levels of knowledge about diabetes, its management and complications: “⋯didn’t really understand how T2DM works and how exercise could affect it.” Most participants did not monitor blood glucose levels regularly: “monitoring sugar regularly to me is obsessive behaviour.” (iii) Financial and time commitments were the two most common barriers to exercise, especially for people with young children. (iv) HIIT was well-tolerated. Participants valued the individual supervision - “having the supervision gives you structure and a commitment.” However, participants were unlikely to continue with the HIIT program independently or unsupervised. Clinical implication: Although diagnosis of EOT2D can be an impetus for behaviour change, diabetes management in this cohort was not prioritised over work and family commitments. Diabetes management and education in this young cohort needs to have tailored approaches. Disclosure Y. Gu: None. A. Harmer: None. J. Wong: Advisory Panel; Self; Sanofi. Speaker’s Bureau; Self; AstraZeneca, Merck & Co., Inc. A. Gauld: None. M.I. Constantino: None. P.A. Munoz: None. S. Dennis: None. Funding Diabetes Australia; Sydney Local Health District

Background Exercise intolerance is present even in the early stages of pulmonary arterial hypertension (PAH) and is associated with poorer prognosis. Respiratory muscle dysfunction is common and may contribute to exercise limitation. We sought to investigate the effects of inspiratory muscle training (IMT) to improve exercise capacity in PAH. Methods Adults with PAH were prospectively recruited and randomly assigned to either IMT or a control group. At baseline and after 8 weeks, assessment of respiratory muscle function, pulmonary function, neurohormonal activation, 6-minute walk distance and cardiopulmonary exercise testing variables were conducted. Inspiratory muscle strength was assessed by maximal static inspiratory pressure (PImax). The IMT group performed two cycles of 30 breaths at 30-40% of their PImax 5 days a week for 8 weeks. Results Twelve (12) PAH patients (60614 years, 10 females) were recruited and randomised (six in the IMT group and six in the control group). After 8 weeks, the IMT group improved PImax by 31 cm H2O compared with 10 cm H2O in controls, p=0.02. Following IMT, 6-minute walk distance improved by 24.5 m in the IMT group and declined by 12 m in the controls (mean difference 36.5 m, 95% CI 3.5-69.5, p=0.03). There was no difference in peak oxygen uptake between-groups (mean difference 0.4 mL/kg/min, 95% CI 22.6 to 3.4, p=0.77). There was no difference in the mean change between-groups in neurohormonal activation or pulmonary function. Conclusion In this pilot randomised controlled study, IMT improved PImax and 6-minute walk distance in PAH patients.

Introduction: The prevalence of early-onset type 2 diabetes (EOT2D; diagnosed with T2DM before 40 years old), has increased sharply in recent years. Peripheral neuropathy (DPN) is a common and debilitating complication associated with T2DM, and it is also common in EOT2D, even among adolescents. Nerve excitability studies (NES) examine nerve axonal ion channel function; and may allow early detection of axonal dysfunction. The aim of this study was to explore the differences in NES outcomes between a cohort with EOT2D and matched healthy controls. Method: Thirteen participants with EOT2D with no clinical evidence of DPN and 14 matched healthy control participants (HC) were included in the study. Nerve conduction studies (NCS) were used to assess amplitude, latency, and conduction velocity in sural (sensory) and peroneal (motor) nerves. Motor and sensory NES were conducted on the median nerve. NES parameters assessed included strength-duration time constant, threshold electrotonus (TE), current-threshold relationship and recovery cycle. HbA1c was measured. Independent sample t-tests were used to compare the group means ± standard deviations. Results: Participants with EOT2D (F:M 5:8, age 34.1±6.7yr, BMI 31.7±5.4kg∙m-2) differed from matched HC (F:M 6:8, age 32.5±5.1yr, BMI 29.6±4.4kg∙m-2) for HbA1c (EOT2D=6.8±1.0%, HC=5.2±0.3%, p<0.0001). There were no significant between-group differences in any NCS parameters, confirming the absence of clinical neuropathy. Minor changes in sensory axon NES were found in TE, which measures internodal conductances. Sensory depolarizing TE (TEd) at 10-20ms was decreased significantly in the EOT2D group (TEd 10-20ms: EOT2D = 60.1±2.9ms, HC = 62.9±3.0ms, p = 0.02). There were no significant changes in motor NES. Conclusion: Participants with EOT2D and no clinical evidence of DPN may demonstrate minor changes in sensory axonal function. Prospective studies are required to determine the clinical significance and progression of these changes. Disclosure Y. Gu: None. A.R. Harmer: None. S.M. Dennis: None. T. Li: None. H.C. Timmins: None. P. Loh: None. N. Garg: None. T. Dharmadasa: None. J. Wong: Advisory Panel; Self; Sanofi. Speaker’s Bureau; Self; AstraZeneca, Merck & Co., Inc. A. Gauld: None. P.A. Munoz: None. S.B. Park: None. Funding Diabetes Australia; Sydney Local Health District

