Abstracts from The XXV Brazilian Diabetes Society Meeting

OP—001 Impact of Insulin Pump and Sensor Use on Fear of Hypoglycemia and Mental Health in Patients with Type 1 Diabetes

Witte, RR1; Lucena, PAL1; Pisani, RBF1; Sant’Ana, MEC1; Siqueira, RA1

(1) Universidade Iguaçu, Nova Iguaçu, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: OP—001

Introduction: Type 1 diabetes mellitus (T1DM) requires strict glycemic control, with hypoglycemia being a common occurrence that can cause severe consequences, including cognitive impairment. Fear of this complication adversely affects patients’ mental health and quality of life. Technologies such as continuous glucose monitors and insulin pumps have been increasingly adopted to improve glycemic control and mitigate these risks. This study investigated the influence of treatment modality on fear of hypoglycemia, stress, anxiety, and depression in individuals with T1DM. Objective: To analyze the impact of insulin pump and sensor use on fear of hypoglycemia, stress, anxiety, and depression levels in patients with T1DM. Methods: A cross-sectional study was conducted with 477 adults with T1DM via an electronic questionnaire. Clinical data and treatment modalities were collected, and the “Fear of Hypoglycemia” (FoH) and “Depression, Anxiety, and Stress Scale” (DASS-21) scores were applied. Data were analyzed using Jamovi 2.3 software. Shapiro–Wilk, Levene, Welch ANOVA, and Kruskal–Wallis tests were employed (p < 0.05). Results: The combined use of an insulin pump and sensor yielded the best outcomes: lowest mean scores for stress (14.9), anxiety (7.95), and depression (9.81). Patients using multiple daily insulin injections and glucometers showed higher means: stress (17.3), anxiety (11.4), and depression (13.7). The FoH scores were also more favorable in the pump and sensor group (worry: 34.4; behavior: 18.7). Additionally, the type of healthcare system, public or private, did not influence patients’ mental health. Conclusion: The adoption of technologies such as insulin pumps and continuous glucose sensors is associated with a reduced fear of hypoglycemia and improved mental health indicators in patients with type 1 diabetes mellitus (T1DM). Their use should be encouraged as part of comprehensive care, which includes both medical and psychological support.

OP—002 Clinical Predictors of Kidney Dysfunction in Type 1 Diabetes Mellitus: A Stratified Analysis by Gender and Ketoacidosis

Pinheiro, MHP1; Guidorizzi, NR1; Xavier, AB1; Bergamo, GC1; Cremon, BG1; Paula, FJA1; Gomes, PM1; Mermejo, LM1

(1) Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil

Diabetology & Metabolic Syndrome 2026: OP—002

Introduction: Type 1 diabetes (T1DM) is a well-established risk factor for chronic kidney disease (CKD), typically manifesting as diabetic kidney disease (DKD). CKD severity is classified by the KDIGO guidelines, which combine glomerular filtration rate (GFR) and albuminuria categories. Objective: To assess CKD occurrence and staging in individuals with T1DM, correlating kidney function with clinical factors, and evaluating the influence of gender, insulin regimen, and diabetic ketoacidosis (DKA) at disease onset on renal outcomes. Methods: An observational, retrospective study analyzing data from 530 patients with T1DM followed at a single university hospital between January 2014 and June 2025. CKD staging was determined based on GFR and albuminuria, and its association with clinical parameters was evaluated. Results: The cohort included 298 women (56.2%) and 232 men (43.8%), with a median age of 28 years (interquartile range [IQR]: 22–36). Reduced GFR (stage G3a or worse) was identified in 57 patients (10.8%), while albuminuria (A2 or worse) was present in 164 patients (30.9%). Among 295 patients with available data, 147 (49.8%) had a history of DKA at disease onset. GFR declined by an average of 1.9 per year of disease duration in men and 1.2 in women (p = 0.02). Additionally, each additional year of age at diagnosis was associated with a GFR reduction of 2.3 in men and 1.1 in women. The regression model explained 41.4% of GFR variance in men (R² = 0.41) and 20.4% in women (R² = 0.20). Current HbA1c was the only significant predictor of albuminuria (coefficient 55.1, p = 0.008). Patients using the “Carbohydrate Counting” insulin regimen had a higher proportion of normoalbuminuria (A1) compared to those on a fixed basal-bolus regimen (82.0% vs. 66.5%, p = 0.04). Although DKA at disease onset did not significantly impact mean GFR (p = 0.492) or albuminuria levels (p = 0.421), it modulated CKD progression as disease duration had a slightly greater impact on GFR decline in patients with prior DKA (-1.6 vs. -1.4, p < 0.001), while age at diagnosis had a stronger effect in those without DKA (-1.7 vs. -1.3, p < 0.001). Conclusion: In T1DM, disease duration, younger age at diagnosis, and male were associated with more pronounced GFR decline, while HbA1c was a predictor of albuminuria. DKA at onset modulated CKD progression, and flexible insulin regimens were related to better albuminuria profiles. These findings highlight important risk factors for kidney disease in T1DM.

OP—003 Exploratory Analysis of Clinical Variables for Automated Prediction of Specialist Referrals in Diabetic Retinopathy Screening

Araújo, T1; Linn, T1; Chichelero, G1; Navaux, P1; Malerbi, FK2; Schaan, BD1; Reis, M1

(1) Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil; (2) Universidade Federal de São Paulo, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: OP—003

Introduction: Diabetic retinopathy (DR) is a leading cause of preventable blindness, highlighting the need for early detection and timely referral. While image-based algorithms are promising, incorporating routinely collected clinical and laboratory data into automated models may enhance DR screening and referral strategies. Objective: To identify clinical and laboratory variables most relevant for improving the performance of a DR referral algorithm. Methods: The study included 1,056 patients with type 1 or 2 diabetes followed at an outpatient clinic in a public hospital in southern Brazil between 2019 and 2021. Patients underwent color fundus photography (CFP) for DR screening and had at least one HbA1c, renal, and lipid profile within the same year. Clinical and laboratory data were collected from interviews and medical records. The study was approved by the institutional ethics committee (no. 2019–0113). We utilized a retinal and clinical data dataset, although our current model only uses images as input. We analyzed 32 available attributes in our dataset using a decision tree classifier to determine the most informative clinical variables for future integration. These attributes included medical history, demographics, and lab results. The model is structured as a flowchart and classifies patients as either referable or non-referable for DR based on a sequential analysis of clinical variables. The decision tree ranks features according to their contribution to classification, highlighting those that provide early and practical insights. This ranking helps guide the selection of relevant clinical data, eventually aiming to enhance model performance. Results: HbA1c and duration of diabetes were the top-ranked variables according to the decision tree model. Other clinical attributes with high importance included glomerular filtration rate (GFR) and urinary albumin excretion (UAE). The table summarizes the top-ranked clinical attributes and their respective importance scores. These scores reflect each variable’s contribution to distinguishing between patients classified as referable or non-referable for specialist care. Conclusion:: The decision tree highlighted several routinely collected clinical variables as highly relevant for predicting DR referrals. These findings support integrating clinical and laboratory data into image-based models to enhance the accuracy of automated screening systems, particularly in large-scale public healthcare settings. Support: FIPE, CNPq, CAPES, Fapergs.

OP—004 Prevalence Of Diabetic Kidney Disease In Brazil: A Systematic Review With Meta-Analysis

Chichelero, GM1; Pessil, L1; Xavier, G2; Reis, M1; Schaan, BD1

(1) Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil; (2) Universidade Federal de Minas Gerais, Minas Gerais, MG, Brasil

Diabetology & Metabolic Syndrome 2026: OP—004

Introduction: Chronic hyperglycemia in diabetes leads to long-term complications such as diabetic kidney disease (DKD), a significant contributor to end-stage kidney disease worldwide. Despite its public health impact, Brazil lacks robust epidemiological data on DKD. Objective: To assess DKD prevalence in Brazilian adults with diabetes. Methods: Three databases (PubMed, LILACS, EMBASE) were searched through August 2023 for studies on diabetes, nephropathy, DKD, and prevalence, regardless of language. Included studies met these criteria: (1) cross-sectional, cohort, case–control studies or baseline data from randomized clinical trials, (2) conducted in Brazil, and (3) describing the frequency of DKD in adults with type 1 or type 2 diabetes. Studies involving animals, editorials, reviews, and studies of selective populations – such as pregnant women, or those exclusively including kidney transplant recipients or patients on renal replacement therapy—were also excluded. Protocol registered at PROSPERO (CRD420251071438). Overall and subgroup prevalence estimates with 95% confidence intervals (CI) were calculated from reported DKD frequencies in individuals with diabetes. Pooled estimates used a random-effects inverse variance method with arcsine transformation to address heterogeneity. Individual study CIs were calculated via Clopper-Pearson, and heterogeneity assessed by I². Meta-analysis applied inverse variance with a logit link. Analyses were performed using PERSyst-MA v1.0, based on R package meta v7.0–0. Results: The search retrieved 1435 articles published; 184 duplicates were excluded. After screening titles and abstracts, 955 articles were removed. Of the 296 full-text articles assessed, 49 met the inclusion criteria (n = 25,791). The prevalence rate of DKD was 28.80% (95% CI 24.25–33.84, I2 98%). No significant difference was found for type 1 diabetes (29.48%; 95% CI 22.05–38.18, I² 94%), type 2 diabetes (30.56%; 95% CI 22.94–39.42, I² 97%), or studies including both types (27.26%; 95% CI 20.70–35.00, I² = 99%); p = 0.83. DKD prevalence was similar across healthcare settings: 31.51% (95% CI 25.35–38.40, I² 98%) in tertiary care, 26.94% (95% CI 22.19–32.28, I² 70%) in primary care, and 21.42% (95% CI 12.73–33.74, I² 98%) in mixed settings. Prevalence before (29.39%; 95% CI 12.80–54.15, I² 98%) and after 2005 (29.17%; 95% CI 24.49–34.33, I² 98%) was also comparable. Conclusion:: DKD is highly prevalent and burdensome, with heterogeneity highlighting the need for multicenter studies using standardized methods.

OP—005 Relationship Of Glucose Variability With Perinatal Outcomes In Pregnant With Type 1 Diabetes

Silva, CL1; Machado, GP1; Guntzel, GF1; Rodrigues, TC1

(1) Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: OP—005

Introduction: For many years, measuring glycemic variability (GV)was not possible. However, with the increased use of continuous glucose monitors, this has changed. Objective: This systematic review sought to synthesize the existing data in the literature on parameters used to estimate GV and its relationship with perinatal and maternal outcomes, as well as to evaluate which is the best glycemic variability parameter for this purpose and to establish whether these metrics can be useful to guide the management of pregnant women with type 1 diabetes. Methods: The search was performed on the main database platforms: PUBMED, EMBASE, WEB OF SCIENCE, and LILACS in December 2024 and updated in June 2025. This search was conducted independently by two researchers using the following terms and their equivalents: type 1 diabetes, continuous glucose monitoring, glycemic variability, and gestational, fetal, neonatal, and perinatal outcomes. There were no language restrictions. Data from grey literature available on the four databases were also included. This review was registered in PROSPERO CRD42024621744 and conducted according PRISMA. Population: Pregnant women with type 1 diabetes mellitus Exposure: High glycemic variability measured by glycemic variability divided by standard deviation, coefficient of variation (CV), standard deviation (SD), MAGE, MODD, ADDR, M-value, J-index, and CONGA Comparator: Low glycemic variability following the same parameters Outcomes: Large for gestational age newborn, fetal macrosomia, pre-eclampsia and hypertensive disorders in pregnancy, cesarean delivery, premature birth, neonatal hypoglycemia, neonatal ICU admission, newborn hyperbilirubinemia, newborn respiratory dysfunction, shoulder dystocia and birth trauma, APGAR score, birth weight, gestational age at birth, fetal mortality, neonatal mortality. Results: Nineteen studies were included. Greater GV at the end of pregnancy has been associated with higher rates of large fo gestational age newborns and, among the measures studied, the J index appears to have a greater correlation. GV in the early period of pregnancy appears to have a greater correlation with the incidence of preeclampsia.its severity, and its earlier onset. Other perinatal outcomes, have been little studied to date. Conclusion: Higher GV in late pregnancy was associated with large for gestational age newborns, and the J-index appears to be the measure. GV in early pregnancy seems to be associated with pre-eclampsia, with greater severity and earlier onset.

OP—006 Performance of Cardiovascular Risk Calculators in Long-Standing Type 1 Diabetes: A Multicenter Retrospective Comparison with 10-year Outcomes

Garcia, PM1; Paliares, IC2; Lauria, MW3; Dualib, PM2; Dib, SA2; Sá, JR2; Costa, AH1; Sena, MCR1; Zajdenverg, L1; Dantas, JR1; Rodacki, M1

(1) Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (2) Universidade Federal de São Paulo, São Paulo, SP, Brasil; (3) Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil; (4) Universidade Federal de São Paulo, São Paulo, SP, Brasil; (5) Universidade Federal do Rio de Janeiro, Rio de Janeiro—RJ, Brasil

Diabetology & Metabolic Syndrome 2026: OP—006

Introduction: Subjects with type 1 diabetes (T1D) are at higher risk for cardiovascular (CV) disease, but the optimal risk stratification in this population remains a matter of debate. Calculators validated for the general population may lack precision, while T1D-specific tools are still under evaluation Objective: To assess the performance of four cardiovascular risk (CVR) calculators in subjects with long-term T1D, according to the rate of events. Methods: This multicenter retrospective study included adults with T1D for more than 10 years from 3 centers in Southeastern Brazil. For each participant, the 10-year CVR was estimated using 4 tools: Brazilian Diabetes Society (SBD), Brazilian Society of Cardiology (SBC), Steno Type 1 Risk Engine (ST1RE) and LIFE-T1D. Outcomes (coronary artery disease, heart failure, and ischemic stroke) occurring with a 10-year follow up were recorded. Categories that indicated a risk of cardiovascular events of at least 20% within 10 years were considered risk predictors. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and odds ratios (ORs) were calculated to assess each model’s performance. Results: The sample comprised 569 patients (55.4% of whom were females). Their mean age, T1D duration and body mass index were 28.6 years (± 10.7), 18.0 years (± 7.14) and 25.0 kg/m² (± 4.2), respectively. 22.6% had hypertension and 6.9% were smokers. Events occurred in 29 patients (5.3%). There were 26 deaths (4.6%), but they were not considered outcomes since it was not possible to determine the cause. The SBD calculator had a sensitivity of 79.3%, specificity of 54.5%, PPV of 8.9%, and NPV of 97.9% (OR 4.6). The SBC calculator, which classifies all individuals with T1D for over 10 years as high risk, achieved 100% sensitivity but low specificity (7.6%) and PPV (5.7%), precluding OR calculation. ST1RE demonstrated the highest OR (13.6; p < 0.001) and specificity (95.5%), but limited sensitivity (40.7%). LIFE-T1D had the lowest sensitivity (20%) but high specificity (98.3%) and PPV (40%), although it remains unvalidated in the Brazilian population. Conclusion: General population calculators (SBC, SBD) had heterogeneous results but tended to overestimate CVR, while specific calculators (ST1RE and LIFE-T1D) underestimated it. No calculator proved to be ideal, and it is possible that an alternative method that could combine the current methods would be more suitable for patients with long-term T1D.

OP—007 Contraceptive Methods Used By Adolescents With Diabetes Mellitus

Gerhardt, CR1; Amaral, MF2; Coutinho, MKP3; Remonti, LLR4; Satler, F4; Leitao, CB1

(1) Universidade Ferderal do Rio Grande do Sul, Porto Alegre, RS, Brasil; (2) Universidade Lutherana do Brasil, Porto Alegre, RS, Brasil; (3) Instituto da Criança Com Diabetes, Porto Alegre, RS, Brasil; (4) Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: OP—007

Introduction: Prevention of unplanned pregnancies is essential in adolescents with diabetes mellitus (DM). The Long-acting reversible contraceptive methods (LARCs), such as intrauterine devices and etonogestrel implant, are effective, safe, and reversible, and are the most appropriate for preventing pregnancies in adolescents and in those women with inadequate glycemic control and chronic complications or comorbidities to avoid maternal–fetal complications. Objective: To describe the contraceptive methods used by adolescents (10–18 years of age) with DM treated at a referral center for the treatment of children and adolescents with DM in southern Brazil. Methods: Cross-sectional study developed through review of medical records to collect clinical data and interview using a structured questionnaire. Approved Ethics Committee:58,015,622.8.3001. 5530. Results: Of the 373 adolescents with DM included in the study, 306 were interviewed so far. The mean age was 13.6 + 2.6 years old. Regarding the type of diabetes, 293 (95,7%) had DM1. 215 (70,3%) had menarche, with a mean age of 11.6 + 1,39 years old. 57 (%) had initiated sexual intercourse, with a mean age of initiation of 15.2 + 1.42 years old. 72 adolescents were using contraception methods 46 (64%) receive a prescription from a medical professional and 26 (36%) had started using contraception method without professional evaluation. The most used contraceptive methods are combined oral contraceptive 36 (50%); male condom 12 (17%), injectable combined contraceptive 8 (11,1%); quarterly injectable progesterone 6 (8,3%); etonogestrel implant 5 (7%), oral progesterone contraceptive 4 (5,6%), patch 1 (1,4%). There were no reports of pregnancies among the interviewees. Conclusion: Although most adolescents who initiate sexual activity use contraceptive methods, low adherence to the use of LARCS, only 5 use the etonogestrel implant, which is one of the most suitable methods due to its safety and high efficacy. Many adolescents use contraceptive methods without a prescription. The data reinforce the importance of including the topic of contraception and pregnancy planning in routine consultations for adolescents with DM from the beginning of puberty, as well as public policies that expand access to contraceptive methods, especially LARCs, and the provision of information to this population.

OP—008 Glycemic Profile in Pregnant Women After Bariatric Surgery: Insights from Continuous Glucose Monitoring

Nabuco, A1; Fragoso, L2; Leal, ME2; Bagdadi, LV1; Rodacki, M2; Dantas, JR2; Mata, F1; Oliveira, MM1; Zajdenverg, L1

(1) Maternidade Escola da Universidade Federal do Rio de Janeiro. Serviço de nutrologia. Universidade Federal do Rio de Janeiro, RJ, Brasil; (2) Departamento de Clínica Médica, serviço de nutrologia. faculdade de medicina da Universidade Federal do Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: OP—008

Introduction: The oral glucose tolerance test (OGTT) is the standard diagnostic method for gestational diabetes mellitus (GDM). After bariatric surgery (BS), it may be unsuitable due to the risk of dumping syndrome and difficulties in interpreting results from altered gastric emptying. Assessing glycemic profiles and their associations with maternal–fetal outcomes may help detect dysglycemia in this population. Objective: To describe continuous glucose monitoring (CGM) profiles in pregnant women without prior diabetes after BS and correlate findings with maternal–fetal outcomes. Methods: Pregnant women with a history of BS from a prenatal outpatient clinic were invited to participate. isCGM (Freestyle Libre 1, Abbott) was used between 24–28 gestational weeks for 14 days, with scans before and 1 h after meals. Metrics were obtained from the Libreview® program, including mean glucose, glycemic variability (GV), time in range (TIR; 63–140 mg/dL), time above range (TAR > 140 mg/dL), and time below range (TBR; < 63 mg/dL). Results: Twelve women with prior Roux-en-Y gastric bypass (n = 8) or vertical sleeve gastrectomy (n = 4) were included. Mean age was 37.7 years, BMI 33.6 kg/m², gestational weight gain 6.05 (− 1.8 to + 16.5) kg, and time from BS to pregnancy 6.3 (1–20) years. isCGM was initiated at a mean of 27.6 weeks and showed: mean glucose 91.5 ± 9 mg/dL, GV 30.6 ± 19%, TIR 81.9 ± 27% (median 93%), TAR 6,82 ± 4,49%, TBR 4.73 ± 6.43% (median 4%). Median birth weight was 3315 (2670–3885) g. Seven women had CGM values suggestive of GDM (fasting > 95 mg/dL or 1 h-postprandial > 140 mg/dL). No correlation was found between GDM and fetal weight percentile (r =  − 0.24), but both large-for-gestational-age newborns were from this group. All neonatal hypoglycemia cases occurred in the GDM group. No significant association was found between CGM metrics and fetal abdominal circumference percentile, though GV showed a positive, non-significant trend (r = 0.43; p = 0.21). Conclusion: In post-BS pregnancies, isCGM identified a high proportion of elevated glucose levels. Monitoring pre- and postprandial glucose may aid in diagnosing and managing GDM in this population. These women also showed frequent hypoglycemia and a significant GV. GV may relate to increased fetal abdominal growth. Larger studies are needed to confirm these associations.

OP—009 From Ketoacidosis to Recovery: Clinical and Laboratory Differences Among Patients With A⁻Β⁺ And A⁺Β⁻ Ketosis-Prone Diabetes – A Systematic Review and Meta-Analysis

Motta, LB1; Yu, MY1; Abbott, LA1; Sarni, ROS1; Sa, JR1

(1) Centro Universitário Faculdade de Medicina do ABC, Santo André, SP, Brasil

Diabetology & Metabolic Syndrome 2026: OP—009

Introduction: Ketosis-prone diabetes (KPD) is an atypical form of diabetes characterized by episodes of diabetic ketoacidosis (DKA) and isolated ketosis. The Aβ classification stratifies KPD based on islet autoantibodies (A⁺/⁻) and beta-cell function (β⁺/⁻). Among subtypes, A⁻β⁺ is the most frequent, presenting features of both type 1 and type 2 diabetes. Despite growing interest, no prior meta-analysis has focused exclusively on A⁻β⁺ KPD patients in the context of DKA or directly compared them to A⁺β⁻ KPD, a group more similar to type 1 diabetes. Objective: To compare the clinical and laboratory characteristics of A⁻β⁺ and A⁺β⁻ KPD following DKA. Methods: A systematic review was conducted across five databases through August 2024. Eligible studies assessed GAD65 autoantibodies and beta-cell function. Outcomes included baseline characteristics and longitudinal HbA1c and C-peptide data. Random-effects meta-analyses were performed using RevMan 5.4, reporting mean differences (MD), risk ratios (RR), and 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic; p < 0.05 was considered statistically significant. The protocol was registered in PROSPERO (CRD420251028769). Results: Seven observational studies were included, with 427 of 619 individuals classified as A⁻β⁺ KPD. Compared to A⁺β⁻ patients, A⁻β⁺ had higher BMI (MD 5.47 kg/m²; 95% CI 3.90 to 7.05; p < 0.00001; I² = 58%) and were more likely to have a family history of diabetes (RR 1.74; 95% CI 1.29 to 2.34; p = 0.0003; I² = 0%). No significant differences were observed in age, sex, glucose, or pH. At DKA onset, A⁻β⁺ KPD showed worse glycemic control (HbA1c MD 1.01%; 95% CI 0.11 to 1.92; p = 0.03; I² = 29%) and higher fasting C-peptide (MD 1.36 ng/mL; 95% CI 0.46 to 2.27; p = 0.003; I² = 95%). Between 6 and 12 months of recovery, patients with A⁻β⁺ showed greater beta-cell function improvement from baseline in fasting C-peptide (MD 0.92 ng/mL; 95% CI 0.08 to 1.76; p = 0.03; I² = 94%) and glucagon-stimulated C-peptide measures (MD 2.46 ng/mL; 95% CI 2.21 to 2.70; p < 0.00001; I² = 0%). After 1 year, A⁻β⁺ KPD had lower HbA1c levels (MD -2.27%; 95% CI -2.93 to -1.61; p < 0.00001; I² = 27%) and a higher likelihood of insulin therapy discontinuation (RR 32.77; 95% CI 6.69 to 160.42; p < 0.0001; I² = 0%). Conclusion: In DKA-onset KPD, A⁻β⁺ patients exhibit more glucotoxicity-related risk factors but experience greater beta-cell recovery and exogenous insulin independence than A⁺β⁻, reinforcing the prognostic value of Aβ classification.

OP—010 Glucose Profile In Individuals With GCK-MODY Diabetes: Insights From Continuous Glucose Monitoring In A Case–Control Study

Canzian, MB1; Abreu, GM1; Souza, RB2; Andrade, AF2; Tarantino, RM1; Rosado, EL1; Junior, MC2; Zajdenverg, L1; Rodacki, M1

(1) Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (2) Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: OP—010

Introduction: Diabetes that occurs due to a mutation in a single gene is called monogenic diabetes. Although still considered rare, it may be underdiagnosed or misclassified as other types of diabetes. The most frequent mutation is an inactivating one in the glucokinase (GCK) enzyme, which leads to GCK-MODY, characterized by mild and stable fasting hyperglycemia, typically identified in young patients with a positive family history. Diagnosis is confirmed through genetic testing; however, access remains limited and costly. Pharmacological treatment is not routinely indicated, as it is believed there is no significant risk for complications. Nevertheless, there is still a lack of data in the literature on a broader assessment of glucose profiles using continuous glucose monitoring (CGM) in patients with GCK-MODY. Objective: Descriptively evaluate glucose behavior in patients with genetically confirmed GCK-MODY using intermittent CGM metrics, and to compare these findings with data obtained from a control group without diabetes. Methods: This is a cross-sectional, observational case–control study. All participants used CGM for 14 days. Reports and metrics such as time in range (TIR), time above range (TAR), time below range (TBR), time in tight range (TITR), estimated average glucose, and glucose management indicator (GMI) were generated and compared between groups. Statistical analysis was performed using SPSS version 11.0, and a p-value < 0.05 was considered statistically significant. Results: In the GCK-MODY group, all participants had a TIR > 70%, indicating adequate glycemic control. Only one had a TITR < 50%. No patient had a TITR > 96%, the expected level for non-diabetic individuals, which was achieved by the control group. Compared to the control group, the GCK-MODY group showed lower TITR (0.78 ± 0.14 vs. 0.96 ± 0.33; p < 0.001), and higher TAR (0.026 ± 0.05 vs. 0.001 ± 0.003; p = 0.0123), GMI (6.3 ± 0.26 vs. 5.7 ± 0.17; p < 0.001), and estimated average glucose (124.6 ± 11.26 vs. 100 ± 7.42; p < 0.001). No associations were found between specific genotypes and the magnitude of glucose profile abnormalities. Conclusion: Despite stable glycemic patterns and adequate TIR, our findings reveal consistent glycemic abnormalities when using more sensitive parameters such as TITR. The GCK genotype did not correlate with glycemic phenotype, highlighting the importance of considering non-genetic factors in disease expression.

OP—011 Trends In Type 2 Diabetes Burden And Risk Factors Across Brazilian Regions: Findings From The Global Burden Of Disease Study 2021

Teixeira, PP1; Duque-Cartagena, T1; Cabral, LS1; Goulart, BNG1; Reis, R1; Gerchman, F1; Colpani, V2; Malta, DC3; Xu, YY4; Schimidt, MI1; Rita Mattiello1; Duncan, BB1

(1) Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil; (2) Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, SP, Brasil; (3) Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil; (4) Institute for Health Metrics and Evaluation, University of Washignton, United States

Diabetology & Metabolic Syndrome 2026: OP—011

Introduction: Despite significant advancements in the treatment of type 2 diabetes mellitus (T2DM), recent projections indicate that this condition will become Brazil´s leading cause of morbimortality by 2050, underscoring an urgent public health challenge. Objective: This study aimed to comprehensively describe national and regional trends in T2DM prevalence, incidence, disease burden and exposure to its main risk factors across Brazil from 1990 to 2021. Methods: We sourced data from the Global Burden of Diseases Study (GBD) 2021 to obtain estimates and annual changes of T2DM deaths, incidence, prevalence, Years of Life Lost (YLLs), Years Lived with Disability (YLDs), and Disability Adjusted Life Year (DALYs) in Brazil and its regions. We present trends in diabetes metrics, age-standardized unless otherwise stated, as well as the exposure to T2DM risk factors between 1990 and 2021. Results: The national prevalence of T2DM increased by 37.4% (95% UI 32.7 to 42.6) and the incidence by 32.3% (95% UI 27.6 to 37.7) from 1990 to 2021. Deaths due to T2DM decreased by 18.0% (95% UI 21.4 to 15.3), and the accompanying YLLs by 22.8% (95% UI 20.2 to 25.8). YLDs increased by 35.4% (95% UI 29.1 to 41.3), while DALYs’ rates reduced by 3.1% (95% UI 1.7 to 8.2) since 1990. The Northeast region showed higher prevalence, incidence, YLLs, and YLDs in 2021, while the North region had the most pronounced increases. In consonance with the aging of Brazil´s population, national crude prevalence and DALYs increased considerably more, by 135.5% (95% UI 127.5 to 145) and 79.2% (95% UI 69.8 to 87.8), respectively. Consumption of sugar-sweetened beverages had the most pronounced increases, particularly in the Central-West, South, and Southeast regions, followed by high BMI and the consumption of red and processed meat. Physical inactivity showed smoother but consistent increases in all regions, and the exposure to smoking and air pollution decreased. Conclusion: The escalating T2DM burden in Brazil, likely associated with the increasing exposure to its risk factors, underscores the critical need for public policies centered on prevention and the reduction of health inequalities.

OP—012 Glycemic Control and Quality of Life in Youth with Type 1 Diabetes: Evidence from a Multicenter Study in Brazil

Sparapani, VC1; Barber, ROLB2; Santos JS3; Lucca, M4; Ramelho, ELR5

(1) Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil; (2) Children’s Hospital Los Angeles, United States; (3) Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil; (4) Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brasil; (5) Universidade Federal da Paraíba, João Pessoa, PB, Brasil

Diabetology & Metabolic Syndrome 2026: OP—012

Introduction: Children and adolescents with type 1 diabetes face unique challenges. Their perception of quality of life may be influenced by their age-specific developmental needs. Enhancing quality of life is as important as achieving good glycemic control and preventing complications in disease management. This requires adaptation from not only the child, but also the entire family. Objective: The goal is to identify the glycemic control and quality of life of children and adolescents from four Brazilian health services. Methods: This cross-sectional, descriptive study was conducted with caregivers, as well as with children and adolescents with type 1 diabetes, between March and September 2021, in three Brazilian regions: Santa Catarina, São Paulo and Paraíba. The study used a questionnaire containing sociodemographic and clinical variables, as well as the Paediatric Quality of Life Inventory™ 3.0 Diabetes Module. A higher score indicates poorer quality of life. Descriptive analyses were performed using SPSS software (version 18). The study was approved by the Ethics Committee. Results: A total of 346 children and adolescents participated in the study, of whom 52% were girls and 48% boys. Participants were distributed into three age groups: 5–7 years (11.9%), 8–12 years (38.6%), and 13–18 years (49.5%). The mean HbA1c was 8.8% ± 2.5. Regarding acute events in the previous six months, 26 patients (7.5%) required emergency treatment for hyperglycemia, and eight (2.3%) for hypoglycemia. Hospitalization occurred in 14 patients (4.1%) due to diabetic ketoacidosis, 30 (8.7%) due to hyperglycemia, and seven (2.0%) due to hypoglycemia. Parents generally reported a worse quality of life than their children in the 8–12 years (36.61 [29.46–43.75] vs. 33.04 [25.89–41.52]) and 13–18 years age groups (38.39 [29.46–48.88] vs. 37.95 [30.36–46.43]). Interestingly, among children aged 5–7 years, self-reported quality of life was slightly higher than parental perception (29.46 [21.21–39.29] vs. 30.36 [21.87–41.07]) Conclusion: Perceptions of quality of life with diabetes among children and adolescents can highlight important gaps in treatment management. The results regarding glycaemic control and acute complications such as hyperglycaemia, hypoglycaemia and ketoacidosis emphasise the need for diabetes education focusing on practical care and mental health skills. Support from families and primary caregivers should be tailored to the specific needs of the Brazilian child and adolescent population.

OP—013 Prevalence Of 1h-G Abnormalities During OGTT And Its Associated Clinical And Laboratory Characteristics In A Subsample Of Cystic Fibrosis Patients: A Pilot Study

Torraca, FS1; Cotovio NP1; França, JPO1; Vasconcellos, CAVA1; Tannus, LRM1; Cobas, RA1; Palma, CCSSV1

(1) Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: OP--013

Introduction: Cystic fibrosis (CF) is an autosomal recessive disease caused by mutations in the FC transmembrane conductance regulator (CFTR) gene, affecting multiple organs, primarily lungs, pancreas, and intestine. CF-related diabetes (CFRD) is the main extra-pulmonary complication of CF, affecting approximately 50% of adult patients. Screening for CFRD should be performed using the oral glucose tolerance test (OGTT) starting at age of 10 years. In 2024, the 1-h glucose (1h-G) ≥ 209 mg/dL and between 155 and 208 mg/dL were included as a diagnostic criterion for diabetes and prediabetes. Objective: To describe the prevalence of 1h-G abnormalities during OGTT and its associated clinical and laboratory characteristics in a subsample of CF patients. Methods: Cross-sectional study evaluating patients with confirmed CF by genetic testing and/or sweat test, aged ≥ 18 years attending a tertiary multidisciplinary public clinic. Clinical, anthropometric, and laboratory data were collected using standardized questionnaires. 75g-OGTT was performed and fasting, 1h-G and 2h-G were determined. Age at CF diagnosis, CF duration, body mass index (BMI), glycated hemoglobin (A1c), and forced expiratory volume in 1 s (FEV1) were analyzed. Statistical analysis was performed using Jamovi software. Results are presented as n (%), mean ± standard deviation and median [interquartile range]. Results: Ten patients with CF without prior diabetes diagnosis were evaluated, 5 (50%) female, aged 27.9 ± 7.6 years, with age at CF diagnosis of 54 [12–234] months, CF duration 335 ± 91.3 months, A1c 5.7 ± 0.4%, BMI 23.3 [18.9–27.3] kg/m², and mean FEV1 was 61 ± 29.4%. Fasting glucose was normal in 8 (80%). Three (30%) individuals presented 1h-G ≥ 209 mg/dL, 6 (60%), between 155 and 208 mg/dL and 1 (10%), < 155 mg/dL. Individuals with 1h-G ≥ 209 mg/dL presented BMI of 18 [17.6–23]) kg/m², FEV1 of 42 ± 31.7% and A1c of 5.9 ± 0.5%. Those with 1h-G ≥ 209 mg/dL presented BMI of 23.5 [21.3–27.3] kg/m², FEV1 of 72.4 ± 24.1% and A1c of 5.6 ± 0.4%. Conclusion: CFRD diagnosis follows the same criteria used for diabetes mellitus in the general population; however, fasting glucose and A1c show lower sensitivity, and clinical decline may precede diagnosis in CF individuals. The 1h-G OGTT demonstrated to be more sensitive for early glucose abnormalities in CF patients, allowing earlier diagnosis of dysglycemia that may adversely affect CF progression and CFRD complications. Larger studies using the 1h-G OGTT in routine annual screening for CF patients are needed.

OP—014 Salivary Extracellular Vesicles in Individuals with Diabetes Mellitus Secondary to Pancreatic Ductal Adenocarcinoma versus Type 2 Diabetes Mellitus: Exploratory Characterization

Reis, AA1; Matheus, LHG2; Machado, MCC3; M A. C. Machado4; Torrecilhas, AC5; S. Oba-Shinjo6; G. Palmisano7; Marie, SKN6; Correa-Giannella, ML8

(1) Faculdade de Medicina do ABC, Santo André, SP, Brasil; (2) Laboratório de Carboidratos e Radioimunoensaio do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil; (3) Disciplina de Emergências Clínicas (LIM-51) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil; (4) Hospital Nove de Julho, São Paulo, São Paulo, SP, Brasil; (5) Departamento de Ciências Farmacêuticas da Universidade Federal de São Paulo, Diadema, SP, Brasil; (6) Departamento de Neurologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sâo Paulo, SP, Brasil; (7) Departamento de Parasitologia do Instituto de Ciências Biológicas da Universidade de São Paulo, São Paulo, SP, Brasil; (8) Laboratório de Carboidratos e Radioimunoensaio, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Pàulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: OP—014

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is often diagnosed at advanced stages and has a dismal prognosis. Recent-onset diabetes mellitus (RODM, < 3 years) may be a paraneoplastic manifestation of PDAC. Differentiating it from type 2 diabetes (T2D) offers a window for early PDAC detection and potential curative treatment. Extracellular vesicles (EVs) are membrane-bound particles found in biological fluids, including saliva, carrying proteins, RNAs, and microRNAs. They have emerged as promising biomarkers for several diseases. Objective: To compare the salivary EV profile of individuals with PDAC + RODM versus those with long-standing T2D, as an exploratory step in identifying possible associations with PDAC and evaluating the biomarker potential of salivary EVs. Methods: 12 individuals with PDAC + RODM and 12 with long-standing T2D, matched by sex (50% female) and age (mean ± SD: 70.2 ± 10.3 and 70 ± 10.5 yrs, respectively) were included. Saliva was collected before PDAC surgery. EVs were isolated using an automated CL-4B resin system and characterized via nanoparticle tracking analysis (NTA) and flow nanocytometry for annexin (a marker of ectosomes), and for CD9, CD63, and CD81 (canonical markers of exosomes, EVs formed through the endosomal pathway and considered more suitable to reflect cell-specific molecular signatures). Group comparisons and correlations with clinical variables were assessed using non-parametric tests. Results: No significant differences in EV count or average size were observed between groups. Compared to T2D, the PDAC + RODM group had a higher proportion of EVs in the 100—200 nm range (63.5% vs. 49.2%; p = 0.0003), lower positivity for annexin (11.54% vs. 20.68%; p = 0.039), CD63 (0.09% vs. 0.21%; p = 0.032), and CD81 (2.55% vs.6.02%; p = 0.044), but higher positivity for CD9 (10.6% vs. 7.3%; p = 0.0023). Among annexin + EVs, CD63 positivity was also lower in the PDAC + RODM group (2.75% vs. 3.98%; p = 0.044). Correlations with clinical variables for the PDAC + RODM group are presented in Table 1. Conclusion: The distinct EV immunophenotype in individuals with PDAC + RODM suggests that salivary EVs may reflect tumor-specific features and represent a promising non-invasive biomarker source for PDAC detection.(Supported by FAPESP and CNPq).

Table 1 (abstract OP–014).

Significant correlations between clinical variables and phenotypic features of salivary extracellular vesicles (EVs) for the PDAC + RODM group.

OP—015 Association Between Ultra-Processed Food Consumption and Glycemic Control in Children and Adolescents with Type 1 Diabetes Mellitus

Dias, GNC1; Machado, RCM1; Farias, DR1; Carvalho, O1; Pimentel, IF1; Sizisnande, PM1; Mathias, ABGA1; Luescher, JL1; Costa, VM1; Padilha, PC1

(1) Universidade Federal do Rio de Janeiro—Rio de Janeiro—RJ—Brasil

Diabetology & Metabolic Syndrome 2026: OP—015

Introduction: Type 1 diabetes mellitus (T1DM) is the most common chronic disease in childhood. Adequate and healthy eating forms the basis of T1DM treatment and aims to meet glycemic goals and prevent acute and chronic complications, especially cardiovascular risk. Excess weight and diet quality in children and adolescents with T1DM are recognized as the main challenges encountered. Furthermore, to date, there are few studies on the consumption of ultra-processed food (UPF) in this population. Objective: To evaluate the association between UPF consumption and glycemic control in children and adolescents with T1DM. Methods: Cross-sectional study, carried out in a reference treatment center in Rio de Janeiro/Brazil, between 2015 and 2023. The sample consisted of 263 participants, aged between 7 and 16 years old and diagnosed with the disease at least 1 year ago. Exclusion criteria include having other autoimmune diseases, hemoglobinopathies and incomplete information on food consumption and glycemic control. Sociodemographic, clinical, anthropometric and dietary data were collected. Univariable logistic regression was used to estimate the crude odds ratio (OR), with the respective 95% confidential interval (CI). Results: UPF corresponded to 28.6 ± 16.5% of the daily total energy value (TEV), with the highest consumption being found in those participants with inadequate glycemic control (p = 0.043). The carbohydrate, total lipid, saturated fatty acid and cholesterol levels were higher in the tertiles with the highest consumption—T2 and T3 (p < 0.001; p = 0.004, respectively). There was a tendency to present higher body mass index (BMI) values when glycemic control was inadequate (p = 0.056). In this population, the most consumed UPF categories were: bread, cakes and cookies (20.8%); sweetened drinks (14%) and fast food (13.7%). Conclusion: The tertiles of highest UPF consumption were associated with inadequate glycemic control. Integrated actions are needed to reduce the consumption of UPF, especially by children and adolescents with T1DM.

OP—016 Impact of a Plant-Based Dietary Intervention on Continuous Glucose Monitoring Metrics in Type 2 Diabetes: A Randomized Clinical Trial

Correia, PE1; Teixeira, PP1; Martins, BB1; Backes, L1; Chadanowicz, LK1; Scalco, BG1; Bonato, LFA1; Fraga, BL1; Fossari, LT1; Porepp, OSC1; Hu, Y2; Gerchman, F1;

(1) Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil; (2) Johns Hopkins University, United States

Diabetology & Metabolic Syndrome 2026: OP—016

Introduction: Continuous glucose monitoring (CGM) provides detailed information on glycemic metrics beyond glycated hemoglobin (HbA1c), enabling a more personalized management of type 2 diabetes mellitus (T2DM). Interventions that increase plant protein intake may improve glycemic control. However, their impact on CGM-derived metrics remains underexplored. Objective: To assess the effect of partial replacement of animal proteins with plant proteins on CGM-derived metrics in adults with T2DM. Methods: In this 24-week, open-label, single-center, two-arm interventional trial, adults (18–65 years, BMI 25–40 kg/m², HbA1c 7.0–11.0%) were randomized to a control diet or a plant-based diet; both hypocaloric, targeting 5% weight loss in 24 weeks. CGM (FreeStyle Libre®) was used at baseline and after 12 weeks of intervention. Outcomes were GV, TIR, TAR, TBR, and GMI. Analyses were performed using SPSS, version 31, and the generalized estimating equations (GEE) method was used to test for group, time, and group × time effects. Results: Fifty-eight participants (n = 30 control and n = 28 plant-based) were included, and 4 dropped out (3 control and 1 plant-based). Mean diabetes duration was 10 years (5–16.2) in the control group and 12 years (9–19) in the plant-based group. Median HbA1c was 8.3% (7.7–9.9) and 8.7% (7.8–9.9), and BMI was 31.5 kg/m² (± 3.7) and 31.6 kg/m² (± 3.7), respectively. Both groups showed significant improvements over time in GMI (Control: 8% [95% CI: 7.6 to 8.4] to 7.3% [95% CI: 6.9 to 7.7]; Plant-based: 7.97% [95% CI 7.5 to 8.4] to 7.3% [95% CI: 7 to 7.6]; p < 0.001), TIR (Control: 45.1% [95% CI: 35.5 to 57.2] to 62.7% [95% CI: 53.7 to 73.2]; Plant-based: 47.6% [95% CI: 38.4 to 58.9] to 61% [95% CI: 52.8 to 70.6]; p < 0.001), and TAR (Control: 55.2% [95% CI: 45.3 to 67.3] to 35.4% [95% CI: 26.6 to 47.2]; Plant-based: 51% [95% CI: 42.3 to 63.1] to 36.9% [95% CI: 28.7 to 47.4]; p < 0.001). GV and TBR did not differ significantly between groups or overtime. No group × time interaction was observed. Conclusion: There was an improvement in CGM-derived glycemic parameters in both groups, with increased TIR and reduced TAR and GMI. No differences were detected between the diets, and GV remained unchanged. This is the first RCT to show that a plant-based diet provides the same beneficial cardiometabolic effects as a standard diet in people with T2DM, opening possibilities for lifestyle-based care. Thus, healthcare professionals may prioritize adherence, tailoring recommendations to patients’ preferences and lifestyle.

OP—017 The Hidden Spectrum: Disordered Eating Behaviors in Type 1 Diabetes with HbA1c < 6.5%

Figueiredo, JCM1; Trevisan, TL2; Pavin, EJ3; Silveira, MSVM4

(1) Private Practice, Belo Horizonte, MG, Brasil; (2) Private Practice, Itajaí, SC, Brasil; (3) University of Campinas, Campinas, SP, Brasil; (4) University of Campinas; Mental Health and Diabetes Institute, Campinas, SP, Brasil

Diabetology & Metabolic Syndrome 2026: OP—017

Introduction: Disordered eating behaviors (DEBs) are commonly observed in people with type 1 diabetes (PWT1D) and include restrictive eating, binge eating, purging, and diabetes-specific behaviors such as insulin omission for weight control. DEBs are associated with higher glycated hemoglobin (HbA1c) and complications. Emerging evidence highlights distinct subtypes of DEBs, with distinct clinical presentations such as desinhibition, compensatory behaviors, restriction and body dissatisfaction and concerns about type 1 diabetes (T1D). Objective: To investigate the characteristics and clinical profiles of Brazilian PWT1D at high risk for DEBs who maintain HbA1c levels below 6.5%. Methods: This sub-analysis used data from a previous nationwide study. Participants (PWT1D) with Diabetes Eating Problem Survey–Revised, Brazilian version (DEPS-R-BR) scores ≥ 20—a threshold indicating high risk for DEBs were included. They were divided into two groups based on HbA1c: < 6.5% and ≥ 6.5%. Group comparisons were performed using Chi-square or Mann–Whitney tests. A stepwise multivariate linear regression was conducted. The significance level was set at 0.05. Results: A total of 139 PWT1D from across Brazil were included. The majority were female (92%), with a mean age of 28.6 ± 6.66 years. The average duration of T1D was 13.7 ± 8.44 years, and the mean age at diagnosis was 15.2 ± 7.55 years. Most participants (79.9%, n = 111) used multiple daily injections (MDI), while 20.1% (n = 28) used an insulin pump. The mean BMI was 25 ± 4.59, and 30.2% self-reported using medication for weight loss. Twenty-eight participants had HbA1c < 6.5%. This group was associated with older age (p = 0.018), lower total DEPS-R-BR scores (p = 0.007), and lower scores on compensatory behaviors (p < 0.001). Conclusion:: This study identifies a potential subgroup of PWT1D who are at high risk for DEBs despite maintaining adequate glycemic control (HbA1c < 6.5%). These findings challenge the assumption that favorable glycemic outcomes exclude the presence of DEBs and highlight the complexity of eating behaviors in this population. Recognizing and characterizing distinct DEB subtypes is essential, as they may have unique clinical presentations and require tailored strategies for psychiatric, psychological and metabolic management.

OP—018 Ultra-Processed Foods Consumption in Subjects with Type 2 Diabetes Mellitus and Excessive Weight Submitted to A Plant-Based or a Healthy Standard Dietary Intervention: A Blinded Analysis of a Parallel, Randomized Clinical Trial

Martins, BB1; Teixeira, PP1; Correia, PE1; Kunzler, LB1; Porepp, OSC1; Natividade, GR1; Chadanowicz, LK1; Fraga, BL1; Premebida, SM1; Scalco, BG1; Fossari, LT2; Bonato, LFA2; Gerchman, F1

(1) Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil; (2) Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: OP—018

Introduction: Plant-based diets (PBDs) have been linked to improvements in cardiometabolic health due to lower intake of animal products and higher intake of vegetables, seeds, plant oils, and fruits. However, it is unknown whether recommending this diet reduces the consumption of ultra-processed foods (UPFs) when compared to a standard healthy diet. Objective: To compare the impact of a PBD vs. a standard healthy diet on UPFs consumption in adults with type 2 diabetes mellitus (T2DM) and excessive weight Methods: We conducted a single-center, parallel, randomized clinical trial comparing the effect of PBD vs a standard healthy diet in adults with T2DM and excessive weight. This preliminary blinded analysis included participants aged 18–65 years and with BMI 25–40 kg/m². They were assigned to a PBD with reduced animal foods or a control standard healthy diet following T2DM guidelines. Both diets were hypocaloric, targeting 5% weight loss over 24 weeks. Dietary intake was assessed by weighted food records (3 non-consecutive days at baseline; 7 consecutive days at weeks 12 and 24). Nutrient analysis was assessed with NutriBase 19 Pro and food processing degree was categorized according to the NOVA classification. Analyses were performed using Generalized Estimating Equations in SPSS 18.0, with statistical significance at p < 0.05. Results: Eighty participants were included [40 per group; 65% female, 66.3% white, mean BMI 31.0 ± 3.4 kg/m², mean weight 82.8 ± 13.5 kg, and median HbA1c 8.7% (7.8–9.8)] with no between-group differences. Sixty completed the study. There was a significant reduction of the following parameters over time, with no differences between groups: total energy intake (Group A = Δ -488.8 kcal [95% CI: -805.6 to -172.1] vs. Group B = Δ -554.2 kcal [95% CI: -806.8 to -301.7]; p < 0.001), in natura or minimally processed foods (Group A = Δ -56.6 kcal [95% CI: -213.6 to -100.3] vs. Group B = Δ -162.6 kcal [95% CI: -321.7 to -3.4]; p = 0.002) and processed foods (Group A = Δ -237.2 kcal [95% CI: -408.3 to -66.1] vs. Group B = Δ -153.5 kcal [95% CI: -249.8 to -57.3]; p < 0.001). There was no difference in caloric intake of culinary ingredients. However, Group B demonstrated a greater improvement in calory intake from UPFs (Group A = Δ -188.3 kcal [95% CI -334.6 to -42.0] vs. Group B = Δ -221.2 kcal [95% CI -351.9 to 90.5]; interaction p = 0.041). Conclusion: Both diets were effective in reducing total energy and UPFs intake over time, but the reduction in caloric intake of UPFs was different between groups.

OP—019 Body Roundness Index Assessment in Women with and without Metabolic Risk After Bariatric Surgery

Santos, RP1; Cruz, AMF1; Carvalho, JV1; Antunes, JF1; Rigueira, JSG1; Fonseca, EP1; Vieira, CMAF2; Volpe, CMO1

(1) Faculdade de Saúde Santa Casa Belo Horizonte, Programa de Pós-graduação Stricto Sensu em Medicina- Biomedicina, Belo Horizonte, MG, Brasil; (2) Centro de Especialidade Médicas, Grupo Santa Casa Belo Horizonte, Belo Horizonte, MG, Brasil

Diabetology & Metabolic Syndrome 2026: OP—019

Introduction: Obesity is associated with multiple cardiometabolic comorbidities. Bariatric surgery is effective for weight reduction and improving metabolic profile. The Body Roundness Index (BRI) is a promising tool for estimating central adiposity, which is strongly linked to metabolic risk; however, its use in the postoperative setting remains underexplored. Glycated hemoglobin (HbA1c) reflects recent glycemic control and is widely used as a metabolic risk marker. Objective: In this context, the aim of this work was to evaluate the BRI in women undergoing gastric bypass, comparing pre- and postoperative groups with and without cardiometabolic risk defined by HbA1c. Methods: This cross-sectional study, approved by the Ethics Committee of Santa Casa Hospital in Belo Horizonte, Brazil (approval number 69385917.7.0000.5138), included women aged 30 to 60 years. Participants were divided into four groups: preoperative without risk (Pre-NR, n = 7), preoperative with risk (Pre-R, n = 14), postoperative without risk (Post-NR, n = 12), and postoperative with risk (Post-R, n = 9). Cardiometabolic risk was defined by HbA1c values: < 5.7% (without risk) and ≥ 5.7% (with risk). Median time since surgery was 2 years (1–11 years in Post-NR; 1–9 years in Post-R). Body mass index (BMI) and BRI were calculated using conventional anthropometric methods, based on weight, height and waist circumference measurements (WC)). Data were expressed as mean ± standard deviation. Statistical analysis was performed using ANOVA followed by Tukey’s post-test (p < 0.05). Results: Age was significantly higher in the Post-R group compared to the Pre-NR group (p < 0.05), and comparisons between these groups were excluded. Postoperative patients showed significant reductions in body weight, BMI, BRI, and WC compared to the Pre-R group (p < 0.05). Within the postoperative cohort, the Post-R group had significantly higher BRI (7.5 ± 2) and WC (105 ± 12) values than the Post-NR group (BRI 4.4 ± 1.4; WC 83.2 ± 9.9) (p < 0.05), suggesting persistent central fat accumulation. HbA1c levels were significantly elevated in the Pre-R group (7.51 ± 1.8%) and remained increased in the Post-R group (6.1 ± 0.3%) compared to the Post-NR group (5.33 ± 0.2%; p < 0.05). Conclusion: Bariatric surgery leads to significant anthropometric and metabolic improvements; however, a subset of patients retains residual cardiometabolic risk, as indicated by elevated BRI. HbA1c proved useful for risk stratification, underscoring the need for continuous postoperative monitoring.

OP—020 Metabolic Impact of One-Anastomosis Gastric Bypass on Insulin Resistance

Martinez, GS1; Felipe David Mendonça Chaim FDM2; Chaim EA2

(1) Pontifícia Universidade Católica de Campinas, Campinas, SP, Brasil; (2) Universidade Estadual de Campinas, Campinas, SP, Brasil

Diabetology & Metabolic Syndrome 2026: OP—020

Introduction: Obesity is a chronic disease affecting millions of people worldwide. It is associated with conditions such as type 2 diabetes and hypertension and is also linked to insulin resistance (IR), a metabolic imbalance that leads to hyperglycemia. Diagnostic tools such as the Homeostatic Model Assessment (HOMA-IR) and the triglyceride-glucose index (TyG) are commonly used to identify IR. Bariatric surgery, particularly the Roux-en-Y gastric bypass (RYGB), has proven effective in managing obesity and IR. The most recent technique, One Anastomosis Gastric Bypass (OAGB), has also shown promising results, but further studies are still needed. Objective: To evaluate changes in insulin resistance following OAGB and compare them with outcomes in RYGB patients. Methods: A retrospective longitudinal analysis was conducted on 79 patients who underwent OAGB between 2017 and 2023. A control group, submitted to RYGB, was analyzed for comparison. Groups were matched by age, sex, and body mass index (BMI). HOMA-IR and TyG indices were measured pre and postoperatively. The Wilcoxon test for paired non-parametric samples was used for statistical analysis. The study was previously approved by the Comitê de Ética em Pesquisa em Seres Humanos under protocol CAAE 58184516.2.0000.5404, ethical approval no. 3.706.249. Results: The OAGB group consisted of 79 patients, of whom 17 (21.5%) were male and 62 (78.5%) were female. The same distribution applied to the RYGB group due to matching. The median age was 37 years for the OAGB group and 36 years for the RYGB group. HOMA-IR values, assessed pre and postoperatively, showed a statistically significant reduction (p < 0.001), indicating improvement in insulin sensitivity in both groups. Similarly, TyG values also demonstrated significant reduction (p < 0.001), suggesting improved metabolic parameters following surgery with both techniques. Patients submitted to OAGB showed a reduction in median BMI from 44.79 to 37.36 kg/m², whereas those undergoing RYGB experienced a decrease from 43.46 to 36.14 kg/m². Conclusion: The findings suggest that the OAGB technique contributes to a reduction in insulin resistance in both sexes. This was demonstrated through significant reductions in HOMA-IR and TyG indices after surgery. Furthermore, the OAGB method proved to be as effective as the conventional Roux-en-Y gastric bypass, supporting its use as a viable surgical alternative.

OP—021 Prevalence Of Obesity And Its Association With Paternal Obesity In 2-To-14 Years-Old Offspring Exposed To Gestational Diabetes In Utero: a Retrospective Cohort

Muradian, MMP1; Dualib, PM2; Spallicci, DG1; Souza, FD1; Abate, MCO1; Micaela Frasson, M1; Jordão, MC1; Dib, SA2; Pititto, BA2

(1) Faculdade de Medicina do ABC; Programa de Pós-Graduação em Endocrinologia e Metabologia, (2) Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: OP—021

Introduction: Gestational Diabetes Mellitus (GDM) and maternal obesity are associated with obesity in offspring, but the impact of father’s obesity on the metabolic health of offspring needs more studies. Objective: To evaluate the association of obesity in offspring exposed to GDM in utero with pre-gestational maternal and paternal obesity (BMI ≥ 30kg/m2). Methods: This retrospective cohort study involved 148 children aged 2–14 years, born to mothers with GDM. Data was collected during routine antenatal care and an evaluation of the children were performed 2 to 14 years later. Excessive weight was defined according to WHO criteria. For children ≥ 5 years (n = 88): BMI-Z score ≥  + 2 = obesity; ≥  + 1and <  + 2 = overweight, and for children < 5 years (n = 60): BMI-Z score >  + 3 = obesity; ≥  + 1and <  + 3 = overweight. Offspring’s overweight/obesity was compared by presence of parental pre-gestational obesity. Results: Prevalence of pre-gestational obesity was 49.3% among mothers and 25.7% among fathers. In children aged 2-to-4yrs, overall prevalence of overweight/obesity was 20.0%; being 7.7% when neither parent had obesity, 17.4% when just one parent had the condition and 54.5% when both parents were affected (p = 0.005). Among children aged 5-to-14 yrs, overall prevalence of obesity was 57.0%; 21.2% when neither parent had obesity; 34.1% when one parent was affected; and 63.6% when both parents were affected (p = 0.034). In regression analysis father’s obesity was associated with offspring obesity (OR 8.2 95%CI 2.6 to 25.6, p < 0.001) after adjustments for mother’s age and obesity and gestational weight gain. Conclusion: There is a gradual increase in the prevalence of overweight/obesity among offspring when one or both parents are affected with pre-gestational obesity. Father’s obesity had an influence on children’s overweight/obesity, independent of mother’s characteristics. These results emphasize the significance of addressing pregestational paternal obesity as a potential modifiable risk factor to reduce cardiometabolic risk in offspring exposed to gestational diabetes in uterus. (Supported by FAPESP).

OP—022 A Pilot Randomized Trial Of a Brazilian Diabetes Prevention Program Targeting Lifestyle Changes In High-Risk Individuals

Pagano R1; Ostolin TLVP1; Fonseca DC1; Marcadenti A2; Carvalho APPF3; Weber B1; Dalto C4; Lara E5; Noleto FCM6; Bressan J7; de Almeida JC8; Machado MMA9; Rogero MM10; Koller OG11; Soares RCS12; Pinto SL6; Sahade V13; Oliveira CZ1; Marcelino GW1; Trevisan CM1; Bersh-ferreira AC1

(1) Beneficência Portuguesa de São Paulo- São Paulo, SP, Brasil; (2) Hcor Research Institute, São Paulo, SP, Brasil; (3) Unidade de Hipertensão Arterial, Hospital das Clínicas da Universidade Federal de Goiás, Goiânia, GO, Brasil; (4) Departamento Ciência da Nutrição, Escola de Nutrição, Salvador, BA, Brasil; (5) Independent Researcher, São Paulo, SP, Brasil; (6) Programa de Pós Graduação em Ciências da Saúde, Curso de Nutrição-Universidade Federal do Tocantins, Palmas, TO, Brasil; (7) Graduate Program in Nutrition Science, Department of Health and Nutrition, Universidade Federal de Viçosa, Viçosa, MG, Brasil; (8) Departamento de Nutrição- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil; (9) Unidade de Hipertensão Arterial, Hospital das Clínicas da Universidade Federal de Goiás, Goiânia, GO, Brasil; (10) Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, SP, Brasil; (11) Programa de Pós Graduação em Alimentação, Nutrição e Saude, Programa de Pós Graduação em Ciências Médicas: Endocrinologia, Universidade Federal do Rio Grande do Sul, vPorto Alegre, RS, Brasil; (12) Department of Health and Nutrition, Universidade Federal de Viçosa, Viçosa, MG, Brasil; (13) Departamento Ciência da Nutrição, Escola de Nutrição, Universidade Federal da Bahia, Salvador, BA, Brasil

Diabetology & Metabolic Syndrome 2026: OP—022

Introduction: Type 2 diabetes (T2D) is increasing globally. Prediabetes, a major risk factor, is often undiagnosed and untreated. While many countries have effective national prevention programs, Brazil, despite having public policies and educational materials aligned with diabetes prevention, lacks structured implementation—highlighting the importance of this study. Objective: To evaluate the pilot Brazilian Diabetes Prevention Program (PROVEN-DIA) in improving diet quality and average physical activity time among individuals at high risk of developing T2D. Methods: In this multicenter pilot RCT, adults at high risk for T2D were randomized to an intervention or usual-care control group and followed for three months. Both groups were encouraged to improve their diet and physical activity through the same educational content, but the intervention group received it within a structured, personalized lifestyle program with regular follow-ups. Outcomes included diet quality, assessed by the Diet Quality Index Revised for the Brazilian Population (DQIR—score ranges from 0 to 100, with higher scores indicating better overall dietary quality), and weekly time spent in moderate to vigorous physical activity (MVPA). We employed a mixed-effects regression model with fixed effects for group, time, and their interaction, and adjusted for sex and research center. Results: The sample consisted of 220 participants with a mean (standard deviation) age of 48.7 (9.6) years, and women predominated (71.8%). Diet quality improved significantly in the intervention group, as reflected by higher DQIR scores (< 0.001). The intervention group increased from 62.9 (14.4) to 67.5 (14.4), while the control group decreased from 65.2 (14.54) to 62.6 (14.7). The gain in DQIR was mainly attributable to greater vegetable consumption (p = 0.014) and reductions in total saturated fat (p = 0.003) and added sugar intake (p = 0.032). These qualitative dietary improvements occurred without significant differences between groups in total energy intake or overall macronutrient distribution. No significant differences were observed between groups for weekly time spent in MVPA (p = 0.70). Conclusion: This pilot version of the Proven-Dia program showed promise for improving diet quality. However, strategies for promoting physical activity should be revisited to enhance the program’s overall benefits. Further research through a large-scale effectiveness trial is warranted to inform nationwide implementation.

OP—023 Identification of Distinct Molecular Chronotypes in Pancreatic Islet (Langerhans) Cells and Their Clinical and Pharmacological Relevance to the Understanding And Treatment of Type 2 Diabetes (T2D)

Sá, LGS1; Menezes, MCD1; Migue, RDS1; Figueiredo, DS1

(1) Faculty of Medicine, Federal University of Alagoas, Arapiraca Campus — Laboratory of Morphofunctional Research, Arapiraca, AL, Brasil

Diabetology & Metabolic Syndrome 2026: OP—023

Introduction: Chronotypes are profiles that reflect the preferred phase of the circadian clock (the ~ 24-h biological timer), shaping peaks of hormone secretion and metabolism. In pancreatic islets, hormones are secreted in opposite phases; however, whether distinct cellular chronotypes exist in the human endocrine pancreas and how they relate to type 2 diabetes (T2D) has not been established. Objective: To characterize cellular chronotypes in human islets from normoglycemic (ND) and T2D donors. Methods: We analyzed gene expression from the IMIDIA biobank (GSE76896) in islets from 68 donors (ND = 32; T2D = 36). Sampling times were reconstructed with CIRCUST, and circadian rhythmicity was estimated with the Frequency Modulated Möbius (FMM) model (R; PMIDs 37,769,026 and 31,822,685), considering genes rhythmic if R² ≥ 0.5. Cell-type deconvolution used PSEA.jar (PMID 26955841) and C8 signatures from MSigDB. Group means were compared by Student’s t test. For clinical applications, we mapped our genes to drug targets using the Therapeutic Target Database and DrugBank. Results: Distinct cellular chronotypes emerged: endocrine cells (alpha, beta, delta) were predominantly diurnal, whereas mesenchymal and endothelial compartments were nocturnal. In T2D there was a global phase delay and increased dispersion: mesenchymal 4.78 ± 0.86 h (ND) → 16.22 ± 4.74 h (Δ =  + 11.44 h) and endothelial 4.83 ± 0.87 h → 13.27 ± 5.77 h (Δ =  + 8.44 h); the standard deviation of peak times rose across compartments (e.g., mesenchymal 0.86 → 4.74 h; endothelial 0.87 → 5.77 h; alpha 3.89 → 7.92 h; beta 4.18 → 5.81 h). Mean R² declined from ~ 0.48–0.52 (ND) to ~ 0.25–0.26 (T2D; p ≤ 10⁻¹³), indicating cellular arrhythmicity and collapse of the day–night structure, consistent with altered rhythms of hormones and receptors (decreases: insulin and pancreatic polypeptide, − 1.6; increases: glucagon, + 1.3, and somatostatin receptor 2 [SSTR2], + 1.5). Pharmacological screening highlighted targets with altered circadian expression, particularly among drugs for glycemic control (51%) and diabetic neuropathy (18%). Conclusion:: We demonstrate, for the first time, distinct chronotypes in human islet cells and their impairment in T2D, characterized by phase delay and desynchronization. These findings suggest mechanistic underpinnings of the pathophysiology and support further chronopharmacology studies (timing/dose adjustments) aimed at optimizing glycemic control.

OP—024 Responses Of Moderate-Intensity Aerobic Training On Interleukin-6 Expression In Adipose And Muscle Tissue Of Obese Mice

Ribeiro, JNS1; Ribeiro, PLBS2; Junior, FFL2; Vieira, AM3; Cruz, PWS4; Vasconcelos, AR5; Soares, AHG1; Valente, VJMBS1; Vancea, DMM4; Carvalho, BM6

(1) Faculdade Pernambucana de Saúde, Recife, PE, Brasil; (2) Programa de Pós Graduação em Biologia Celular e Molecular Aplicada- Universidade de Pernambuco, Recife, PE, Brasil; (3) Laboratório de Imunometabolismo-Universidade de Pernambuco, Recife, PE, Brasil; (4) Escola Superior de Educação Física- Universidade de Pernambuco, Recife, PE, Brasil; (5) Programa de Pós Graduação em Reabilitação e Desempenho Funcional-Universidade de Pernambuco, Petrolina, PE, Brasil; (6) Instituto de Ciências Biológicas, Recife, PE, Brasil

Diabetology & Metabolic Syndrome 2026: OP—024

Introduction: Obesity is characterized by a low-grade inflammatory state, associated with increased production of pro-inflammatory cytokines, which may contribute to the development of insulin resistance. Interleukin-6 (IL-6) activity varies depending on the tissue in which it is expressed: when produced by adipose tissue, it contributes to insulin resistance; when produced by skeletal muscle during exercise, it acts as a myokine, exerting anti-inflammatory effects. Objective: The aim of this study was to analyze the response of moderate-intensity aerobic training on IL-6 expression in adipose and muscle tissue of obese mice. Methods: Ten male Swiss mice were divided into two groups: Obese Sedentary Group (OSG) and Obese Moderate Aerobic Group (OMAG). Obesity was induced through an eight-week high-fat diet (carbohydrates: 49.5%; proteins: 15.5%; lipids: 35%). The exercise protocol consisted of swimming in tanks with a diameter of 45 cm and water temperature maintained at 34 °C. The Moderate-Intensity Aerobic Training Protocol (MIATP) consisted of three sessions totaling 2 h, with four 30-min bouts interspersed with 5-min rest intervals. Following anesthesia, adipose and muscle tissues were collected for western blot analysis of IL-6 expression. Statistical analysis was performed using an unpaired Student’s t-test, adopting a significance level of p ≤ 0.05. The study was approved by the local Animal Ethics Committee under protocol nº 08/2020. Results: Analysis of IL-6 expression in adipose tissue revealed that the sedentary group exhibited significantly higher values compared with the aerobic training group (OSG 10,188.07 ± 332.10 vs. OMAG 3,077.05 ± 606.49, p = 0.00). In muscle tissue, IL-6 expression was significantly higher in OMAG compared with OSG (OMAG 19,199.50 ± 125.64 vs. OSG 13,886.00 ± 525.35, p = 0.00). Conclusion: Moderate-intensity aerobic training significantly reduced IL-6 expression in adipose tissue of obese mice. In muscle tissue, the MIATP protocol increased IL-6 expression, likely reflecting its function as an anti-inflammatory and metabolic myokine. These findings suggest that moderate-intensity aerobic training may be effective in modulating inflammation under conditions of obesity.

OP—025 A LightGBM-Powered Chatbot for Real-Time Hypoglycemia Prediction in Type 1 Diabetes: A Machine Learning Approach

Martins, LM1; Quentino, JF2; Lima, LPS1; Freitas, JPA1; Machado, MLP, MLP3; Monteiro, NC4; Gama, FG5; Silva, VDS5; Silva, DG5; Varela, MG3; Santana, NO4; Godoy, CAP1

(1) Department of Medicine, Federal University of Sergipe, Aracaju, SE, Brasil; (2) Department of Computation, Federal University of Sergipe, São Cristóvão, SE, Brasil; (3) Private practice, Aracaju, SE, Brasil; (4) Post-graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, SE, Brasil; (5) Departament of Nutrition, Federal University of Sergipe, São Cristóvão, SE, Brasil

Diabetology & Metabolic Syndrome 2026: OP—025

Introduction: Hypoglycemia affects most people with type 1 diabetes (T1D), yet current continuous glucose monitoring (CGM) systems lack reliable prediction capabilities. Machine learning offers an innovative approach to anticipate hypoglycemia using real-world CGM data. Objective: To develop a machine learning-powered chatbot integrating CGM data for hypoglycemia prediction in T1D management. Methods: We designed a chatbot integrated with a message app, powered by a LightGBM model capable of predicting hypoglycemia at 15-, 30-, 45-, and 60-min horizons. The system automatically alerts users when hypoglycemia (glucose < 70 mg/dL) is predicted. The model was trained exclusively on CGM data from 38 participants with T1D participants followed monthly for five months, without manual input. Results: Participants had a mean age of 23.66 ± 12.15 years, 67% were women, with a mean duration of diabetes of 10.2 years, a mean total daily insulin dose of 0.87 IU/kg (45.2% basal), mean glycated hemoglobin (A1c) 9,3 ± 1,7%. The LightGBM outperformed comparative models (including XGBoost), achieving 86.2% accuracy and 99.1% specificity for hypoglycemia prediction. Prediction was most accurate at 15-min horizons and during rapid glucose declines. Consistent CGM data (fewer interruptions and pseudohypoglycemias) and frequent hypoglycemia episodes further improved predictions. The chatbot interface was integrated into a mobile messaging platform, where it automatically generates hypoglycemia alerts (< 70 mg/dL) with 15-, 30-, 45-, and 60-min prediction horizons based on real-time CGM data, displaying both glucose values and recommended interventions without requiring manual user input, as shown in Fig. 1. Conclusion: The LightGBM-based chatbot demonstrated high specificity and accuracy in hypoglycemia prediction, particularly within a 15-min horizon and during rapid glucose excursions. Performance improved in users with consistent CGM data. While this machine-learning-driven approach shows promise for reducing hypoglycemia risk, further validation is needed.

Figure 1 (abstract OP—025).

The messaging interface shows an automated prediction of hypoglycemia within 15 min, generated from CGM data by the LightGBM model. Display includes current glucose and treatment recommendation.

OP—026 Comparative Evaluation of Point-of-Care (PoC) Glucometers Authorized by the Brazilian Health Regulatory Agency (ANVISA): An Analysis of Analytical Performance

Paccola, GP1; Paleari, RH1; Silva, ALQR1; Montanha, SR1; Piragine, YJ1; Zanini, JCS1; Filho,JOC1; Fava, TH1; Colombo, RNP2; Castilho, GGGR1; Crespilho, FN2; Razera, FPM1

(1) Universidade do Oeste Paulista, Jau, SP, Brasil; (2) Universidade de São Paulo, São Carlos, SP, Brasil

Diabetology & Metabolic Syndrome 2026: OP—026

Introduction: Diabetes mellitus represents a significant global health burden, and precise blood glucose monitoring is critical for optimal disease management, particularly in insulin-dependent individuals. Point-of-care (PoC) glucometers offer rapid results that facilitate timely therapeutic decisions; however, their performance must meet strict accuracy requirements. The International Organization for Standardization (ISO) 15,197:2013 establishes stringent criteria aligned with traceable laboratory methods. Nevertheless, many devices worldwide fail to meet these benchmarks, prompting Brazil’s National Health Surveillance Agency (ANVISA) to revoke several market authorizations in 2018. Objective: This study aimed to evaluate the analytical performance of three PoC glucometers currently approved by the Brazilian Health Regulatory Agency (ANVISA). Methods: Capillary and venous blood samples from 86 adults were collected at primary healthcare units in Jaú, São Paulo, Brazil. Capillary glucose was measured on-site with the three devices and compared with venous plasma glucose (reference method). Additional analyses included repeat measurements after sample storage, assessment of different reagent strip batches, and evaluation of compliance with ISO criteria. Results: All glucometers showed strong positive correlations with the reference method (Spearman’s rho: 0.813–0.843; p < 0.001), yet consistently overestimated glucose values. Bland–Altman analysis revealed systematic positive bias (mean differences: + 7.13 to + 16.31 mg/dL) and wide limits of agreement. Wilcoxon tests confirmed statistically significant differences between PoC and reference values for all devices (p < 0.0001). None achieved the ISO requirement of ≥ 95% of results within acceptable limits: compliance rates were 77.91% (Device A), 59.30% (Device B), and 58.14% (Device C). Mean Absolute Percentage Error (MAPE) ranged from 12.14% to 16.93% (Table 1). Significant variability was observed between devices (p < 0.001), between immediate and delayed measurements (p < 0.001), and among reagent strip batches (p < 0.001). Conclusion: In conclusion, despite strong correlations with laboratory values, the evaluated PoC glucometers demonstrated insufficient accuracy and substantial measurment variability, failing to meet ISO 15197:2013 standards. These findings highlight the need for cautious clinical use, ongoing regulatory oversight, and clear guidance to healthcare professionals regarding the limitations of these devices.

Table 1 (abstract OP—026).

Comparative summary of the three glucometers.

PO—003 Comparative Analysis Of Cases Of Diabetic Ketoacidosis Before And During The Covid-19 Pandemic In Pediatric Patients At a Tertiary Pediatric Hospital

Naccarato, CQ1; Junior, RDRL2

(1) Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto- Ribeirão Preto, SP, Brasil; (2) Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto- Ribeirão Preto, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—003

Introduction: Diabetic ketoacidosis (DKA) is a complication of type 1 diabetes mellitus (T1D) and may be its first clinical manifestation. DKA is the leading cause of morbidity and mortality in children and adolescents with T1D. Recently, the incidence of T1D and DKA has increased in Brazil and globally. Since viral infections are known as triggers of DKA, it is important to assess the impact of the COVID-19 pandemic on this condition. Objective: To compare pediatric hospitalizations for DKA at a tertiary hospital before and during the COVID-19 pandemic, focusing on incidence, severity, complications, and possible links to COVID-19. Methods: A cross-sectional, descriptive study reviewed 180 medical records of patients aged 0–16, hospitalized with DKA at a tertiary pediatric hospital. Data were grouped into pre-pandemic (2016–early 2020) and pandemic (March 2020–May 2023) periods and analyzed statistically. Results: 66 hospitalizations occurred pre-pandemic and 114 during the pandemic. An increase in DKA cases and in severe cases was observed, though not statistically significant. The total cases/per year are shown in the figure below Comparing the groups, there wasn’t change in the most affected sex (female), predominant age group (adolescents), and main severity of hospitalizations (moderate). There was an increase in cases of DKA in previously diabetic patients. During the pandemic, 51% of cases weren’t tested for COVID-19. Of those tested, 7 were positive (2 mild, 1 moderate, 4 severe), comprising 12% of tested cases. Only 1 case was admitted to the ICU, and none died. Five (71%) were T1D onset cases. Regarding complications, in both groups the most prevalent was hypokalemia, followed by hypophosphatemia and hypoglycemia, with no serious outcomes in any of them. The rate of cerebral edema was lower in the pandemic group. The only death occurred in the pre-pandemic group. Overall mortality was low (0.5%). Conclusion: Higher incidence rates of DKA and new cases of T1D were found during the pandemic but without statistically relevance. It wasn’t possible to associate the increased incidence or severity of DKA with COVID-19 infection. Most pandemic hospitalizations were of previously diabetic patients, suggesting management difficulties during isolation. DKA complications were similar across periods. The mortality rate was low, with no increase due to the pandemic. The study resulted in updated DKA treatment intern protocols aligned with 2022 ISPAD guidelines.

PO—004 Diabetes, Inequality and Care: A Study on the Risk of Ketoacidosis in the Public Health System of Rio de Janeiro

Costa, ASMFC1; Parreiras, JAP1; Navarro, TPRB1; Quintanilha, PHM1; Almeida, FV1; Zumpiachiatt, J1; Cabizuca, CA1; Gomes, MB1; Pedroso,JMA4

(1) Universidade do Estado do Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: P0—004

Introduction: Diabetic ketoacidosis (DKA) is a severe acute complication of type 1 diabetes mellitus (T1DM) associated with significant morbidity and frequent hospitalizations. Identifying risk factors for DKA is essential for optimizing disease management. Objective: This study aims to identify factors associated with DKA by comparing social, laboratory, adherence, and comorbidity aspects between groups with and without DKA. Methods: In a retrospective medical record analysis of 437 individuals with T1DM treated at tertiary public Diabetes center in 2024, 193 experienced DKA. The variables evaluated included self-declared ethnicity, educational level, marital status, laboratory tests, treatment adherence, and presence of comorbidities. Results: There was a predominance of young, Black/brown, and single individuals among those affected by DKA. In bivariate analysis, the average age of patients with DKA was 24 years, significantly lower than the control group (33 years; p < 0.001), reflecting vulnerability among young adults. Regarding ethnicity, 59% of cases occurred in Black individuals, highlighting the impact of social inequities. Additionally, 81% were single, suggesting a lack of family support, a well-recognized negative factor in coping with chronic diseases. In laboratory parameters, the mean glycated hemoglobin (A1c) was higher in the DKA group (9.63% vs 8.80%; p < 0.001), indicating poor glycemic control. Triglycerides (120.8 vs 99.0 mg/dL; p = 0.016) and total cholesterol (184.8 vs 170.9 mg/dL; p = 0.019) were also elevated. Multivariate analysis confirmed the association of high HbA1c with DKA (OR 1.32; 95%CI: 1.18–1.48; p < 0.001). Dietary adherence was lower in the DKA group (33.2% vs 27.2%; p = 0.047) and showed a protective effect (OR 0.73; 95%CI: 0.52–0.97; p = 0.044); recurrent hypoglycemia was more frequent in these patients (52.6% vs 47.3%; p = 0.03; OR 1.41; 95%CI: 1.03–1.94; p = 0.029). The model demonstrated good calibration (p = 0.412) and excellent discriminatory ability (AUC = 0.82), highlighting the clinical and statistical relevance of the analyzed factors. Conclusion: Integrated approaches in patient care, such as identifying vulnerability indicators and the continuous reassessment of treatment adherence in the context of each individual’s life, are necessary. Educational strategies must be personalized for better understanding, and multidisciplinary care is essential to break the cycle leading from care disorganization to clinical decompensation.

PO—005 Epidemiological Profile of Deaths from Diabetic Ketoacidosis Associated with Sepsis in Brazil, 2019–2023

Morikawa, LL1; Botelho, JG; Cendretti, GC1; Marcelino, GF1; Silva, BHCS1

(1) Universidade Nove de Julho, Guarulhos, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—005

Introduction: Diabetic ketoacidosis (DKA) is a common emergency in patients with diabetes mellitus (DM), with the main causes being: first decompensation, poor adherence to insulin therapy, infection, or acute cardiovascular events. Sepsis is life-threatening organ dysfunction secondary to a dysregulated host response to infection. The association of DKA and sepsis increases morbidity and mortality. Objective: To assess the epidemiological profile of deaths from DKA associated with sepsis in Brazil from 2019 to 2023. Methods: Cross-sectional, descriptive, and analytical study using data from the Mortality Information System (SIM/DATASUS) from January 2019 to December 2023. Inclusion criteria: deaths in which the underlying cause was “Insulin-dependent diabetes mellitus with ketoacidosis” (ICD-10 code E10.1), associated with “Sepsis, unspecified organism” (ICD-10 code A41.9). Additional associated causes, when present, and documented infectious foci were analyzed. Demographic variables extracted included sex, age, and race/skin color. Statistical analysis was performed using Jamovi for Windows (version 2.6.44.0). Results: A total of 605 deaths were identified. Age ranged from 1 to 100 years (mean 51.4 ± 21.9; median 53). There was no significant difference in age between sexes (p = 0.487) or etiological groups for associated causes (p = 0.284). Females accounted for 60.8% (n = 368). Regarding race/skin color, 48.3% were white and 39.5% mixed-race, with no significant association between etiological group and sex (p = 0.114) or race/skin color (p = 0.269). Annual deaths showed a non-significant upward trend, peaking in 2023 (n = 136; 22.5%). Documentation of the infectious focus was present in 50.1% of cases, with 2.3% occurring alongside cardiovascular events; 23% contained only the ICD-10 codes related to the inclusion criteria, and 12.9% were classified as ill-defined causes. Age distribution by etiological group is shown in Fig. 1. The infectious focus was unspecified in 49.4% of cases; among those identified, respiratory (19.8%) and urinary (17.0%) infections were the most frequent. Conclusion: The profile of deaths from DKA associated with sepsis remained stable during the study period, with respiratory and urinary tract infections as the most common documented foci. The high proportion of cases without etiological specification highlights the need to improve death certificate data recording to support more accurate epidemiological and public health strategies.

Figure 1 (abstract PO—005).

Age Distribution by Etiology Group.

PO—006 Evaluation of the Determining Factors in the Diagnosis of Diabetic Ketoacidosis in the Emergency Room

Jurno, AC1; Chevtchouk, L2; Coelho, VS3

(1) Hospital Universitário Antônio Pedro, Serviço de Endocrinologia e Metabologia, Niteroi, RJ, Brasil; (2) Faculdade de Medicina de Barbacena, Barbacena, MG, Brasil; (3) Complexo Hospitalar de Barbacena, Fundação Hospitalar do Estado de Minas Gerais, Barbacena, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—006

Introduction: Diabetic ketoacidosis (DKA) is a complication associated with type 1 (T1D) and type 2 diabetes (T2D). In adults, mortality is low but increases in the elderly with other comorbidities. Common triggering factors are inappropriate use of insulin and infections. The diagnosis is made meeting 3 criteria: high blood glucose, metabolic acidosis or low serum bicarbonate, and ketosis on blood or urine. Objective: To gather data on individuals with DKA, the causes that led to the complication, and assess compliance with diagnostic criteria. Methods: This is a descriptive, observational, retrospective study analyzing data from patients with DKA on an ER between jan-dec/2022. Medical records were selected based on on-call records and subjected to selection criteria (hypothesis of DKA; ≥ 14 y/o) and inclusion criteria (all DKA diagnostic criteria). Patient profile, test requests, and waiting time until treatment were analyzed, transcribed into a spreadsheet, and processed using statistical software. Results: 730 tables containing all admissions to the ER were submitted to selection criteria, 45 patients were selected. 7 were excluded due to incomplete data. Of the remaining 38, only 15 met the inclusion criteria. Average interval between admission and tests (or the moment DKA hypothesis was raised) was 1h46min, and between blood collection and results (or the start of appropriate treatment) was 1h06min. The absence of urine samples in 45% of patients searching for ketonuria demonstrates the lack of a targeted protocol in the unit. 66% were adults (20 to 59 y/o), and 53% were male. Although 73% had T1D, polyuria and polydipsia were present in only 1 patient, abdominal pain and vomiting in one-third, and hyperglycemia was self-reported on triage in 5 cases. Poor adherence and infectious conditions were the most common triggers (46% and 40%, respectively). Average length of hospital stay was 4.5 days, and there were no negative outcomes – the most common outcome was hospital discharge (73%), followed by interhospital transfer (20%). Conclusion: Hospitalization and mortality rates due to DKA remain high, and reflect a delayed response to a hyperglycemic crisis, resulting from staff unfamiliarity with the condition and the underappreciation of certain complaints in diabetic patients. Continuing education is necessary, and a clear care plan should be provided to facilitate diagnosis and treatment.

PO—007 Factors Associated With Diabetic Ketoacidosis Knowledge Among Individuals With Type 1 Diabetes Mellitus

Pisani, RB1; Gonzalez, VV1; Gonçalves, TG1; Siqueira, RA1

(1) Universidade Iguaçu, Nova Iguaçu, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—007

Introduction: Diabetic ketoacidosis (DKA) is a severe and preventable complication of type 1 diabetes mellitus. Proper recognition of its signs and appropriate home management are crucial to prevent progression and reduce emergency care demand. Objective: To assess the knowledge of individuals with type 1 diabetes regarding DKA and analyze whether their performance is associated with sociodemographic or clinical variables. Methods: A cross-sectional, online study was conducted with 465 individuals diagnosed with type 1 diabetes who completed a 13-item questionnaire on DKA. Responses were analyzed using the Kruskal–Wallis test and the Dwass–Steel–Critchlow–Fligner post hoc test. Results: The median number of correct answers was 6 out of 13. The highest accuracy rates were for recognizing the need for emergency care and insulin maintenance. The lowest rates were observed for knowledge of normal ketonemia values and symptoms of DKA. Participants who received medical guidance during in-office medical consultations, were treated in the private healthcare system, used an artificial pancreas (insulin pump), and presented lower glycated hemoglobin (HbA1c) levels showed better performance on the test (p < 0.01 for all). Conclusion: Guidance provided during clinical consultations (ε² = 0.175) and treatment with an artificial pancreas (ε² = 0.133) were the variables with the largest effect sizes, suggesting their greater relevance in DKA knowledge. Educational strategies aimed at reinforcing the recognition of signs and symptoms of DKA could support better understanding and potentially contribute to improved outcomes.

PO—008 Impaired Awareness of Hypoglycemia in Adults with Type 1 Diabetes Mellitus

Lima, GAB1; Prestes, R1; Almeida, SR1; Moura, IQ1; Fernandes, CR1; Medeiros, VO1; Fujita, MT1; Júnior, CRMA1; Teixeira, MS1; Silva, CMS1

(1) Universidade Federal Fluminense, Niterói, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—008

Introduction: Type 1 Diabetes Mellitus (T1DM) is characterized by autoimmune destruction of pancreatic beta cells and hypoglycemia is a serious and potentially life-threatening complication, representing a critical event that impacts both patient safety and glycemic control. Impaired Awareness of Hypoglycemia (IAH) is a syndrome characterized by a diminished or absent ability to recognize hypoglycemia symptoms, increasing the risk of severe hypoglycemic episodes. Objective: To assess the frequency of hypoglycemia (symptomatic, asymptomatic, and severe) and IAH, as well as the circumstances associated with hypoglycemic episodes. Methods: This was an observational, cross-sectional, prospective, and descriptive study conducted in a tertiary hospital involving adult patients diagnosed with T1DM. Data were collected from medical records and through the completion of hypoglycemia- and IAH-related questionnaire (Clarke questionnaire). Results: A total of 79 patients with T1DM were included, 70% of whom were female, with a mean age of 35 ± 10 years. Among the participants, 88.6% reported symptomatic hypoglycemia and 59.5% reported asymptomatic hypoglycemia. The majority (68.4%) had experienced at least one episode of hypoglycemia with significant neuroglycopenic symptoms (such as apathy, confusion, or disorientation) in the past six months, and nearly half (43.0%) had episodes involving loss of consciousness, seizures, or the need for intravenous glucose in the past year. IAH was identified in 29.1% of the participants based on the Clarke questionnaire. Nocturnal hypoglycemia was the most commonly associated scenario. No significant association was found between the presence of IAH and disease duration, insulin dose, glycemic control or presence of retinopathy. Conclusion: The high prevalence of asymptomatic, severe hypoglycemia and IAH in this population underscores the urgent need for diabetes education and highlights the importance of understanding that glycemic targets may need to be adjusted to reduce hypoglycemic episodes and their associated risks and recurrences.

PO—010 Knowledge About the Use of Glucagon for Severe Hypoglycemia in Patients with Type 1 Diabetes

Witte, BR1; Pisani, RBF1; Siqueira, RA1

(1) Universidade Iguaçu, Nova Iguaçu, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—010

Introduction: Severe hypoglycemia is a common and potentially serious complication of type 1 diabetes (T1D), requiring immediate intervention. Glucagon, a hormone counter-regulatory to insulin, is indicated in such cases and is the main out-of-hospital therapy recommended by international guidelines. However, its use is underestimated in Brazil by both patients and caregivers. Understanding the barriers to appropriate glucagon use is essential to ensure safer and more autonomous management of hypoglycemia. Objective: To assess knowledge and use of the glucagon emergency kit among T1D patients and caregivers, identifying key gaps that hinder its adoption in severe hypoglycemia. Methods: Cross-sectional study using an online questionnaire applied to 1,062 participants—599 T1D patients and 463 caregivers. The instrument assessed sociodemographic data, history of hypoglycemia, and knowledge and possession of glucagon. Statistical analysis included frequency, dispersion, and the Chi-square test (α = 0.05). Results: Among patients, 90.98% reported hypoglycemia, and 52.25% had severe episodes. Among caregivers, 66.59% reported hypoglycemia in those cared for. Still, 85.98% of patients and 85.47% of caregivers never possessed the kit. Moreover, 88.15% of patients and 75.70% of caregivers did not know how to use glucagon; 87.42% of caregivers had never received training. The main reason for not owning the kit was unawareness of its need (34.89% of patients, 23.86% of caregivers), followed by financial difficulty and lack of prescription. Conclusion: Despite frequent severe hypoglycemia in T1D, knowledge and use of glucagon remain limited. Most participants lack access or training, even recognizing its importance. The absence of prescription, education, and support reflects a gap in care. Expanding educational strategies is crucial for enhancing safety and autonomy in the management of T1D.