Determine if the inclusion in the prescription behavior of the medications from the group of sodium-glucose cotransporter inhibitors type 2 (SGLT2) as monotherapy to the Health benefits plan (PBS) due to Resolution 5857 of 2018 of Colombia will change the prescription behavior A database with prescriptions of SGLT2 medications was taken from two Health Maintenance Organization (HMO) in Bogota, Colombia for the 2017 - 2019 period. We made an interrupted time series analysis for comparing the medicines of monotherapy group included in PBS against a control group (SGLT2/Metformin) not included in the policy. Statistical significance tests were applied in the monthly prescription rates to explain the behavior during the study period and a moving average auto-regression model was done. The database was provided by the integral pharmaceutical manager based on the dispensations generated for the HMO From the database provided 8,762 patients with prescription medications from the SGLT2 group were identified. The average monthly prescription rate prior to the inclusion of SGLT2 monotherapy to PBS was 4.3 and 1.8 for the HMO´s. After 32.2 and 10.3 respectively. No significant differences were found with the control group before the policy measure. However, the subsequent variation coefficient for SGLT2 was 4.64 (CI 4.15 - 5.11 95%) for HMO 1 and 1.10 (CI 0.98 - 1.22 95%) for HMO 2 versus the control group of 0.29 (CI 0.21 - 0.37 95% ) for HMO1 and 0.14 (0.11 - 0.16 95%) for HMO 2. The results suggest that implementation of the policy has a positive impact on users, concerning the access of technologies that were not previously covered in PBS. However, historical behavior does not allow to estimate the future impact of the policy.

SummaryAimWe hypothesize that training‐induced changes in muscle oxygen saturation (StO2) assessed by near‐infrared spectroscopy (NIRS) during constant work rate cycling exercise (CWRE) may be a useful marker of the effects of training at ‘vastus medialis’ of the quadriceps in patients with chronic obstructive pulmonary disease (COPD).MethodsIncremental exercise [peak oxygen uptake (VO2)] and CWRE at 70% pretraining peak VO2, before and after 8‐w training, were done in 10 healthy age‐matched subjects (H) [80% men, 65(11) years, FEV1 105(14)%] and 16 COPD patients [94% men, 70(5) years, FEV1 46(11) %] encompassing the entire spectrum of disease severity, recruited in the outpatient clinics. NIRS was used to assess StO2 in the ‘vastus medialis’ of the left quadriceps.ResultsPretraining CWRE decreased StO2 (P<0·05) and generated marked StO2 rebound (P<0·001) after unloading in the two groups. After training, VO2 peak increased in H [253(204) ml min−1] (P<0·01) and in COPD [180(183) ml·min−1] (P = 0·01) and blood lactate fell [−4·4 (2·7) and −1·6(2·3) mmol·m−1] (P<0·05 each). Training generated a further fall in StO2 during CWRE [−10(12)% and −10(10)%, P<0·05] and increased StO2 rebound after unloading [8(7)% and 5(9)%, P<0·05] in both groups.ConclusionEndurance training further decreased StO2 during CWRE, similarly in both groups, likely due to training‐induced enhancement of muscle O2 transfer and utilization. Training‐induced StO2 fall during CWRE may be useful individual marker for non‐invasive assessment of enhanced muscle aerobic post‐training function.