PO—012 Research trends in diabetes among adults aged ≥ 65 years: a scoping review of studies published 2019 – 2025

Pinheiro, LC1; Pinheiro, LC1

(1) Universidade de Fortaleza, Fortaleza, CE, Brasi

Diabetology & Metabolic Syndrome 2026: PO—012

Introduction: Adults aged ≥ 65 years now represent the fastest-growing segment of the diabetes population. Their physiological heterogeneity, multimorbidity and variable life expectancy make simple extrapolation from middle-aged cohorts unsafe, yet most landmark trials under-represent this age group. Mapping what has actually been studied is therefore essential to guide truly geriatric-focused research. Objective: To chart the volume, design and thematic focus of primary studies on diabetes in adults ≥ 65 years published between 2019 and 2025, and to pinpoint gaps in frailty reporting, hypoglycaemia end-points and inclusion of the oldest-old. Methods: A scoping review following Joanna Briggs Institute guidance systematically searched MEDLINE, Embase, Scopus and SciELO on 30 Jun 2025 for articles published between 2019 and 2025 containing keywords for diabetes and older adults. Duplicates were removed; two independent reviewers screened titles/abstracts, assessed full texts and extracted study characteristics. Results: Of 1642 records retrieved, 1 324 remained after deduplication; 188 full texts were reviewed and 95 studies met inclusion criteria. Designs were observational (46%), randomised controlled trials (29%) and qualitative or mixed-methods (25%). Research themes clustered into pharmacotherapy safety or efficacy (42%), lifestyle or rehabilitation interventions (23%), acute metabolic complications such as hypoglycaemia or ketoacidosis (11%), chronic complications and functional decline (15%), and service delivery or telehealth (9%). Only seven trials (7%) enrolled adults ≥ 85 years and deprescribing strategies appeared in five studies. Frailty indices were reported in 19% of observational papers but seldom used to stratify treatment effects; hypoglycaemia was the primary outcome in just 10% of trials despite being the leading cause of diabetes-related emergency admission in this age group. Conclusion: Contemporary literature on diabetes in older adults is expanding but remains weighted toward pharmacotherapy and under-represents the oldest-old, deprescribing, frailty-stratified analyses and functional endpoints. Future research should prioritise pragmatic trials including participants over 80, incorporate frailty status and assess patient-centred outcomes such as autonomy and quality of life.

PO—013 Metformin-associated lactic acidosis (MALA) – Much Described but Little Recognized: A Case Report

Venancio, LTCO1; Lacerda, A1; Valinhas, B1; Carvalho, PGT1

(1) Hospital Federal de Ipanema, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—013

Case Presentation: A 67-year-old female with hypertension, non-dialytic chronic kidney disease(CKD), dyslipidemia, insulin-dependent type 2 diabetes, and coronary artery disease was admitted in September 2023 with metrorrhagia after dual antiplatelet therapy. She used antihypertensives, statins, NPH insulin (15 IU nightly), and metformin 1.7 g/day. During hospitalization, she underwent gynecological investigation for abnormal uterine bleeding, but developed cardiovascular and renal complications, progressing to CKD stage 5 and starting dialysis. After stabilization, she was discharged in good condition on regular and NPH insulin. Five days post-discharge, the patient returned to the hospital with somnolence, nausea, vomiting, refractory hypoglycemia, and deterioration. Family reported she had restarted metformin without medical advice. On physical examination, she was dehydrated, drowsy, and hypotensive. Laboratory tests revealed: pH 7.26, HCO₃⁻ 7.2 mEq/L, pCO₂ 15.8 mmHg, lactate 22 mmol/L, potassium 5.6 mEq/L, without inflammatory marker elevation. Metformin-associated lactic acidosis (MALA) was suspected. The patient underwent urgent hemodialysis, IV hydration, glucose replacement, and treatment for hyperkalemia. After initial improvement, she developed severe malnutrition and multiple complications, culminating in cardiopulmonary arrest, likely from electrolyte imbalance. The patient gave her explicit written consent to publish her information in an open access jornal. Discussion: Metformin is a widely prescribed antidiabetic agent due to its efficacy and safety profile. However, in cases of accumulation—particularly in the setting of renal impairment—it can cause metformin-associated lactic acidosis (MALA), a rare yet potentially fatal condition. Inappropriate use in patients with renal dysfunction impairs hepatic lactate metabolism, leading to serum lactate accumulation. Diagnosis is based on clinical history, high anion gap metabolic acidosis, and hyperlactatemia. Management includes immediate discontinuation of metformin, early hemodialysis, bicarbonate administration in severe cases and supportive hemodynamic care. Final Comments: This case highlights the risks of inappropriate metformin use in patients with advanced renal dysfunction. Although rare, MALA carries high mortality, and early recognition and intervention are crucial for patient survival. It reinforces the importance of continuous education for patients and caregivers regarding antidiabetic use, as well as effective communication among healthcare teams during transitions of care.

PO—014 Ambulatory blood pressure monitoring in type 1 diabetes patients over 10 years of follow-up

Rodrigues, TC1; Cipriane, GD1; Wildner, JTW1

(1) Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—014

Introduction: Reducing diabetes-related complications is an essential goal in the care of type 1 diabetes subjects. Objective: to evaluate the relation between risk factors, including blood pressure (BP) levels measured with ambulatory blood pressure monitoring (ABPM), and the incidence of microvascular and macrovascular complications in outpatients with T1D. Methods: This study included patients with T1D, previous ABPM and clinic follow-up for more than 2 years. For each individual (n = 144), data on blood glucose levels, BP and dyslipidemia were collected to assess the relationship between these risk factors and diabetes- related complications. The main outcome was combined cardiovascular events (CVE): fatal and non-fatal acute myocardial infarction, fatal and non-fatal stroke, ischemic heart disease or peripheral arterial occlusive disease requiring revascularization. Results: During 10 ± 2.75 years of follow-up, individuals with higher blood glucose levels and dyslipidemia had more risk for CVE, RR 2.60 (CI 95%, 1.42–4.78) and RR 11.74 (CI 95%, 1.55–88.58), respectively. Also, 11 of 144 analyzed individuals had the main outcome and presented higher levels of BP during wakefulness compared to patients without CVE (98.3 ± 9.4 vs. 93.0 ± 8.0, p = 0.048). Furthermore, 7 patients died in follow-up and had higher levels of mean BP in 24h (97.1 ± 9.3 vs. 90.6 ± 8.0, p = 0.037), diastolic BP in 24h (80.1 ± 5.1 vs. 74.1 ± 7.6, p = 0.042), in sleep (91.3 ± 13.4 vs. 83.7 ± 9.7, p = 0.049) and in wakefulness (99.9 ± 9.1 vs. 93.0 ± 8.0, p = 0.031) compared to those who survived over 10 years. Conclusion: In this cohort, higher HbA1c levels on follow-up was the major factor associated with the development of outcomes such as cardiovascular and microvascular complications of diabetes. In addition, BP was also an important factor related to the development of these complications, especially those obtained by non-traditional office measures, with lower BP values associated with fewer diabetes complications and mortality.

PO—016 Analysis of Morbidity and Mortality Due to Diabetes Mellitus in Brazil: An Ecological Study from 2014 to 2023

Cruz, AMF1; Faria, IC1; Silva, MEB1; Souza, MRCP2

(1) Centro Universitário de Belo Horizonte, Belo Horizonte, MG, Brasil; (2) Centro de Especialidades Médicas da Santa Casa, Belo Horizonte, MG – Brasil

Diabetology & Metabolic Syndrome 2026: PO—016

Introduction: Diabetes Mellitus (DM) is among the leading causes of chronic morbidity and premature mortality in Brazil, with distributions strongly influenced by socioeconomic disparities. This ecological study examines national trends in morbidity and mortality due to DM in Brazil from 2014 through 2023, based on public data from DATASUS TabNet. Objective: To describe temporal and regional patterns of DM-related hospitalizations and mortality in Brazil between 2014 and 2023, identifying vulnerable regions and age groups. Methods: A retrospective ecological design was adopted, using aggregated data from DATASUS TabNet (SIH‑SUS and SIM systems) on hospital admissions and mortality attributed to DM (ICD‑10 codes) from 2014 to the most recent available year 2023. Rates per 100 000 population were calculated by age group (e.g. 30–69, 70 +), sex, and geographic region. Trends over time were analyzed descriptively, and regional inequalities explored through rate comparisons across North, Northeast, Southeast, South and Central‑West. Results: According to Ministry of Health bulletins, total DM-related deaths increased from approximately 55 000 in 2010 to over 75 000 in 2021; in aggregate, between 2010 and 2021 nearly 753 000 deaths were registered nationally. The North and Northeast exhibited the highest mortality rates (e.g. ≈ 34.4/100 000 in the Northeast) while the lowest rates occurred in the Central‑West (≈ 15.8/100 000 in Minas Gerais). Premature mortality (ages 30–69) declined modestly from \ ~ 34.7 to \ ~ 37 per 100 000 by 2019, but reversed from 2020 onward, likely reflecting pandemic effects on vulnerable populations. Hospitalization data show higher DM morbidity burden in North and Northeast regions, with longer length of stay and higher inpatient mortality rates compared to other areas. Reports also show that mortality is twice as high among individuals with only up to three years of formal education (≈ 59.5/100 000) compared with the total population average. Conclusion: Between 2014 and 2023, Brazil faced persistent regional and social inequalities in diabetes morbidity and mortality, with North and Northeast regions bearing a disproportionate burden. Premature mortality declined slightly until 2019 but rose after 2020, reflecting vulnerability amid the COVID-19 syndemic. Strengthened primary care, targeted prevention, and actions on social determinants are needed. Continuous DATASUS surveillance is crucial to guide policies and curb the diabetes burden.

PO—018 Arterial Pressure Behavior and Association with Vitamin D Levels in Patients with Type 2 Diabetes Mellitus and Early Stage Diabetic Kidney Disease

Lobo, BD1; Fernandes, IJ1; Figueiredo, PAB1; Felício, KM1; Motta, ARB1; Leal, VSG1; Pinheiro, DDS1; Silva, LSD1;Trindade, FMC1; Lemos, GN1; Reis, MSO1; Piani, PPF1; Felício, JS1

(1) Hospital Universitário João de Barros Barreto, Belém, PA, Brasil

Diabetology & Metabolic Syndrome 2026: PO—018

Introduction: Systemic hypertension is the main risk factor for chronic kidney disease (CKD) and often accompanies renal complications of type 2 diabetes mellitus (T2DM), associated with cardiovascular risk. The 24-h blood pressure rhythm and the progression of renal damage in Diabetic Kidney Disease (DKD) have been studied in relation to the possible role of vitamin D (VD) in structural and functional renal changes related to blood pressure control. Objective: To evaluate the association between VD levels and blood pressure in patients with early DKD. Methods: This was a cross-sectional study with 28 patients with incipient DKD (albuminuria 30–299 mg/g) and 47 with clinical DKD (albuminuria ≥ 300 mg/g), undergoing ambulatory blood pressure monitoring, with evaluation of the following parameters: Systolic (SBP) and diastolic (DBP) blood pressures, nocturnal dipping (ND), and blood pressure variability (BPV), using standard deviation (SD), coefficient of variation (CV), variance, and amplitude values. Results: Individuals with clinical DKD had a higher prevalence of chronic complications of T2DM, especially in the history of previous neuropathy. (91,5 vs 57,1%; p < 0,001) and worse glycemic control than those with IDN (160,83 ± 63,33 vs 130,68 ± 40,25mg/dL; p = 0,02). There was no significant association of 25(OH)D between the groups (30,04 ± 8,09 vs 26,61 ± 10,38 ng/mL; p = 0,13). The group with clinical DKD exhibited higher SBP while awake (138,87 ± 16,84 vs 128,14 ± 13,51 mmHg; p = 0,005), while asleep (137,83 ± 20,99 vs 121,96 ± 13,59 mmHg; p < 0,001) and in the morning (145,49 ± 18,20 vs 131,50 ± 17,73 mmHg; p = 0,02.), compared to the group with incipient DKD. In addition, lower calculated systolic ND values were found in the group with clinical DKD (0,82 ± 8,37 vs 4,70 ± 6,91 mmHg; p = 0,02). Finally, systolic BPV was higher in clinical DKD during wakefulness (Variance:274,17 ± 182,09 vs 194,7 ± 113,20 mmHg; p = 0,041) and in the morning (Amplitude:33,77 ± 21,63 vs 21,39 ± 9,02 mmHg; p = 0,005). Conclusion: The group with clinical DKD had a higher prevalence of T2DM complications, higher SBP in all periods evaluated, and higher levels of ND loss. Despite the trend toward lower VD levels, there was no significant difference. No association was observed between VD and blood pressure rhythm, suggesting no direct influence of 25(OH)D on blood pressure in this group of patients. Lower ND and higher morning pressure in clinical DKD indicated higher cardiovascular risk.

PO—022 Cardiac Autonomic Function and Loss of Protective Sensation in Individuals with Type 2 Diabetes Mellitus – A Cross-Sectional Study

Paula, AVL1; Rocha, RB1; Barros, ACS1; Miranda, MB1; Silva, BAK1; Magalhães, ATM1; Cardoso, VS1

(1) Universidade Federal do Delta do Parnaíba, Parnaíba, PI, Brasil

Diabetology & Metabolic Syndrome 2026: PO—022

Introduction: Hyperglycemia can trigger nerve degeneration, leading to sensory and autonomic function alterations, which may occur simultaneously or independently. Objective: To observe the frequency of cardiac autonomic neuropathy in individuals with type 2 diabetes mellitus, with and without loss of protective sensation. Methods: Analytical cross-sectional study approved by the Research Ethics Committee of the Universidade Federal do Delta do Parnaíba (approval number 5.104.985). Participants included individuals diagnosed with type 2 diabetes, both sexes, aged forty to seventy years. Exclusion criteria were the use of central nervous system depressant or stimulant drugs, severe cardiac diseases, and history of stroke. Evaluations were conducted in two sessions, assessing loss of protective sensation (Official Guideline of the Brazilian Diabetes Society) and cardiac autonomic neuropathy (Toronto Diabetic Neuropathy Consensus Panel). Statistical analysis was performed using GraphPad Prism 10.5.0, with a significance level set at 5% (p < 0.05). Results: Sixty-one individuals participated, twenty-four with loss of protective sensation (+ LPOS group) and thirty-seven without loss of protective sensatio (-LPOS group). The mean age was 57.63 ± 7.38 years in the + LPOS group and 56.70 ± 7.06 years in the -LPOS group (p = 0.6301). The mean duration of diabetes diagnosis was 11.93 ± 8.39 years for the + LPOS group and 9.09 ± 6.52 years for the -LPOS group (p = 0.1665). Capillary blood glucose values were 252.3 ± 94.05 mg/dL in the + LPOS group and 204.6 ± 100.7 mg/dL in the -LPOS group (p = 0.0657). No statistically significant differences were observed between the groups for the variables presented. The sex distribution did not differ significantly between groups (p = 0.1740). The initial classification of cardiac autonomic neuropathy was predominant in both groups, occurring in 62.50% (fifteen individuals) of the + LPOS group and 67.56% (twenty-five individuals) of the -LPOS group (p = 0.0552), with no significant difference between groups. Conclusion: Age, duration of diabetes, capillary blood glucose, and sex were independent variables in individuals with type 2 diabetes. The results suggest that loss of protective sensation may not be independently associated with cardiac autonomic neuropathy.

PO—024 Clinical Outcomes of Diabetes Mellitus in Brazil (2021–2024): Nationwide Analysis of Hospitalizations, Mortality and Healthcare Utilization

Godoy, BV1; Souza, PC1; Balarezo, NKG2; Rios, GR3; Barion, IR4; Rodrigues, JP5; Carvalho, MJF6; Iida, APT7; Gomes, KF8; Guilherme, ABCO9

(1) Universidade Nove de Julho, São Paulo, SP, Brasil; (2) Faculdade Santa Marcelina, São Paulo, SP, Brasil; (3) Universidade Nove de Julho, Bauru, SP, Brasil; (4) Faculdade de Medicina de Jundiaí, Jundiaí, SP, Brasil; (5) Faculdade São Leopoldo Mandic, Araras, SP, Brasil; (6) Faculdade de Minas, Belo Horizonte, MG, Brasil; (7) Faculdade de Medicina de Marília, Marília, SP, Brasil; (8) Pontifícia Universidade Católica de Campinas, Campinas, SP, Brasil; (9) Fundação Educacional do Município de Assis, Assis, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—024

Introduction: Diabetes mellitus (DM) is a group of metabolic disorders marked by chronic hyperglycemia due to impaired insulin secretion and/or action. It is highly prevalent worldwide and a growing public health challenge. Recent therapeutic advances, including antidiabetic drugs, and continuous glucose monitoring (CGM), have improved glycemic control and mitigated complications. Assessing the real-world impact of these innovations is crucial for effective public health planning and policy optimization. Objective: To analyze trends in diabetes-related mortality, hospitalizations, and outpatient visits in Brazil from 2021 to 2024, stratified by sex, age, and region. Methods: This is a descriptive epidemiological study using secondary data from Brazil’s public health database (DATASUS/TABNET). Records from 2021 to 2024 were extracted using ICD-10 codes to assess diabetes-related hospitalizations, mortality, and outpatient visits, stratified by sex, age, and region. Annual trends were evaluated using simple linear regression models, with events as the dependent variable and time as the independent variable. The coefficient of determination (R²) was reported to evaluate model fit. Results: A total of 23,035 diabetes-related deaths were reported in Brazil, declining from 6,139 in 2021 to 5,093 in 2024 (-17%), showing a consistent linear trend (R² = 0,98), with an average annual drop of 362,6 deaths. Hospitalizations rose from 129,482 to 136,583 (+ 5.5%), totaling 556,610, with a R² = 0,53. Males accounted for 52.5% of admissions. Similar to the mortality distribution, the Southeast region had the highest hospitalization rate (36%), while the Central-West showed the lowest (7%). Outpatient visits rose from 113 to 150 million, totaling 559.2 million visits (+ 32.7%). A strong upward trend was observed (R² = 0,98), and older adults were predominant: 124 million visits among those aged 60–69, and 90 million among 70–79. Conclusion: Brazil experienced a decline in DM-related mortality, a slight increase in hospitalizations, and a sharp rise in outpatient visits. While trend analysis suggests these patterns reflect the positive impact of therapeutic advances and improved disease management, interpretations must be made with caution due to the limited time series. Nonetheless, persistent demographic and regional disparities underscore the need for targeted strategies to expand outpatient infrastructure and reduce inequities in diabetes care nationwide.

PO—025 Comparative Effects And Dose–response Of Photobiomodulation With Hene 660 Nm And Gaas 904 Nm Lasers In The Repair Of Diabetic Foot Ulcers

Miranda, MB1; Barros, ACS1; Rocha, RB1; Batista, CAP1; Paula, AVL1; Barros, IGL1; Magalhães, AT1; Hazime, FA1; Cardoso, VS2

(1) Universidade Federal do Delta do Parnaíba, Parnaíba, PI, Brasil; (2) Universidade Federal do Delta do Parnaíba, Parnaiba, PI, Brasil

Diabetology & Metabolic Syndrome 2026: PO—025

Introduction: Diabetic foot ulcers are a frequent and serious complication of diabetes mellitus, associated with high morbidity, risk of amputation, and impact on quality of life. Photobiomodulation appears to be a promising tool in the tissue repair process of these lesions. However, there is still a lack of standardized ideal parameters.

Objective: To identify the effects and ideal parameterization of photobiomodulation with HeNe 660 nm wavelength in reducing the area of diabetic foot ulcers using three dosages (4/Jcm2, 8J/cm2, 12J/cm2) compared to the application of GaAs 904 nm at 10 J/cm2 in the tissue repair process of diabetic foot ulcers.

Methods: A randomized, controlled, double-blind clinical trial was approved by the Ethics Committee of the Federal University of Delta do Parnaíba (5,588,474) and ClinicalTrials (NCT05530486). Participants of both sexes, aged > 18 years, with a medical diagnosis of diabetes mellitus, and diabetic foot ulcers were included. Participants with autoimmune disease, psychiatric disorder, infected ulcer, osteomyelitis, ischemia, and/or contraindications to treatment methods were excluded. All patients received photobiomodulation and conventional therapy (Helianthus annuus vegetable oil) twice a week, on non-consecutive days, for 10 weeks. Ninety-two volunteers were randomized and distributed into four groups: (1) Control Group received GaAs 904 nm 10 J/cm2 + dressing; (GL1) HeNe 660 nm 4 J/cm2 + dressing; (GL2) HeNe 660 nm 8 J/cm2 + dressing; and (GL3) HeNe 660 nm 12 J/cm2 + dressing. The primary variable of this study was the ulcer size reduction rate. The SPSS statistical program was adopted, with a significance level of 5%. Cumulative proportion analysis with 50% cutoff points was performed.

Results: The rate of ulcer reduction was similar between the groups after 5 weeks (p = 0.2582) and 10 weeks (p = 0.1164). There was a significant reduction in ulcer size in all groups (p < 0.0001). Regardless of wavelength, all patients had a 50% reduction in wound area with energy densities between 8, 10, and 12 J/cm2. However, the HeNe 660 nm group with an energy density of 4 J/cm2 had a lower proportion of responders.

Conclusion: HeNe 660 nm (4, 8 and 12 J/cm2) and GaAs 904 nm (10 J/cm2) wavelengths promote the healing of diabetic ulcers after 10 weeks of treatment. However, the use of medium and high doses is recommended, as they showed a higher rate of responders.

PO—026 Congenital Generalized Lipodystrophy Type 1 With Severe Axonal Diabetic Neuropathy Mimicking Motor Neuron Disease

GUEDES, MKO1; Araujo, JSAJ1; Boris, NPBN1; Sa, TMST1; Quezado, GDDQG1; Flor, ACFA1; Lopes, FKMLF1; Forte, LBFL1; Filho, AECFA1; Nobrega, PRNP1; Fernandes, VOFV1; Jr, RMMJR1

(1) Universidade Federal do Ceará, Fortaleza, CE – Brasil

Diabetology & Metabolic Syndrome 2026: PO—026

Case Presentation: A 30-year-old woman with diagnosis of congenital generalized lipodystrophy type 1 (compound heterozygous AGPAT2 p.Lys216* and c.589-2A > G pathogenic variant) in the first year of life, based in the presence of hyperphagia, hepatomegaly, prominent muscles in the limbs and diabetes mellitus (A1c 12,9%). Insulin therapy was initiated at age 12 (total insulin dose of 2.8 IU/kg/day). Over time, she developed bilateral diabetic retinopathy, metabolic dysfunction-associated steatotic liver disease with advanced fibrosis (F4 on hepatic elastography), hypertriglyceridemia and low HDL cholesterol. Functionality was preserved until 2020, when progressive paresthesia and paresis emerged in the left lower limb, later involving the left upper limb, with spasticity (predominantly left-sided) and dysarthria. Neurological exam showed dysphonia, dysarthria, global hypertonia (more pronounced on the left), fasciculations in all limbs, muscle strength graded as II in the left upper limb, I in the left lower limb, and IV in the right limbs. Reflexes were brisk proximally (III) and reduced distally (I), with bilateral Babinski sign.Cranial MRI showed thick cystic lesion in the pons, measuring 1.6 × 1.0 cm, showing hypointensity on gradient-echo sequence, possibly corresponding to subacute/chronic hemorrhagic material. No other abnormalities. Electromyography of all four limbs revealed marked, length-dependent, sensorimotor axonal polyneuropathy, more severe in the lower limbs. There was also evidence of moderate, bilateral, focal demyelinating neuropathies: median nerve at the wrist (carpal tunnel syndrome, worse on the left), and ulnar nerve at the elbow (worse on the right). No evidence of myopathy or lower motor neuron disease was found. This pattern is compatible with long-standing diabetic neuropathy. The patient gave her explicit written consent to publish her information in an open access journal Discussion: Congenital generalized lipodystrophy (CGL) is a rare genetic disorder marked by a near-total absence of adipose tissue from birth. Polyneuropathy has been associated with lipodystrophic disorders, but the neuropathy reported so far in patients with CGL1 were classically less severe, mainly with sensitive symptoms like pain and paresthesia in the limbs. Final Comments: Severe axonal diabetic neuropathy mimicking motor neuron disease in the context of congenital generalized lipodystrophy type 1 (CGL1) has not been previously reported.

PO—027 Construction Of A Portable Photobiomodulation Device For Diabetic Wound Treatment

Rocha, RB1; Sá, RE1; Santos, RD1; Machado, FS1; Barros, ACS1; Araújo, AJ1; Cardoso, VS1; Filho1., JDBM

(1) Universidade Federal do Delta do Parnaíba, Parnaíba, PI, Brasil

Diabetology & Metabolic Syndrome 2026: PO—027

Introduction: Diabetic foot ulcers can reduce individuals’ functionality and increase the risk of infection, amputation, and mortality. The development of user-friendly and low-cost treatments may reduce the occurrence of related complications.

Objective: To develop a simple and low-cost photobiomodulation device for the treatment of diabetic wounds.

Methods: The device was designed using a 3D printer with PLA filament, in a pen format, containing nine 940 nm LEDs, and powered by a 9-V battery. Validation as a source of electromagnetic stimulation was performed through black body testing, circuit stress testing, battery consumption, and circuit power analysis. Validation for use in biological tissue was conducted using an in vitro methodology with an MTT assay in mouse fibroblast cells (L929) under hyperglycemic conditions. A control group with no irradiation and a treatment group irradiated with 5 J/cm2 were used.

Results: The black body test confirmed the effectiveness of the device for photoelectric stimulation, providing sufficient energy to alter the black body temperature. A first-degree temperature increase was observed at 17 s, and a second-degree increase at 43 s of irradiation. The circuit stress test demonstrated the device’s safety, recording a 6 °C temperature variation over 546 s. The battery consumption and power analysis indicated that a single battery could power the device for 960 s. The MTT assay assesses cell viability through mitochondrial activity. Accordingly, irradiation with the device showed no cytotoxic effect and resulted in an increased number of viable cells compared to the control. The analysis was performed using the Mann–Whitney test, which identified a statistically significant difference compared to the control group (p < 0.0001).

Conclusion: The device is valid as a source of electromagnetic stimulation and is suitable for use in biological tissue under hyperglycemic conditions.

PO—028 Diabetes And Diabetic Foot: Evaluation Of Hospital Costs In The Brazilian Public Health System

Cruz, AMF1; Calil, RF2; Araújo, MTO2; Souza, MRCP3

(1) Centro Universitário de Belo Horizonte, Belo Horizonte, MG, Brasil; (2) Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil; (3) Centro de Especialidades Médicas da Santa Casa, Belo Horizonte, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—028

Introduction: Diabetes mellitus (DM) is a chronic condition associated with multiple complications, among which diabetic foot stands out as a leading cause of hospitalization, amputation, and high costs in the Brazilian Public Health System (SUS). Evaluating hospital expenditures related to diabetic foot is essential for guiding preventive strategies and optimizing resource allocation.

Objective: To analyze hospital costs associated with diabetic foot in Brazil, comparing them with general diabetes-related admissions, and to assess temporal trends and regional distribution of expenditures in the SUS.

Methods: An ecological, descriptive study was conducted using data from the Hospital Information System (SIH/SUS) available on DATASUS/TABNET. Hospital admissions for DM (ICD-10 E10–E14) and diabetic foot complications (E10.5–E14.5, L97, L98.4, Z89.4) between January 2013 and December 2023 were included. Variables analyzed were number of admissions, total and average hospital costs (in BRL), and length of stay. Data were stratified by year and Brazilian region.

Results: Over the 11-year period, 1,245,380 hospitalizations for DM and 112,540 admissions for diabetic foot were recorded. Total expenditures reached BRL 2.48 billion for DM and BRL 512 million for diabetic foot, representing 20.6% of diabetes-related costs. The average cost per hospitalization for diabetic foot (BRL 4,550) was 2.3 times higher than for general DM admissions (BRL 1,980). The Southeast region accounted for 42% of admissions and 48% of total costs, followed by the Northeast. Length of stay for diabetic foot was longer (mean 11.2 days) compared to DM admissions overall (mean 6.5 days). A progressive increase in average costs was observed, from BRL 3,250 in 2013 to BRL 5,780 in 2023.

Conclusion: Hospitalizations due to diabetic foot represent a significant share of SUS diabetes-related expenditures, with higher average costs and longer hospital stays. These findings highlight the urgent need for preventive care, early detection, and multidisciplinary management strategies to reduce complications and associated costs in Brazil.

PO—030 Diabetic Retinopathy And Type Of Diabetes: Evidence Of More Advanced Forms In Patients With Type 1 Diabetes In A Public Hospital Of The Brazilian Unified Health System

Carvalho, MJF1; Santiago, LB1; Carvalho, LC2; Franco, LM2; Pereira, FB2; Rodrigues, PO3; Penaforte, CL1

(1) Faculdade de Minas, Belo Horizonte, MG, Brasil; (2) Centro Oftalmológico de Minas Gerais, Belo Horizonte, MG, Brasil; (3) Afya Faculdade Ciências Médicas de Ipatinga, Belo Horizonte, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—030

Introduction: Diabetic retinopathy (DR) is a highly prevalent microvascular complication of diabetes mellitus (DM), characterized by a functional impact and recognized as one of the leading causes of avoidable visual loss. Despite advances in diagnosis and treatment, many patients still face difficulties in accessing adequate care, which contributes to worsening the disease.

Objective: To investigate the associations between demographic and ophthalmological characteristics with the occurrence of DR and/or diabetic macular edema (DME), and the type of DM in patients treated through the Brazilian Unified Health System (SUS) at an Ophthalmology Hospital in 2023.

Methods: Electronic health records of patients treated through SUS at an Ophthalmology Hospital in 2023 were reviewed. Data were analyzed using the STATA version 14.2. The variables were characterized and adjusted for sex, ethnicity, type of DR, and presence of DME. To assess associations between categorical and the outcomes: DM type, DR, and presence of associated DME the Chi-square test and Fisher’s Exact Test were used. For quantitative variables, the Kruskal–Wallis and Mann–Whitney tests were applied. All statistical analyses were conducted using a significance level of 5%.

Results: Of the 650 patients with DR and/or DME of whom 9,8% had type 1 diabetes mellitus (T1DM) and 90.2% had type 2 diabetes mellitus (T2DM). The median age of T1DM patients was 37.5 years, while T2DM was 62 years (p < 0.0001). The median diagnosis time was longer in the T1DM group (median of 22 years, IQR: 14–27), compared to the T2DM group (15 years, IQR: 10–21; p = 0.0004). A significant difference was observed in the pattern of retinal impairment between the cohorts (p = 0.003). Patients with T1DM showed a higher frequency of isolated proliferative diabetic retinopathy (PDR) (53.1%) and PDR associated with DME (25.0%). In the T2DM group, isolated PDR was the predominant form (37.9%), followed by isolated non-proliferative diabetic retinopathy (NPDR) (26.5%). No statistically significant differences were found regarding sex (p = 0.334) or ethnicity (p = 0.198) between cohorts.

Conclusion: Patients with T1DM developed more severe forms of DR, whereas those with T2DM exhibited a greater diversity of retinal impairment. These differences may have implications for clinical management, influencing DR screening and treatment strategies according to DM type.

PO—031 Diagnostic Performance Of A Clinical Risk Score For Cardiovascular Autonomic Neuropathy In Elderly Individuals With Type 2 Diabetes

Gomes, A1; Schröder, AL1; Smith, BG1; Palma, CCSSV1; Cobas, RA1; Tannus, LRM1

(1) Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—031

Introduction: Cardiovascular autonomic neuropathy (CAN) is often underdiagnosed in clinical practice. Clinical risk score may help identify individuals at higher risk of developing CAN.

Objective: To assess the diagnostic performance of a clinical risk score for CAN in elderly patients with type 2 diabetes (T2D).

Methods: Cross-sectional study including patients with T2D (≥ 65 years) followed at a tertiary public diabetes clinic. CAN was assessed through cardiovascular autonomic reflex tests (CARTs) and defined as incipient with one and confirmed with two or more abnormal results. A clinical risk score for CAN (0–10 points) was applied, based on seven variables: diabetic retinopathy (3 points), insulin use (2), and 1 point each for glycated hemoglobin (HbA1c) ≥ 8%, resting heart rate ≥ 80 bpm, cardiovascular disease, albuminuria, and physical inactivity. A cut-off of ≥ 4 was used to identify individuals at higher risk for overall CAN. Statistical analysis was performed using Jamovi 2.6.

Results: Eighty-five T2D patients were evaluated (age 74 [69–79] years; diabetes duration 23 [15–28] years; 67.1% female). Insulin therapy was used by 63.5% of participants; HbA1c was 7.4% [7.0–8.5], 32.9% reported regular physical activity and resting heart rate was 67bpm [59–75]. Retinopathy, cardiovascular disease, and albuminuria were present in 40%, 31.8%, and 23.9% of patients, respectively. Based on CARTs, CAN was absent in 52 patients (61.2%), while 33 (38.8%) had incipient (n = 24; 28.2%) or definite CAN (n = 9; 10.6%). Of those with a clinical risk score < 4, 30 out of 38 (negative predictive value = 78.9%) had no evidence of CAN, while 8 (21.1%) were diagnosed with incipient (n = 7) or definite CAN (n = 1). In contrast, 25 out of 47 (positive predictive value = 53.2%) individuals with a score ≥ 4 had CAN (χ2 = 9.14, p = 0.003). Notably, the score demonstrated a much higher negative predictive value (96.7%) for ruling out confirmed CAN.

Conclusion: The clinical risk score demonstrated the ability to stratify risk, with a significantly lower prevalence of CAN among those with a score < 4. However, among individuals with a score ≥ 4, the score did not clearly differentiate those with and without CAN, limiting its discriminatory power in the high-risk group. This suggests it may be a useful tool to exclude CAN in low-risk individuals, potentially reducing the need for more complex testing. Further studies are needed to validate its applicability in broader populations.

PO—032 Diagnostic Value Of Heart Rate-based Methods For Detecting Cardiovascular Autonomic Neuropathy In Individuals With Prediabetes And Type 2 Diabetes

Oliveira, DPSC1; Souza, CAQ1; Facchin, AC1; Mariano, BC1; Pinto, LS1; Peçanha, T2

(1) Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil; (2) Manchester Metropolitan University, United Kingdom

Diabetology & Metabolic Syndrome 2026: PO—032

Introduction: Cardiovascular autonomic neuropathy (CAN) is a serious yet underdiagnosed complication of diabetes mellitus (DM), associated with increased cardiovascular risk and mortality. Practical, non-invasive screening tools are needed to improve early detection in clinical settings. Methods for assessing autonomic dysfunction based on heart rate recording offer a simple, non-invasive, and widely applicable alternative for detecting CAN in DM; however, their diagnostic performance needs to be verified.

Objective: To investigate the diagnostic performance of resting heart rate variability (HRV), post-exercise HRV, and heart rate recovery (HRR) in detecting CAN among individuals with prediabetes (pre-DM) and type 2 diabetes mellitus (T2DM).

Methods: Fifty adults with pre-DM or T2DM participated in the study. The presence of CAN was assessed using five standard cardiovascular autonomic reflex tests (CARTs) that measured heart rate and blood pressure responses to standing; Valsalva maneuver, deep breathing, and handgrip exercise. Participants were classified as CAN + if the cumulative score from five CARTs [each rated as normal (0), borderline (0.5), or abnormal (1)], was ≥ 2. Resting HRV was recorded for 10 min and analyzed in both the time and frequency domains. HRR and post-exercise HRV (RMSSD) were assessed after a submaximal incremental walk test. Statistical analyses included ROC curve analysis to assess diagnostic accuracy (area under the curve [AUC], sensitivity, specificity, and optimal cutoff points determined by the Youden index). Significance was set at p < 0.05.

Results: CAN was present in 58% of participants. Resting HRV indices, especially high-frequency power (HFabs), were significantly lower in the CAN + group in comparison with the CAN- group. HFabs showed the highest diagnostic value for CAN (AUC = 0.775, sensitivity = 67.9%, specificity = 86.4%). Among post-exercise metrics, HRR at 2 min (HRR2min) had the best performance (AUC = 0.672, specificity = 95.2%) but lower sensitivity. No significant differences were found in post-exercise HRV between groups.

Conclusion: Resting HRV, particularly HFabs, demonstrated superior diagnostic value for detecting CAN compared to post-exercise indices. These accessible, non-invasive measures may enhance CAN screening in individuals with pre-DM and T2DM, especially if integrated into wearable technologies.

PO—033 Effect Of High-dose Cholecalciferol On Diabetic Kidney Disease In Patients With Type 2 Diabetes And Diabetic Kidney Disease

Bezerra, IS1; Ruivo, LO1; Figueiredo, PAB1; Motta, ARB1; Leal, VSG1; Barros, MB1; Felício, KM1; Silva, LSD1; Melo, FTC1; Santos, MC1; Reis, MSO1; Lemos, GN1; Felício, JS1

(1) Hospital Universitário João de Barros Barreto, Belém, PA – Brasil

Diabetology & Metabolic Syndrome 2026: PO—033

Introduction: Diabetic kidney disease (DKD) is one of the microvascular complications of type 2 diabetes mellitus (T2DM), affecting 20% to 40% of patients with T2DM and leading to increased morbidity and mortality in these patients. In recent years, studies have shown that vitamin D (VD) plays an important role in T2DM, and reduced VD levels may be associated with its complications.

Objective: The aim of this study was to evaluate the effect of high doses of cholecalciferol on urinary albumin excretion (UACR) in patients with T2DM and DKD (albuminuria > 30 mg/g).

Methods: A 12-week prospective, randomized, double-blind, placebo-controlled study was conducted with 27 patients (placebo group = 11 patients and intervention group = 16 patients), who received 10,000 IU of cholecalciferol per day.

Results: In the intervention group, there was an improvement in VD levels (27.5 ± 8.7 vs. 67.7 ± 19.3 ng/dl; p < 0.001) and worsening of glycemic control, measured by fasting blood glucose (136.4 ± 54.4 vs. 174.0 ± 75.7 mg/dl; p = 0.034) and glycated hemoglobin (8.2 ± 1.1 vs. 9.2 ± 1.7%; p = 0.003). In addition, there was also a downward trend in UACR in the intervention group (Albuminuria Log10 = 2.1 ± 0.3 vs 1.9 ± 0.4 mg/g; p = 0.06), while this did not occur in the placebo group (Albuminuria Log10 = 1.9 ± 0.4 vs 1.8 ± 0.4 mg/g; p = 0.4).

Conclusion: Our study suggests that VD may have a possible effect on reducing albuminuria in patients with T2DM and DKD, however our sample size is still too small to consolidate our findings. Our study is still ongoing to increase the sample size and confirm our initial findings.

PO—034 Effects Of Flaxseed On Microglial Cells (bv-2) Under Hyperglycemic Conditions

Correa, DL1; Colpo, E1; Cadoná, FC1; D’Avila, CMS1

(1) Universidade Franciscana, Santa Maria, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—034

Introduction: Diabetes Mellitus, characterized by persistent hyperglycemia, is associated with metabolic dysfunction and increased oxidative stress, especially in the central nervous system. In this context, functional foods with antioxidant properties have been investigated as adjuvants in modulating cellular responses. Defatted brown flaxseed stands out for its nutritional profile, containing omega-3, fibers such as lignans, phenolic compounds, and peptides, which confer anti-inflammatory and neuroprotective properties.

Objective: To investigate the protective effect of defatted flaxseed on BV-2 cells under hyperglycemic conditions.

Methods: BV-2 cells were exposed to a concentration of 100 µM glucose and subsequently treated with aqueous extract of defatted brown flaxseed at different concentrations (50, 100, 250, 500, and 750 µg/mL) for 72 h. After this period, the MTT assay was performed to measure cell viability.

Results: As shown in Fig. 1A, exposure to high glucose resulted in reduced cell viability in BV-2 cells, indicating a cytotoxic effect in a hyperglycemic environment. However, treatment with defatted brown flaxseed extract was able to partially reverse this damage, promoting increased cell proliferation compared to the group treated only with glucose (Fig. 1B). Between concentrations of 100 µg/mL and 500 µg/mL, an improvement in viability was observed, suggesting a cytoprotective effect of the extract against glucotoxic stress. Considering that microglial dysfunction in hyperglycemic environments is associated with neuroinflammatory and degenerative processes, the results indicate that flaxseed extract can positively modulate the microglial response, favoring homeostasis and showing neuroprotective potential in dysregulated metabolic contexts.

Conclusion: Thus, this study significantly contributes to advancing knowledge on natural interventions in the neuroimmune-metabolic axis, providing a basis for the future development of preventive and therapeutic strategies to mitigate the deleterious effects of hyperglycemia on the central nervous system.

Figure 1 (abstract PO—034).

(a) Glucose control. (b) proliferation levels of BV-2 microglial cells exposed to defatted brown flaxseed extract for 72 h.

PO—035 Effects Of Optimized Therapeutic Intervention On The Pathophysiology Of Wound Healing In Diabetic Foot

Dias, MO1; Melo, AAC2; Pollis, SO3; Mendes, KSON1

(1) Universidade de Cuiabá—Cuiabá—MT—Brasil; (2) Instituto Master de Ensino Presidente Antonio Carlos—Araguari—MG—Brasil; (3) Universidade Cidade de São Paulo—São Paulo—SP—Brasil

Diabetology & Metabolic Syndrome 2026: PO—035

Introduction: Diabetic foot is a severe chronic complication of diabetes mellitus, often linked to infections, ulcerations, and a high risk of amputation. Its pathophysiology involves a persistent proinflammatory state, endothelial dysfunction, impaired angiogenesis, peripheral neuropathy, and immune and tissue repair alterations. These factors lead to delayed granulation, poor re-epithelialization, and a higher risk of infection. Optimized therapeutic interventions aim to modulate these mechanisms to improve healing and reduce long-term complications.

Objective: To analyze the effects of optimized therapeutic interventions on the pathophysiological mechanisms of wound healing in the diabetic foot.

Methods: A narrative literature review was conducted using PubMed, MEDLINE, Embase, and Cochrane, as well as specialized journals, covering 2022–2025. The descriptors “skin ulcer,” “diabetic foot,” “healing,” and “clinical management” were used for the search. Clinical trials, systematic reviews, and meta-analyses with clear results on efficacy, healing time, and amputation rates were included.

Results: Interventions such as negative pressure wound therapy (NPWT), hyperbaric oxygen therapy (HBOT), platelet-rich plasma (PRP), multimodal matrices, and low-level laser therapy, combined with strict glycemic control (HbA1c < 7), have shown greater efficacy in reducing ulcer area, accelerating healing, stimulating granulation and angiogenesis, and lowering amputation rates.

Conclusion: Optimized therapeutic interventions address the healing pathophysiology by modulating chronic inflammation, poor angiogenesis, and extracellular matrix dysfunction. Strategies such as NPWT, HBOT, PRP, and normoglycemia promote healing and prevent severe complications. The early integrated adoption of these therapies improves outcomes and prevents chronic wound progression. More robust studies and guidelines are needed to validate this approach in the early stages of treatment.

PO—037 Evaluation Of The Degree Of Diabetic Peripheral Neuropathy In A Care Group In Primary Healthcare In Northern Brazil

Oliveira, VS1; Pena, FPS1; Ferreira, DQ1; Silva, EM1; Santos, KC1; Schneider, IJC2

(1) Universidade Federal do Amapá, Macapá, AP, Brasil; (2) Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil

Diabetology & Metabolic Syndrome 2026: PO—037

Introduction: Diabetic peripheral neuropathy affects up to 50% of people with diabetes mellitus, causing foot deformities as it impacts peripheral myelinated motor fibers. This leads to changes in foot anatomy, which increases the likelihood of ulcers.

Objective: To assess the degree of diabetic peripheral neuropathy in participants of a diabetes care group.

Methods: This was a quantitative, descriptive, and cross-sectional study approved by the research ethics committee. It included participants from a research project focused on the care of people with diabetes, who were followed by a multidisciplinary team in primary healthcare in Amapá in 2023. Sociodemographic, clinical, and lifestyle data were collected. The degree of diabetic peripheral neuropathy was assessed using the Neuropathy Symptom Score (mild 3–4, moderate 5–6, severe 7–9 points) and the Neuropathy Impairment Score (mild 3–5, moderate 6–8, severe 9–10 points). Descriptive statistical analysis was performed, including absolute and relative frequencies, means, medians, standard deviations, and 95% confidence intervals for proportions and means.

Results: 44 individuals participated, predominantly women (93.2%), with an average age of 62.18 years. Most had low education (29.5% with incomplete elementary school) and a family income of 1 to 3 minimum wages (59.1%). Regarding lifestyle, 68.2% practiced physical activity. Type 2 diabetes mellitus was prevalent at 72.7%, and hypertension was associated in 65.9%. Additionally, 86.4% had been diagnosed for over 10 years. The average body mass index was 39.07 kg/m2, classifying 36.4% as obese. Biochemical parameters indicated an average fasting glucose of 176.81 mg/dL, glycated hemoglobin of 8.43%, total cholesterol of 230.78 mg/dL, HDL of 53.10 mg/dL, LDL of 132.74 mg/dL, and triglycerides of 212.77 mg/dL. The Neuropathy Symptom Score had an average of 3.45, with 36.4% of individuals being asymptomatic, 20.5% having mild symptoms, 25% moderate, and 18.2% severe. Neuropathic impairment had an average of 0.86 (95% CI: 0.25–1.47), being absent in 81.8% of participants, mild in 15.9%, and severe in 2.3%.

Conclusion: Neuropathic impairment was low, despite the participants’ high-risk profile. This highlights that follow-up by a multidisciplinary team in primary care may be a crucial protective factor to mitigate the progression of neuropathy and improve long-term clinical outcomes.

PO—038 Evaluation Of The microRNA Mir-499a Polymorphism In Patients With Diabetes And Diabetic Kidney Disease

Sella, BP1; Brito, BL1; Oliveira, BMB1; Hildebrando, I1; Zangari, MEM1; Maronezi, MG1; Frederico, RCP1; Liboni, RD1; Montemor, CN1

(1) Pontifícia Universidade Católica do Paraná, Londrina, PR, Brasil

Diabetology & Metabolic Syndrome 2026: PO—038

Introduction: Chronic hyperglycemia is the main factor responsible for the microvascular complications associated with DM. Excess glucose triggers an inflammatory state through the accumulation of substances such as advanced glycation end-products (AGEs), which lead to structural cellular modifications and the production of inflammatory cytokines. This process, initiated by cellular injury and impaired glomerular filtration, results in the development of Diabetic Kidney Disease (DKD), which in its most severe form progresses to the need for renal replacement therapy. Early diagnosis and screening methods may help reduce complications and mortality. This study proposes the investigation of genetic markers for the early detection of DKD.

Objective: To evaluate the polymorphism of microRNA-499a in individuals with type 1 and type 2 diabetes, with or without diabetic kidney disease, and to investigate potential associations between genotypes and disease presence.

Methods: A case–control study was conducted with 87 DM patients (T1DM and T2DM). DNA was extracted from saliva to analyze miR-499a genotypes (heterozygous, homozygous dominant, and homozygous recessive). Genotype distribution was compared between patients with and without DKD.

Results: Among the study population, 52.9% had type 2 diabetes. This group showed a significantly higher prevalence of DKD (84%) compared to those with type 1 diabetes (16%). Patients with cardiovascular comorbidities, under treatment with statins, multiple oral hypoglycemic agents, and antihypertensive medications, had significantly higher rates of DKD. A similar correlation was observed with abdominal circumference: patients with DKD had, on average, a 14 cm larger abdominal circumference than those without DKD. Regarding miRNA-499a, no statistically significant association was found with DKD. Although the GG genotype increased the likelihood of symmetric distal sensory-motor polyneuropathy (SDPN) by approximately threefold in the sample, this genotype did not show similar behavior in other microvascular complications.

Conclusion: No significant association was found between miR-499a polymorphism and DKD. Results may have been influenced by nephroprotective use and other pathophysiological mechanisms. Further studies in non-DM populations, with larger samples and broader biomarker panels, are needed to clarify genetic contributions to DKD.

PO—039 Evolution Of Healing Associated With The Presence Of Arteriopathy In Diabetic Wounds Treated With Photodynamic Therapy

Silva, LVO1; Rodrigues, RP1; Magalhães, FO1; Ceron, PIB1; Pelegrinelli, AC1; Junior, GT1; Martins, FPS1; Oliveira, VF1; Martins, AMNS1; Alves, NP1

(1) Universidade de Uberaba, Uberaba, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—039

Introduction: Photodynamic Therapy (PDT) is positioned as a promising alternative in the treatment of one of the most important complications of diabetes mellitus (DM), which is the appearance of ulcers. PDT has an antimicrobial effect without inducing bacterial resistance, in addition to stimulating healing and reducing costs with hospitalizations and amputations.

Objective: To evaluate the association between the presence of diabetic wound artery disease and evolution with photodynamic therapy.

Methods: Lesions classified as grade I or II and stage B or D, according to the Texas classification, were included in the study. All participants were over 18 years of age. At the beginning of the treatment, arterial doppler of the affected limb was performed. Photodynamic therapy (PDT) sessions were performed twice a week. At each visit, the lesions were photographed and measured by planimetry. The therapeutic protocol used a high-power red LED array (Lince, MMoptics, Brazil), with peak emission at 630 nm and intensity between 50 and 150 mW/cm2, positioned on the infected tissue for 10 min, after the application of the methylene blue photosensitizer. Statistical analysis was performed using SPSS software, version 25.0, using the chi-square test, with a significant level of 5%. The results were expressed as mean ± standard error of the mean (SEM).

Results: A total of 18 patients were analyzed, totaling 25 lesions, all of whom were diagnosed with type 2 diabetes mellitus. The majority were male (66.7%), with a mean age of 63.78 ± 1.87 years, performing an average of 20.76 ± 2.28 sessions of PDT. There was a reduction of 59.82 ± 7.79% of the lesions, with a mean initial area of 21.60 ± 5.58 cm2 and a mean final area of 8.30 ± 3.02 cm2. Among the wounds analyzed, 52% were associated with arteriopathy, while 44% did not have arteriopathy. There was no statistically significant association between the presence of arteriopathy and the percentage of lesion reduction (Chi2 = 5.505, p = 0.702). There was no amputation during treatment.

Conclusion: PDT is an efficient measure in the care of diabetic wounds, including those with arteriopathy. Thus, the technique has high healing rates, thus reducing the incidence of invasive procedures that, in addition to overloading the health system, also decreases the quality of life of patients.

PO—040 Exploring The Prevalence Of Eating Disorders And Influencing Factors In Type 1 Diabetes

Matsuura, FHC1; Ferreira, IF1; Jardim, JVS1; Gazolla, LG1; Maroun, LRGB1; Mansur, RP1; Paula, GGA1; Graceli, ML1; Vargas, ML1; Cabizuca, CA1; Smith, BG1; Tannus, LRM1; Menezes, NF1; Martins, ISS1; Costa, ASMF1

(1) Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—040

Introduction: The incidence of eating disorders has been increasing and may impact the management of chronic diseases such as Type 1 diabetes, which relies on lifestyle modifications, glycemic monitoring, and insulin therapy.

Objective: To evaluate the prevalence of eating disorders in Type 1 diabetes and their association with clinical and metabolic control.

Methods: Patients aged ≥ 12 years completed a clinical–epidemiological questionnaire and had laboratorial exams evaluated. Eating disorders were assessed using the Diabetes Eating Problem Survey-Revised questionnaire. This screening tool consists of 16 items rated on a Likert scale (0–5). The score ranges from 0 to 80, with a score ≥ 20 indicating a high risk of an eating disorder. Statistical analysis was performed using Jamovi 2.6. This study was conducted following the approval of the local ethics committee. All participants provided informed consent prior to their inclusion in the research.

Results: Forty individuals were evaluated, 24 (60%) female, aged 25 [18.8–34.5] years, diabetes duration of 15 [8–21] years, glycated hemoglobin (HbA1c) of 9.1% [8.1–10.7], daily insulin dose 0.8 ± 0.3 IU/Kg/day, body mass index (BMI) of 24 [21.7–28.5] kg/m2 and family income of 3,500 [2,125–5,800] BRL. 23 (59%) were physically active, 13 (32.5%) had overweight/obesity and 12 (30%) screened positive for eating disorders. Individuals at high risk had significantly higher HbA1c levels (11.0 [10.1–11.7] %) compared to those at low risk (8.3 [7.62–9.28]%); p < 0.001. Additionally, family income was significantly lower in the high-risk group (2450 [1880–4000] BRL) compared to the low-risk group (4500 [3000–6000] BRL); p = 0.017. No significant associations were observed between high risk for eating disorders and other variables, including hypertension, dyslipidemia, peripheral neuropathy and retinopathy, diabetic kidney disease, diabetes duration, overweight/obesity, insulin requirements, socioeconomic status, or self-monitoring of blood glucose.

Conclusion: In our study, we found a 30% prevalence of risk for eating disorders, which is comparable to findings from other studies. Patients at risk exhibited poorer glycemic control and lower family income. These findings highlights the importance of routine screening for eating disorders in Type 1 diabetes, as such conditions may impair metabolic management and treatment adherence and address socioeconomic disparities.

PO—041 Factors Associated With At‑risk Foot In Older Adults With Type 2 Diabetes In The Extreme South Of Bahia State

Pires, VLR1; Mourão, DM1; Passinho, RS1

(1) Universidade Federal Do Sul Da Bahia, Teixeira De Freitas, Ba, Brasil

Diabetology & Metabolic Syndrome 2026: PO—041

Introduction: Diabetes affects 589 million adults worldwide and 16.62 million in Brazil in 2024. In developing countries, up to 25% of patients present foot ulcers, usually resulting from neuropathy and peripheral arterial disease. The term “at-risk foot” refers to the presence of factors that increase the likelihood of foot lesions, such as neuropathy, deformities, poor circulation, or a history of ulcers. This assessment guides preventive measures and reduces complications.

Objective: To identify factors associated with at-risk foot in older adults with type 2 diabetes.

Methods: This was a cross-sectional analytical study including 155 older adults with type 2 diabetes, enrolled in primary health care in Itamaraju, Bahia, Brazil. Participants were assessed through structured interviews and foot clinical examination, based on the protocol of the Foot Care Interest Group Task Force of the American Diabetes Association. Associations between exposure variables (sociodemographic, clinical, and lifestyle) and the outcome “at-risk foot” were analyzed. The Mann–Whitney test was used for numerical variables, Fisher’s exact test for dichotomous categorical variables, and Pearson’s chi-square test for polytomous variables. All analyses were conducted using RStudio software. Approved by the Research Ethics Committee (CAAE: 79,286,624.4.0000.8467).

Results: The prevalence of at-risk foot was 8.67%. Older adults with at-risk foot had significantly higher age (median = 72 years; IQR = 11.0) compared to those without (median = 66 years; IQR = 8.0; p < 0.001). Body mass index (BMI) was lower in those with at-risk foot (median = 26.6; IQR = 6.57) compared to those without (median = 28.8; IQR = 6.34; p < 0.05). Living alone was more common among those with the condition (13.5%) than among those without (3.9%), while most older adults without at-risk foot lived with others (43.9%) (p < 0.05), suggesting a possible association between living alone and increased vulnerability. Additionally, 6.2% of older adults with at-risk foot had been using the same oral hypoglycemic agent for 1 to 5 months, while no cases were observed in the comparison group.

Conclusion: The analysis underscores the importance of a comprehensive approach to the care of older adults with type 2 diabetes, one that addresses not only clinical factors but also social determinants such as isolation. Investing in preventive strategies and early surveillance may contribute to reducing the risk of foot-related complications and fostering more equitable and effective care.

PO—042 Factors Associated With Peripheral Neuropathy In Patients With Type 2 Diabetes Mellitus

Maciel, JPS1; Arruda, PV1; Costa, GS1; Soares, ME1; Mello, LCQ1; Viola, LFC1; Marques, JNC1; Santi, A1

(1) Universidade Federal de Rondonópolis, Rondonópolis, MT, Brasil

Diabetology & Metabolic Syndrome 2026: PO—042

Introduction: Peripheral diabetic neuropathy (PDN) is the most common microvascular complication of type 2 diabetes mellitus (T2DM). In Brazil’s Midwest region, there is a scarcity of studies evaluating its prevalence and associated factors in secondary-level healthcare services.

Objective: This study aimed to assess the prevalence and associated factors of PDN in patients with T2DM treated at a reference center in a municipality of the Midwest region of Brazil.

Methods: A cross-sectional study was conducted with 276 T2DM patients from August 2021 to December 2023. PDN diagnosis was based on the Neuropathy Disability Score, complemented by the Neuropathy Symptom Score, Visual Analog Pain Scale, and Protective Plantar Sensitivity Test. Sociodemographic and lifestyle data were obtained through interviews, and clinical and laboratory information was extracted from medical records.

Results: Among participants, 178 were diagnosed with PDN, yielding a prevalence of 64.5% (95% CI, 58.9–70.1%). Most were female (59.0%), aged > 67 years (37.7%), and had a prolonged duration of diabetes (> 10 years in 52.3%). Poor glycemic control and sedentary lifestyle were observed in 78.9% and 85.4% of patients, respectively. In ultivariate analysis, male sex [Prevalence Ratio (PR) 1.32; 95% CI, 1.12–1.56], retirement/inactivity (PR 1.43; 95% CI, 1.11–1.85), diabetes duration > 10 years (PR 1.22; 95% CI, 1.03–1.44), sedentary lifestyle (PR 1.34; 95% CI, 1.02–1.76), peripheral arterial occlusive disease (PAOD) (PR 1.25; 95% CI, 1.08–1.46), and prior myocardial infarction (MI) (PR 1.21; 95% CI, 1.01–1.45) were associated with higher PDN prevalence.

Conclusion: The high prevalence of PDN suggests greater attention should be given to male and elderly individuals with long-standing diabetes and cardiovascular disease history. Interventions should focus on lifestyle modification, particularly increasing physical activity, and controlling cardiovascular risk factors.

PO—043 Hospitalizations For Advanced Diabetic Foot Disease: Case Volume And Total Costs In Brazil

Khouri, MFME1; Filho, ARN2; Silva, MAT1

(1) Universidade Unigranrio Afya, Rio de Janeiro, RJ, Brasil; (2) Faculdade de Ciências Médicas da Universidade Souza Marques, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—043

Introduction: Diabetic foot is a multifactorial complication of diabetes mellitus, resulting from the combined effects of peripheral neuropathy and peripheral arterial disease. This combination ultimately leads to chronic ulcerations and an increased risk of amputations. Peripheral vascular insufficiency reduces tissue perfusion, impairs wound healing, and favors bacterial colonization. These alterations contribute to a challenging clinical scenario that requires early diagnosis to prevent surgical outcomes.

Objective: To evaluate the trends in the number of hospitalizations, regional distribution across Brazil, and the total cost of treating diabetic foot complications to the public health system.

Methods: This is an ecological study analyzing hospitalizations due to diabetic foot complications in Brazil from January 2014 to December 2024, as well as their associated total cost. Data were collected from the Hospital Information System available on the website of the Department of Informatics of the Brazilian Unified Health System. The selected variables included: treatment for progressed diabetic foot, hospital admission authorization, region, year of care and total cost.

Results: During the analyzed period, 240,630 hospitalizations for diabetic foot complications were recorded, with a total expenditure of BRL 145,019,182.64. A consistent upward trend in hospitalizations was observed, with a 94.69% increase from 2014 to 2024. The only year showing a decrease was from 2019 to 2020, with a 5.86% drop; however, this did not lead to a reduction in treatment costs. The region with the highest number of cases was the Northeast (39.31%), followed by the Southeast (32.08%), North (14.19%), South (8.21%), and Center-West (6.18%).

Conclusion: The highest concentration of hospitalizations occurred in the Northeast, possibly due to socioeconomic factors and disparities in healthcare access. The 2020 decline may relate to bed prioritization for severe COVID-19 cases. The economic impact was significant, with a cumulative cost exceeding BRL 145 million to the Brazilian Unified Health System. The rising hospitalizations due to diabetic foot highlight not only the high prevalence of diabetes in Brazil but also gaps in prevention, lesion screening, and effective glycemic control in primary care.

PO—045 Impact Of Diabetes And Diabetic Retinopathy On Quality Of Life: A Study From An Urban Center In Brazil

Barbieri, VOA1; Barbieri, GA2; Araujo, PHB3; Regatieri, CVS4; Malerbi, FK5; Bahia, LR6

(1) Hospital São Julião, Campo Grande, MS, Brasil; (2) Universidade Federal de São Paulo, São Paulo, SP, Brasil; (3) Universidade Unigranrio, Rio de Janeiro, RJ, Brasil; (4) Universidade Federal de são Paulo, São Paulo, SP, Brasil; (5) Universidade Federal de São Paulo, São Paulo, SP, Brasil; (6) Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—045

Introduction: Diabetic retinopathy (DR) is one of the main microvascular complications of diabetes mellitus and a leading cause of preventable visual impairment in adults. Its consequences extend beyond vision, contributing to absenteeism, functional limitations, and reduced quality of life.

Objective: This study aimed to evaluate the association between the presence and severity of DR and quality of life in individuals with type 1 or type 2 diabetes mellitus, while also considering clinical and social variables.

Methods: A cross-sectional analysis was conducted with 600 adults in Campo Grande, Brazil, recruited from primary care units (n = 301) and a tertiary hospital (n = 299). DR was graded using retinal images captured with handheld cameras or through in-person ophthalmologic evaluations. Quality of life was assessed using the EuroQol-5D-3L and EQ-VAS instruments. Additional data included sociodemographic factors, comorbidities, and productivity loss.

Results: Patients with proliferative DR and/or diabetic macular edema presented significantly worse scores in the dimensions of mobility (p = 0.001), self-care (p = 0.017), and usual activities (p < 0.0001). They also reported higher rates of medical leave, unemployment, and early retirement due to visual problems (p < 0.0001). Severity of DR was not associated with lower EQ-5D-3L index scores, and overall quality of life did not differ significantly between healthcare levels. In multivariate analysis, the comorbidities most strongly associated with reduced quality of life were hypertension (p = 0.034), stroke (p = 0.042), chronic kidney disease (p < 0.0001), and particularly depression/anxiety (p < 0.0001).

Conclusion: These findings highlight the need for early screening and integrated care focused on frequent comorbidities in diabetes. The lack of association between DR severity and quality of life may reflect sensitivity limitations of the EuroQol instrument in capturing the full burden of visual disease. Moreover, healthcare access may act as a confounding factor, potentially leveling health-related quality of life perception between patients with mild and advanced disease. Response bias related to questionnaire administration in healthcare settings may influence how patients report their health status and thus should be also considered in the interpretation of results. Further research is needed to better capture the burden of DR.

PO—046 Impact Of Waist-to-height Ratio On Microvascular Outcomes In Patients With Type 1 Diabetes Mellitus After 10 Years Of Follow-up

Campos, GN1; Paliares, IC1; Torres, LS1; Aroucha, PMT1; Pititto, BA1; Dib, SA1; Dualib, PM1

(1) Escola Paulista de Medicina, São Paulo, SP – Brasil

Diabetology & Metabolic Syndrome 2026: PO—046

Introduction: Type 1 Diabetes Mellitus (T1DM) confers substantial risk for macro and microvascular complications such as retinopathy, nephropathy, and neuropathy, requiring accessible and efficient screening methods. Waist-to-Height Ratio (WHtR) has emerged as a predictor of progression of these outcomes in T1DM. Being a low-cost, easy-to-apply anthropometric measure, and potentially superior to BMI, validating WHtR may optimize risk stratification in these patients.

Objective: To evaluate whether WHtR can predict progression of microvascular outcomes in T1DM.

Methods: A retrospective cohort was conducted analyzing electronic medical records of patients diagnosed with T1DM for > 5 years, aged > 18, followed in a specialized tertiary outpatient clinic. Patients were divided by WHtR using the 0.5 cutoff, and from these groups microvascular complications and clinical-laboratory parameters were assessed at diagnosis and after 10 years. Student’s t-test was applied for numerical variables and Chi-square test for categorical ones. Statistical significance was set at p < 0.05.

Results: A total of 378 individuals with T1DM were included: 147 had WHtR ≤ 0.5 and 231 had WHtR > 0.5 [baseline mean age 26.2 ± 8.8 vs 29.2 ± 10.1y (p = 0.1); DM duration 22.3 ± 7.8 vs 25.3 ± 8.5y (p = 0.23)]. Baseline BMI was 21.6 ± 2.1 in WHtR ≤ 0.5 and 25.5 ± 3.6 in WHtR > 0.5 (p < 0.01). Those with WHtR > 0.5 had more dyslipidemia (p = 0.004), double diabetes (p < 0.001), hypertension (p < 0.001), greater use of oral antidiabetics (p < 0.001) and statins (p = 0.003). The WHtR ≤ 0.5 group showed lower TG/HDL ratio at baseline (p = 0.022), which persisted at 10 years (p = 0.042). Regarding complications, WHtR > 0.5 was associated with higher peripheral neuropathy rates after 10 years (p = 0.045), greater neuropathy progression (p = 0.012), and more diabetic kidney disease (p = 0.04). No difference was found in retinopathy.

Conclusion: In this 10-year retrospective cohort, WHtR > 0.5 was associated with worse microvascular complications such as peripheral neuropathy, nephropathy, and progression of neuropathy. In our tertiary care setting, central adiposity was associated with worsening of microvascular complications in T1DM.

PO—047 Importance Of Diabetic Foot Screening In The Prevention Of Diabetic Neuropathy: Epidemiological Profile Of Patients With Diabetes In A Municipality In Minas Gerais

Almeida, ND1; Almeida, ND1; Ferreira, GG2; Ferreira, GG2; Bicalho, JG2; Bicalho, JG2; Martins, IC2; Martins, IC2; Campos, LA2; Campos, LA2; Aguiar, FM2; Aguiar, FM2; Binda, NS1; Binda, NS1

(1) Universidade Federal De Ouro Preto, Ouro Preto, MG, Brasil; (2) Centro Universitário De Belo Horizonte, Belo Horizonte, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—047

Introduction: Diabetes mellitus (DM) is one of the main public health challenges, associated with high morbidity and mortality and the risk of chronic disabling complications such as peripheral diabetic neuropathy, which is an important risk factor for the development of diabetic foot, a condition associated with ulcers, infections, and amputations. Systematic screening for neuropathy, combined with annual foot assessments, is a fundamental measure for early diagnosis and prevention of the progression of complications. Primary Health Care (PHC) plays a strategic role in this process through longitudinal monitoring, health education, and the application of clinical protocols.

Objective: In this sense, the present study sought to evaluate the epidemiological profile of patients with DM in a municipality in Minas Gerais, as well as the regularity of health monitoring and the performance of annual diabetic foot assessments.

Methods: This is an observational, cross-sectional study conducted with a group of 334 patients diagnosed with DM. Clinical data and data related to regular health monitoring were collected, and the performance of annual foot examinations for screening diabetic neuropathy was verified, according to electronic medical records. Data analysis was conducted using descriptive statistics, with calculation of absolute and relative frequencies.

Results: The results, described in Table 01, show that the sample is mainly composed of patients with DM2 (95.8%), with a long diagnosis time and a low rate of regular follow-up (37.1%). Glycemic control is outside the therapeutic target in most cases, which is reflected in the high prevalence of chronic complications, especially retinopathy and neuropathy. In addition, adherence to preventive measures, such as diabetic foot examination, is extremely low, corresponding to only 4.8% of the patients evaluated.

Conclusion: The results point to significant weaknesses in the monitoring of these patients, especially regarding low adherence to annual diabetic foot examinations. The absence of this practice compromises the prevention of neuropathy and increases the risk of ulcers and amputations. This reinforces the strategic role of PHC in the organization of care, with the need to implement effective screening and regular monitoring protocols. Strengthening these actions contributes to reducing complications, improving patients’ quality of life, and lowering costs to the healthcare system.

Table 1 (abstract PO—047).

Epidemiological profile of patients diagnosed with diabetes mellitus (DM)

PO—048 Infection Rate In The Treatment Of Diabetic Wounds With Photodynamic Therapy

Silva, LVO1; Rodrigues, RP1; Magalhães, FO1; Ceron, PIB1; Peregrinelli, AC1; Junior, GT1; Martins, FPS1; Oliveira, VF1; Silva, AMN1; Alves, NP1

(1) Universidade de Uberaba, Uberaba, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—048

Introduction: Photodynamic therapy (PDT) is a therapeutic modality that combines a photosensitizer, specific light, and tissue oxygen to generate reactive oxygen species with a local cytotoxic effect, capable of eliminating microorganisms, controlling infections, and favoring tissue repair.

Objective: To evaluate the clinical and epidemiological profile of patients with diabetic wounds and to monitor the evolution of infections during photodynamic treatment.

Methods: We evaluated 18 patients with 25 lesions of grade I or II, stages B or D (Texas Classification). Cultures were collected at the beginning of treatment to identify pathogens. PDT sessions occurred twice a week, with lesions photographed and measured by planimetry at each visit. Evolution was evaluated by clinical signs, secretion, and use of medications. The therapy used a red LED array (630 nm, 50–150 mW/cm2) for 10 min after application of methylene blue. The data were analyzed using SPSS 25.0, using chi-square tests, with a significance level of 5%. Results were presented as mean ± SME.

Results: 12 men (66.7%) were evaluated, all with type 2 diabetes, with a mean age of 63.78 ± 1.87 years, performing an average of 20.76 ± 2.28 GT sessions. There was a reduction of 59.82 ± 7.79% of the lesions, with a mean initial area of 21.60 ± 5.58 cm2 and a mean final area of 8.30 ± 3.02 cm2. It was observed that 80% of the lesions had active infection at the beginning. Among them, 36% were associated with Gram-positive bacteria, 28% with Gram-negative bacteria and 16% with multiple infections. There was no association between lesion reduction and the presence of infection (Chi2 = 4.792, p = 0.309), or type of infection (Chi2 = 9.582, p = 0.653).

Conclusion: PDT proved to be effective in the management of diabetic wounds, promoting a significant reduction in the lesional area even in infected cases. In addition to enhancing healing, the technique contributes to the clinical control of infections, and can reduce the need for invasive procedures, reduce costs to the health system, and improve the quality of life of patients.

PO—049 Low Self-management And Educational Skills In People With Diabetes Mellitus In A Diabetic Foot Clinic In A Public Reference Center

Gaspar, LF1; Lopes, LSG1; Facanha, LOS2; Marinho, LGJ1; Rocha, IMA1; Amaral, LLG1; Silva, LFA3; Machado, IB2; Facanha, CFS2

(1) Centro Universitario Christus, Unichristus, Fortaleza, CE, Brasil; (2) Universidade de Fortaleza, Fortaleza, CE, Brasil;(3) Universidade Estadual Do Ceara, Fortaleza, CE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—049

Introduction: The high prevalence of diabetes-related complications and their negative impact on health outcomes constitute major challenges in the management of chronic diseases, especially in developing countries. Diabetic foot–related complications contribute to this scenario, and the effectiveness of implementing health education interventions aimed at self-care is well recognized in the literature.

Objective: To assess the clinical profile and adherence to self-care activities of patients with diabetic-related foot complications.

Methods: This was a cross-sectional study including a sample of 155 patients attending an open-access diabetic foot outpatient clinic in a public healthcare reference center in northeast of Brazil. Data was obtained through interviews and complemented with secondary data from medical records. Adherence to self-care was measured using the Summary of Diabetes Self-Care Activities Questionnaire (SDSCA), that assesses the performance of specific behavior on days per week. The scores for each item can range from 0 to 7, with higher scores indicating better adherence. The study was approved by IPADE ethic board (CAAE: 39,700,720.0.0000.5049).

Results: The mean age of the sample was 60.2 years (range: 17–85 years), and the mean duration of diabetes was 14.4 years (range: 1–40 years). Regarding educational attainment, 11% were illiterate, and 51.6% had only completed elementary school. Combined use of oral antidiabetic agents and insulin accounted for 53.3% of treatment. In the sample, 29% had a previous history of amputation, and 24% were former smokers and 2 patients were smokers. Only 37 patients had available glycated hemoglobin results, with a mean of 8.8% (SD: 1.64). Medication adherence was the most prevalent self-care activity (5.56 days/week ± 1.90 SD), while physical activity had the lowest prevalence (1.19 days/week ± 2,16SD). Regarding the foot care adherence domain, the mean was 5.13 days/week(± 2.35SD).

Conclusion: This result shows a high-risk population with low level of education, high history of tabaco use, previous amputations, and a frequent unavailability of glycated hemoglobin results that raises questions regarding proper care. Nevertheless, the patients presented a good adherence to self-care in the domains of medications and foot care, which may reflect the moment of acute disease the patients were on and the efforts for diabetes education at the reference center.

PO—050 Mortality In Long-standing Type 1 Diabetes: A Multicenter Retrospective Study In Brazil

Fassbender, IPB1; Dantas, JR1; Garcia, PM1; Costa, AH1; Sena, MCR1; Paliares, IC2; Dualib, PM2; Dib, SA2; Lauria, MW3; Zajdenverg, L1; Rodacki, M1

(1) Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (2) Universidade Federal de São Paulo, São Paulo, SP, Brasil; (3) Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—050

Introduction: Type 1 Diabetes Mellitus (T1D) is associated with increased mortality despite therapeutic advances. Chronic complications of diabetes and infections are the main causes of death, but data on Brazilian patients are scarce.

Objective: To analyze causes of death and associated risk factors in long-standing T1D patients.

Methods: Retrospective review of medical records of T1D patients with ≥ 20 years of disease duration, followed at three centers in southeastern Brazil. Causes of death were analyzed alongside clinical and laboratory data. Categorical and continuous variables were analyzed using chi-square or Fisher’s exact test, and the Mann–Whitney test, respectively, with a significance level of p < 0.05. In 2014, the 10-year cardiovascular risk (CVR) for each patient was estimated using four tools: Brazilian Diabetes Society (SBD), Brazilian Society of Cardiology (SBC), Steno Type 1 Risk Engine (ST1RE), and LIFE-T1D, to assess their mortality performance.

Results: The sample consisted of 577 patients: 55.3% female and 56% white. Mean age was 38.7 ± 10.8 years, T1D duration 28 ± 7.1 years, body mass index (BMI) 24.9 ± 4.2 kg/m2, and glycated hemoglobin (HbA1c) 8.47 ± 1.73%. There were 29 deaths (5%). Infections were the most frequently reported causes (sepsis 14%, endocarditis 7%). Other causes included cancer, diabetic ketoacidosis, acute myocardial infarction, heart failure, sudden death, and bloodstream infection (each 3%). In 55% of cases, the cause of death was unknown. Deceased patients were mostly female (p = 0.002) and had higher rates of hypertension and chronic complications such as retinopathy, nephropathy, neuropathy and peripheral arterial disease (all p < 0.001). They also had lower estimated glomerular filtration rate (eGFR) (84.3 ± 33.9 vs. 101.8 ± 21.8 mL/min, p = 0.019) and higher triglycerides (167.7 ± 167.2 vs. 87.0 ± 58.4 mg/dL, p = 0.014). Mortality was higher in those not using insulin analogs (basal analog vs. NPH, p = 0.003; fast analog vs. regular insulin, p < 0.001). No significant differences were found for age, T1D duration, BMI, HbA1c, LDL cholesterol, ethnicity, or smoking. Among the CVR tools, only the STENO score was significantly associated with mortality (p = 0.008).

Conclusion: Infections were the leading cause of death in this long-standing T1D cohort. Higher triglycerides and lower eGFR were associated with increased mortality, highlighting the impact of poor metabolic control and chronic complications. Among CVR scores, STENO had the strongest predictive value for mortality.

PO—052 Ophthalmological Evaluation Of The Effect Of Therapies With Dapagliflozin Or Glibenclamide In Patients With Type 2 Diabetes: Randomized And Controlled Clinical Trial

Fernandes, VHR1; Breder, I1; Sposito, AC1

(1) Universidade Estadual de Campinas, Campinas, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—052

Introduction: Despite technological advances, Diabetic Retinopathy (DR) remains a major cause of visual morbidity, with its prevalence expected to rise substantially in the coming decades. While glycemic control has proven effective in delaying diabetic complications, achieving and maintaining this target remains challenging in real-world clinical settings. The potential for antidiabetic agents to modulate retinal cell physiology is still largely unexplored. To date, no pharmacological therapy has demonstrated direct retinal effects capable of halting early DR progression beyond systemic metabolic control. Among emerging candidates, sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown promise for early-stage diabetic eye disease. However, large-scale trials assessing their systemic efficacy did not systematically investigate retinal outcomes. Spectral-Domain Optical Coherence Tomography (SD-OCT) enables in vivo assessment of retinal layers and early detection of diabetic macular changes. Prior studies indicate that neuroretinal thinning in central retinal thickness (CRT) may precede clinical signs of DR, highlighting its potential as a subclinical biomarker.

Objective: This study evaluated CRT variation in type 2 diabetes mellitus (T2DM) patients treated with dapagliflozin versus glibenclamide for 12 weeks.

Methods: Ninety-seven participants (mean age 57 ± 7 years) with T2DM and clinical or subclinical atherosclerosis were randomized 1:1 to dapagliflozin (10 mg/day) or glibenclamide (5 mg/day), in addition to metformin XR (1.5 g/day). SD-OCT images were acquired at baseline and post-treatment.

Results: Fasting glucose and HbA1c levels were similar between groups. No DR progression was observed. CRT increased by + 2 ± 6 μm in the dapagliflozin group and decreased by -1 ± 7 μm in the glibenclamide group (P = 0.001).

Conclusion: These findings suggest that short-term dapagliflozin therapy may exert retinal effects independent of glycemic control, supporting its potential role in early DR modulation. Further studies are warranted to confirm this hypothesis and explore SGLT2i as candidates for retinoprotective pharmacotherapy.

PO—054 Persistence Of Mauriac Syndrome In The 21st Century: Retrospective Study Of Seven Type 1 Diabetes Mellitus Patients

Schvinger, KR1; Rezende, JCA1; Magalhães, BABM1; Gabbay, MAL1; Dib, SA1

(1) Universidade Federal de São Paulo, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—054

Introduction: Mauriac Syndrome (MS) is a rare condition first described in 1930, associated with patients with long-standing type 1 diabetes mellitus (T1DM) and chronically poor glycemic control. Typical manifestations include short stature, delayed puberty, cushingoid facies, hepatomegaly, elevated transaminases, and dyslipidemia. Over the past decades, T1DM management has evolved with the introduction of new insulin formulations, advanced delivery systems, and continuous glucose monitoring technologies. Nevertheless, limited access to these resources in certain populations may still result in the occurrence of MS.

Objective: Describe the clinical characteristics, disease course, and outcomes of patients diagnosed with Mauriac Syndrome over the past seven years.

Methods: Retrospective analysis of electronic medical records from T1DM patients followed between 2019 and 2025 who fulfilled clinical criteria for MS, defined as short stature (height Z-score < –2), hepatomegaly, and poor glycemic control (HbA1c > 9%). Demographic, clinical, and laboratory parameters, along with changes observed after treatment intensification with insulin therapy and multidisciplinary team management, were assessed.

Results: Seven patients were included, with a mean age of 20.4 years (SD 5.3), mean age at T1DM diagnosis of 4 years (SD 3), and mean disease duration of 14.8 years (SD 5.7), predominantly male (85.7%). The mean HbA1c was 12.3% (SD 1.6), with an average of 8.6 diabetic ketoacidosis (DKA) episodes (SD 10.5). All patients presented short stature (mean height Z-score –2.84 ± 0.55) and a mean total daily insulin dose of 1.32 IU/kg/day (SD 0.34), of which 51.2% was basal insulin. Overall, 71% experienced at least two DKA episodes, 57.1% had diabetic retinopathy, and 42.8% had positive microalbuminuria. Following treatment optimization with intensive insulin therapy and multidisciplinary management, 6 out of 7 patients achieved improved glycemic control, with a mean HbA1c reduction of 2.3 percentage points from the first to the last year of follow-up.

Conclusion: Despite significant technological advances in T1DM care, MS persists and should be considered in the differential diagnosis of growth delay and liver abnormalities. Moreover, it is associated with an early increase in acute and chronic complications. Optimized insulin therapy from diagnosis can prevent or reverse MS, underscoring the importance of equitable access to technologies and specialized care.

PO—057 Teleophthalmology For Screening Diabetic Retinopathy In Primary Health Care In A City In The State Of São Paulo: A Cross-sectional Study

Assis, LLA1; Malerbi, FK2; Chiaroti, R1; Consoli, LMFV1; Motozo, VPP1; Junior, FB1; Oliveira, REM1,3

(1) Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brasil; (2). Departamento de Oftalmologia e Ciências Visuais da Universidade Federal de São Paulo, São Paulo, SP, Brasil; (3) Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo e Universidade de Brasilia, DF, Brasil

Diabetology & Metabolic Syndrome 2026: PO—057

Introduction: Diabetic retinopathy is one of the most common microvascular complications of diabetes, and its prevalence has increased significantly, primarily due to increased life expectancy. Screening in primary care is essential to identify and treat the disease promptly. In this scenario, teleophthalmology has proven to be a resolute, accessible, and cost-effective model for reducing irreversible ocular damage.

Objective: To estimate the prevalence of diabetic retinopathy among individuals taking insulin who attend primary healthcare in the municipality of Jardinópolis, São Paulo state, Brazil.

Methods: Cross-sectional study with a probabilistic sample of 152 participants. Data collection was carried out through interviews, laboratory blood and urine tests, and fundoscopy with a portable retinal camera attached to a device connected to a smartphone. The captured images were automatically analyzed using deep learning algorithms to classify retinal changes and diabetic retinopathy.

Results: The prevalence of diabetic retinopathy was estimated to be 28.3% (95%CI 21.1–35.4), with most of the cases corresponding to mild non-proliferative diabetic retinopathy (65.1%). No association was found between diabetic retinopathy and the variables investigated. Concordance test between self-reported and diagnosed diabetic retinopathy showed a Kappa coefficient of 0.30 (95%CI, 0.13 – 0.47), in which 16.5% of the participants reported having no diabetic retinopathy despite being diagnosed as having it. However, 9.9% of the participants self-reporting having diabetic retinopathy were not diagnosed with it.

Conclusion: The prevalence of diabetic retinopathy is within the national range. The lack of knowledge on the diagnosis of diabetic retinopathy and aspects related to such a complication of diabetes was found to be worrying. Therefore, one highlights the importance of primary healthcare programs in promoting comprehensive care to diabetic individuals, including ocular health.

PO—059 The G Allele Of The Mmp9 Rs17576 Polymorphism Is Associated With A Protective Effect Against Microvascular Complications In Type 2 Diabetes Mellitus Patients

Brondani, LA1; Favieiro, JP1; Assmann, MS1; Dieter, C1; Crispim, D1

(1) Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—059

Introduction: Matrix metalloproteinase 9 (MMP-9) is a zinc-dependent endopeptidase that remodels the extracellular matrix, alters basement membranes, and participates in processes such as angiogenesis and inflammation in diabetes mellitus. Hyperglycemia-induced oxidative stress and inflammation increase MMP-9 levels. Diabetic retinopathy (DR) and diabetic kidney disease (DKD) are influenced by genetic factors, including MMP9 variants. Such polymorphisms may drive inflammation, structural kidney changes, and contribute to DR and DKD development.

Objective: To evaluate the association between rs17576 A/G polymorphism in the MMP9 gene and T2DM complications.

Methods: This case–control study was conducted as follows. For DKD, 590 individuals were included and divided into two groups: 413 patients with T2DM and severe DKD, and 177 participants with more than 10 years of T2DM and no history of DKD. For DR, 555 individuals were included and divided into two groups: 369 patients with T2DM and DR, and 186 participants with more than 10 years of T2DM and no history of DR. The study was approved by the Research Ethics Committee of HCPA (protocol number AGHUSE 20230159). The rs17576 A/G polymorphism in the MMP9 gene was genotyped using a TaqMan allele discrimination assay via real-time PCR.

Results: The genotypic frequencies of rs17576 A/G polymorphism in the MMP9 gene were in Hardy–Weinberg equilibrium (p > 0.05) in the control group. In DKD, the frequency of the G/G genotype was 10.7% in patients with T2DM and severe DKD and 14.1% in the control group (p = 0.003). For DR, the frequency of the G/G genotype was 10.8% in patients with T2DM and DR, and 19.4% in the control group (p = 0.017). In the recessive inheritance model, there was a 64% protection against the development of DR (OR [95% CI] = 0.358 [0.960 – 1.205], p = 0.001), which remained significant after adjustment for sex, ethnicity, glycated hemoglobin, and arterial hypertension.

Conclusion: The presence of the G allele of the rs17576 A/G polymorphism in the MMP9 gene is associated with protection against the development of DKD and DR in patients with T2DM; however, further studies in other populations are needed to confirm this finding.

PO—060 The Prevalence Of Cognitive Decline In Individuals With Type 2 Diabetes Mellitus Followed In Primary Health Care: Association With Other Complications

Matos, MR1; Carvalho, JX2; Borges, MLP3; Novaes, F4; Malerbi, F4; Lannes, M5; Oba-Shinjo, SM1; Nohmi, RL1; Guedes, BF1; Camargo, MVOZ1; Brucki, SMD1; Correa-Giannella, ML1; Marie, SKN1

(1) Faculdade De Medicina Da Universidade De São Paulo, São Paulo, SP, Brasil; (2) Universidade Nove De Julho, São Paulo, SP, Brasil; (3) Campos Do Jordão, São Paulo, SP, Brasil; (4) Universidade Federal De São Paulo, São Paulo, SP, Brasil; (5) Campos Do Jordão, Campos Do Jordão, SP- Brasil

Diabetology & Metabolic Syndrome 2026: PO—060

Introduction: Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease associated with multiple microvascular and microvascular complications, impacting morbidity and mortality in this population. Diabetic retinopathy, diabetic kidney disease, diabetic peripheral neuropathy, cardiovascular autonomic neuropathy, and diabetic encephalopathy, which increases the risk of cognitive decline, are among these diabetic complications. There is a scarcity of epidemiological data on the prevalence ofdiabetic complications and the presence of cognitive decline in T2DM in primary health care. Although the investigation of diabetes and its complications is among the main indicators of the Ministry of Health and state and municipal health protocols, they are poorly investigated in primary health care.

Objective: The present study proposes to identify cognitive decline and evaluate their correlation with the prevalence of chronic complications of DM2 in individuals monitored in primary health care, in Basic Health Units in São Paulo—SP, Vitória da Conquista—BA and Campos do Jordão—SP.

Methods: The evaluation of the 4 diabetic complications and the cognitive decline was performed at time (0) and is being performed 2 years later.

Results: This is a multicenter study in which 1,727 individuals with DM2 were treated between July 2023 and June 2025, 63% women, 49.1% white ethnicity (self-reported), diabetes time of 10 ± 8.91 (mean and standard deviation) years, glycemic control (HbA1c) performed annually in only 67% at the beginning of the study increased to 99.28%, while the performance of microalbinuria control to detect diabetic kidney disease increased from 16.6% to 95.28%. Regarding diabetic complications: 11.2% Diabetic retinopathy (using a portable fundus camera), 14.41% diabetic kidney disease (using CKD-EP), 26.34% diabetic peripheral neuropathy (neuropathic symptom score and Semmes-Weintein monofilament), 9.66% cardiovascular autonomic neuropathy (spectral analysis and Ewing tests) and 11.75% cognitive decline (using Minimental). Negative binomial regression (MMSE errors) was analyzed to verify the correlation of demographic and clinical characteristics with cognitive decline in the population of São Paulo—SP.

Conclusion: The high rates of complications observed in primary care make it extremely important to identify under-researched diabetic complications and develop strategies for their management, promoting health and preventing them through health education for professionals and patients.

PO—062 Trends In Hospitalizations For Complicated Diabetic Foot In Espírito Santo Between 2020 And 2024: A Retrospective Analysis Of Hospital Data

Marchiori, FW1; Dias, HAC1

(1) Faculdade Brasileira de Cachoeiro, Cachoeiro de Itapemirim, ES, Brasil

Diabetology & Metabolic Syndrome 2026: PO—062

Introduction: Complicated diabetic foot represents one of the most severe complications of diabetes mellitus, characterized by ulceration, infection, and/or destruction of deep tissues. This condition is responsible for significant morbidity and mortality and constitutes one of the leading causes of non-traumatic lower limb amputation worldwide. It is estimated that up to 25% of individuals with diabetes will develop foot ulcers during their lifetime, and approximately half of these cases result in hospitalization.

Objective: This study aims to describe the trends in hospitalizations for the treatment of complicated diabetic foot in the state of Espírito Santo between 2020 and 2024.

Methods: This is an ecological, descriptive, and retrospective study, based on secondary data from the Brazilian Unified Health System Hospital Information System (SIH/SUS). The variable analyzed was the annual number of hospitalizations for complicated diabetic foot treatment, considering hospitalizations in Espírito Santo from 2020 to 2024.

Results: A total of 2,425 hospitalizations were recorded, with 291 in 2020, 448 in 2021, 616 in 2022, 639 in 2023, and 431 in 2024. There was a progressive increase from 2020 to 2023, totaling a growth of 119.6%, followed by a reduction of 32.6% in 2024. Previous studies suggest that the increase in hospitalizations may be related to failures in screening and early management of foot lesions, while the subsequent decline may reflect the adoption of preventive measures, changes in care pathways, or administrative factors related to data recording.

Conclusion: During the analyzed period, there was a trend of increasing hospitalizations for complicated diabetic foot until 2023, with a decrease in the final year of the series. The study exclusively used secondary data, without clinical or etiological detail, which limits the ability to establish direct causal relationships. Nonetheless, the results reinforce the need to strengthen prevention strategies, healthcare team training, and regular monitoring of diabetic patients’ feet, aiming to reduce severe complications, amputations, and prolonged hospital stays.

PO—063 The Beneficial Impact Of Curcuma Longa On Endothelial Glycocalyx, Matrix Metalloproteinases, And Redox-sensitive Biomarkers In Type 2 Diabetes Mellitus

Viudes, DR1; Mateus, AR2; Silva, CA2; Franco, MC3

(1) Universidade Federal de São Paulo, Programa de Pós graduação em Medicina Translacional, São Paulo, SP, Brasil; (2) Universidade Estadual Paulista, Araçatuba, SP, Brasil; (3) Universidade Federal de São Paulo, Departamento de Fisiologia, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—063

Introduction: Type 2 Diabetes Mellitus (T2DM) is characterized by chronic hyperglycemia, insulin resistance, and a persistent state of inflammation and oxidative stress, which contribute significantly to microvascular complications. The endothelial glycocalyx (EG), a crucial protective layer on the vascular endothelium, is often compromised in T2DM, leading to increased vascular permeability and dysfunction. Curcuma longa and its active compound, curcumin, possess well-documented anti-inflammatory and antioxidant properties.

Objective: To evaluate the specific beneficial effects of Curcuma longa extract (CLE) supplementation on plasma biomarkers related to endothelial glycocalyx integrity, matrix metalloproteinase activity, and key redox-sensitive and inflammatory signaling pathways in adult patients with T2DM.

Methods: This is a randomized controlled study involving 76 adult participants with T2DM, randomized to receive either CLE supplementation (1,200 mg/day) (n = 46) or placebo (n = 30) for three months. Plasma levels of hyaluronic acid (HA), syndecan-1 (SDC1), syndecan-4 (SDC4), matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), thioredoxin-1 (Trx1), thioredoxin-binding protein-2 (TBP2), sirtuin-1 (SIRT1), nuclear factor erythroid 2–related factor 2 (Nrf2), and the p65 subunit of nuclear factor kappa B (NF-κB p65). Baseline and post-intervention (3 months) levels were evaluated.

Results: After three months of intervention, the CLE group demonstrated significant reductions in plasma levels of SDC1, SDC4, and HA, indicating improved endothelial glycocalyx integrity. These improvements were accompanied by significantly lower circulating levels of both MMP-2 and MMP-9 in the CLE group. Furthermore, CLE supplementation led to a significant increase in plasma Trx1, SIRT1, and Nrf2 levels, and a significant reduction in TBP2 and NF-κB p65 subunit concentrations.

Conclusion: The findings suggest that CLE supplementation modulates critical plasma biomarkers associated with endothelial glycocalyx degradation, matrix remodeling, and cellular redox and inflammatory signaling in adult patients with T2DM. This important impact, particularly the restoration of endothelial integrity and the activation of endogenous antioxidant and anti-inflammatory pathways, underscores the promising role of Curcuma longa as an adjunctive therapeutic agent to reduce vascular complications and improve overall metabolic health in T2DM.

PO—064 Association Between Oxidative Stress Markers And Fasting Glucose Levels In Military Police Officers

Nascimento, VL1; Perufo, VF1; Parcianello, BD1; Camargo, YA1; Menezes, CR1; D’Ávila, CMS1; Cadoná, FC1; Schuch, NJ1

(1) Universidade Franciscana, Santa Maria, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—064

Introduction: Oxidative stress is related to insulin resistance and diabetes mellitus. Among military police officers, occupational and lifestyle factors can impact glucose metabolism and redox balance.

Objective: To evaluate the association between oxidative stress markers and fasting glucose in military police officers from the central region of Rio Grande do Sul, Brazil.

Methods: A cross-sectional study was conducted with 73 military police officers. Sociodemographic, anthropometric data, fasting glucose, and oxidative stress markers—nitric oxide (NO, μM) and DCFH-DA (relative fluorescence)—were collected. Glucose was classified as normal (< 100 mg/dL) or elevated (≥ 100 mg/dL). Mann–Whitney test, ANCOVA adjusted for age, sex, and BMI, Spearman correlation, linear regression, and odds ratio (OR) by Fisher’s exact test (p < 0.05) were used.

Results: The sample had a predominance of males (78.1%) and a mean age of 38.37 ± 6.48 years. Mean values were: glucose 93.64 ± 9.68 mg/dL, nitric oxide 0.22 ± 0.16 μM, and DCFH-DA 27,965.95 ± 5,340.89. There was a weak positive correlation between glucose and nitric oxide (r = 0.276; p = 0.0932) and a weak negative correlation with DCFH-DA (r =  − 0.174; p = 0.2967), without statistical significance. In the Mann–Whitney test, nitric oxide was higher in elevated glucose (0.29 vs. 0.16 μM; p = 0.048), with borderline significance after adjustment (p = 0.052). DCFH-DA did not differ between groups (p = 0.148; adjusted p = 0.550). Spearman correlations showed no significant association between glucose and nitric oxide (ρ = 0.215; p = 0.196) or DCFH-DA (ρ =  − 0.271; p = 0.100). In linear regression, nitric oxide showed a non-significant positive association (simple β =  + 19.07; p = 0.093; multiple β =  + 15.34; p = 0.192). Median analysis showed no increased risk of elevated glucose for high nitric oxide (OR = 3.38; p = 0.604) or high DCFH-DA (p = 0.105).

Conclusion: Military police officers with elevated fasting glucose showed higher nitric oxide levels, suggesting a possible relationship between oxidative stress and glycemic alterations. Although not statistically significant in other analyses, the findings highlight the importance of monitoring these markers in the metabolic follow-up of this population.

PO—065 Cardiometabolic Profile And Cardiovascular Risk Factors In A Community-based Screening In São Paulo: Insights From 2024 “World Heart Day Campaign”.

Pineda-Wieselberg, RJ1; Carvalho, ACBC1; Kitamura, LCS1; Rodrigues, C1; Alves, J1; Miranda, AP1; Yoshimura, L1; Canon, VLP1

(1) Associação de Diabetes Juvenil, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—065

Introduction: Cardiovascular diseases (CVD) and diabetes mellitus (DM) are major causes of morbidity and mortality. Early detection of risk factors in community settings supports targeted prevention. Large-scale, real-world screening can inform public health interventions.

Objective: To describe the clinical and biochemical profile of adults screened during the 2024 World Heart Day in São Paulo, comparing those with and without self-reported DM and exploring associations with CVD.

Methods: Cross-sectional study of 560 adults screened in 2024. Data included demographics, self-reported diagnoses, medication use, smoking, and CVD history. Blood pressure, capillary glucose, and lipid profile were measured on-site. Continuous variables were compared with Welch’s t-test, categorical with chi-square, and CVD associations assessed by logistic regression (p < 0.05).

Results: DM prevalence was 17.5% (n = 98). DM participants were older (60.6 ± 11.1 vs. 50.0 ± 15.5 y, p < 0.001), had higher systolic BP (135.4 ± 18.6 vs. 130.1 ± 19.4 mmHg, p = 0.013), glucose (168.7 ± 74.7 vs. 130.6 ± 42.3 mg/dL, p < 0.001) and triglycerides (188.4 ± 74.5 vs. 167.8 ± 83.2 mg/dL, p = 0.017). No differences in diastolic BP, total cholesterol, LDL, or HDL. Among non-DM, 5.0% had glucose ≥ 180 mg/dL, suggesting undiagnosed DM. LDL ≥ 130 mg/dL occurred in 32.0% overall; LDL ≥ 70 mg/dL in 81.2% of DM. Logistic regression identified older age (OR 1.12; 95%CI 1.03–1.22), hypertension (OR 9.20; 95%CI 0.98–85.9) and lower triglycerides (OR 0.98; 95%CI 0.97–1.00) as independent correlates of CVD..

Conclusion: Screening revealed high prevalence of risk factors, with strong links between DM, hypertension, and CVD. The inverse association between triglycerides and CVD likely reflects reverse causality and treatment effects—patients with CVD often adopt lifestyle changes or receive lipid-lowering therapy. This cross-sectional design limits causal inference, and the small number of CVD cases may affect stability. Integrated community screening combining biochemical and clinical assessment may enhance early detection and intervention in high-risk groups.

PO—066 Cardiometabolic Profile, Abdominal Obesity, And Metabolic Alterations In Military Police Officers Of Rio Grande Do Sul

Nascimento, VL1; Perufo, VF1; Parcianello, BD1; Camargo, YA1; Tomazi, AB1; Menezes, CR1; Santos, BM1; Correa, DL1; Schuch, NJ1

(1) Universidade Franciscana, Santa Maria, RS – Brasil

Diabetology & Metabolic Syndrome 2026: PO—066

Introduction: General and abdominal obesity have been increasing globally, posing a significant public health challenge. Body mass index (BMI) and waist circumference are key markers for cardiometabolic risk. Evaluating these parameters in specific groups, such as Military Police officers, supports preventive strategies.

Objective: To describe the cardiometabolic profile, prevalence of abdominal obesity, and glycemic and lipid alterations in Military Police officers from the central region of RS.

Methods: A cross-sectional study was conducted with 73 Military Police officers. Sociodemographic, anthropometric (BMI, waist circumference), fasting blood glucose, and lipid profile (total cholesterol, HDL, and triglycerides) data were evaluated. Abdominal obesity was defined according to WHO criteria (≥ 94 cm for men; ≥ 80 cm for women), altered blood glucose according to the American Diabetes Association (≥ 100 mg/dL), and dyslipidemia according to the Brazilian Society of Cardiology (2022).

Results: The sample was predominantly male (78.1%), with a mean age of 38.37 ± 6.48 years, mean BMI of 28.46 ± 3.47 kg/m2, and mean waist circumference of 92.66 ± 21.51 cm. Mean values were: fasting glucose 93.64 ± 9.68 mg/dL; total cholesterol 192.87 ± 39.36 mg/dL; HDL 44.48 ± 9.53 mg/dL; triglycerides 121.85 ± 45.09 mg/dL; systolic blood pressure 124.78 ± 10.29 mmHg; diastolic blood pressure 77.63 ± 11.14 mmHg. Significant correlations included: age–glucose (r = 0.324; p = 0.044), age–triglycerides (r = 0.533; p < 0.001), BMI–waist circumference (r = 0.497; p < 0.001), and waist circumference–total cholesterol (r = 0.474; p = 0.002). No significant differences were observed between groups with normal and elevated glucose levels or between sexes, although age (p = 0.0598) and glucose (p = 0.0569) showed a trend. Among men, notable correlations included BMI–waist circumference (r = 0.500; p < 0.001), waist circumference–total cholesterol (r = 0.474; p < 0.01), and age–triglycerides (r = 0.533; p < 0.001); among women, BMI–waist circumference (r = 0.630; p < 0.05).

Conclusion: The profile found indicates a high cardiometabolic risk, reinforcing the need for preventive actions and health promotion in this population.

PO—067 Clinical And Functional Repercussions Between Diabetic And Non-diabetic Individuals After Stroke

Moreira, MCM1; Pinto, EB1

(1) Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil

Diabetology & Metabolic Syndrome 2026: PO—067

Introduction: Stroke is one of the leading causes of death, disability, and dementia worldwide. Individuals with diabetes are at increased risk of stroke and often present worse outcomes, especially due to alterations in small cerebral vessels.

Objective: To identify whether there are differences in sociodemographic and clinical characteristics between diabetic and non-diabetic patients after stroke admitted to a Stroke Unit.

Methods: This was an analytical, cross-sectional observational study conducted with patients hospitalized with ischemic stroke in a Stroke Unit. Primary data were obtained from the cohort “Functional outcomes in individuals after stroke” (CAAE 78442724.0.0000.5544). Sociodemographic information (age, sex, education, income) and clinical data extracted from medical records (length of hospital stay, stroke type, comorbidities) were collected, and the following scales were applied: the National Institutes of Health Stroke Scale (NIHSS) to assess stroke severity, the Modified Rankin Scale (mRS) to measure functional disability, and the Hospital Mobility Scale (HMS) to analyze mobility restrictions. After univariate analysis, variables with p < 0.20 were included in a multivariate model.

Results: The sample consisted of 100 patients, 35 in the diabetic group and 65 in the non-diabetic group, with similar median age between groups. After multivariate analysis adjusted for age, variables that remained associated with the diabetic group after stroke were hypertension (OR: 8.59; 95%CI: 2.01–62.08; p = 0.011), greater mobility impairment (OR: 1.15; 95%CI: 1.03–1.29; p = 0.013), and presence of dyslipidemia (OR: 4.65; 95%CI: 1.36–17.64; p = 0.017).

Conclusion: Among individuals admitted to a Stroke Unit in a public hospital, those with diabetes had a higher prevalence of hypertension, dyslipidemia, and greater in-hospital mobility impairment compared to non-diabetic individuals.

PO—068 Impact Of Type 2 Diabetes Mellitus On The Outcomes Of Cardiopulmonary Arrest In Emergency Care Services In Bauru, São Paulo

Pinto, NC1; Netto, AS1; Albuquerque, WL1; Negrato, CA1; Alencar, JCG1

(1) Universidade de São Paulo- Faculdade de Medicina de bauru, Bauru, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—068

Introduction: Type 2 diabetes mellitus (T2DM) is a multifactorial disease characterized by chronic hyperglycemia secondary to peripheral insulin resistance. It is well established that T2DM is associated with a significantly increased cardiovascular risk, including the occurrence of myocardial infarction. Cardiac arrest (CA), in turn, is frequently related to cardiovascular events. It is defined as a clinical condition in which the patient is unresponsive to external stimuli, presents with agonal or absent breathing, and lacks a palpable central pulse, leading to the progressive failure of vital organs and requiring immediate resuscitation. Despite the strong correlation between T2DM and increased cardiovascular risk, the association between T2DM and outcomes following CA remains poorly understood.

Objective: To analyze the impact of T2DM on CA outcomes, as well as the influence of factors such as age, sex, and initial arrest rhythm, in patients treated at emergency care services in Bauru, São Paulo, Brazil.

Methods: This was a retrospective cross-sectional epidemiological study based on cardiac arrest records from emergency care services in the municipality of Bauru during the year 2024. Data extracted from medical records included initial arrest rhythm, past medical history, patient age, and clinical outcomes. The study was approved by the Research Ethics Committee of the Bauru School of Dentistry. Descriptive statistics were performed using Jamovi® software, version 2.3.28.

Results: A total of 137 patients were included, of whom 26 had a previous diagnosis of T2DM. The mean age was similar between groups, being 65.1 years in patients with T2DM and 63.7 years in those without the diagnosis. The proportion of women was 47% among patients without T2DM and 31% among those with T2DM. Analysis of the initial arrest rhythm revealed a predominance of pulseless electrical activity (PEA) among patients with T2DM (61%), with shockable rhythms observed in only 6.7%. In contrast, patients without T2DM showed a predominance of asystole (51.1%), and shockable rhythms were more frequent (21.2%). Regarding outcomes, the rate of return of spontaneous circulation (ROSC) was 42.1% among patients without T2DM, compared with 54.2% in those with T2DM.

Conclusion: Given these results, T2DM might not be associated with worse CA outcomes, although further prospective studies with larger sample sizes are needed to confirm these findings.

PO—069 Individual And Contextual Factors Associated With The Coexistence Of Hypertension And Diabetes In The Municipality Of Belo Horizonte: A Multilevel Analysis

Ribeiro, TC1; Velasquez-Melendez, G1; Tonaco, LAB1; Malta, DC1; Souza, HP1; Moreira, AD1

(1) Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—069

Introduction: Unhealthy lifestyle habits, obesity, socioeconomic and environmental conditions are associated with diabetes mellitus (DM) and systemic arterial hypertension (SAH). The coexistence of these conditions has a high prevalence in Brazil.

Objective: To estimate the association between individual and contextual factors and the coexistence of SAH and DM in Belo Horizonte from 2006 to 2018.

Methods: Cross-sectional study using Vigitel, with adults from Belo Horizonte, MG, from 2006 to 2018. We conducted analysis for small areas, making it possible to identify intra-urban inequalities. The outcome variable was the coexistence of DM and SAH. Explanatory variables included sociodemographic characteristics, lifestyle habits, body mass index (BMI), and the Social Vulnerability Index (SVI). A multilevel logistic regression model was applied (individuals as level 1; coverage areas of Primary Health Care Units (PHCUs) as level 2). The variance of the intercept was estimated to identify variability in the likelihood of DM/SAH coexistence across PHCU areas. Individual-level explanatory variables were included in the model and SVI was added as a contextual variable. A 5% significance level was adopted.

Results: The null model in the multilevel analysis demonstrated significant variability in the probability of DM/SAH coexistence across PHCU areas (p < 0.001). In the final model, the following individual variables were significantly associated with the outcome: age (OR:1.06;95%CI:1.05–1.06), self-identified Black race compared to White (OR:1.29; 95%CI:1.01–1.65), being single compared to being married (OR: 1.51; 95%CI: 1.21–1.88), BMI (OR:1.09; 95%CI:1.08–1.11), education level of 8–12 years (OR: 0.76; 95%CI: 0.64–0.90) and ≥ 12 years (OR: 0.54; 95%CI: 0.43–0.67) compared to < 8 years of schooling, abusive alcohol consumption (OR:0.62; 95%CI:0.48–0.81), and leisure-time physical activity (OR:0.86; 95%CI: 0.73–1.01). Living in areas of medium or high/very high social vulnerability increased the likelihood of DM/SAH coexistence compared to low-risk areas (OR:1.20; 95%CI:1.00–1.46 and OR:1.31; 95%CI:1.02–1.67, respectively). The inclusion of the SVI in the final model resulted in a 12.5% reduction in the variability across areas.

Conclusion: Both contextual and individual factors are associated with the likelihood of DM/SAH coexistence, highlighting the role of social vulnerability and individual characteristics in this dual burden of disease.

PO—070 Latent Class Analysis Identifies Distinct Phenotypic Profiles In Patients With Diabetes Mellitus And Coronary Artery Disease

AROUCHA, PMT1; Paliares, IC1; Vidotto, TM1; Cocitta, CDF1; Caixeta, AM2; Pimpinato, AG2; Choi, SNJH3; Dualib, PM1; Sá, JRD4; Dib, SA1

(1) Disciplina de Endocrinologia do Departamento de Medicina da Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP, Brasil; (2) Disciplina de Cardiologia do Departamento de Medicina da Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP, Brasil; (3) Disciplina de Oftalmologia do Departamento de Medicina da Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP, Brasil; (4) Disciplina de Endocrinologia do Departamento de Medicina da Faculdade de Medicina do ABC, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—070

Introduction: Cardiovascular disease is the leading cause of morbidity and mortality in diabetes mellitus (DM). Coronary artery disease, often diffuse and multivessel, represents a key manifestation, particularly in type 2 diabetes (T2D). Recent studies suggest that subclassifying DM into clinical clusters may help predict DM complications. Objective: To identify distinct phenotypic profiles by latent class analysis (LCA) among patients with T2D submitted to coronary angiography (CAG). Methods: We analyzed 548 adults with T2D undergoing CAG. Median diabetes duration was 10 years (range 0–56), and mean age at CAG was 63.1 ± 9.7 years. Coronary involvement was defined as ≥ 70% stenosis in major epicardial arteries, ≥ 50% in the left main artery or prior coronary intervention. Coronary segments analyzed included the right coronary artery (RCA), left anterior descending (LAD), circumflex (CX), diagonal branches, left main, posterior branches, intermediate, and marginal arteries. LCA was applied to identify latent patterns of coronary involvement. Results: LCA identified two latent classes: “Low involvement” (296 patients, 54%; 95% CI: 49.7–58.2) and “Moderate-to-high involvement” (252 patients, 46%; 95% CI: 41.8–50.3). The moderate-to-high class showed probabilities of ≥ 70% for RCA and LAD involvement, moderate probabilities for CX (52%) and marginal (33%) arteries, and low to negligible involvement of other segments. In contrast, the low involvement class had less than 25% probability of RCA and LAD involvement and negligible involvement of other arteries (Figure). Compared to the low involvement group, the moderate-to-high class was significantly associated with male sex (OR: 2.7; p < 0.001), older age at CAG (OR: 1,04; p = 0,004), aspirin use (OR: 2,6; p = 0,006), previous history of myocardial infarction (OR: 5,08; p < 0,001) and previous coronary artery bypass grafting (OR: 5,021; p = 0,017), with no differences in diabetes duration, BMI or glycated hemoglobin in these two groups. Conclusion: We identified two distinct coronary phenotypic profiles in patients with T2D. The moderate-to-high involvement group consisted of older male patients with previous history of myocardial infarction and coronary artery bypass grafting, despite similar diabetes duration, BMI and glucose control between groups. Integrating DM phenotyping with coronary lesion patterns via LCA may provide a complementary tool for cardiovascular risk stratification and precision management in diabetes care.

PO—071 Performance Of The Life-T1D Cardiovascular Risk Tool And Optimal Cut-Off In A Brazilian Cohort With Long-Standing Type 1 Diabetes

Garcia, PDM1; Paliares, IC2; Lauria, MW3; Dib, SA2; Dualib, PM2; Sá, JRD2; Costa, AH1; Sena, MCRD1; Rodacki, M1; Zajdenverg, L1; Vezzani, JRD1

(1) Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (2) Universidade Federal de São Paulo, São Paulo, SP, Brasil; (3) Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil

Diabetology & Metabolic Syndrome 2026: PO—071

Introduction: In recent years, cardiovascular risk (CVR) prediction tools specifically designed for individuals with type 1 diabetes (T1D) have been developed. Among them, the LIFE-T1D, developed and validated in Europe, is evaluated here for the first time in a Brazilian T1D cohort. Objective: To evaluate the performance of LIFE-T1D in predicting 10-year CV events in individuals with long-standing T1D in Brazil, and to identify the optimal cut-off point for this population. Methods: This retrospective study analyzed medical records of subjects with T1D for over 10 years, from 3 centers in Southeastern Brazil. For each patient, 10-year CVR was calculated using LIFE-T1D. CV outcomes included coronary artery disease (CAD), heart failure (HF) and ischemic cerebrovascular accident (iCVA) within 10-year follow-up. Receiver operating characteristic (ROC) curve was used to evaluate the discriminative performance of LIFE-T1D (Fig. 1), and the area under the curve (AUC) was calculated. Diagnostic performance metrics were calculated: sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) using the newly identified cut-off and the conventional high-risk threshold of ≥ 20%. Results: A total of 384 patients were included, 57.0% were females; mean age: 30.3 years; mean disease duration 19.0 years. The mean body mass index was 25.52 kg/m2; 22.1% had hypertension and 5.9% were smokers. During the 10-year follow-up, there were 20 CV events (15 CAD, 4 iCVA, and 1 HF). AUC for LIFE-T1D was 0.839, indicating good discrimination. The optimal cutoff point identified was a 10-year risk of 4.85% (p < 0.001), yielding a sensitivity of 80.0%, specificity of 81.3%, PPV of 19%, and NPV of 98.7%. With the ≥ 20% threshold, sensitivity was 20.0%, specificity 98.3%, PPV 40%, and NPV 95.7% (p < 0.001). Conclusion: In this Brazilian cohort with long-standing T1D, LIFE-T1D demonstrated good overall performance. The conventional ≥ 20% threshold showed low sensitivity, however a lower cut-off of 4.85% significantly improved sensitivity while maintaining acceptable specificity. A key limitation is that LIFE-T1D was developed and validated in lower-risk European populations, while Brazil is considered a high-risk region. Despite this, when applied with the optimal risk threshold, LIFE-T1D exhibits robust accuracy in predicting CV risk in the Brazilian population studied.

Figure 1 (abstract PO—071).

ROC curve for LIFE-T1D.

PO—072 Predictive Accuracy Of The ST1RE Cardiovascular Risk Score In Type 1 Diabetes: Auc And Optimal Threshold Estimation

Garcia, PDM1; Lauria, MW2; Paliares, IC3; Dib, SA3; Dualib, PM3; Sá, JRD3; Sena, MCRD1; Costa, AH1; Vezzani, JRD1; Zajdenverg, L1; Rodacki, M1

(1) Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (2) Universidade Federal de São Paulo, São Paulo, SP, Brasil; (3) Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil

Diabetology & Metabolic Syndrome 2026: PO—072

Introduction: In recent years, cardiovascular risk (CVR) prediction tools specifically designed for individuals with type 1 diabetes (T1D) have been developed. Among them, the Steno Type 1 Risk Engine (ST1RE) has shown promise but may underestimate risk in certain populations. Its performance has not yet been optimized for Brazilian individuals with T1D. Objective:: To determine the optimal cut-off for the ST1RE calculator to improve its accuracy in predicting 10-year cardiovascular events in a Brazilian T1D population. Methods: This retrospective study analyzed medical records of individuals with T1D diagnosed for over 10 years, from 3 centers in Southeastern Brazil. For each patient, 10-year CVR was calculated using ST1RE. Cardiovascular (CV) outcomes included coronary artery disease (CAD), heart failure (HF), ischemic cerebrovascular accident (iCVA) and peripheral artery disease (PAD) within 10-year follow-up. Receiver operating characteristic (ROC) curve was used to evaluate the discriminative performance of ST1RE (Fig. 1), and the area under the curve (AUC) was calculated. Diagnostic performance metrics were calculated: sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) using the newly identified cut-off and the original ST1RE high risk threshold (≥ 20% risk over 10 years). Results: A total of 523 patients were included, 55.44% were females; mean age: 28.9 years; mean disease duration 17.9 years. The mean body mass index was 25.03 kg/m2; 22.7% had hypertension and 7.07% were smokers. During the 10-year follow-up, there were 35 CV events (18 CAD, 7 iCVA, 8 PAD, and 2 HF). AUC for ST1RE was 0.864, indicating good discrimination. The optimal cutoff point identified was a 10-year risk of 5.18% (p < 0.001), yielding a sensitivity of 88.9%, specificity of 72.2%, PPV of 14.8%, and NPV of 98.7%. Conclusion: In this Brazilian cohort with long-standing T1D, the ST1RE calculator demonstrated good overall performance. However, its original ≥ 20% threshold underperformed in sensitivity. A lower cut-off of 5.18% significantly improved sensitivity while maintaining acceptable specificity. This trade-off appears appropriate for a screening tool aimed at identifying patients at increased cardiovascular risk.

Figure 1 (abstract PO—072).

ROC curve for steno type 1 risk engine.

PO—075 Glycemic Index And Glycemic Load Of The Diet In Pregnant Women With Preexisting Diabetes Mellitus: A Prospective Cohort Study

Saunders, C1; Lourenço, KDSMDS1; Silva, LBGD1; Lacerda, ASSPND1; Rodrigues, LR1; Vieira, MDA1; Silva, ERDS1; Marques, JG1; Carvalho, ALDS1; Souza, LGD1; Camelo, LL1; Santos, BMBD1; Moraes, MCD1; Sena, MSDS1; Moreira, SC1; Silva, MHRD1; Jesus, KBMLD2; Santos, KD2

(1) Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (2) Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ – Brasil

Diabetology & Metabolic Syndrome 2026: PO—075

Introduction: The Glycemic Index (GI) and Glycemic Load (GL) of the diet play a key role in glycemic control among pregnant women with diabetes mellitus, as they influence postprandial glycemic response. Effective glycemic management is associated with a reduced risk of adverse outcomes, such as excessive gestational weight gain, hypertensive disorders, fetal macrosomia, and neonatal hypoglycemia. Objective: To calculate and classify the GI and GL of the diet of pregnant women with previous diabetes. Methods: Prospective cohort study nested in a randomized clinical trial, including pregnant women over 18 years with previous diabetes, followed up in prenatal care at a public maternity hospital in Rio de Janeiro between 2016 and 2024. Eligible pregnancies involved a single fetus and gestational age under 28 weeks. Dietary intake was assessed by a food frequency questionnaire in the 2nd and 3rd trimesters. An automated spreadsheet based on the “International table of glycemic index and glycemic load values” was used to calculate and classify dietary glycemic index and glycemic load. GI was classified as low (≤ 55), medium (> 55 and < 70) and high (≥ 70); GL as low (< 80g), moderate (80g ≤ GL ≤ 120g) and high (> 120g). Results: Among the 120 pregnant women analyzed, 54.2% had type 2 diabetes and 45.8% had type 1 diabetes. The mean GA was 56.42 (SD = 6.09) in the 2nd trimester and 55.64 (SD = 7.19) in the 3rd trimester, with no significant difference (p = 0.98). Median GC was 117.53 (IQR = 91.31–150.0) in the 2nd trimester and 110.22 (IQR = 83.10–146.13) in the 3rd trimester, also with no significant difference (p = 0.46). In the 2nd trimester, diets were classified as low (47.1%) and medium (52.9%) GI. In the 3rd, proportions were similar: low (48.3%), medium (50.6%), and high (1.1%) GI. Diets with moderate (36.5%) and high (49.0%) GL were more common in the 2nd trimester. In the 3rd, high glycemic load diets decreased (41.1%), while low (18.4%) and moderate (40.2%) increased. Conclusion: Most pregnant women maintained medium GI and high GL diets throughout pregnancy. However, in the 3rd trimester, there was a shift toward lower values, possibly due to increased prenatal visits and nutritional guidance, including reduced intake of ultra-processed foods. It was observed that the nutritional intervention boosted the reduction of diets with high GI and GL, possibly favoring the glycemic control of these pregnant women.

PO—076 Adapting The Findrisc Score For The Long-Term Prediction Of Type 2 Diabetes Mellitus In Women With Prior Gestational Diabetes Mellitus

Spallicci, DG1; Muradian, MMP1; Souza, FD1; Abate, MCO1; Frasson, M1; Jordão, MC1; Dib, SA2; Pititto, BDA2; Dualib, PM2

(1) Faculdade de Medicina do ABC; Programa de Pós-graduação em Endocrinologia e Metabologia, (2) Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—076

Introduction: Gestational diabetes mellitus (GDM) is a prevalent metabolic disorder during pregnancy, associated with an increased risk of developing type 2 diabetes mellitus (T2DM) postpartum. Epidemiological data indicate that women with prior GDM have up to a tenfold higher risk of developing T2DM, underscoring the need for early identification and long-term follow-up. The FINDRISC questionnaire is a validated tool for assessing T2DM risk in the general population but was not designed for women with GDM. This study proposes an adapted version for this group. Objective: To evaluate whether a diabetes mellitus risk score, adapted from the FINDRISC and applied during pregnancy, can accurately predict the long-term risk of developing T2DM in women with prior GDM. Methods: Retrospective cohort of 212 women with prior GDM, evaluated 2–16 years postpartum (2007–2024) at a tertiary diabetes-pregnancy clinic. The FINDRISC was adapted by replacing the abdominal circumference variable with gestational weight gain—classified as adequate or inadequate based on the Institute of Medicine—and adding insulin use. Variables scored: age, pregestational BMI, gestational weight gain, insulin use, hypertension, diet (fruit/vegetable intake), physical activity, any lifetime dysglycemia, and family history of T2DM. Data were obtained from gestational records; participants underwent a 75g OGTT and were classified as normoglycemic, glucose intolerant, or diabetic according to Brazilian Diabetes Society criteria. Results: Of 202 women, 114 were normoglycemic, 43 glucose intolerant, and 45 with T2DM. Mean values for age, pre-gestational BMI, and gestational weight gain were similar across groups: 34.2(+ 5.6) years, 29.5(+ 6.3) kg/m2, and 8.4(+ 7.4) kg in the normoglycemic group; 33.5 years(+ 5.7), 30.0 (+ 5.9)kg/m2, and 9.2(+ 9.3) kg in the glucose intolerance group; and 34.2 (+ 5.7)years, 31.5(+ 4.4) kg/m2, and 8.5(+ 6.6) kg in the T2DM group (p = 0.33, p = 0.23, p = 0.98). No significant differences for insulin use (p = 0.17), hypertension (p = 0.26), diet, family history (p = 0.48), or physical activity (p = 0.26). The modified FINDRISC score showed no statistically significant differences between the groups (p = 0.515) Conclusion: Findings suggest the modified FINDRISC has limited ability to predict T2DM in women with prior GDM. Despite targeted adaptations to the original score, it did not distinguish normoglycemic, glucose-intolerant, and diabetic groups, underscoring the need for more specific risk tools for this high-risk population. (supported by fapesp).

PO—077 Adequacy Of Gestational Weight Gain Of Pregnant Women With Hyperglycemia According To The Brazilian Charts And Associated Factors

Moraes, MC1; Vieira, MA1; Abras, A1; Silva, LBG1; Santos, K2; Lourenço, KSMDS1; Lacerda, ASSPN1; Sinquini, C1; Lima, L1; Saunders, C1

(1) Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (2) Universidade Federal do Rio de Janeiro e Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—077

Introduction: Weight gain is a physiological aspect of pregnancy, resulting from fetal-placental growth and maternal tissue growth. Gestational hyperglycemia is associated with adverse perinatal outcomes, such as hypertensive disorders, macrosomia, preterm birth, and others. Monitoring gestational weight gain (GWG) is an important part of prenatal care, especially in pregnant women with hyperglycemia, given its influence on the occurrence of adverse perinatal outcomes. Objective: To analyze the adequacy of GWG according to Brazilian gestational weight gain curves and associated factors among pregnant women with hyperglycemia. Methods: This is an observational, cross-sectional study with data collected between 2021 and 2023. Participants were pregnant women aged ≥ 18 years, with at least one prenatal visit, a singleton pregnancy, a diagnosis of pregestational or gestational diabetes mellitus, and availability of anthropometric data in medical records. Sociodemographic, clinical, obstetric, and prenatal and nutritional care data were evaluated. In the statistical analysis, the Kruskal–Wallis test was used to compare medians and Pearson’s chi-square test to compare frequencies, in SPSS version 25.0. Statistical significance was set at p < 0.05. Results: 198 women were studied, with a median age of 31.0 (27.0–37.0) years. Of this total, non-white skin color was reported by 68.5% (n = 135), 74.7% (n = 148) completed high school, 61.4% (n = 121) had paid work, 85.1% (n = 166) lived with a partner and 93.4% (n = 184) lived in housing with adequate sanitation conditions. The majority began pregnancy with obesity (48.5%, n = 96). The prevalence of insufficient, adequate and excessive GWG were 36.4% (n = 72), 16.1% (n = 32) and 47.4% (n = 94), respectively. The factors associated with GWG were glycated hemoglobin in the 1st and 2nd trimesters (p = 0.03 and p = 0.03, respectively) and fasting glucose in the 1st, 2nd, and 3rd trimesters (p =  < 0.01, p = 0.03, and p = 0.01, respectively), with higher values observed in cases of excessive GWG. Regarding perinatal outcomes, GWG was associated with the need for hospitalization during pregnancy (p = 0.02), with cases of excessive GWG requiring more days of hospitalization than others. Conclusion: These findings reinforce the importance of GWG control during pregnancy. Research considering the recommendations of the Brazilian weight gain curves is needed to consolidate their use among pregnant women with hyperglycemia.

PO—078 Assessment Of The Family Planning Profile In Women With Chronic Comorbidities: Type 1 Diabetes Or Post-Bariatric Surgery. Knowledge Does Not Reflect Adherence

Caneca, KDO1; Costa, MMI1; Alves, ME1; Ferreira, NCA1; Rodacki, M1; Zajdenverg, L1

(1) Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—078

Introduction: The increasing prevalence of chronic conditions like obesity and diabetes mellitus (DM) during pregnancy is a significant public health issue. Brazil ranks among the top 10 countries in type 1 diabetes prevalence, with an estimated 1.5% of pregnancies in women with type 1 DM (T1DM). The global rise in obesity, projected to affect 1.65 billion people by 2030, may increase the number of women of reproductive age undergoing bariatric surgery (BS). Due to elevated maternal and fetal risks in these populations, family planning and preconception care are key to preventing complications. Objective: To assess knowledge and adherence to family planning methods among women with T1DM or a history of BS. Methods: An observational, analytical study was conducted with women aged 15–50 years from specialized outpatient clinics. Data were collected through questionnaires administered individually. The study population included women with T1DM or who had undergone BS. Results: The study included 71 non-pregnant women of childbearing age (66 with T1DM and 5 post-BS). Among them, 25.3% had experienced abortion and 56.3% had delivered a baby. The mean age was 28.87 years; 57.7% were Black and 66.2% were single. Regarding income, 27.1% earned more than three minimum wages, 50% between two and three and 22.9% earned up to one. Most (71.8%) had ≥ 9 years of schooling. Mean T1DM diagnosis age was 12.2 years, and mean time post-BS was 7.6 years. Most (71.8%) reported never receiving guidance about the ideal time to become pregnant. Only 21.1% reported that they were using an effective method (IUD or oral contraceptive – OC). The most known methods were IUD (92.9%), male condom (91.5%), injectable contraceptive (91.5%), and female condom (95,8%). Past use methods included: OC (62%), IUD (19.7%), injectable contraceptives (22.5%) and male condom (40.9%). Although 91.5% understood and agreed with the concept of planned pregnancy, 66.7% of those previously pregnant had unplanned pregnancies and only 22.2% used folic acid preconceptionally. Six current and five former smokers were identified; eight had quit during pregnancy. Alcohol was consumed weekly by 53.5% of participants and one continued drinking in early pregnancy. Conclusion: Despite high awareness of contraceptive methods, effective use remains low. This gap indicates the need for structured, ongoing reproductive counseling for women with chronic conditions to improve planning and reduce maternal–fetal risks.

PO—079 Association Between Comorbidities And Maternal–Fetal Outcomes In Pregnant Women With Type 2 Diabetes Mellitus At A Public Healthcare Referral Center

Pereira, ANM1; Amaral, LLG1; Aragão, IFM1; Façanha, CFS1; Montenegro, AXCB2; Rocha, IMA1

(1) Centro Universitário Christus, Fortaleza, CE, Brasil; (2) Centro Integrado de Diabetes e Hipertensão, Fortaleza, CE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—079

Introduction: Type 2 diabetes mellitus (T2DM) during pregnancy represents a high-risk obstetric condition, particularly when associated with multiple comorbidities. Conditions such as obesity, hypertension, and dyslipidemia interact synergistically with chronic hyperglycemia, increasing the risk of adverse pregnancy outcomes, including perinatal death, preeclampsia, prematurity, fetal growth disorders, and the need for intensive care unit admission, among others. Nevertheless, the risks faced by these patients have been underestimated in populations managed within the public healthcare system in our setting. Objective: To Study adverse pregnancy outcomes and the presence of comorbidities associated with DM2 in pregnancy. Methods: This was a retrospective observational study involving the review of 84 medical records of pregnant women with T2DM attended between 2014 and 2024 at a public healthcare reference center in Northeast Brazil. The study was approved by the Ethics Committee of IPADE (CAAE: 80,431,724.6.0000.5049). Results: In this group, of T2DM pregnant women, with a mean age of 34.5 ± 4.6 years old, 79.8% had at least one comorbidity in addition to diabetes, with 48.8% having two or more associated conditions. Obesity was found in 90%, 37% had dyslipidemia and 32,2% hypertension. Regarding gestational outcomes, 69.8% presented maternal complications such as hypertensive crisis, hospitalization for blood glucose management, pregnancy loss, and infection. In terms of neonatal outcomes, 6.5% presented congenital malformations, notably cardiac malformation and hip dysplasia, 14.2% were considered large for gestational age or macrosomic, and 10.7% had low birth weight. Furthermore, 50% of cases had some neonatal complication, including hypoglycemia, jaundice, and respiratory disorders, and 28.1% required neonatal intensive care. Obesity and hypertension were associated with a higher risk of obstetric complications (p = 0.047) in T2DM pregnancy. Conclusion: Comorbidities and adverse pregnancy outcomes are highly prevalent among pregnancies in women with T2DM. The additional burden of obesity and hypertension on this population has been consistently demonstrated in previous studies. These findings underscore the substantial risk faced by these patients and highlight the necessity for interventions through preventive strategies, health education, and structured preconception care, designed to mitigate maternal and perinatal risks.

PO—080 Association Between Gestational Diabetes Mellitus Treatment With Or Without Insulin And Cardiometabolic Health Of 2-To-14 Years-Old Offspring

Marson, MER1; Dualib, PM1; Bittencourt, L1; Ramos, SC1; Souza, FDS1; Abate, MCO1; Montero, MF1; Jordão, MC1; Pititto, BA1

(1) Universidade Federal de São Paulo, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—080

Introduction: The influence of different treatments on the health of children and adolescents born to mothers with GDM is essential for guiding prevention strategies. Objective: Aim: To evaluate whether the treatment of hyperglycemia during pregnancy in women with GDM including lifestyle changes (LC) with or without insulin is associated with the cardiometabolic health of 2-to-14 years-old offspring. Methods:This retrospective cohort study involved 186 children aged 2–14 years, born to mothers with GDM defined according to Brazilian Diabetes Society. Data was collected during routine antenatal care. Current evaluation of the children was performed and the cardiometabolic risk factors (CMRF) were defined according to WHO criteria; BMI for children over 5 years: BMI-Z score ≥  + 2 = obesity; ≥  + 1 and <  + 2 = overweight, and for children under 5 years: BMI-Z score >  + 3 = obesity; ≥  + 2 and <  + 3 = overweight; ≥  + 1 and <  + 2 = overweight risk; BP ≥ 90thpercentile = hypertension; pre-diabetes by elevated HbA1c ≥ 5.7%; dyslipidemia = HDL ≤ 45mg/dL, LDL > 110mg/dl and/or TG ≥ 130mg/dL (> 10years) or TG ≥ 100 mg/dL (0-9years). Offspring’s CMRF were compared by the type of treatment during pregnancy with GDM: with or without insulin; multiple logistic regression analysis was performed. Results: In the group that used insulin (38.7% of the pregnancies) there was greater prevalence of prediabetes [15.3% vs. 6.2%, p = 0.042] and of elevated blood pressure/hypertension [20% vs. 10.6%, p = 0.077], and greater mean levels of HbA1c [5.3(0.4) vs. 5.1(0.3)%, p = 0.001] and of fasting glucose [84.7(7.2) vs. 82.5(6.8)mg/dl, p = 0.047] compared to non-insulin users. There was no statistical difference between the groups concerning prevalence of other CMRF, as well as regarding to other maternal, paternal or child variables (age, BMI, lipid profile, insulin levels, HOMA-IR, HOMA-beta). In regression analysis, maternal insulin use during pregnancy was associated with the occurrence of prediabetes in offspring (OR 3.294, 95% CI 1.097 to 9.893, p = 0.034) even after adjustments for child’s age, child’s BMI, maternal pregestational BMI, maternal education level, exclusive breastfeeding for less than 4 months and cesarean delivery. Conclusion: Insulin use in GDM increases offspring’s prediabetes risk by over 200%, independent of age, BMI, breastfeeding, delivery type, or maternal BMI/education. These findings highlight insulin use as a marker of higher metabolic risk and reinforce the need for cardiometabolic prevention strategies.

PO—081 Availability, Understanding, And Choice Of Contraceptive Methods For Women With Diabetes Mellitus

Gerhardt, CR1; Santos, BS1; Remonti, LLR2; Lubianca, JN1; Satler, F2; Leitão, CB1

(1) Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brasil; (2) Hospital De Clínicas De Porto Alegre- Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—081

Introduction: Pregnancy Planning In Women With Diabetes Mellitus (dm) Is Essential. Inadequate Blood Glucose Levels Are Associated With Unfavorable Maternal Outcomes And Progression Of Chronic Complications Of Dm. Objective: To Verify Which Contraceptive Methods (cm) Are Chosen By Women With Dm When They Have Access To And Guidance On Cm, Their Degree Of Satisfaction And Permanence Over 24 Months. Methods: Prospective Cohort Study, Conducted By A Hospital, Including Women Aged 10 To 49 Years With Dm Treated At The Endocrinology Outpatient Clinic. Ethics Committee: 58,015,622.8.0000.5327. Women Who Agree To Participate In The Study Receive Guidance On The Available Contraceptive Methods And The Most Appropriate For Ones Each Patient, Respecting The Contraindications Of The Eligibility Criteria Of The World Health Organization (who). An Interview Is Conducted With Detailed Demographic, Reproductive History, And Medical Health Questions. The Patient Chooses The Contraceptive Method They Want, After Being Monitored By Telephone For 24 Months To Assess Continuity, Satisfaction With The Method And Occurrence Of Pregnancy. Results: 97 Women Included, Between 14 And 49 Years Old, The Average Age Was 30,38 + 8.4 Years. 66 (68%) Have Dm1 0.73 (75%) Have A Steady Partner. 42 (43%) Were Using Contraindicated Contraceptive Methods, 24 (25%) Were Using Barrier Methods And 31 (32%) Had No Contraindications To The Contraceptive Method In Use. 64 (66%) Chose Etonogestrel Implant, 14 (14,3%) Levonorgestrel Iud (intrauterine Device), 13 (13,4%) Oral Progestin, 4 (4,1%) Copper Iud, 1 (1,1%) Combined Oral Contraceptive And 1 (1,1%) Progestogen Only Injectables. To Date, 7 Patients Have Had Their Etonogestrel Implant Removed For Reasons Were: Weight Gain, Menstrual Irregularity And Desire For Pregnancy And 3 Patients Have Discontinued Desogestrel Due To Desire To Become Pregnant And Side Effects. Three Patients Are Pregnant. Average Use Of The Chosen Cm Was 16.3 Months. Conclusion: Ten Patients Stopped Using Their Chosen Contraceptive Method.the Most Chosen Method Was The Etonogestrel Implant. Most Patients Chose Methods Highly Recommended Due To Their Efficacy And Safety: Larcs (long-acting Reversible Contraceptives). When These Patients Have The Opportunity To Access And Choose The Contraceptive Method Of Their Preference, They Tend To Choose A Larc. Based On These Results, It Is Essential That Improvements Be Implemented In Access To And Availability Of Contraceptive Methods For Family Planning For Women With Dm.

PO—082 Breastfeeding And Incidence Of Diabetes Mellitus In Women With A History Of Gestational Diabetes Mellitus

Ramos, SC1; Dualib, PM1; Cherubini, KA2; Alecrim, MJ1; Valença, MCTV1; Schmid, MI2; Pititto, BA1

(1) Postgraduate Program in Endocrinology and Metabolism, Federal University of São Paulo, São Paulo-SP, Brazil, São Paulo, SP, Brasil; (2) Postgraduate Program in Epidemiology, Department of Social Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil, Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—082

Introduction: Women who had gestational diabetes mellitus (GDM) are up to ten times more likely to develop Type 2 diabetes mellitus (T2D) and potential of breastfeeding as a strategy for diabetes prevention has been shown in studies from different countries, but Brazil. Breastfeeding can suffer socioeconomic and cultural influences, justifying the investigation of its potential as a preventive measure in the context of women’s life and access to health in Brazil. Objective: To evaluate the association of breastfeeding with the incidence of Type 2 diabetes mellitus (T2D) in women with previous gestational diabetes mellitus (GDM) in a multicenter group study LINDA-Brasil (Lifestyle Intervention for Diabetes Prevention After pregnancy) with up to 3 years of specific follow-up. Methods: This cohort study enrolled 2617 women with GDM followed-up in tertiary centers in different Regions of Brazil. Breastfeeding was categorized as: < 6months; ≥ 6 to11 months; ≥ 12 months. After child-birth, women were handled to perform a laboratory examination of oral glucose tolerance test at specific postpartum times: 2 months and every 6 months. Incidences of diabetes were compared according to time of breastfeeding. Results: The mean (SD) age was 32(6) years old and had 44% of pre-gestational obesity and 55% were overweight. Incidences of type 2 diabetes were 43%, 44% and 34%, respectively according to groups of time of breastfeeding: < 6months; ≥ 6 to11 months; ≥ 12 months (qui-squared p < 0.001; linear-by-linear p < 0.001). In Cox regression analysis, breastfeeding for more than 12 moths was inversely associated with incidence of DM2 (HR 0.275 95% CI 0.118 – 0.638, p = 0.003) independent of age, BMI, schooling and race. Conclusion: Breastfeeding was a protective factor against type 2 diabetes (T2D) in women with a history of gestational diabetes (GDM) over a three-year period, which reinforces the importance of promoting breastfeeding as a public health strategy in Brazil. Actions aimed at supporting women in the postpartum period can change the epidemiological context of type 2 diabetes (T2D) and all its complications.

PO—083 Comparison Of Clinical And Demographic Characteristics And Maternal–fetal Outcomes Between Pregnant Women With Type 1 And Type 2 Diabetes At A Tertiary Care Center

Torraca, FS1; Biar, MMM1; Albuquerque, FOB1; Vasconcellos, CAVA1; Souza, F2; Abib, RCA1; Cabizuca, CA1

(1) Universidade do Estado do Rio de Janeiro, Rio De Janeiro, RJ, Brasil; (2) Universidade Federal do Estado do Rio de Janeiro, Rio De Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—083

Introduction: Poorly controlled pre-gestational diabetes mellitus (PGDM) is associated with a higher risk of maternal–fetal complications. Despite differences between type 1 (T1D) and type 2 diabetes (T2D), most studies on PGDM during pregnancy evaluate patients as a single group. With the increasing prevalence of pregnancies in women with T2D, there is growing interest in understanding the similarities and discrepancies between these populations. Objective: To compare clinical and demographic characteristics and maternal–fetal outcomes of pregnant women with T1D and T2D followed at a tertiary care center. Methods: Retrospective cohort study including women with T1D and T2D followed between 2013 and 2024. Pre-pregnancy clinical and demographic data were collected: age, diabetes duration, comorbidities, BMI, income, education level, ethnicity, gestational age at first visit, HbA1c, and microvascular complications. Outcomes assessed were newborn weight, delivery type, NICU admission, prematurity, and fetal malformations. Continuous and categorical variables were presented as median [IQR] and relative frequencies, respectively. Group comparisons used Mann–Whitney or chi-square tests, with significance set at p < 0.05. Results: A total of 210 pregnant women were included, 72 (34.3%) with T1D. Compared to those with T2D, T1D women were younger (27 [22–32] vs. 35 [29–39] years, p < 0.001), had longer diabetes duration (12 [8–15] vs. 3 [1–6] years, p < 0.001), lower BMI (23.6 [20.4–26.7] vs. 34.0 [29.8–38.5] kg/m², p < 0.001), and higher pre-pregnancy HbA1c (10.0 [8–12] vs. 7.9 [6.8–8.7]%, p < 0.001). Hypertension was more frequent in T2D (40.6% vs. 13.9%, p < 0.001), while retinopathy (42.5% vs. 5.7%, p < 0.001) and nephropathy (33% vs. 8.1%, p = 0.036) were more common in T1D. No significant differences were found in other clinical-demographic parameters. Maternal–fetal outcomes were also similar between groups: macrosomia (15.6% vs. 17.4%, p = 0.82), birth weight (2,975 [2,567–3,582] g vs. 3,150 [2,840–3,635] g, p = 0.316), cesarean rate (84.8% vs. 83.3%, p = 0.84), NICU admission (46.4% vs. 50.9%, p = 0.7), prematurity (40% vs. 26.3%, p = 0.19), and fetal malformations (9.4% vs. 10.1%, p = 0.9). Conclusion: Among women with PGDM, those with T1D were younger, had lower BMI, worse glycemic control, and a higher prevalence of microvascular complications. Maternal–fetal outcomes were similar across groups, highlighting the need for close monitoring regardless of diabetes type.

PO—085 Differences in Glycemic Control and Insulin Needs Throughout Pregnancy in Women with Type 1 and Type 2 Diabetes

Biar, MMM1; Torraca, FS1; Albuquerque, FOB1; Souza, F2; Vasconcellos, CAVA1; Cabizuca, CA1; Abib, RCA1

(1) Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (2) Universidade Federal do Estado do Rio de Janeiro- Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—085

Introduction: Studies have shown that hyperglycemia during the organogenesis period increases the risk of fetal malformations and miscarriage in women with pregestational diabetes mellitus (PGDM). The gold standard treatment for these patients is insulin, with glycemic targets lower than those of the general population. Although international studies have already explored the differences in insulin requirements and glycemic control between type 1 (T1DM) and type 2 diabetes (T2DM) during pregnancy, there is a lack of Brazilian data evaluating these parameters longitudinally and comparatively. Objective: To compare insulin doses and hemoglobin A1c (HbA1c) levels across each trimester of pregnancy in patients with T1DM and T2DM, followed in a specialized outpatient clinic within a tertiary care center. Methods: Retrospective cohort study with clinical data collection from medical records of pregnant women with T1DM and T2DM followed between 2013 and 2024. Continuous and categorical variables were described as median [IQR] and percentage, respectively. Total insulin dose (U/kg) and HbA1c (%) were evaluated each trimester of pregnancy. Differences between groups were analyzed using the non-parametric Mann–Whitney test with SPSS software version 30.0. Results: A total of 210 pregnant women were included, 72 (34.3%) with T1DM and 138 (65.7%) with T2DM. HbA1c values were 8.4% [6.8–10.4] for T1DM and 7.0% [6.2–8.0] for T2DM (p = 0.001) in the first trimester; 6.9% [6.3–7.2] versus 6.2% [5.7–6.8] (p = 0.003) in the second; and 6.5% [5.7–7.1] versus 6.1% [5.6–6.7] (p = 0.043) in the third trimester. Total insulin dose was 0.6 U/kg [0.5–0.8] for T1DM and 0.5 U/kg [0.3–0.7] for T2DM (p = 0.013) in the first trimester; 0.8 U/kg [0.6–1.0] versus 0.5 U/kg [0.3–0.8] (p < 0.001) in the second; and 0.9 U/kg [0.6–1.1] versus 0.7 U/kg [0.5–1.0] (p = 0.035) in the third trimester. Conclusion: Pregnant women with T1DM required higher insulin doses and showed poorer glycemic control throughout pregnancy compared to those with T2DM. While international cohorts have reported similar findings, this is, to our knowledge, the first Brazilian study to present trimester-specific data on insulin requirements (U/kg) and HbA1c in both diabetes types. A better understanding of the specific characteristics of each type of pregestational diabetes is essential to guide more individualized care and improve maternal–fetal outcomes.

PO—087 Efficacy And Safety Of Insulin Degludec In Pregnant Women With Diabetes: A Meta-analysis Of Observational Studies And Randomized Clinical Trials

Graciolli, LHMSG1; Santos, DM2; Pasiani, JE3; Trindade, GTF2; Cruz, JPM4; Mascarin, AL2; Lima, MM2; Cocco, GB2

(1) Faculdade De Medicina De Jundiaí, Jundiai, SP, Brasil; (2) Fundação Educacional Do Município De Assis, Assis, SP, Brasil; (3) Universidade Brasil, Fernandópolis, SP, Brasil; (4) Universidade Federal De São Carlos, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—087

Introduction: The choice of basal insulin during pregnancy remains uncertain, particularly regarding ultra-long-acting analogues such as insulin degludec. Although widely used in other populations, its safety and efficacy in the gestational context remain controversial. Given its increasing use in clinical practice, it is essential to assess its impact on clinically relevant maternal–fetal outcomes. Objective: To evaluate, through meta-analysis, the safety and efficacy of insulin degludec in pregnant women with diabetes, with emphasis on outcomes such as neonatal hypoglycemia, preeclampsia, preterm birth, LGA (large for gestational age), and SGA (small for gestational age) Methods: A meta-analysis was conducted including nine studies (randomized clinical trials and observational studies), totaling 1,058 pregnant women with type 1, type 2, or gestational diabetes. The outcomes analyzed were: neonatal hypoglycemia, preeclampsia, preterm birth (< 37 weeks), LGA, and SGA. Event data by total participants in each group (insulin degludec vs. comparators such as NPH or glargine) were extracted and analyzed using a random-effects model, with calculation of relative risk (RR) and 95% confidence interval (CI). Results: Insulin degludec was not associated with an increased risk of neonatal hypoglycemia (RR 0.93; 95% CI 0.72–1.20), preeclampsia (RR 0.94; 95% CI 0.68–1.30), preterm birth (RR 0.87; 95% CI 0.65–1.17), LGA (RR 0.89; 95% CI 0.68–1.18), or SGA (RR 1.08; 95% CI 0.55–2.12). No statistically significant heterogeneity was observed among the studies (I² < 30%). The data suggest a slight trend toward benefit of degludec in most neonatal outcomes. Conclusion: Insulin degludec demonstrated a safety and efficacy profile comparable to that of other basal insulins used during pregnancy, with no association with worse maternal–fetal outcomes. These findings support its use as a viable therapeutic alternative in the management of gestational diabetes, particularly in patients at higher risk for glycemic variability.

PO—088 Factors Associated with Dysglycemia Within Two Years After a Pregnancy Complicated by Gestational Diabetes Mellitus

Oyama, PRL1; Pitito, BA1; Dib, SA1; Dualib, PM1

(1) Universidade Federal de São Paulo, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—088

Introduction: Women with prior gestational diabetes (GDM) face an 8–tenfold higher risk of type 2 diabetes (T2DM). The recommended 6–12-week postpartum oral glucose tolerance test (OGTT) is poorly attended (41–58%), contributing to underdiagnosis and lack of early intervention. Identifying risk factors during pregnancy that predict postpartum dysglycemia is essential to optimize screening strategies and target follow-up efforts to those at highest risk. Objective: Evaluate anthropometric and biochemical features of women with GDM that could predict dysglycaemia within 2 years after delivery. Methods: A total of 1,124 women with confirmed GDM were initially identified. After applying predefined exclusion criteria—twin pregnancy (3), incomplete records (1), or absence of postpartum OGTT within 24 months (570) —the final analytic sample comprised 550 women with GDM assisted at a tertiary diabetes-pregnancy clinic between 2007 and 2024. Clinical history, pregnancy outcomes, anthropometric measures, and laboratory data were compared between women who did or did not develop dysglycaemia (prediabetes/T2DM) defined according to ADA criteria based on a 75 g OGTT performed within 24 months postpartum. Results: Participants had mean(SD) age of 33.8(5.7) yrs and BMI of 29.7(5.8) kg/m2. At ≤ 2 years postpartum, 418 (76.0%) remained euglycaemic and 132 (24.0%) developed dysglycaemia, being 122 prediabetes and 10 T2DM. During prenatal care, the group with dysglycaemia had higher frequencies of pre-gestational BMI ≥ 30kg/m2 [54.0 vs 40.5%, p = 0.008], insulin requirement [47.0 vs 32.8, p = 0.003] and caesarean section [65.2 vs 55.2%, p = 0.043]; lower frequencies of smoking [6.9 vs 16.3%, p = 0.008]; and higher levels of plasma glucose in OGTT: fasting [97.5(SD) vs 93.2(SD)mg/dL, p = 0.006]; 1-h [182.x(SD) vs 171.x (SD)mg/dL, p = 0.003]; 2-h [151.8(SD) vs 142.6(SD) mg/dL, p = 0.004] comparing with the euglycaemic group. Multivariable analysis confirmed that 2-h OGTT glucose during pre-natal care was an independent factor associated with dysglycaemia (OR 1.02, 95% CI 1.00–1.03; p = 0.012). Conclusion: Regardless of pregestational BMI or insulin treatment, maternal glycemia during pregnancy—particularly 2-h OGTT values—remains a strong independent predictor of progression to T2DM within 2 years postpartum.

PO—089 Gestational Weight Gain In Pregnancies With Type 2 Diabetes: Insights From A Retrospective Cohort Of Brazilian Women

Reichelt, AJ1; Hirakata, VN1; Campos, MAA2; Oppermann, MLR1

(1) Hospital De Clínicas De Porto Alegre, Porto Alegre, RS, Brasil; (2) Hospital Nossa Senhora Da Conceição, Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—089

Introduction: Gestational weight gain (GWG) adequacy has traditionally been classified according to the Institute of Medicine (IOM) guidelines, now under the National Academy of Medicine. Recently, Brazil introduced its own national recommendations for pregnancy weight gain. Objective: We aimed to compare GWG adequacy based on both sets of guidelines and to evaluate their association with pregnancy outcomes in women with type 2 diabetes receiving care at two public hospitals in Brazil. Methods: We included women with clinical characteristics of type 2 diabetes. Categories of GWG, adequate, insufficient, or excessive, were defined according to the two criteria. Primary outcomes were preterm birth (delivery < 37 weeks), neonatal hypoglycemia, admission to the neonatal intensive care unit (NICU), large for gestational age (LGA) babies, small for gestational age babies (SGA), and macrosomia (> 4000 g). We applied the McNemar test for comparison of GWG adequacy and the Poisson regression for the multivariable analyses. In the adjusted models, we entered the BMI categories, 3rd-trimester HbA1c, and GWG categories. Models accounting for macrosomia, neonatal hypoglycemia, and NICU were adjusted further for gestational age at birth. Results are presented as adjusted relative risk (aRR) and 95% confidence interval, p value. Results: We included 585 women, 414 (71%) with obesity. Mean maternal age was 32.7 ± 5.9 year, mean pregestational body mass index (BMI) was 34.4 ± 7.8 kg/m2, and mean gestational age at delivery, 37.1 ± 3.0 weeks. The Figure displays the frequencies of GWG adequacy by both recommendations. The Brazilian criteria classified GWG as excessive more often (p < 0.001). In the Brazilian criteria models, macrosomia was the only factor associated with (excessive) GWG (n = 496; aRR 2.03,95% CI 1.01–4.10, p = 0.048). In models by the IOM criteria, neonatal hypoglycemia (n = 475; aRR 0.57, 95% CI 0.35–0.92, p = 0.020) and LGA babies (n = 489; aRR 0.68, 95% CI 0.49–0.94, p = 0.019) showed an inverse association with insufficient GWG; macrosomia was directly associated with excessive GWG (n = 496; aRR 2.02, 95% CI 1.21–3.39, p = 0.007). Conclusion: Adequate GWG was uncommon, while excessive GWG occurred in ~ half of the cohort by the Brazilian criteria. Although only macrosomia (among six neonatal outcomes) was associated with (excessive) GWG in multivariable analyses, the frequency of excessive GWG, on top of an already high pregestational BMI, in women with type 2 diabetes was alarming, demanding prompt action from the medical staff.

PO—090 Impact of Early Diagnosis of Overt Diabetes on Pregnancy Outcomes: a Retrospective Cohort Study in Brazilian Women

Oppermann MLR1; de Campos MAA2; Hirakata VN3; Reichelt AJ3

(1) Hospital de Clínicas de Porto Alegre e Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil; (2) Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brasil; (3) Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—090

Introduction: Early diagnosis of gestational diabetes has been shown to improve certain pregnancy outcomes. However, data are limited for pregnant women with overt diabetes—those who meet the diagnostic criteria for diabetes based on hyperglycemia identified for the first time during pregnancy. Objective: We aimed to compare pregnancy outcomes between women with overt diabetes diagnosed early (≤13 weeks of gestation) and those diagnosed later in pregnancy. Methods: Women with overt diabetes from a retrospective cohort of 646 women exhibiting a type 2 diabetes phenotype were included. The groups of early and later diagnosis were compared for features, pregnancy outcomes, and associated factors. We performed multivariable analyses using linear regression (continuous variables) and Poisson regression with robust variances (dichotomic variables). Results include the number of women available for each analysis and are presented as b (linear coefficient) or adjusted relative risk (aRR) with 95% CI, p value. Results: Of 217 participants with overt diabetes, 118 (54.4%) had a diagnosis in the first trimester (early group). In univariable analyses, women in the early group had more chronic hypertension and a family history of hypertension. They also had fewer hospital admissions, and lower gestational weight gain and 3rd-trimester HbA1c. Maternal and neonatal outcomes were similar. In multivariable analysis, the early diagnosis group had a lower gestational weight gain (n=196; - 3.6 kg; -5.9-1.3; p<0.01) and 3rd trimester HbA1c (n=160; -0.27; -0.05- -0.01; p=0.04). Maternal hospital admission was inversely associated with early diagnosis (n=194; aRR 0.74; 0.59-0.92; p=0.01) and directly associated with a higher initial HbA1c (n=194; aRR 1.27; 1.18-1.37; p<0.01). Early diagnosis did not impact any other pregnancy outcome. Preeclampsia was linked to previous chronic hypertension (n=200; aRR 1.65; 1.03-2.66; p=0.04). Neonatal hypoglycemia (n=150; aRR 2.08; 1.07-4.05; p=0.03) and neonatal intensive care unit admission (n=150; aRR 1.70; 1.10-2.62; p=0.02) were directly linked to an HbA1c ≥ 6.5%. Neonatal hypoglycemia was inversely associated with maternal obesity (n=150; aRR 0.46; 0.25-0.85; p=0.01) (Figure 1) Conclusion: In this cohort of pregnant women with overt diabetes, diagnosis up to the 13th week impacted positively on some maternal metabolic aspects, without improving relevant pregnancy outcomes.

PO—091 Influence of Chrononutrition on Maternal and Perinatal Outcomes in Pregnant Women with Pre-Gestacional Diabetes Mellitus

Lacerda AS1; dos Santos K2; Saunders C1

(1) Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (2) Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—091

Introduction: pre-gestational diabetes mellitus is associated with a higher risk of adverse pregnancy outcomes. Glycemic control is essential to minimize these risks, and chrononutrition, which considers the timing of food intake throughout the day, emerges as a promising strategy to optimize this control during pregnancy. Objective: this study aimed to investigate the association between chrononutrition and maternal and perinatal outcomes throughout pregnancy in women diagnosed with pre-gestational diabetes mellitus. Method: this is a longitudinal observational study including 115 pregnant women with type 1 and type 2 pre-gestational diabetes mellitus, followed during the second and third trimesters at a public referral hospital in Rio de Janeiro between 2016 and 2025. Food consumption was assessed using 24-hour dietary recalls in the second and third trimesters. Chrononutrition parameters included number of eating episodes, diurnal or nocturnal eating patterns, meal times, and total caloric intake by period and by meal. Logistic and linear regression analyses were conducted to investigate associations between chrononutrition variables and clinical outcomes. Results: a higher number of eating episodes was associated with a 58% lower chance of preeclampsia (adjusted OR = 0.42; p = 0.014), indicating a protective effect of eating frequency. Pregnant women with a nocturnal eating pattern in the third trimester had an average increase of 25 days in neonatal intensive care unit length of stay (adjusted β = 24.85; 95% CI: 7.24 to 42.46). Additionally, diabetes mellitus type was associated with this outcome, with longer neonatal intensive care unit stays among infants born to women with type 2 diabetes mellitus (adjusted β = 14.77; 95% CI: 0.36 to 29.17). Conclusion: the data suggest that the temporal distribution of food intake throughout the day may significantly influence clinical outcomes in pregnant women with pre-gestational diabetes mellitus and their infants, reinforcing the importance of chrononutrition as a therapeutic strategy.

PO—092 Maternal Mortality Due to Diabetes in Pregnancy (2014–2023)

Godoy BV1; Morikawa LL2; Couto FS3; de Oliveira VCC1; de Moraes MB4; Féris MEER4; Rocha MCP3; de Oliveira BGG3; de Sousa LMR1; de Andrade ISR5

(1) Universidade Nove de Julho, São Paulo, SP, Brasil; (2) Universidade Nove de Julho, Guarulhos, SP, Brasil; (3) Faculdade de Medicina de Marília, Marília, SP, Brasil; (4) Faculdade de Medicina de Jundiaí, Jundiai, SP, Brasil; (5) Faculdade de Medicina de Marília, Marília, SP, Brasil; (6) Universidade de Marília, Marília, SP, Brasil; (7) Pontifícia Universidade Católica de Campinas, Campinas, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—092

Introduction: Diabetes mellitus during pregnancy is one of the most common complications in the gestational period and may lead to adverse outcomes for both maternal and fetal health. In Brazil, maternal mortality remains a significant public health challenge. Identifying factors associated with maternal deaths related to diabetes in pregnancy, as well as monitoring their trends over time, is essential to support prevention and care policies. Objective: To analyze the temporal trend and epidemiological profile of maternal mortality due to diabetes mellitus in pregnancy in Brazil from 2014 to 2023. Methods: This is a descriptive epidemiological study using secondary data extracted from the Mortality Information System (SIM), available through the Brazilian Unified Health System’s Department of Informatics (DATASUS). The study included maternal deaths among women of reproductive age, recorded between 2014 and 2023, whose underlying cause was classified as "Diabetes mellitus in pregnancy" (ICD-10: O24). The variables analyzed included year of death, geographic region, age group, and race/skin color. Data were obtained from the “Mortality – since 1996 by ICD-10” section and sourced from the Ministry of Health through the Health Surveillance Secretariat (SVS) and the General Coordination of Information and Epidemiological Analysis (CGIAE). Results: A total of 128 deaths of women of reproductive age due to diabetes in pregnancy were recorded. Most occurred in the Southeast (52 deaths; 40.6%) and Northeast (46; 35.9%) regions, with the lowest number observed in the Central-West (6; 4.6%). The year 2021 recorded the highest number of deaths (18; 14%), followed by 2018 (15; 11.7%). The lowest number was in 2017 (9 deaths; 7%). The most affected age group was 30–39 years (49 deaths; 38.3%), followed by 20–29 years (48; 37.5%). Among adolescents aged 15–19 years, there were 9 deaths (7%). Regarding race/skin color, most were mixed-race women (76; 59.4%), followed by white (36; 28.1%) and Black women (11; 8.6%). Conclusion: Between 2014 and 2023, most maternal deaths due to diabetes mellitus in pregnancy occurred in the Southeast and Northeast regions, predominantly among women aged 30 to 39 years and those identified as mixed race. These findings underscore the importance of strengthening prenatal care, with emphasis on early detection and appropriate management of gestational hyperglycemia, particularly among more vulnerable populations.

PO—095 Pregnancy Outcomes in Women with Type 1 Diabetes Mellitus at a Tertiary Care Center

Girao MB1; Moura LSNT1; Dib SA1; Pititto BA1; Dualib PM1

(1) Universidade Federal de São Paulo, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—095

Introduction: Pregnant women with Type 1 Diabetes Mellitus (T1DM) have a two- to fivefold increased risk of adverse maternal-fetal outcomes, including large for gestational age (LGA) infants, neonatal hypoglycemia, congenital malformations, perinatal mortality, preeclampsia, and worsening renal function and retinopathy. However, planned pregnancy with adequate glycemic control significantly reduces these risks. Objective: To describe the clinical profile of pregnant women with T1DM and maternal-fetal outcomes at a tertiary hospital in São Paulo. Methods: Retrospective cohort study involving 240 pregnant women with T1DM, followed at a specialized outpatient clinic within the São Paulo Healthcare System, from 2007 to 2025. Clinical and laboratory variables were collected from medical records and expressed as absolute frequencies, medians, means, and standard deviations. Results: The mean age was 26.3 ±5.9 years, with a mean diabetes duration of 13.8 ±7.0 years. Mean HbA1c levels were 8.6 ±1.7% in the first trimester, 7.2 ±1.3% in the second, and 7.0 ±1.0% in the third. Regarding insulin therapy, 45 used continuous insulin infusion systems and 195 used multiple daily injections. 64.2% of women had appropriate weight gain, 7.4% inadequate and 28.4% excessive. Concerning microvascular diabetic complications, 24.1% had diabetic kidney disease, 14.8% had mild/moderate non-proliferative diabetic retinopathy (NPDR) and 8.7% had severe NPDR/proliferative retinopathy. Obstetric complications occurred in 41.9%, including preeclampsia (11%), hypertension (3.5%) and miscarriage (5.8%). The cesarean section rate was 66.3%. Neonatal complications occurred in 82.3% of cases, including LGA (22%), jaundice (43.8%), neonatal ICU admissions (34.9%), respiratory distress (31.7%), hypoglycemia (31.3%), malformations (11%) and neonatal death (4.3%). Conclusion: Patients presented elevated HbA1c levels in early pregnancy, indicating limited preconception counseling, as ideal levels for conception are <6%. However, levels improved significantly in the second and third trimesters (p<0.01). Preeclampsia occurred in 11%, lower than the 17% reported in the literature for T1DM (five to six times higher than in the general population). The cesarean section rate was high (66.3%), compared to the average for women without T1DM (51.2%), but similar to other studies with T1DM (70.2%). Despite prenatal follow-up and glycemic improvements, the rate of neonatal complications remains high, including LGA fetuses, malformations and fetal mortality.

PO—096 Pregnant Women with Type 2 Diabetes: An Alert for Social Disadvantage and Associated Comorbidities

Aragão IFM1; Amaral LLG1; Pereira ANM1; Hasbun MRLM2; Gaspar LF1; Montenegro AXCB3; Façanha CFS3

(1) Centro Universitário Christus, Fortaleza, CE, Brasil; (2) Universidade Federal do Ceará, Fortaleza, CE, Brasil; (3) Centro Integrado de Diabetes e Hipertensão, CIDH, Fortaleza, CE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—096

Introduction: Pregestational diabetes has significantly increased in prevalence as a complicating factor during pregnancy, particularly due to type 2 diabetes mellitus (T2DM), which quadrupled from 2000 to 2019, following the obesity epidemic. Evidence shows maternal T2DM confers a higher risk of fetal and perinatal death compared with maternal type 1 diabetes mellitus. However, due to the misconception that it is a less severe condition, treatment for these patients is often delayed or neglected. Objective: To evaluate maternal characteristics and comorbidities in a group of pregnant women with T2DM. Methods: This was a retrospective observational study involving a review of medical records of pregnant women with T2DM managed at a public health care reference center in Northeast Brazil. The study was approved by the Ethics Committee of IPADE (CAAE: 80431724.6.0000.5049). Results: Data of 84 pregnant women with T2DM were analyzed. They had a mean age of 34.5±4.6 years old, low education degree (39% had 4 years or less of education), mean disease duration of 4.47±1.6 years, and 17.9% were diagnosed during pregnancy. Chronic complications were present in 16,7% of them, and 4,8% had retinopathy. Pregnancy plans were not made for 85,1% of them, and around 80% were treated in primary care or were not receiving regular treatment prior to pregnancy. The first visit to an endocrine reference center was during the mean gestational age of 19 weeks. Their mean pre-pregnancy BMI was 32.3±5.5, and only 9.8% had normal pre-pregnancy BMI. Comorbidities were frequent, as 79.8% had at least one comorbidity in addition to diabetes: Obesity (65.2%), dyslipidemia (37%) , hypertension (32.2%) and 8.3% had depression or anxiety. Patients with a lower education degree had a higher mean A1C level during the third trimester of pregnancy, with mean A1C of 6.39±1.0% (p<0.036). Conclusion: This data reveals a concerning risk profile among pregnant women with T2DM, presented with a cluster of risk factors which can lead to adverse outcomes. Despite this, the majority of these patients did not have access to specialized care to prepare for pregnancy. This underscores the need for special attention and strategies to improve management of women with T2DM in childbering age.

PO—097 Risk Factors for Gestational Diabetes in Brazil: a Systematic Review

Alves AL1; Salheb AN2; Cruz CCS2; Vieira JS2; Barros LM2; Silva MEF2; Lima MADE2; Monteiro BHM2

(1) Centro universitário metropolitano da Amazônia, Belém, PA, Brasil; (2) Centro Universitário Metropolitano da Amazônia, Belém, PA, Brasil

Diabetology & Metabolic Syndrome 2026: PO—097

Introduction: Gestational diabetes mellitus (GDM) is a glucose intolerance diagnosed during pregnancy, associated with complications such as preeclampsia, macrosomia, and an increased future risk of type 2 diabetes. Its main risk factors include elevated body mass index (BMI), advanced maternal age and family history of type 2 diabetes mellitus, highlighting the need for early screening. Objective: To analyze the most prevalent risk factors for gestational diabetes mellitus in the Brazilian population. Methods: A systematic review was conducted following the PRISMA guidelines. Searches were performed in the PUBMED, LILACS, SCOPUS and EMBASE using “Gestational Diabetes”, “Brazil”, “Risk Factors”, “Obesity” and “Maternal Age” as search terms. Cohort, Case-Control and Cross-Sectional studies addressing the risk factors were also included. Results: After screening 1.079 records, 577 duplicates were removed and 9 studies were selected for full text review of which 4 were included in the synthesis. Analysis of these studies (n=5.146 pregnant women) quantified the occurrence of GDM , with prevalence ranging from 2.8% to 14.9%. The lowest prevalence was found in a population-based cohort (61/2.144), while the highest was observed in a high risk referral service (43/288). One study in the public healthcare system reported a prevalence of 5.7% (115/2.014). Elevated pre-pregnancy Body Mass Index (BMI) was the most prominent factor. The prevalence of GDM among obese women (BMI ≥ 30) was 9.3% (42/449) compared to 2.4% (6/251) in non-obese women. For BMI ≥ 25, the prevalence was 7.0% (72/1.021) in overweight/obese women compared to 4.1%(43/1.043) in women with normal weight. Advanced maternal age and family history were other associated factors. For maternal age ≥ 30 years, the prevalence of GDM was 12.7% (32/251) against 8.6% (94/1.094) in younger women. A family history of diabetes increased the risk, with prevalence of 6.6% (40/603) among women with family history versus 4.7% (65/1.386) without family history. Conclusion: Elevated pre-pregnancy BMI is the main risk-factor for GDM in Brazil, followed by advanced maternal age and family history of diabetes. Heterogeneity in prevalence reinforces the need for targeted screening. These findings underline the importance of primary prevention strategies focused on weight control in women of reproductive age to mitigate the incidence of GDM.

PO—098 Risk Factors for Insulin Therapy in Gestational Diabetes Mellitus Patients Treated at a Tertiary Outpatient Clinic

Carvalho MG1; Gomes PM1; Damaso EL 2; Moisés ECD3

(1) Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil, Ribeirão Preto, SP, Brasil; (2) Faculdade de medicina de Bauru, Universidade de São Paulo, Bauru, SP, Brasil; (3) Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil, Ribeirão Preto, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—098

Introduction: Gestational diabetes mellitus (GDM) is a frequent pregnancy complication associated with adverse maternal and neonatal outcomes. Identifying predictors of insulin therapy is essential to optimize monitoring and prevent complications. Objective: To evaluate clinical and biochemical risk factors associated with insulin therapy requirement in GDM patients. Methods: This retrospective cohort analyzed 438 pregnant women diagnosed with GDM at a tertiary outpatient clinic between 2017 and 2018. After applying exclusion criteria—multiple pregnancies, overt pregestational diabetes, incomplete records, and follow-up shorter than one month—181 patients were included. Clinical variables assessed were maternal age, pre-pregnancy weight,body mass index, gestational age at diagnosis, fasting glucose levels, and lipid profile. Patients were classified into insulin and non-insulin groups. Statisticalanalyses included t-tests, chi-square tests, log-binomial regression, and conditional inference trees, with significance set at P<0.05. Results: The mean maternal age was 31.9 years, and the mean body mass index was 32.6 kg/m², characterizing an obese population. Insulin therapy was required for 46.4% of patients. Those requiring insulin were diagnosed earlier (15.1 vs. 19.5 weeks; p=0.009) and had higher fasting glucose at diagnosis (97.4 vs. 87.7 mg/dL; p<0.001) and during the oral glucose tolerance test (97.9 vs. 92.1 mg/dL; p=0.008). Elevated low-density lipoprotein cholesterol (≥130mg/dL) increased the risk of insulin therapy (relative risk 1.44; p=0.036). Maternal age and pre-pregnancy weight were not significantly associated with insulin requirement. Conclusion: Early diagnosis, fasting hyperglycemia, and dyslipidemia, particularly elevated LDL cholesterol, are independent predictors of insulin therapy in GDM. This study highlights accessible clinical markers that can be incorporated into prenatal care to stratify risk, optimize resource allocation, and improve maternal and fetal outcomes.

PO—099 Shared Risk, Shared Habits: Dietary Patterns in Mothers with a History of Gestational Diabetes and Overt Diabetes and Their Children

Dias LBAF1; Jordão MC1; de Souza FD1; Montero MF1; de Oliveira MCM1; da Costa CCP1; Mattar R2; Dualib PM3; Pititto BA4

(1) Post-Graduation Program in Endocrinology and Metabology, Universidade Federal de São Paulo, São Paulo, SP, Brasil; (2) Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, SP, Brasil; (3) Department of Endocrinology and Metabology, Universidade Federal de São Paulo, São Paulo, SP, Brasil; (4) Department of Preventive Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—099

Introduction: Evidence suggests that eating patterns in childhood are influenced by family dietary habits and tend to persist throughout life. This is an important matter mainly in high cardiometabolic risk individuals such as women with diabetes in pregnancy and their offspring. Objective: To assess the association between maternal dietary intake in women with history of gestational diabetes (GDM) or overt diabetes and the dietary habits of their children. Methods: A retrospective cohort study enrolling 222 women with GDM or overt diabetes followed in prenatal care service, who were recalled along with their children for revaluation of clinical and nutritional status 2 to 14 years after birth. Dietary intake was assessed using a questionnaire adapted from SISVAN (Brazilian Food and Nutrition Surveillance System). Results: Current evaluation showed that women were 40.9(6.3) years old and had 55% of obesity and 54.5% of metabolic syndrome. Children were 6.2 (2.9) years, being 54% female, 19.4% with obesity and 11.7% with metabolic syndrome. Children of mothers who reported eating meals in front of screens showed a higher prevalence of the same behavior (84.3% vs. 34.0%; p<0.001) compared to those who did not have this habit; these children were about 10 times more likely to adopt the same behavior (OR 10.8; 95%CI 5.5–21.0), independent of sex, age, or BMI. We observed higher frequencies of children’s intake in the previous day of processed meats (65.7 vs. 11.7%; p<0.001), soft drinks (85.2 vs. 29.8%; p<0.001), fruits (72.5 vs. 58.2%; p=0.037), beans (81.5 vs. 42.2%; p<0.001) and fruits/vegetables/greens (62.4 vs. 44.9%; p=0.010) in the group of mothers who had the same habit. Children were 17 times more likely to consume soft drinks (OR 17.3; 95% CI: 8.3–36.0), 15 times more likely to consume processed meats (OR 15.4; 95% CI: 7.5–31.5), 6.3 times more likely to eat beans (OR 6.3; 95% CI: 3.3–12.2), 2.4 times more likely to consume fruits (OR 2.4; 95% CI: 1.3–4.5), and twice as likely to eat fruits/vegetables/greens (OR 2.0; 95% CI: 1.2–3.5) when their mothers had the same dietary habits, independent of the child’s age, sex, or BMI. Conclusion: Maternal consumption of both healthy and unhealthy foods significantly increased the likelihood of similar behaviors in children, independent of child’s age, sex, and BMI. Given that mothers with a history of GDM and overt diabetes and their children are at increased cardiometabolic risk, these findings highlight the importance of family-based nutrition education strategies.

PO—100 Use of Advanced Hybrid Closed-Loop Therapy in Pregnant Women with Type 1 Diabetes: Outcomes from Real-Life Cases

Pessoa BMA1; Dantas JR1; de Oliveira MM1; Rodacki M1; Mata FB1; Zajdenverg L1

(1) Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—100

Case Presentation: The use of advanced hybrid closed loop (AHCL) systems with pregnancy-adapted algorithms is linked to improved gestational outcomes compared to multiple daily insulin injections. However, real-world data on pregnant women using the Minimed 780G, which lacks a pregnancy-specific algorithm, remain limited. Case Presentation: This report describes the clinical evolution of three pregnant women with type 1 diabetes (T1D) monitored at a specialized maternity hospital who chose to continue AHCL 780G therapy throughout pregnancy. Case 1: A 38-year-old woman with 24 years of T1D presented HbA1c levels of 6.4%, 5.1%, and 5.4% in the first, second, and third trimesters, respectively. In the third trimester, time in range (TIR) was 90% with 10% time below range (TBR). She needed to input larger amounts of carbohydrates than she actually intakes to manage postprandial glucose excursion. Cesarean delivery occurred at 37 weeks without maternal complications. The newborn was appropriate for gestational age but developed hypoglycemia. Case 2: A 26-year-old woman with 13 years of T1D had HbA1c values of 7.5%, 6.1%, and 6.2% in the first, second, and third trimesters, respectively. TIR in the third trimester was 85%, with 1% TBR. Due to sensor shortages, the automated mode was temporarily disabled. She also reported higher carbohydrate intake than consumed. Cesarean was performed at 37 weeks with no maternal complications. The newborn was large for gestational age (LGA) and had hypoglycemia. Case 3: A 28-year-old woman with T1D for 14 years showed HbA1c values of 8.1%, 6.9%, and 6.6% in the first, second, and third trimesters, respectively. In the third trimester, TIR was 76%, with 90% time in automated mode, but high glycemic variability (coefficient of variation 42–46%) and 9% TBR with frequent symptomatic hypoglycemia. Cesarean section was performed at 38 weeks. Postpartum, the patient developed preeclampsia. The newborn was LGA and experienced hypoglycemia. The patients gave their explicit written consent to publish their information in an open access journal. Discussion: Despite AHCL use, neonatal hypoglycemia was observed in all cases. The 780G system, without a pregnancy-specific algorithm, may require overreporting of carbohydrate intake to manage insulin resistance in later pregnancy. Final Comments: Managing T1D in pregnancy with AHCL systems not adapted for gestation requires individualized strategies and close clinical monitoring to optimize maternal and neonatal outcomes.

PO—101 Absence of Impact of ABO and Rh Maternal-Paternal-Fetal Blood Groups Incompatibility on the Age at Diagnosis of Type 1 Diabetes Mellitus

Rodrigues ACM1; Lopes LCP1; Santos VM1; Negrato CA1

(1) Faculdade de Medicina de Bauru, Universidade de São Paulo, Bauru, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—101

Introduction: Type 1 Diabetes Mellitus (T1DM) results from the autoimmune destruction of pancreatic beta cells that produce insulin, arising from the interaction between poorly understood genetic and environmental factors. In recent decades, epidemiological data (Weets et al., 2002) have shown an anticipation in the age of disease diagnosis, with clinical manifestations identified in progressively younger age groups. This phenomenon, observed particularly in children under 5 years of age, makes it necessary to investigate underlying fetal and perinatal immunological triggers, which appear to play a significant role in modulating autoimmunity. Among the investigated risk factors, maternal-infant blood incompatibility stood out as a predictor for early disease development in the case-control study by Dahlquist et al. (1990). In the specific analysis of incompatibilities, a greater tendency of effect was noted for the ABO system compared to the Rh system, although in statistically insignificant proportions. In light of this, this study aims to assess the impact of maternal and paternal ABO and Rh blood incompatibility on the age at diagnosis of T1DM. Objective: To assess the impact of ABO and Rh blood group incompatibility on the age at diagnosis of T1DM Methods: This is a retrospective cohort study using data obtained from medical records of patients treated at an endocrinology clinic in Bauru-SP. Maternal, paternal, and offspring blood types for ABO and Rh groups were evaluated, along with the age at T1DM diagnosis. Statistical analysis was performed using R software (version 4.4.2) with Shapiro-Wilk, Wilcoxon, and Kruskal-Wallis tests. The study was approved by a Research Ethics Committee. Results: Data from 97 individuals were included in the analysis, with a mean age at T1DM diagnosis of 13.02 ± 8.80 years. No statistically significant difference was observed in the age at T1DM diagnosis between individuals with and without paternal blood group incompatibility in the ABO group (p=0.469), Rh group (p=0.349), or both groups combined (p=0.687). Similarly, no statistical significance was found regarding maternal incompatibility in the ABO group (p=0.755), Rh group (p=0.184), or both groups simultaneously (p=0.531). Conclusion: No statistically significant association was found between ABO and Rh blood group incompatibility and the age at diagnosis of T1DM.

PO—102 ADD2DIA Study: Real-World Evidence in People with Type 2 Diabetes Mellitus for Evaluating the Effectiveness and Safety of Adding Sodium-Glucose Cotransporter-2 Inhibitor to Modified Release Gliclazide – Results from the Brazilian Population

Moreira RO1; Gomes TP2; Lima RV2

(1) Instituto Estadual de Diabetes e Endocrinologia, Juiz de Fora, MG, Brasil; (2) Servier, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—102

Introduction: Sodium-Glucose Cotransporter-2 Inhibitor (ISGLT-2) are important medications for the treatment of Type 2 Diabetes Mellitus (T2DM). However, there is a limited body of evidence about the efficacy of adding an ISGLT-2 to Glicazide MR in Real World Clinical Practice. Objective: To evaluate the effectiveness of adding SGLT2i to the baseline therapy of MR gliclazide in people with T2DM through glycated hemoglobin (HbA1c), weight, and blood pressure (BP) changes. Methods: Multicenter, retrospective, international study involving 25 sites in 5 countries (Brazil, China, Philippines, Saudi Arabia, Turkey). Adult T2DM patients treated with gliclazide MR ≥60mg/day and background therapies for ≥ 2 years were eligible for add-on SGLT2i. Results: The analysis included 89 Brazilian patients diagnosed 13.3 ± 7.9 years ago (mean age ± SD 61.9 ± 10.2 years, 53.92% men). Patients were at high cardiovascular risk; most of them (84.5%) were overweight/obese (mean BMI 31.3 ± 5.8 kg/m2), had dyslipidemia(70.8%), hypertension (76.4%) and atherosclerotic cardiovascular disease (30.3%). Mean baseline value of HbA1c was 8.7% ± 1.6, and systolic / diastolic BP 137.4 ± 22.5 and 81.0 ± 11.6mmHg, respectively. The mean dose of MR gliclazide was 85.3 ± 29.3 mg/day, and the mean time to start SGLT2i treatment after gliclazide was 4.1 ± 3.7 years. Dapagliflozin was the most prescribed SGLT2i (76.4%). There was a reduction in HbA1c of 0.8 ± 1.9%, in mean systolic and diastolic BP of 7.2 ± 20.2 and 6.8 ± 12.4mmHg, respectively, and a mean weight reduction of 4.0 ± 4.3kg. The mean duration of the MR gliclazide + SGLT2i combination was 2.3 years and was considered well-tolerated, with few adverse events (5 patients, 2 hypoglycemia episodes, no severe case). Conclusion: The late adjustment in prescription despite high HbA1c values, high cardiovascular risk, and overweight/obesity at baseline demonstrates clinical inertia and the importance of awareness about treatment intensification. The MR gliclazide + SGLT2i combination was an effective and well-tolerated strategy to address critical gaps in T2D management with benefits of glycemic control, cardiometabolic risk and body weight reduction, especially in patients at high risk who need the holistic, multidisease approach.

PO—103 Adherence to Insulin Therapy in Primary Health Care in a Municipality in São Paulo: a Cross-Sectional Study

Consoli LMFV1; Chiaroti R1; Assis LLA1; Motozo VPP1; Junior FB1; de Oliveira REM2

(1) Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brasil; (2) Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo e Universidade de Brasília, Brasília, DF, Brasil

Diabetology & Metabolic Syndrome 2026: PO—103

Introduction: Low adherence to diabetes medication treatment is a recognized problem in clinical practice and can lead to unfavorable outcomes with harm to individuals, families, and the community. Objective: To estimate the prevalence of adherence to insulin therapy among individuals with a medical diagnosis of diabetes, using insulin, and registered with primary health care services in the city of Jardinópolis, São Paulo, Brazil. Methods: This is a cross-sectional study with 152 participants and a simple probability sample. Blood and urine samples were collected, as well as ophthalmological fundus examinations using a portable retinal camera on a smartphone and face-to-face interviews. Adherence was estimated using the Treatment Adherence Measure insulin, a version validated in Brazil. Results: There was a higher frequency of women (63.2%), without private health insurance (84.2%), with a medical diagnosis of type 2 diabetes (93.3%), inadequate glycemic control (76.9%), albuminuria normal (56.7%) and without diabetic retinopathy (71.7%). The prevalence of insulin therapy adherence was estimated at 47.4% (95% CI 39.4–55.3). Higher adherence to insulin therapy was observed among males, self-reported non-white race/ethnicity, and those diagnosed with systemic arterial hypertension. A negative association was observed with alcohol abuse, amputation, and among those with private health insurance (p<0.05). Conclusion: Adherence to insulin therapy was low, and this scenario can lead to acute and chronic complications with varying impacts, including increased healthcare costs. The identified barriers suggest the need for multidimensional interventions in primary health care aimed at managing medication therapy to enable disease control. Furthermore, strengthening health education initiatives that encourage self-care and empowerment of people using insulin is proposed.

PO—104 Age-Based Suggestive Endotypes of Type 1 Diabetes: Do Findings in Caucasians Populations Apply to a Multiethnic Brazilian Cohort?

Guimarães RS1; Veiga AM1; Caneca KO1; Silva JMS1; Dantas JR1; Zajdenverg L1; Rodacki M1

(1) Hospital Universitário Clementino Fraga Filho- faculdade de medicina da Universidade Federal do Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—104

Introduction: Type 1 diabetes (T1D) shows clinical and immunological heterogeneity, and different endotypes have been proposed mainly in Caucasian populations. Classification into endotype 1 (E1) and endotype 2 (E2) has been associated with distinct profiles of autoimmunity, β-cell preservation, age at onset, and disease progression. Diagnosis before the age of 7 years is highly suggestive of E1, whereas diagnosis at 13 years or older is highly suggestive of E2. It is still unclear whether these endotypes are also observed in multiethnic populations, such as the Brazilian. Objective: To describe the epidemiological and immunological profiles of patients with T1DM classified by age at diagnosis (< 7 vs ≥ 13 years of age) as suggestive of different endotypes. Methods: This was a retrospective analysis of patients with T1D followed at a tertiary referral hospital. Demographic data, family history of diabetes, positivity for anti-glutamic acid decarboxylase (GADA) and anti-tyrosine phosphatase IA-2 (IA2A) antibodies, presence of other autoimmune diseases, and residual C-peptide were assessed in individuals with variable disease duration. Patients were categorized as E1 or E2 according to the age at onset (< 7 or ≥ 13 years, respectively). Categorical variables were compared using the chi-square test and continuous variables using the Mann-Whitney test, with significance set at p<0,05. Results: Of 213 patients, 57 were E1 and 156 E2. 51.2% were females. Their mean age and disease duration were 37.3 ± 16.7 and 19.7 ± 12.4 years, respectively. GADA was positive in 25.9% of E1 and 43.2% of E2 (p=0.034). Family history of T1D was more frequent in E2 (56.1% vs. 38.6%, p=0.03). IA2A positivity and frequency of other autoimmune diseases showed no significant differences (p=0.15 and 0.85), respectively). Residual C-peptide was higher in E2 (25.2% vs. 5.3%, p=0.009). Conclusion: In this multiethnic Brazilian cohort, the age-based classification suggestive of endotypes reproduced some differences reported in predominantly Caucasian populations, with E2 showing a higher frequency of GADA positivity and better residual β-cell function than E1. These findings support further studies to validate endotype-based approaches in diverse populations, aiming for more personalized strategies in T1D management. However, we cannot exclude that the observed difference in GADA frequency reflects variations in antibody persistence rather than true differences in GADA positivity, as most individuals in our cohort had long-standing T1D.

PO—105 Analysis of Hospital Admissions and Deaths Due to Diabetes Mellitus in the Southeast Region from 2019 to 2024: an Ecological Study

Souza BA1

(1) Universidade Vila Velha, Vila Velha, ES, Brasil

Diabetology & Metabolic Syndrome 2026: PO—105

Introduction: Diabetes mellitus (DM) is a chronic disease with high prevalence and is a major cause of morbidity and mortality in Brazil, particularly affecting the elderly, women, and ethnic/racial minorities. It comprises a group of metabolic disorders characterized by hyperglycemia, resulting from defects in insulin secretion and/or action. Persistent hyperglycemia is associated with acute and chronic complications affecting multiple organs, generating a substantial burden on health services. In Brazil, understanding the dynamics of this condition requires considering social, economic, and racial inequalities, which influence access to diagnosis, treatment, and disease management. Objective: To analyze the profile of hospital admissions and deaths due to DM in the southeast region of Brazil from 2019 to 2024, according to age, sex, and race/skin color. Methods: This descriptive study used secondary data from the Hospital Information System of the Unified Health System (SIH/SUS), provided by Department of Informatics of the Unified Health System (DATASUS). Data were extracted, organized, and analyzed using Microsoft Excel. Results: During the study period, there were 295,908 hospital admissions and 13,102 deaths attributed to DM. Hospital mortality was higher among the elderly (6.6%) compared to children and adolescents (0.3%). Regarding sex, men accounted for a higher absolute number of admissions (162,762), whereas women had a higher in-hospital mortality rate (5.0% vs 3.9%). Analysis by race/skin color revealed significant disparities: Black individuals had the highest mortality rate (5.2%), followed by White (4.4%) and Brown individuals (3.9%). Conclusion: Despite the universal coverage of the Unified Health System (SUS) and advances in public policies addressing diabetes, the magnitude of the disease, combined with social inequalities and structural and financial limitations of the health system, makes DM a major challenge for Brazilian public health. Preventive and management strategies should be prioritized, focusing on the most vulnerable groups, including the elderly, women, and racially disadvantaged populations, to reduce morbidity and mortality and improve the quality of life of affected individuals.

PO—106 Application of FINDRISC and Biochemical Testing in Community Diabetes Screening: the “Comunidades” Experience in São Paulo

Pineda-Wieselberg RJ1; de Carvalho ACBC1; Kitamura LCS1; Rodrigues C1; Alves J1; Miranda AP1; Yoshimura L1; Canon VLP1

(1) ADJ Diabetes Brasil, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—106

Introduction: Type 2 diabetes mellitus (DM) is a major public health challenge, with high morbidity and mortality. Early identification of at-risk individuals is essential to enable preventive actions. The FINDRISC score, based on anthropometric, clinical, and lifestyle variables, is widely used for screening. In Brazil, however, there are few real-world urban data integrating FINDRISC with biochemical confirmation. Objective: To compare clinical, anthropometric, and biochemical profiles of individuals with and without DM in São Paulo, and identify predictors of higher FINDRISC categories. Methods: Cross-sectional study of 283 adults screened in community settings (2025). Data included demographics, self-reported DM, FINDRISC score, anthropometrics, capillary glucose, HbA1c, and lipid profile. Chi-square and Welch’s t-tests compared groups; multinomial logistic regression assessed predictors of FINDRISC categories (p<0.05). Results: Of the 283 participants, 24 (8.5%) reported a previous diagnosis of DM. The mean age was significantly higher among people with DM compared to those without (70.3 vs. 53.6 years; p<0.001). HbA1c (7.70% vs. 6.11%; p<0.001) and blood glucose (168.5 vs. 106.9 mg/dL; p<0.001) were also significantly higher in the DM group. No significant differences were observed for BMI, waist circumference, total cholesterol, HDL, LDL, triglycerides, fruit consumption, or physical activity. Among individuals without DM, 22.0% had HbA1c ≥6.5%, suggesting possible undiagnosed DM. In the regression model, higher age and elevated HbA1c were the strongest predictors of higher FINDRISC categories. . Conclusion: The results demonstrated that community-based screening can identify individuals with poor glycemic management and a substantial proportion of possible undiagnosed diabetes cases. Age and HbA1c were key discriminators of higher risk profiles, reinforcing the importance of including biochemical testing alongside questionnaires in public screening campaigns. The absence of significant differences in BMI and waist circumference suggests that in this population, anthropometric measures alone may be insufficient to stratify diabetes risk. Expanding similar screening strategies could improve early detection and facilitate timely intervention in high-risk urban communities.

PO—107 Assessment of Endocrinologists’ Attitudes and Knowledge Regarding the Disposal of Contaminated Sharps Waste Among Insulin-Using Patients with Diabetes Mellitus

Silva CMS1; Lima GAB1; Taboada GF1; Pereira EK1; Rocha SG1

(1) Universidade Federal Fluminense, Niterói, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—107

Introduction: Diabetes mellitus is a chronic disease and a global public health concern. Approximately 20–25% of individuals with diabetes require insulin therapy and utilize medical supplies that generate contaminated sharps waste. Evidence from the literature indicates that, in the home setting, this waste is frequently disposed of improperly, posing risks to public health and the environment. The primary contributing factors include insufficient patient education and the lack of specific legislation addressing the disposal of household medical waste. Objective: To assess the frequency with which endocrinologists in Brazil provide guidance on the home disposal of insulin-related sharps waste, as well as to evaluate their knowledge on the topic. Methods: This was a cross-sectional, observational study conducted via an online questionnaire Results: A total of 56 endocrinologists participated in the study, with a mean age of 46.4 ± 9.8 years and a mean of 22.0 ± 9.9 years of professional experience since medical school graduation. The majority (78.6%) reported that they routinely counsel patients on sharps waste disposal. Among those who did not, the most common reason (50%) was lack of time during patient consultations. However, 42 endocrinologists provided incorrect guidance, recommending disposal in PET bottles or cardboard containers such as milk or juice cartons. While most respondents correctly advised patients to dispose of sharp waste at primary healthcare centers, 21 also recommended inappropriate alternatives such as hospitals, pharmacies, or household trash. Only 41% of participants reported having received formal training on the subject. The Brazilian Society of Endocrinology and Metabolism (SBEM) was identified as the main source of information. Notably, 87.5% of respondents expressed interest in having this topic more frequently addressed in conferences, lectures, and continuing education courses Conclusion: While most endocrinologists report advising patients on the disposal of sharps waste, this guidance is often inaccurate. These findings highlight the need for enhanced medical education and training on appropriate sharps waste disposal to improve both patient safety and environmental outcomes.

PO—108 Assessment of Insulin Therapy Self-Management by People with Diabetes Monitored by Primary Health Care: a Cross-Sectional Study

Neto JCGL1; Almeida SO1; Oliveira LS1; Gonçalves ABS1; de Sousa AD1; de Sá LRPF1; dos Santos LF1; Santos RS1; Damasceno MMC2

(1) Universidade Federal do Piauí, Floriano, PI, Brasil; (2) Universidade Federal do Ceará, Fortaleza, CE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—108

Introduction: Proper diabetes management requires behavioral changes and adherence to medication treatment. To achieve therapeutic goals, many patients require exogenous insulin but face challenges such as low health literacy and therapeutic inertia, often resulting in irreversible complications. Patients’ lack of technical knowledge, insufficient training of healthcare professionals, and limited access contribute to glycemic imbalance and reduced life expectancy. Given this scenario, it is essential to understand whether people using insulin are administering it correctly. Objective: To evaluate the self-management of insulin therapy by people with diabetes monitored in Primary Health Care. Methods: A cross-sectional study was conducted between August and December 2024 in 17 Basic Health Units in Floriano, Piauí, Brazil. Participants were individuals with diabetes aged ≥18 years, of both sexes, using insulin for at least six months, and responsible for all insulin steps (preparation, administration, disposal). Sociodemographic data were collected, and participants demonstrated the insulin therapy steps, which were recorded and evaluated according to the Brazilian Diabetes Society checklist. The study was approved by the Research Ethics Committee (protocol 6,746,565/2024). Results: Among 60 participants, mean age was 58.5 years, most were women (56.7%), married (58.3%), Black (71.7%), with up to nine years of schooling (36.7%). Type 2 diabetes predominated (71.7%), and 50% had used insulin for less than five years. Significant gaps were found in all phases of insulin therapy. In pre-preparation, checking expiration date (65%) and liquid appearance (60%) showed moderate adherence, while recording the vial start date (20%) and waiting the proper time after refrigeration (25%) were low. In preparation, although 65% performed hand antisepsis, essential steps such as antisepsis of vial seal (20%), air injection (25%), and bubble removal (31.7%) were uncommon. In administration, correct practices like slow injection (83.3%) and 90° angle (81.7%) were frequent, but site inspection (55%) and post-application counting (60%) need improvement. Only 31.7% discarded needles correctly, increasing accident risks. Conclusion: These findings reveal critical gaps and reinforce the need for educational strategies to ensure safe, effective insulin self-management.

PO—109 Association Between Continuous Cash Benefit Coverage and Hospital Admissions for Diabetes Mellitus in Brazil: An Ecological Study (2007–2024)

Fabricio SEP1; Garces TS1; Damasceno LLV1; Marques SJS1; Cestari VRF1; Florêncio RS1; Flor AC1; de Araújo AL2; Moreira TMM1

(1) Universidade Estadual do Ceará, Fortaleza, CE, Brasil; (2) Universidade Regional do Cariri, Cariri, CE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—109

Introduction: The Continuous Cash Benefit (BPC), established by the Organic Law of Social Assistance (LOAS), guarantees a monthly minimum wage to older adults aged 65 or over, or to individuals with disabilities of any age. To be eligible for this benefit, the per capita household income must be equal to or less than one-quarter of the minimum wage. This study examines the association between BPC coverage and hospital admissions due to diabetes mellitus (DM) in Brazil. Objective: To investigate the association between Continuous Cash Benefit (BPC) coverage and hospitalization rates for diabetes mellitus in Brazil from 2007 to 2024. Methods: This ecological, cross-sectional study used secondary data extracted in March 2025. The study covered the entire Brazilian territory, with a population of 212.6 million inhabitants. Data sources included the Atlas of Human Development in Brazil and the Hospital Information System (SIH) of the Department of Informatics of the Unified Health System (DATASUS). Hospitalizations due to diabetes mellitus were identified using ICD-10 codes E10 to E14: type 1 DM, type 2 DM, malnutrition-related DM, other specific types, and unspecified DM. Hospitalization rates were calculated by dividing the number of DM-related hospital admissions in each federative unit and year by the corresponding population, multiplied by 100,000 inhabitants. Population data were obtained from DATASUS. Data processing was performed using Microsoft Excel. Spatial autocorrelation (Global Moran’s I) and hotspot analysis (Getis-Ord Gi) were conducted using GeoDa software. Regression analysis was performed in R using the spdep package. A Generalized Linear Model (GLM) was used to assess the association between BPC coverage and hospitalization rates. Results: A total of 2,327,162 hospital admissions for DM were recorded in Brazil between 2007 and 2024, corresponding to a rate of 63.87 admissions per 100,000 inhabitants. In the bivariate GLM analysis, BPC coverage was significantly associated with hospitalization rates for diabetes mellitus (p = 0.01). Conclusion: The analysis revealed a statistically significant association between BPC coverage and DM-related hospital admissions. These findings suggest that social protection mechanisms, such as the BPC, may influence healthcare utilization patterns among vulnerable populations.

PO—110 Association Between Delivery Type, Birth Order, and Stressful Events on the Onset of Type 1 Diabetes in a Brazilian Cohort

Costa AH1; de Sena MCR1; Montalvão BS1; Dantas JR1; Zajdenverg L1; Rodacki M1

(1) Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—110

Introduction: The contribution of environmental factors to the development of type 1 diabetes (T1D) is still uncertain. Perinatal factors, including delivery type, birth order, and exposure to stressful events, may influence this process. However, evidence in the Brazilian population is still scarce. Objective: To investigate the association between delivery type, birth order, and stressful events preceding symptom onset in a Brazilian outpatient population with T1D. Methods: Descriptive, cross-sectional study based on interviews with patients with T1D from a tertiary center. Data included delivery type (vaginal or cesarean), birth order (considering siblings from the same mother), stressful events immediately prior to symptom onset, and family history of diabetes or autoimmune diseases. Results: Among 250 respondents, 30% (76/248) were second-born, 25% (61/248) first-born, 16% (39/248) only children, and 13% (33/248) third-born. Of 242 patients, 55% were delivered by cesarean section and 45% by vaginal birth. Stressful events preceding symptom onset were reported by 38% (93/245), including intense emotional distress (55%), infection (30%), and other events (14%). Family history analysis showed that 73 (29.2%) participants had a relative with T1DM (including 22 siblings), 165 (66%) had relatives with type 2 diabetes, and 32 (12.8%) reported autoimmune diseases in the family. Conclusion: In this cohort, second-born children were more frequently affected, contrasting with literature suggesting higher risk among first-borns. The higher frequency of cesarean deliveries aligns with prior studies linking this factor to T1DM risk. Although not present in most cases, stressful events were reported by over one-third of patients and may act as triggers in genetically predisposed individuals. These findings reinforce the multifactorial nature of T1DM and the need for further studies in diverse populations to clarify environmental and genetic interactions in disease pathogenesis.

PO—111 Association Between HLA Alleles and Haplotypes in an Admixed Population of Brazilian individuals with Type 1 Diabetes with Other Autoimmune Disease: A Brazilian Multicenter Study

Gomes MB1; dos Santos Jr GC2; Pinheiro GRC3; Azulay RS4; Carvalho PRVB5; Silva DA6; Negrato CA7; Porto LC5

(1) Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (2) Laboratory of Metabolomics, Department of Genetics, IBRAG, Rio de Janeiro State University, Rio de Janeiro, RJ, Brasil; (3) Department of Internal Medicine, Reumathology Unit, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (4) Service of Endocrinology, University Hospital of the Federal University of Maranhão, São Luís, MA, Brasil; (5) Histocompatibility and Cryopreservation Laboratory, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (6) DNA Diagnostics Laboratory, Forensic Science Laboratory, Roberto Alcantara Gomes Biology Institute, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (7) Universidade de São Paulo, Faculdade de Medicina de Bauru, Bauru, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—111

Introduction: Type 1 diabetes (T1D) is an autoimmune disease (AID) frequently associated with other AIDs, particularly thyroid diseases (AITD), that affect almost 25% of individuals with T1D. The histocompatibility leukocyte antigen (HLA) system that accounts for about 50% of genetic predisposition to T1D, mainly related to class II molecules, is the common genetic axis for the coexistence of AIDs. Objective: This study aimed to investigate the association of T1D with other AIDs, class II HLA alleles/haplotypes, self-reported color/race, and genomic ancestry (GA) in the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG). Methods: This retrospective and cross-sectional study included 1,607 individuals with T1D, enrolled between August 2011/August 2015. AIDs diagnoses were retrieved from medical records. African, European, and Native Amerindian GAs were estimated using a panel of 46 AIM-INDEL markers. Class II HLA alleles (HLA-DRB1*, HLA-DQA1*, and HLA-DQB1*) were genotyped by PCR-RSSO (high-resolution LABType, One Lambda Inc., West Hills, USA) combined with Luminex technology while 449 (28.1%) participants underwent DNA analysis by Next Generation Sequencing (NGS.AID with hyper- or hypothyroidism were matched by sex, self-reported race/color, and geographic birth regions to T1D patients without other AID, in a 1:3 ratio, to compare HLA allele frequencies. Results: AIDs were found in 292 individuals (18.2%). The most frequent AIDs were hypothyroidism (n=32; 14.8%), hyperthyroidism (n=25; 1.6%), vitiligo (n=18; 0.6%), and rheumatoid arthritis (n=13; 0.4%). In total, 15 individuals (0.9%) had more than one AID, most often the combination of vitiligo and rheumatoid arthritis). Patients who self-reported as white, and female were more frequent among those with AIDs, respectively (181- 61.9% vs 643 - 48.9% and 188 - 60.1% vs 670 - 50.9%; p<0.001). These patients also had a higher European GA (68.0±19.9% vs 63.3±21.8; p<0.001). No differences were observed between HLA allele frequencies of T1D with hypothyroidism versus T1D. DQB1*04:02g and DQA1*04:01g were more frequent among T1D with hyperthyroidism (OR 18.7 and 9.2, respectively). HLA-DRB1*04:05g, DQA1*03:01g and DQB1*03:02g were more frequent in patients without hyperthyroidism. Conclusion: Female sex and higher European GA were associated with the occurrence of other AID in patients with T1D. In individuals with T1D and hyperthyroidism, the haplotype DQA104:01-DQB104:02 may represent a risk factor.

PO—112 Association Between rs1337791, rs7211, rs6610650 and rs476141 SNVs and Susceptibility of T1 Diabetes Mellitus in the Brazilian Population

de Souza BJ1; da Silva DA2; Porto LC3; dos Santos GC4; Canani LH5; Corrêa-Gianella MLC6; Gomes MB7

(1) Laboratório de Bioinformática Aplicada à Saúde, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (2) Laboratório de Diagnóstico de DNA, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (3) Laboratório de Histocompatibilidade e Criopreservação, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (4) Laboratório de Metabolômica, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (5) Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil; (6) Laboratório de Carboidratos e Radioimunoensaio, Universidade de São Paulo, São Paulo, SP, Brasil; (7) Departamento de medicina Interna, Universidade do Estado do de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—112

Introduction: Type 1 Diabetes mellitus (T1DM) is an autoimmune disease characterized by pancreatic beta-cell destruction and lifelong dependence on exogenous insulin. Most knowledge of T1DM etiology derives from studies conducted in Non-Hispanic White (NHW) populations. However, Brazil—home to over 100,000 young individuals with T1DM—presents a high-burden and genetically admixed population, in which traditional risk loci may not fully explain disease susceptibility. This highlights the need for population-specific genetic studies. Objective: To investigate the association between selected single-nucleotide variants (SNVs) and the risk of T1DM in a Brazilian population. Methods: We conducted a case-control study including 1,625 individuals with T1DM and 1,154 healthy controls from Brazil. A total of 46 SNVs were genotyped using multiplex fluorescent PCR and tested for association with T1DM risk. Logistic regression models were adjusted for covariates and multiple testing. Results: Significant associations were found for several SNVs. TXNIP rs7211 showed a strong risk association for genotype AA (AA vs. GG: OR = 22.27, 95% CI = 15.84–31.14, adjusted P = 2.84×10⁻⁷²) and AG (AG vs. GG: OR = 1.87, 95% CI = 1.57–2.24, P = 5.25×10⁻¹²). CYBB promoter SNV rs6610650 GA genotype was protective (GA vs. G: OR = 0.52, 95% CI = 0.42–0.65, P = 1.43×10⁻⁸). LRP6 rs1337791 was associated with increased risk for AA (AA vs. GG: OR = 9.61, 95% CI = 7.34–11.98, P = 5.59×10⁻⁶⁵) and AG (AG vs. GG: OR = 1.80, 95% CI = 1.49–2.14, P = 2.22×10⁻¹¹). In contrast, the long non-coding RNA SNV LOC339529 rs476141 conferred protection for GT (GT vs. GG: OR = 0.21, 95% CI = 0.18–0.26, P = 5.82×10⁻⁶⁴) and TT genotypes (TT vs. GG: OR = 0.17, 95% CI = 0.14–0.22, P = 2.25×10⁻⁴¹). Conclusion: Our findings suggest that SNVs previously implicated in diabetic complications—such as neuropathy (rs1337791), retinopathy (rs7211), and nephropathy (rs6610650 and rs476141)—are also associated with T1DM susceptibility in the Brazilian population. These results offer novel insights into the genetic architecture of T1DM in admixed populations and reinforce the need for ancestry-informed analyses in future studies.

PO—113 Beyond Time in Range: a Real-World Glycemic Outcomes with The Minimed™ 780g System in Brazil, Insights from a Single-Center Experience

Alves STF1; Montalvão BS1; Vianna RGP2; Alves JPSF1; Alves MEF1; de Freitas FV1

(1) Clínica Solange Travassos, Rio de Janeiro, RJ, Brasil; (2) Faculdade de Ciências Exatas e Tecnologia, PUC-São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—113

Introduction: Automated insulin delivery (AID) systems have transformed glycemic management in type 1 diabetes (T1D), achieving levels of control previously difficult with conventional therapies. Alongside these advances, new metrics have emerged to better capture overall glycemic quality. The Glycemic Risk Index (GRI) integrates hyperglycemia (Time Above Range) and hypoglycemia (Time Below Range) into a single score. Objective: To evaluate glycemic outcomes, including the GRI, in a Brazilian T1D population using the MiniMed™ 780G system in real-world clinical practice. Methods: We performed a retrospective analysis of CareLink™ data from individuals with T1D using the MiniMed™ 780G advanced hybrid closed-loop system at a private center in Rio de Janeiro, Brazil. Data were collected between November 2023 and August 2025. From 161 available records, we selected those with ≥70% of sensor wear during a 14-day period. A total of 128 records met inclusion criteria and were analyzed. Results: Mean time in range (TIR 70-180 mg/dL) was 73.8% ± 8.4%, with mean glucose of 150.1 mg/dL ± 14.1. Time <70 mg/dL averaged 1.5% ± 1.4% and <54 mg/dL, 0.3% ± 0.5%. Time 180 - 240mg/dL was 18.4% ± 6.3% and >240 mg/dL, 5.9% ± 3.8%. Mean GMI was 6.89% ± 0.3% and coefficient of variation 32.9% ± 4.4%. The mean GRI was 28.3 ± 9.0, with hypoglycemia component of 1.5 ± 1.5. Conclusion: The MiniMed™ 780G system enabled good metabolic control with minimal hypoglycemia burden in this real-world Brazilian cohort. The GRI proved to be a useful complementary parameter to capture overall glycemic quality, emphasizing that residual risk remains mainly related to hyperglycemia. These findings support the clinical utility of AID systems in routine care and reinforce the potential of GRI as an additional tool for individualized treatment assessment in T1D.

PO—114 Bioimpedance Vector Analysis (Biva) in People with Type 1 Diabetes: a New Clinical Evaluation

Pena NF1; Froes LP1; Miranda GP1; Mendes MIV1; Costa PM1; Duarte A1; Torres HG1; Lauria MW1

(1) Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—114

Introduction: Phase Angle (PA) measured by bioimpedance analysis (BIA) can be useful in assessing health status and cell membrane integrity in various medical conditions. Low values in patients with Diabetes Type 1 (T1D) may indicate loss of body cell mass or a catabolic state resulting from glycemic imbalance. BIA vector analysis (BIVA) is a method that allows for a better understanding of hydration status and cell mass compared to PA alone Objective: To assess the potential of BIVA as an adjunct to PA in the assessment of individuals with T1D. Methods: Male and female patients with T1D underwent low-intensity (800 μA), single-frequency (50 kHz) BIA analysis to obtain PA and to create a BIVA graph with tolerance ellipses at the 50th, 75th, and 100th percentiles. The graphs were generated with custom code in Python 3.10, using the Pandas, NumPy, Matplotlib, and Seaborn libraries. Each point represented a participant plotted on the plane and classified by PA quartiles of the Brazilian population in different grayscale gradations, highlighting the distribution of participants in relation to the tolerance ellipses generated from a control population. Results: We studied 88 T1D patients (53.4% women), aged 36.2+11.3 years, with mean HbA1C values of 8.57+1.84% (8.96+2.09 x 8.12+1.40, p = 0.032, F x M) and control group with 46 patients (63% women, NS), with mean ages of 34.0+9.2 (women) and 39.2+14.9 (men), NS. Between patients and controls, the PA was 5.50 X 6.65 (p = 0.000) in women and 6.70 x 8.16 (p = 0.000) in men, with most men and women with T1D in the 1st quartile of the Brazilian population (44.7% and 41.5%). 89.5% (n = 34) of patients in the (first quartile of PA (F = 21/47; M = 17/41) are outside the 75% ellipse. In both sexes, cases with lower PA tend to the right of the imaginary vector line corresponding to the longitudinal axis of the ellipse and towards the higher/outer percentiles of the ellipses. In men, P1 cases appear to be related to increased resistance, a phenomenon not observed to the same extent in women. Conclusion: The inclusion of BIVA allowed a better assessment of cellular integrity by PA in people with T1D.

PO—117 Characterization of Sharps Waste Generated by Individuals with Type 2 Diabetes Mellitus Receiving Insulin Therapy

Flor AC1; Garcia AA2; Negreiros FDS2; de Araújo AL3; de Aquino MJN2; Moreira TR2; Lima GS1; Moreira LS1; Cestari VRF1; Moreira TMM1

(1) Universidade Estadual do Ceará, Fortaleza, CE, Brasil; (2) Universidade Federal do Ceará, Fortaleza, CE, Brasil; (3) Universidade Regional Do Cariri, Cariri, CE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—117

Introduction: Individuals with type 2 diabetes mellitus undergoing insulin therapy produce used medical sharps daily, such as syringes, needles, and lancets. Improper disposal of these items poses significant risks to public health and the environment, including needlestick injuries and environmental contamination. A lack of proper guidance often leads to unsafe disposal practices. Objective: To characterize the types of sharps waste and their disposal practices among individuals with type 2 diabetes mellitus undergoing insulin therapy. Methods: A cross-sectional study was conducted between May and July 2025 at the endocrinology and metabolism outpatient clinic of a university hospital in a Northeastern Brazilian state capital. The study protocol was approved by the institutional Research Ethics Committee (approval number: 6,675,970). Data were extracted from nursing records, resulting in a final sample of 101 patients with available documentation. Results: The majority of participants were female (67%), with ages ranging from 50 to 72 years (mean age 61 ± 11 years). Seventy-seven percent had been diagnosed with diabetes for over ten years. Regarding sharps usage, 63.4% used syringes with attached needles, and 32.6% used disposable insulin pens. Patients administered one to four injections per day and reused the same needle three to five times daily; in 4% of cases, the device type was unspecified. No records were found quantifying materials used for daily glucose monitoring. The limitations of these data were attributed to the availability of supplies through Brazil’s Unified Health System and inconsistent patient access. All participants reported improper storage and disposal practices, including disposal in household waste, reuse of needles and lancets, and unsafe transportation of materials. Conclusion: The use of sharps among individuals with diabetes necessitates close attention, particularly due to physical limitations and insufficient access to proper guidance, which may compromise safe management. Despite the limitations of a localized sample, the findings underscore the urgent need for educational interventions focused on proper containment, safe disposal, and environmental considerations of sharps waste among insulin users.

PO—118 Clinical and Psychobehavioral Profiles of Individuals with Type 2 Diabetes in Primary Health Care Settings

Mariano BC1; de Oliveira ACPP2; da Silva KLS1; Reis BO1; de Oliveira DPSC3; de Souza IA1; da Silva LP1; Martinez DG1

(1) Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil; (2) Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (3) Universidade Federal Fluminense, Rio de Janeiro, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—118

Introduction: Type 2 Diabetes Mellitus represents a growing challenge to public health, requiring effective strategies within Primary Health Care. Its management goes beyond glycemic control, being influenced by clinical and psychobehavioral factors that affect treatment adherence and health outcomes. Identifying these profiles is crucial for designing effective interventions and optimizing health outcomes, thereby addressing gaps in knowledge. Objective: To describe the clinical and psychobehavioral profiles of individuals with Type 2 Diabetes Mellitus who are users of Primary Health Care. Methods: This cross-sectional, descriptive study used data from a population-based survey (Approval No. 6,090,623). Data collection, conducted between September 2023 and April 2024, took place in 19 urban and rural Primary Health Units in a municipality in Minas Gerais, Brazil. Sample size calculation was based on an estimated prevalence of 7.0%. Data were obtained through a sociodemographic questionnaire, clinical variables, and self-reported psychobehavioral aspects, including mental health indicators (stress, anxiety, insomnia, depression), health perception, sleep, diet, lifestyle habits (alcohol and tobacco use), treatment adherence, physical activity, and use of health services. Results: The sample comprised 101 individuals. Systemic arterial hypertension was reported by the majority, followed by dyslipidemia. Stress, anxiety, insomnia, and depression were frequently mentioned, along with high prevalence of non-restorative sleep. Most participants rated their health as regular or poor, reported inadequate eating habits, and engaged in low levels of physical activity. Alcohol consumption and tobacco use were present in a significant portion of the sample. While most participants reported adherence to clinical treatment, all used primary health care services, with fewer accessing secondary, tertiary, or private services. Conclusion: The findings underscore the need for multidisciplinary health programs within Primary Health Care, aiming to address not only the clinical aspects of Type 2 Diabetes Mellitus but also psychobehavioral demands and the promotion of healthy lifestyles. Identifying these profiles is essential for designing effective and targeted care strategies. The predominant use of Primary Health Care services, compared to lower demand for other levels of care, reinforces its strategic role in the management of this population.

PO—121 Diabetes Hospitalizations: A Comparison Between the South and Southeast Regions

Patrocinio GF1; Ferreira FM2; Graciolli LHMSG1; da Silva LLF1; Moura YS3

(1) Uninove, São Paulo, SP, Brasil; (2) Universidade Municipal de São Caetano do Sul, São Caetano do Sul, SP, Brasil; (3) Universidade Salvador, Salvador, BA, Brasil

Diabetology & Metabolic Syndrome 2026: PO—121

Introduction: Diabetes mellitus is a chronic metabolic disease characterized by persistent hyperglycemia caused by defects in insulin secretion or action. When inadequately controlled, it can lead to acute and chronic complications, including ketoacidosis, infections, renal failure, cardiovascular disease, and amputations, often requiring hospitalization. In public health, hospitalization rates for diabetes are important indicators of outpatient care quality, reflecting gaps in prevention, early diagnosis, and disease control. Analyzing these data helps assess the burden on the health system and guide more effective management and prevention strategies. Objective: An epidemiological survey of hospitalizations for diabetes in the South and Southeast regions of Brazil between 2012 and 2024. Methods: This ecological, descriptive, cross-sectional, and retrospective study aimed to perform an epidemiological survey of hospitalizations for diabetes in the South and Southeast regions of Brazil between 2012 and 2024. Data were obtained in 2025 from the DATASUS online database, selecting hospitalizations for diabetes (ICD E14) in the target regions. Variables included number of hospitalizations, race, age, sex, and type of care. Results: A total of 821,148 hospitalizations were recorded: Southeast 578,715 (70.47%) and South 242,433 (29.53%). Annual distribution was: 2012: 4,464 (0.54%), 2013: 71,704 (8.73%), 2014: 69,953 (8.52%), 2015: 68,798 (8.38%), 2016: 65,831 (8.02%), 2017: 67,816 (8.26%), 2018: 68,560 (8.35%), 2019: 69,078 (8.41%), 2020: 64,416 (7.85%), 2021: 64,511 (7.86%), 2022: 68,016 (8.28%), 2023: 70,401 (8.57%), 2024: 67,600 (8.23%). By type of care: elective 39,313 (4.79%) and emergency 781,835 (95.21%). Age distribution: <1 year: 1,389 (0.17%), 1–4 years: 6,268 (0.76%), 5–9 years: 12,470 (1.52%), 10–14 years: 25,083 (3.05%), 15–19 years: 22,934 (2.79%), 20–29 years: 42,735 (5.21%), 30–39 years: 51,746 (6.30%), 40–49 years: 87,130 (10.61%), 50–59 years: 159,734 (19.46%), 60–69 years: 197,317 (24.03%), 70–79 years: 143,290 (17.45%), ≥80 years: 71,052 (8.66%). By sex: male 418,101 (50.90%), female 403,047 (49.10%). Racial distribution: white 397,607 (48.41%), black 55,469 (6.76%), brown 217,984 (26.54%), yellow 10,931 (1.33%), indigenous 359 (0.04%), no information 138,798 (16.90%). Conclusion: The study revealed high hospitalization numbers, predominantly emergencies and patients over 50 years. Balanced sex distribution; white and mixed-race predominated. Data gaps stress prevention and outpatient care to ease hospital strain.

PO—122 Diabetes Mellitus Mortality in Brazil Over Two Decades: an Epidemiological Analysis (2003–2023)

Colchesqui MCB1; Meneguelli LA1; Alves GC1; Reis JS2; Jesus LA1; Queiroz MN1; Silva NCF1

(1) Universidade Anhembi Morumbi, São Paulo, SP, Brasil; (2) Fundação Penápolis Educacional, Penápolis, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—122

Introduction: Diabetes Mellitus (DM) prevalence has risen sharply in Brazil, now ranking sixth worldwide. Objective: Given its prevalence and role as a gateway to other comorbidities, this study aimed to analyze DM mortality trends in Brazil between 2003 and 2023, stratified by age group, sex, skin color and regional mortality rates. Methods: This is an ecological time-series study using epidemiological data from the SIM/DATASUS on deaths classified under ICD-10 codes E10–E14 from 2003 to 2023. For theoretical support, a review of five articles from the Virtual Health Library was conducted with Portuguese descriptors “Mortalidade,” “Epidemiologia,” “Diabetes Mellitus,” and “Brasil,” applying filters for full text, last five years, and excluding duplicates, COVID-19-related studies, and non-Brazilian populations. Results: Between 2003 and 2023, Brazil recorded 1,321,311 DM deaths. ICD-10 analysis showed unspecified DM (E14) predominance with 82.1% of deaths (1,084,702), followed by type 2 (E11) with 151,923 (11.5%), type 1 (E10) with 73,635 (5.6%), other types (E13) with 3,715, and malnutrition-related (E12) with 1,336 deaths. Mortality was strongly linked to aging: 58.6% (774,361) occurred in those aged 70+. Type 1 DM was more common among adults 20–59, while type 2 rose sharply after age 50, reflecting the typical clinical profiles of these conditions. Regarding sex, of the 1,210,212 records, 55.1% were women and 44.9% men, with type 1 DM being more common in men and type 2 in women. Skin color data (1,152,688 records) showed predominance of White (52.7%) and Brown (37.6%), followed by Black (9.6%) and Indigenous (0.2%) populations. Mortality rates by major regions (1,214,323 records), adapted from IBGE censuses 2010–2022 averages, were highest in the Northeast (7.17‰), followed by South (6.66‰), Southeast (5.94‰), Center-West (4.69‰), and lowest in the North (4.56‰). Conclusion: The findings indicate that DM remains a significant cause of mortality in Brazil, particularly among the elderly, women, and white and brown populations, with notable regional disparities, while lower mortality rates in the North likely reflect underreporting due to limited healthcare access. The high prevalence of the unspecified code (E14) limits epidemiological analysis and highlights the need to improve the quality of death certificate reporting. Strengthening accurate diagnosis and directing public policies toward more vulnerable groups are essential for the surveillance, prevention, and control of the disease in the country.

PO—123 Diabetes Mortality by Age Group and Sex in Brazil Over the Last 10 Years

Franzoi NM1; Colchesqui MCB2; Almeida AC3; Souza AS4; Santana ABF3; Guilherme ABCO5; Keller GD3; Gonzalez GL6; Nozaki JEP3

(1) Centro Universitário Ingá, Maringá, PR, Brasil; (2) Universidade Anhembi Morumbi, São Paulo, SP, Brasil; (3) Universidade Nove de Julho, São Paulo, SP, Brasil; (4) Universidade Anhembi Morumbi, São José dos Campos, SP, Brasil; (5) Fundação Educacional do Município de Assis, Assis, SP, Brasil; (6) Faculdade de Ciências Médicas de Santos, Santos, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—123

Introduction: Diabetes mellitus is a major global and national public health concern and remains one of the leading causes of morbidity and mortality. It is a chronic metabolic disorder characterized by hyperglycemia and associated microvascular and macrovascular complications. In recent decades, its prevalence has increased, driven by population aging, sedentary lifestyles, and unhealthy dietary patterns. Beyond its high prevalence, diabetes accounts for a substantial number of deaths, particularly among older adults. Recent data suggest a narrowing of the mortality gap between sexes, with higher male mortality rates observed in certain age groups. Objective: To analyze diabetes mellitus mortality in Brazil over the last decade, stratified by age group and sex. Methods: This study consists of a descriptive epidemiological review using secondary data from the TabNet/DATASUS database covering the period 2013–2023. Mortality from diabetes mellitus was analyzed by age group and sex, and comparative patterns were described. Results: From 2013 to 2023, Brazil recorded 732,433 deaths attributable to diabetes mellitus, of which 396,549 (54.1%) occurred in women and 335,820 (45.8%) in men. The highest mortality counts were observed in the 70–79-year age group (205,870 deaths) and in individuals aged 80 years or older (226,756 deaths). In these age categories, female mortality predominated: 70–79 years, 110,780 female vs. 95,071 male deaths; ≥80 years, 144,937 female vs. 81,799 male deaths. Conversely, male mortality predominated in the 50–69-year range: 50–59 years, 46,886 male vs. 38,007 female deaths; 60–69 years, 84,898 male vs. 79,530 female deaths. Conclusion: Although overall mortality from diabetes mellitus is slightly higher among women, the predominance shifts according to age group. Men account for most deaths between 50 and 69 years, whereas women predominate from age 70 onwards. This pattern may be partially explained by the postmenopausal decline in estrogen, which is associated with increased insulin resistance. The elderly population represents the majority of diabetes-related deaths, reflecting their greater vulnerability to complications. These findings underscore the need for targeted public health policies and effective primary care strategies, as well as vigilant medical follow-up for high-risk populations.

PO—124 Diagnostic Performance and Bias-Corrected Estimation of Sarcopenia using a Consumer-Grade Bioimpedance Device in Women with Type 2 Diabetes

Dos Santos TBL1; Maciel GR2; Nunes ASM3; Ribeiro JNS4; Aguiar BG5; Malheiros GM5; Bandeira F1

(1) Postgraduated Program in Health Sciences, University of Pernambuco, Recife, PE, Brasil; (2) Afya School of Medical Sciences, Jaboatão dos Guararapes, PE, Brasil; (3) Division of Endocrinology and Diabetes, Agamenon Magalhães Hospital, Recife, PE, Brasil; (4) Pernambucana School of Health, Recife, PE, Brasil; (5) School of Medical Sciences, University of Pernambuco, Recife, PE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—124

Introduction: Sarcopenia is a progressive skeletal muscle disorder strongly associated with physical disability, falls, fractures, metabolic deterioration, and premature mortality. In women with type 2 diabetes (T2DM), particularly those postmenopausal, the combination of insulin resistance, chronic low-grade inflammation, and hormonal decline accelerates muscle loss, increasing the risk of sarcopenic obesity and functional impairment. Early detection is essential, yet dual-energy X-ray absorptiometry (DXA), the clinical reference method, remains costly and inaccessible in many healthcare settings. Consumer-grade bioelectrical impedance analysis (BIA) devices are portable, affordable, and radiation-free, but their diagnostic performance and agreement with DXA in this high-risk population require robust validation. Objective: To assess the diagnostic accuracy of a consumer-grade BIA device compared with DXA for detecting sarcopenia in women with T2DM and to evaluate the impact of a regression-based bias correction model for improving fat-free mass index (FFMI) estimation. Methods: In this cross-sectional study, 103 women with T2DM underwent same-day BIA (OMRON HBF-514C) and DXA (GE Lunar Prodigy), anthropometric measurements, handgrip strength, and Short Physical Performance Battery (SPPB) testing. Sarcopenia was defined using fat-free mass index (FFMI), skeletal muscle index (SMI), and validated DXA-based cut-offs. Analyses included Spearman correlation, Bland–Altman plots, Cohen’s kappa, receiver operating characteristic (ROC) curves, and multivariable linear regression for bias adjustment. Results: FFMI-BIA correlated strongly with FFMI-DXA (r=0.881) and SMI (r=0.854), both p<0.001. ROC-derived optimal FFMI-BIA cut-offs yielded AUCs of 0.878 and 0.873, achieving sensitivities of 87.8% and 85.1% and specificities of 79.3% and 82.8%. Agreement for FFMI-based classification was moderate (κ=0.575). The regression model incorporating FFMI-BIA, body mass index, and handgrip strength explained 78.3% of FFMI-DXA variance, reducing mean bias from –0.477 kg/m² to –0.0009 kg/m² and narrowing limits of agreement to –2.07 to 2.07 kg/m². Conclusion: A widely available consumer-grade BIA device, when combined with a simple correction equation, can deliver accurate and calibrated estimates of sarcopenia risk. This integrated approach provides a scalable solution for early identification of sarcopenia in women with T2DM, especially in primary care and resource-limited environments.

PO—125 Economic Impact and Regional Variations of Diabetes Mellitus Hospitalizations in Brazil (2013-2023)

Vasconcellos RCMS1; de Campos LOMC1

(1) Universidade Federal da Bahia, Salvador, BA, Brasil

Diabetology & Metabolic Syndrome 2026: PO—125

Introduction: Diabetes Mellitus (DM) imposes a significant financial burden on healthcare systems, especially in developing countries like Brazil. Complications from the disease are among thea leading causes of hospitalization, resulting in high costs and uneven impacts across the country’s regions. Objective: To analyze the economic impact of DM hospitalizations on the Sistema Único de Saúde (SUS) and the regional variations in the number of cases and hospital costs between 2013 and 2023. Methods: This is a descriptive study based on data from the SUS Hospital Information System (SIH/SUS), accessed via DATASUS, covering the period from January 2013 to December 2023. Data were collected on the total number of hospitalizations, the average cost per hospitalization, and total expenditure across Brazil’s five regions (North, Northeast, Central-West, Southeast, and South). The analyses were conducted using measures of absolute frequency, percentage variation, and proportional distribution by region. Results: DM hospitalizations totaled 1,477,256 cases. The average cost per hospitalization was R$788.05 in 2013, showing a 73.27% increase until 2023. In the period, accumulated inflation was 88.02%, showing that despite the nominal growth in the costs per hospitalization, real spending decreased, which may mean more cost-efficient care. Total expenditure on hospitalizations in the country reached R$1,164,150,743.47 in 2023, representing an increase of 62.98% between 2013. The Southeast region had the highest average cost (R$ 921.90), while the North had the lowest (R$ 665.13). The Northeast (35.17%) and Southeast (32.17%) regions accounted for the majority of hospitalizations. The North region showed the largest relative increase (17.76%), and the South region showed the largest relative decrease (19.16%) in the number of cases. North and Southeast regions recorded the longest average length of stay while the South, had the shortest. The national average was 6.4 days. Conclusion: DM hospitalizations in Brazil show a growing financial cost and an unequal regional distribution. The most populous regions account for the majority of cases and expenditures, while the North region stood out for a significant growth in hospitalizations. These findings underscore the need for regionalized public policies that prioritize strengthening primary care and equitably allocating resources to reduce the financial burden and address disparities in diabetes management.

PO—128 Epidemiological Profile of Hospitalized Patients with Diabetes and HIV in Brazil’s Unified Health System (SUS), 2019–2024

Patrocinio GF1; de Oliveira GJ1; Rovaron BSE1; Bessa Facin ALB; Lemos PA1

(1) Uninove, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—128

Introduction: Diabetes mellitus and human immunodeficiency virus (HIV) infection are chronic conditions associated with high morbidity and mortality worldwide, particularly in low- and middle-income countries (World Health Organization, 2023). Their coexistence increases the risk of complications, hospitalizations, and adverse outcomes. In Brazil, where the Unified Health System (SUS) ensures universal access to healthcare, describing the epidemiological profile of patients with both conditions is essential to guide public health policies and improve care delivery. Objective: To analyze hospitalizations for diabetes mellitus and HIV in Brazil’s Unified Health System (SUS) from 2019 to 2024. Methods: This was an ecological, descriptive, and retrospective study based on secondary data obtained from the DATASUS database in 2025. Hospitalizations registered between 2019 and 2024 with simultaneous diagnoses of diabetes mellitus (ICD-10 E14) and HIV infection (ICD-10 B20–B24) were included. Variables analyzed were number of hospitalizations, sex, age group, race/skin color, type of care, average length of hospital stay, and main causes of admission. Data analysis was descriptive, using absolute and relative frequencies. Results: From 2019 to 2024, 12,430 hospitalizations were recorded in patients with concurrent diagnoses of diabetes mellitus and HIV. Most cases occurred in men (58%), mainly in the 40–59 age group (46%). The average hospital stay was 11.3 days. The leading causes of hospitalization were opportunistic infections associated with metabolic decompensation (39%), vascular complications and diabetic foot (21%), and chronic kidney failure (14%). Conclusion: The findings indicate that middle-aged men account for the majority of hospitalizations due to the coexistence of diabetes and HIV, with prolonged hospital stays and infectious and metabolic complications as the main causes. These results highlight the need for preventive strategies focused on metabolic control, early management of opportunistic infections, and monitoring of chronic complications to reduce hospitalizations and improve the quality of life in this vulnerable population.

PO—129 Epidemiological Profile of Type 2 Diabetes Mellitus Hospitalizations in Brazil’s Unified Health System: an Analysis of Regional and Age-Related Disparities (2015-2024)

Pala D1; de Jesus RF; Silva HP; Sarquis C1

(1) Faculdade Pitágoras de Medicina, Eunápolis, BA, Brasil; (2) UNIFTC/UNEX, Salvador, BA, Brasil

Diabetology & Metabolic Syndrome 2026: PO—129

Introduction: The increase in longevity associated with lifestyle changes, such as unbalanced diets and sedentary behavior, aggravates the national scenario of type-2 diabetes mellitus (T2DM) in the elderly, becoming a real and growing concern. Brazil, due to its territorial extension and population miscegenation, presents a complex scenario when analyzing differences between federative regions. Several factors influence these differences, such as healthcare access across different age groups and socioeconomic conditions. Objective: Therefore, the objective of this study was to analyze the epidemiological profile of SUS hospitalizations for diabetes according to regions and age groups. Methods: This is a quantitative, descriptive, and retrospective study using DATASUS/TABNET data. The analyzed variables were: regions, age group, year (2019-2024), and ICD-10 (Metabolic and endocrine diseases). The statistical analyses performed were ANOVA, Pearson correlation, and temporal trends (p<0.05). Excel 2010 was used. Results: total of 767,731 T2DM hospitalizations were analyzed (2019-2024). Results revealed striking differences between Brazilian regions (Figure 1). The North region presented the highest hospitalization rate (78.08/100k inhabitants), followed by Northeast (73.46/100k), South (59.31/100k), Southeast (58.98/100k), and Central-West (54.67/100k) (ANOVA: p<0.001). The highest age concentration was in patients ≥50 years, representing 68.2% of cases, with peak in the 60-69 years age group (26.8%). There was an increasing temporal trend in regions with highest rates: North (+4.2%/year; r=0.89; p<0.01) and Northeast (+1.8%/year; r=0.64; p<0.05). These differences were significant between North vs Central-West (Δ=23.41/100k; p<0.001) and Northeast vs Central-West (Δ=18.79/100k; p<0.001). The identified regional disparities reveal inequities in diabetes care access, with North/Northeast regions showing patterns that may reflect changes in dietary habits, sedentary lifestyle, and limited access to primary disease prevention. The predominance of hospitalizations in patients ≥50 years reflects population aging and the need for service adaptation. Conclusion: Study findings emphasize regional disparities requiring targeted policies for primary prevention, enhanced public health programs, and specialized elderly care. T2DM demands integrated territorial approaches with age-specific strategies to optimize diabetes management and outcomes.

Figure 1 (abstract PO–129).

Emporal evolution of diabetes mellitus hospitalization rates in Brazil’s unified Health system by geographic regions, 2019-2024 line chart showing temporal trends of diabetes hospitalization rates across the five Brazilian regions throughout the analyzed period. Source: Hospital information system of Brazil’s unified Health system (SIH/SUS). Data processed by the Department of informatics of the unified Health system (DATASUS)

PO—130 Factors Associated with Self-Management ff Insulin Therapy: an Integrative Review

Neto JCGL1; dos Reis LF1; Gonçalves ABS1; de Sá LRPF1; Almeida SO1; Oliveira LS1; Santos RS1; de Sousa AD1; da Penha JC1

(1) Universidade Federal do Piauí, Floriano, PI, Brasil

Diabetology & Metabolic Syndrome 2026: PO--130

Introduction: Diabetes Mellitus is a chronic condition with high prevalence and severe complications when not properly managed. Self-management of insulin therapy is essential for glycemic control and risk reduction, but adherence is influenced by multiple factors. Objective: To identify factors influencing insulin therapy self-management. Methods: Integrative review guided by the PICo strategy: Population (people with diabetes), Phenomenon of Interest (self-management), and Context (insulin therapy). Searches were conducted in October 2024 in PubMed, Web of Science, LILACS, and BDENF. Inclusion criteria: original studies (quantitative/qualitative), published from January 2019 to September 2024, involving insulin-dependent individuals with type 1 or 2 diabetes. Exclusions: reviews, case reports, theses, dissertations, and studies on gestational diabetes or other therapies. Data were analyzed descriptively and qualitatively; evidence levels followed Oxford Centre for Evidence-based Medicine. Results: The search identified 726 articles; 37 met eligibility after PRISMA screening. Evidence showed that self-management is influenced by individual, behavioral, and systemic factors. Barriers included limited knowledge of insulin handling, incorrect storage, and low functional health literacy, compromising treatment safety. Cognitive burden and difficulty in behavioral change were recurrent challenges. Facilitators included professional support and health education, which promoted understanding and autonomy. Digital technologies emerged as promising tools for monitoring, reminders, and patient-professional interaction. Conclusion: Insulin therapy self-management faces challenges such as knowledge gaps, improper storage, limited literacy, cognitive overload, and behavioral resistance. Conversely, consistent professional guidance, targeted education, and technology integration can enhance adherence and safety. Implementing comprehensive educational programs and leveraging digital tools are recommended to strengthen autonomy and improve glycemic outcomes.

PO—131 Frequency of Positive Autoantibodies and Their Association with Other Autoimmune Diseases in Patients with Type 1 Diabetes

Caneca KPO1; Silva JMS1; Dantas JR1; Zajdenverg L1; Rodacki M1

(1) Universidade Federal do Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—131

Introduction: Type 1 diabetes (T1D) is an autoimmune disease that leads to the destruction of pancreatic β cells, resulting in a deficiency in insulin secretion. The presence of antibodies, such as glutamic acid decarboxylase (GADA) and islet tyrosine phosphatase 2 (ANTI-IA2), is crucial for disease classification. Objective: The study aims to evaluate the frequency of GADA and ANTI-IA2 antibodies and their associations with other autoimmune diseases and random C-peptide levels in patients with T1D. Methods: This was a cross-sectional study that included a review of medical charts and measurement of GADA and ANTI-IA2 in patients with a clinical diagnosis of T1D, followed up at a tertiary center. Data were collected on age, gender, age at diagnosis, duration of disease, GADA and ANTI-IA2 titers, body mass index (BMI), random C-peptide levels, and diagnosis of other autoimmune diseases. Results: The sample comprised 282 patients with mean age, age at onset and disease duration of 35.34, 15.8, and 20.3 years, respectively. Thyroid diseases, vitiligo, celiac disease, psoriasis, and autoimmune hepatitis were found in 13%, 0.3%, 1.4%, 0.3%, and 0.3% of the cases, respectively. GADA (+) was detected in 40.2% of cases and was associated with other autoimmune diseases (p=0.006). Preserved C-peptide (>0.6) was identified in 16.6% of cases (46) and in 10.2% of those with more than 5 years of disease (aqui colocar o titulo medio). ANTI-IA2 was positive in 7.9% of the cases. It was not associated with either preserved C-peptide (p=1.0) or other autoimmune diseases (p=0.519). In patients with more than 10 years of disease, there was a difference in the levels of C-peptide (p=0.05) and ANTI-IA2 (p=0.046), but not for ANTI-GAD (p=0.689) and the prevalence of other autoimmune diseases (p=0.616). Conclusion: : In this sample with long-standing T1D, a relevant proportion of patients remained with positive serum autoantibodies. Although GADA was the most common antibody, anti-IA2 was also detected in a few cases. While long-standing GADA was associated with a higher frequency of other autoimmune diseases and C-peptide, the same was not observed for anti-IA2.

PO—132 Genetic Basis of MODY in Brazilian Patients Investigated Through Exome Sequencing

Andrade AF1; Souza RB2; Snaider D2; Saggioro BB2; Borges F2; Rodrigues MVS2; Zembrzuski VM2; Fonseca ACP3; Junior MC2; Abreu GM2

(1) University of Grande Rio/AFYA, Itaboraí, RJ, Brasil; (2) Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brasil; (3) Federal University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—132

Introduction: Maturity Onset Diabetes of the Young (MODY) is the most common monogenic subtype, characterized by early onset, autosomal dominant inheritance, and a primary defect in the pancreatic β-cell. Although targeted sequencing panels (tNGS) of genes such as GCK and HNF1A are widely used, recent studies highlight the value of whole-exome sequencing (WES) in identifying rare variants. In Brazil, large-scale studies using WES for MODY are still lacking, which could significantly expand the genetic characterization of the disease in this population. Objective: This study aimed to investigate the genetic basis of monogenic diabetes in patients from Rio de Janeiro through a virtual gene panel applied to WES, assessing the frequency and relevance of pathogenic variants in MODY-associated genes. Methods: A total of 32 individuals were selected based on diabetes diagnosis before the age of 40, family history in at least two generations, and absence of autoantibodies (anti-GAD and anti-IA2). Analyses were performed using a virtual panel of 17 MODY-related genes (ABCC8, APPL1, BLK, CEL, GCK, HNF1A, HNF1B, HNF4A, INS, KCNJ11, KLF11, MTTL1, NEUROD1, PAX4, PDX1, RFX6, WFS1). Variants were prioritized according to: (1) sequencing quality (AB: 40–60% for heterozygotes, >60% for homozygotes); (2) location in exonic regions or within 10 bp of splice sites; (3) non-synonymous protein effect; (4) population frequency <1% in gnomAD or ABraOM; (5) clinical relevance according to predefined filters. Results: A total of 14 potentially pathogenic variants were identified in 13 individuals, distributed across six genes. Variants were classified according to ACMG guidelines as: 1 pathogenic (7.1%) and 5 likely pathogenic (35.7%). Two variants were identified in the same patient: in the genes WFS1 (exon 8) and KCNJ11 (exon 1), classified as likely pathogenic and pathogenic, respectively. In addition, variants were identified in other patients in the genes NEUROD1 (exon 1) and GCK (exons 1, 2, and 5), all classified as pathogenic or likely pathogenic. These variants are rare, conserved across species, and either absent or at very low frequencies in population databases. Conclusion: WES demonstrated high effectiveness in detecting rare MODY variants, enhancing molecular diagnosis and providing deeper insight into the genetic heterogeneity of the disease in the Brazilian population.

PO—133 Genomic Ancestry in Individuals with Type 1 Diabetes from Brazil and Portugal

Ferreira LL1; do Vale S2; Duarte MA2; Silva AL2; Porto LC1; Turchetto-Zolet AC3; Silva DA1; Gomes MB1

(1) Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (2) Unidade Local de Saúde Santa Maria, Portugal; (3) Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—133

Introduction: Brazil and Portugal had an intertwined history for over 500 years, and nowadays Portugal has a higher incidence of type 1 diabetes (T1D) than Brazil, that presents an admixture involving European, African, and Native American contributions, whereas Portugal has a relatively homogeneous population predominantly of European origin. Objective: Therefore, the aim of this study was to compare the components of genomic ancestry (GA) in individuals with T1D from Brazil and Portugal, and to identify whether differences in GA composition between the two populations may provide insights into the pathogenesis of T1D in both countries. Methods: A total of 1,698 Brazilian and 107 Portuguese individuals with T1D were analyzed. GA was estimated using 46 ancestry-informative markers (AIM-INDELs) and analyzed with GeneMapper and Structure software. Statistical analyses included the Kruskal–Wallis, Mann–Whitney, and chi-square tests. The Brazilian and Portuguese populations were categorized into admixed and not admixed groups. For the Fst genetic analysis, the T1D populations were compared with Brazilian control populations and the HGDP-CEPH panel (Pereira et al., 2012). Results: Not admixed Portuguese individuals exhibited a GA composition of 97% European, 1% African, and 0.1% Native American (NAM). Not admixed Brazilians presented 94% European, 2.7% African, and 3.1% NAM ancestry. Admixed Portuguese individuals showed 32% European, 60% African, and 6.85% NAM, whereas admixed Brazilians had 61% European, 23% African, and 15.5% NAM. These findings demonstrate that the Brazilian admixed T1D individuals have a higher frequency of European GA and a lower frequency of African GA compared with their Portuguese admixed counterparts, reflecting differences in the timeline admixture in both countries. Among Brazilians, regional heterogeneity was observed: The South showed the highest European GA, whereas the North exhibited higher NAM GA. Fst analysis indicated low but statistically significant genetic differentiation between groups, with the greatest proximity between not admixed Portuguese and Southern Brazilians. Conclusion, the difference in the proportion of GA in individuals with T1D in Brazil and Portugal could be due to diverse admixture dynamics in both countries. Our data should drive future research areas related to identifying other genetic variants, such as the HLA system in Brazil and Portugal, that may contribute to a better understanding of the pathogenesis of the disease in both countries.

PO—135 Heterogeneity of Diabetes Mellitus associated with Stiff-Person Syndrome (SPS)

Franco BE1; Farias I1; Dib SA1; Oliveira A1; Moises RS1

(1) Universidade Federal de São Paulo, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—135

Introduction: SPS is a rare neurological disease characterized by muscle stiffness, painful spasms, high titers of anti-GAD autoantibodies, and associations with other autoimmune conditions such as diabetes mellitus (DM) and thyroiditis. However, DM associated with SPS is not well characterized. Objective: To investigate the frequency, characteristics, risk factors, and impact of DM in SPS on quality of life and functionality. Methods: Twenty-two individuals with SPS were clinically and immunologically evaluated (anti-GAD, anti-IA2, anti-TG, anti-TPO) and genotyped for HLA class II (loci DRB1, DQA1, DQB1). Pancreatic beta-cell function was analyzed using a standard meal tolerance test (Sustagen®), with glucose and C-peptide measured at 0 and 90 minutes. Severe insulin deficiency was defined as fasting C-peptide < 0.3 ng/mL and/or stimulated C-peptide <0.6 ng/mL. Fasting C-peptide >= 0.3 ng/mL and/or >=0.6 ng/mL after stimulation indicate significant insulin secretion. Insulin resistance was assessed by HOMA2 (HOMA-IR ≥1.4) and estimated glucose disposal rate (eGDR <8), indicating insulin resistance. Quality of life and disability levels were assessed using the SF-36 questionnaire and the modified Rankin Scale (mRS), respectively. Results: Mean age was 48.2 ± 12.4 years, 18 were women. DM was present in 45.5% of patients, especially among anti-GAD+ cases (56.2%). Beta-cell function was heterogeneous: 5 patients had severe insulin deficiency (all anti-GAD+), 5 had significant insulin secretion (one anti-GAD-), and 4 showed insulin resistance. The DR3 haplotype (DRB103:01-DQA105:01-DQB1*02:01) was most frequent (54.5%), with no link to DM. However, protective alleles (DRB1:15/11/13; DQB1*06:02 or 06:03; DQB1*03:01) were more common in non-diabetics than in anti-GAD+ diabetics (75% vs. 22.2%, p=0.03), suggesting a protective effect. Autoimmune thyroiditis affected 63.6% of the patients. All had some disability, 27% were moderate/severe (mRS≥ 4). Quality of life was significantly impaired, mainly in the physical domain. DM and anti-GAD titers did not significantly impact disability or quality of life. Conclusion: DM and autoimmune thyroiditis are common in SPS patients. The heterogeneity of DM, regarding autoimmunity, beta-cell function, and insulin resistance, calls for personalized approaches. No HLA risk haplotypes were identified, but protective alleles were observed. SPS substantially impacts functionality and quality of life, regardless of DM presence.

PO—137 Hospitalizations for Diabetes Mellitus among the Indigenous Population in Brazil, 2011–2023: a Time Series Study

Alves AL1; Salheb AN1; Cruz CCS1; Vieira JS1; Barros LM1; Silva MEF1; Lima MADE1; Monteiro BHM1

(1) Centro Universitário Metropolitano da Amazônia, Belém, PA, Brasil

Diabetology & Metabolic Syndrome 2026: PO—137

Introduction: Diabetes Mellitus (DM) is a major public health issue in Brazil, with significant impacts on morbidity, mortality, and hospital costs. Among Indigenous peoples, a particular scenario emerges, shaped by socioeconomic vulnerabilities, barriers to healthcare access, and rapid dietary changes due to nutritional transition. The progressive replacement of traditional foods with diets rich in simple carbohydrates and ultra-processed products has contributed to the rising prevalence of DM and its complications in this population. Despite its relevance, few studies specifically address hospitalization rates and determinants of diabetes among Indigenous groups, limiting the development of culturally appropriate public policies and interventions. Objective: To analyze the temporal trend of hospitalizations for Diabetes Mellitus among the Indigenous population in Brazil. Methods: Ecological time series study using data from the Brazilian Unified Health System’s Hospital Information System (SIH/SUS) from 2011 to 2023. Temporal trends were analyzed through joinpoint regression, considering annual percent change (APC) and significance at a 95% confidence level. Results: A total of 3,294 hospitalizations for Diabetes Mellitus were recorded among the Indigenous population during the study period. Trend analysis identified two joinpoints, in 2013 and 2016, dividing the series into three distinct periods. From 2011 to 2013, there was a sharp and statistically significant increase of 9.96% per year (p=0.009). Between 2013 and 2016, the trend reversed to a decline of 2.18% per year, without statistical significance. From 2016 to 2023, hospitalization rates resumed an upward trajectory, with a statistically significant increase of 1.12% per year (p=0.03). Conclusion: Hospitalizations for Diabetes Mellitus among Brazil’s Indigenous population show an overall upward trend, with a significant increase in the most recent period, suggesting that current prevention and management strategies may be insufficient to curb the problem. These findings highlight the urgent need for culturally appropriate and targeted public health policies.

PO—138 Impact of Sex and Diabetes Type on the Age at Death: a Retrospective Brazilian Comparative Analysis

Santos VM1; Lopes LCP1; Rodrigues ACM1; Previdelli LK2; Negrato CA1

(1) Faculdade de Medicina de Bauru, Universidade de São Paulo, Bauru, SP, Brasil; (2) Universidade Nove de Julho, Bauru, Bauru, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—138

Introduction: Higher mortality rates from diabetes mellitus (DM) in women have been reported in several studies. This increase is attributed mostly to cardiovascular diseases (Rao Kondapally Seshasai et al., 2011). In contrast, several studies showed a higher and rising prevalence of deaths among men, as seen in the multinational study conducted in the Americas by Antini et al. (2024) and in the Global Burden of Disease data (2015). This disparity highlights the need for regional-level investigations to understand epidemiological trends, considering the interactions between sex and DM type based on the particularities of local contexts Objective: To compare the impact of sex and DM type on the age at death Methods: Data were categorized by sex (male/female), DM type (DM1/DM2), DM duration (<10, 10–19, 20–29, 30–39, >40 years) and the age at death. Variables with significant associations (p<0.05) were included in survival analyses using Kaplan–Meier curves and Cox proportional hazards models. Likelihood ratio tests compared nested models. HR > 1 indicated higher risk of earlier death; HR < 1 indicated longer survival. T-tests compared mean age at death. Analyses were performed using R software version 4.2.0. This study was approved by USP Ethics Committee (Prot. 37022220.0.0000.5417); judicial authorization granted death certificate access Results: For DM1 individuals (58.49% women; 41.51% men), no statistically significant sex difference was found in mortality risk, mean age at death (50.08 vs. 47.33 years; p = 0.695) and DM duration (23.0 vs. 21.93 years; p = 0.753). Among DM2 individuals, women (53.86%) showed a significantly lower mortality risk than men (HR: 0.70) and died at an older average age (75.92 vs. 70.77 years; p < 0.001). No significant differences were found in DM2 duration (20.31 vs. 21.81 years; p = 0.082). Finally, the average time from DM diagnosis to death was 22.13 years in DM1 and 20.80 years in DM2, in Table 1Conclusion: Based on the provided data, a significant difference in mortality risk between sexes was observed only for DM2. Specifically, women with DM2 demonstrated a 30% lower mortality risk, which corresponded to an average five years older age at death. Conversely, in cases of DM1, sex did not emerge as a significant factor influencing the age at death or other evaluated variables. Furthermore, DM type did not show a statistically significant difference in the mean time from diagnosis to death.

PO—139 Impact of the Implementation of Artificial Intelligence and Machine Learning-Based Tools on Glycemic Control and the Incidence of Complications in Patients with Diabetes Mellitus: A Cohort Study in Health Centers in Brazil

Martins MFF1; Sorage LA2; Pizetti L1; Rodrigues ALC3; Paiva MER1; Sollis C4; Gutierrez SL5; da Silva JM6; Gomes YFS1; Mota ICM1; Kischel HP7

(1) Universidade Nove de Julho, Bauru, SP, Brasil; (2) Universidade Veiga de Almeida (RJ) , Rio de Janeiro, RJ, Brasil; (3) Centro Universitário de Belo Horizonte, Belo Horizonte, MG, Brasil; (4) Universidade de Marília, Marília, SP, Brasil; (5) Faculdade São Leopoldo Mandic Araras, Araras, SP, Brasil; (6) Fundação Educacional do Município de Assis, Assis, SP, Brasil; (7) Faculdade de Excelência, Feira de Santana, BA, Brasil

Diabetology & Metabolic Syndrome 2026: PO—139

Introduction: Diabetes mellitus (DM) is one of the major global public health challenges, with high morbidity and mortality rates and increasing costs for healthcare systems. In recent years, the integration of digital technologies, such as continuous glucose monitoring (CGM), combined with tools based on Artificial Intelligence (AI) and Machine Learning (ML), has transformed diabetes care. However, studies in the Brazilian context remain limited. Objective: This cohort study aims to compare the effectiveness of type 2 DM (T2DM) management using traditional clinical approaches versus AI/ML-based algorithmic recommendations, focusing on glycated hemoglobin (HbA1c) reduction. Additionally, it seeks to analyze the predictive consistency of AI/ML algorithms in maintaining glycemic stability over a three-month period. Methods: This is a cohort study based on secondary analysis of data available in the scientific literature. A search was conducted in BVS, MEDLINE, LILACS, SciELO, and PubMed using the descriptors: “Diabetes Mellitus,” “Artificial Intelligence,” “Machine Learning,” “Disease Management,” “Glycemic Control,” and “Self-care.” A total of 15 articles published between 2019 and 2024 in Portuguese and English were selected, all meeting the FINER criteria. Studies not directly addressing the application of AI in diabetes management were excluded. Results: In the analysis of 8,472 medical visits, AI/ML-based management showed superior outcomes compared to traditional approaches, with a mean HbA1c reduction of 0.94% versus 0.73%. In an external sample, the reduction was 0.79% versus 0.61%. The algorithms demonstrated greater consistency in predicting glycemic trends. Conclusion: The implementation of AI/ML tools in Brazilian health centers has shown a positive impact on glycemic control and the reduction of complications in patients with DM. These technologies enhance diagnostic access, improve care personalization, and promote greater patient engagement. Despite promising results, further studies and investments in infrastructure and professional training are necessary to enable large-scale adoption in the Brazilian healthcare system.

PO—140 Influence of Genetic Ancestry on High-Risk HLA-dr3/dr4 Haplotypes in Individuals with Type 1 Diabetes from an Admixed Brazilian Population: a Pilot Study

Azulay S1; Ferreira LL2; Rodrigues V3; Tavares MG1; Facundo AN4; Lago DF4; Nascimento GC4; Magalhães M3; Turchetto-Zolet A5; Porto LC5; Carvalho PRVB6; Silva D7; Faria M4; Gomes MB8

(1) University Hospital of the Federal University of Maranhão/EBSERH, São Luís, MA, Brasil; (2) DNA Diagnostic Laboratory, State University, Rio de Janeiro, RJ, Brasil; (3) Research Group in Clinical and Molecular Endocrinology and Metabology, Federal University of Maranhão, São Luís, MA, Brasil; (4) Endocrinology Unit, University Hospital of the Federal University of Maranhão/EBSERH, São Luís, MA, Brasil; (5) Postgraduate Program in Genetics and Molecular Biology, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brasil; (6) Histocompatibility and Cryopreservation Laboratory (HLA), Rio de Janeiro State University, Rio de Janeiro, RJ, Brasil; (7) DNA Diagnostic Laboratory, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (8) Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—140

Introduction: Type 1 diabetes mellitus (T1D) is, in most cases, attributed to an autoimmune process. The major genetic risk factor associated with T1D lies in the leukocyte histocompatibility antigen (HLA) system, particularly in HLA-DR and HLA-DQ. Objective: This study investigated the association between autosomal, mitochondrial (maternal), and Y chromosome (paternal) ancestry and the presence of high-risk HLA-DR3/DR4 haplotypes in individuals with T1D and controls from an admixed population. Methods: We determined the HLA of patients with T1D and controls. Autosomal, mitochondrial, and Y-chromosome ancestries were then analyzed. Results: A total of 152 individuals with T1D and 117 controls were included in the study. A significantly higher proportion of T1D individuals carried HLA-DR3/DR4 haplotypes compared to controls (79.6% vs. 49.6%, OR = 3.97, 95% CI: 2.32–6.78, P <0.001). No differences were observed between T1D and control groups for African, European, or Native American autosomal ancestry proportions. Similarly, mitochondrial DNA and Y chromosome ancestry did not differ significantly between groups. Among individuals with T1D, African ancestry ≥50% was significantly less frequent in those with DR3/DR4 haplotypes compared to those with non-DR3/DR4 haplotypes (5.0% vs. 19.4%, OR = 0.21, 95% CI: 0.06–0.73, P = 0.008), indicating a negative association between African ancestry and high-risk alleles of HLA system in T1D. In contrast, European ancestry ≥50% was more common among individuals with DR3/DR4 haplotypes than those without DR3/DR4 haplotypes in the T1D group (52.1% vs. 25.8%, OR = 3.12, 95% CI: 1.29–7.53, P = 0.009), suggesting a positive association. There was no association between the distribution of high-risk HLA-DR3/DR4 and combined ancestries of mitochondrial DNA and the Y chromosome in the control (P = 0.374) and T1D (P = 0.262) groups. Conclusion: The main findings of this study reinforce the relevance of HLA-DR3/DR4 haplotypes in the risk of developing T1D, highlighting the influence of autosomal ancestry on the distribution of high-risk HLA haplotypes. Specifically, a negative association is observed with African ancestry and a positive association with European ancestry, particularly in individuals with T1D. Additionally, the findings suggest that neither maternal nor paternal ancestry is significantly linked to the presence of high-risk HLA haplotypes in this admixed Brazilian population, indicating the need for further studies in other regions of the country.

PO—141 Influence of SGLT2 Inhibition on Myocardial Sirtuin Expression and Cardiac Remodeling in Rats with Type 1 Diabetes Mellitus

Marreiros APS1; Muniz AD1; Sant’Ana PG1; Meirelles ALB1; Santos ACC1; Ojopi EPB1; Souza LM1; Rodrigues EA1; Okoshi K1; Okoshi MP1

(1) Botucatu Medical School, Sao Paulo State University, Botucatu, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—141

Introduction: Inhibition of sodium-glucose co-transporter 2 (SGLT2) has cardiovascular benefits in patients with Type 2 diabetes mellitus (DM). The mechanisms involved in beneficial effects have not yet been fully clarified. Studies suggest that SGLT2 inhibitors interact with sirtuins, proteins that modulate cellular survival and apoptosis, autophagy, mitochondrial function, and stress response. In DM, sirtuin 3 improves mitochondrial function, oxidative stress, and insulin resistance. Few investigators have evaluated the cardiovascular effects of SGLT2 inhibition in Type 1 DM. Objective: To analyze the effects of the SGLT2 inhibitor dapagliflozin (Dapa) on cardiac structure, ventricular function, and myocardial expression of sirtuins 3 and 6 in Type 1 DM rats. Methods: Male Wistar rats were allocated into control (C), C treated with Dapa (C-Dapa), DM, and DM treated with Dapa (DM-Dapa) groups. DM was induced by a single streptozotocin injection, 50 mg/kg. Dapa was added to the rat chow at a dosage of 10 mg/kg/day for 16 weeks. Cardiac remodeling was evaluated by echocardiogram at the end of the study and protein expression by Western blot. Statistical analysis: ANOVA complemented by the Tukey or Kruskal–Wallis and Dunn tests (p<0.05). Results: Echocardiogram data will be presented. Protein expression of sirtuins 3 and 6 did not differ between the groups. Conclusion: Treatment with dapagliflozin attenuates left cardiac chambers dilation, left ventricular hypertrophy, and systolic and diastolic dysfunction, and does not modulate protein expression of myocardial sirtuins 3 and 6 in rats with Type 1 diabetes mellitus.

PO—143 Interpretation of Glycated Hemoglobin in a Patient with Complex Cyanotic Congenital Heart Disease

Kupfer R1; Rocha RP1; Lima ALB1

(1) Instituto Estadual de Diabetes e Endocrinologia, Rio de Janeiro, RJ, Brasil. 118

Diabetology & Metabolic Syndrome 2026: PO—143

Case Presentation: The diagnosis of Diabetes Mellitus (DM) can be challenging. Glycated hemoglobin (HbA1c) has been used for the diagnosis of DM since 2009. However, certain conditions may compromise its accuracy, such as chronic hypoxia and erythrocytosis. Patients with cyanotic congenital heart disease (CCHD) may present with chronic hypoxia, which can lead to secondary polycythemia and interfere with the interpretation of HbA1c values. This report describes the case of a patient with complex cyanotic heart disease and polycythemia, in whom an isolated elevation of HbA1c led to a misdiagnosis of DM. A 19-year-old female from Rio de Janeiro, Brazil, with CCHD (ventricular septal defect and pulmonary artery trunk atresia) followed at the National Institute of Cardiology, with recurrent hospitalizations for phlebotomy due to polycythemia, was referred to the endocrinology clinic for elevated HbA1c of 6.5% despite a fasting plasma glucose of 78 mg/dL. She reported progressive weight loss over recent months but denied polyuria, polydipsia, polyphagia, or use of hyperglycemic medications. On examination, she presented with persistent central cyanosis, digital clubbing, body weight of 48 kg, and a BMI of 22 kg/m2. Repeat laboratory testing confirmed normal fasting plasma glucose (73 mg/dL) and a normal 2-hour oral glucose tolerance test (141 mg/dL). Fructosamine was within normal range (187 μmol/L), and anti-GAD antibodies were negative (<5 IU/mL), ruling out DM. The patient’s guardian gave their explicit written consent to publish the patient’s information in an open access journal. Discussion: HbA1c results from the non-enzymatic glycation of hemoglobin A and is reliable only when erythrocyte lifespan is normal (~120 days). In chronic hypoxia, erythropoietin stimulates erythrocytosis, altering the proportion of young erythrocytes and their exposure time to glucose, which may falsely elevate HbA1c values. Studies have shown that erythrocytosis associated with high altitude and chronic hypoxia may increase the optimal cut-off point for DM diagnosis and follow-up, underscoring the need for caution when interpreting this marker in isolation. Final Comments: HbA1c levels may be influenced by hematologic factors, limiting their use for DM diagnosis, as in the present case. Therefore, isolated elevation of HbA1c without classic symptoms or confirmatory abnormal glucose measurements should be interpreted cautiously in patients with polycythemia. Diagnostic decisions must consider the clinical context to avoid inappropriate management based on a single laboratory parameter.

PO – 146 Late MODY-HNF4A Diagnosis in a Previously Misclassified T2DM Patient: Clinical and Therapeutic Lessons

Ferreira LF1; Dantas A2; Junior AS2; Teles MG2

(1) Unidade Mista de Saúde Júlia Terezinha Amaral, Iraí de Minas, MG, Brasil; (2) Universidade de São Paulo, Grupo de Diabetes Monogênico, Unidade de Endocrinologia Genética e Laboratório de Endocrinologia Molecular e Celular / LIM25, Faculdade de Medicina, , São Paulo, SP, Brasil; (3) Universidade de São Paulo, Grupo de Diabetes Monogênico, Unidade de Endocrinologia Genética e Laboratório de Endocrinologia Molecular e Celular / LIM25, Faculdade de Medicina, São Paulo, SP, Brasil; (4) Universidade de São Paulo, Grupo de Diabetes Monogênico, Unidade de Endocrinologia Genética e Laboratório de Endocrinologia Molecular e Celular / LIM25, Faculdade de Medicina, São Paulo, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—146

Case Presentation: An 88-year-old male patient from Minas Gerais, Brazil, previously diagnosed with type 2 diabetes mellitus (T2DM), presented for a routine follow-up visit. The patient denied any history of overweight and reported the onset of polyuria, polydipsia, and fatigue at age 20. His first laboratory evaluations were performed at age 48, at which time he was diagnosed with T2DM. Initial treatment consisted of metformin monotherapy, after which bedtime insulin was introduced and approximately six years after diagnosis, he transitioned to full insulin therapy. The patient reported a strong familial occurrence of diabetes among daughters, granddaughters, and great-granddaughters. One daughter was genetically diagnosed with the heterozygous c.48C>G:p.(Tyr16*) mutation in HNF4A gene (NM_175914.4). Genetic testing confirmed the presence of the same HNF4A variant, establishing the diagnosis of MODY (Maturity-Onset Diabetes of the Young) due to an HNF4A mutation. Following this diagnosis, his treatment regimen was optimized: insulin was discontinued, and gliclazide monotherapy was initiated. Subsequent HbA1c values remained between 6.8% and 7.7%. The patient gave his explicit written consent to publish his information in an open access journal. Discussion: MODY is a form of monogenic diabetes frequently misdiagnosed as type 1 or type 2 diabetes due to underrecognition and limited access to confirmatory genetic testing. Mutations in the HNF4A involves a mutation in a transcription factor that promotes insulin secretion, thereby explaining the favorable therapeutic response to insulin secretagogues, such as sulfonylureas. Key clinical indicators include diabetes onset before the age of 25, a family history of diabetes affecting at least three generations, and a history of fetal macrosomia or transient neonatal hypoglycemia. Even in patients diagnosed at an older age, the presence of these features across generations warrants consideration of MODY, ideally beginning the genetic investigation with the youngest affected family members. Final Comments: This case highlights the importance of accurate diabetes classification, which enables significant therapeutic adjustments, such as discontinuation of insulin and effective use of sulfonylureas, ultimately improving glycemic control and patient quality of life. Detailed history-taking, early clinical recognition, and genetic testing are essential, particularly in patients with a suggestive family history and early-onset symptoms, emphasizing the role of MODY differential diagnosis in clinical practice.

PO—148 Molecular Diagnostic Application in Rare Diabetes as a Tool for Precision Health

Abreu GM1; de Souza RB1; Ferreira A1; Snaider D1; Borges F1; Saggioro BB1; Rodrigues MVS1; Tarantino R2; Rodacki M2; Zajdenverg L2; Zembrzuski VM1; Rosado EL3; Junior MC1

(1) Laboratório de Genética Humana, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil; (2) Serviço de Diabetes e Nutrologia, Departamento de Clínica Médica da Faculdade de Medicina, Rio de Janeiro, RJ, Brasil; (3) Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—148

Introduction: Among the rare forms of diabetes, Maturity-Onset Diabetes of the Young (MODY) is notable, characterized by onset before age 25, autosomal dominant inheritance, and a primary defect in pancreatic β cells. Mutations in at least 14 genes have been associated with this condition. Due to its rarity and limited dissemination, MODY is underdiagnosed, and patients with these forms frequently receive incorrect diagnoses, impacting their management. Objective: In this way, in the present study, we aimed to screen variants in genes previously associated with MODY in Brazilian patients with a clinical suspicion of rare diabetes to provide molecular diagnosis, contribute to prognosis and genetic counseling, and support more appropriate treatment. Methods: We included 108 probands with a clinical phenotype of monogenic diabetes and 86 relatives for molecular analysis of 11 genes using Sanger sequencing. Results: Fifty percent (54%) of the sample had potentially pathogenic variants. Mutations in GCK were the most frequent (32 probands), followed by HNF1A (16 probands); one variant was identified in each of the following genes: HNF4A, HNF1B, NEUROD1, PAX4, PDX1, and MT-TL1. A family segregation study of the mutation was performed in 28 families (86 relatives), of whom 52 individuals carried the variant. The GCK-MODY group showed age at diagnosis (AAD), fasting glucose (FG), and HbA1c compatible with the expected phenotype (AAD: 12.73 ± 9.11 years; FG: 123.07 ± 15.97 mg/dL; HbA1c: 6.4 ± 0.54%). Regarding the clinical diagnosis before genetic testing, 25% of patients were erroneously diagnosed as type 1 diabetes, and 40% were using insulin or an oral hypoglycemic agent. Approximately one-third of patients in the HNF1A-MODY group had a prior diagnosis of type 2 diabetes (AAD: 20.18 ± 8.98 years; FG: 121.66 ± 23.60 mg/dL; HbA1c: 7%), and only one of sixteen was not on pharmacological therapy. Conclusion: Following molecular diagnosis, clinicians can implement personalized treatment benefiting patients, as the literature already establishes that most of the individuals with GCK-MODY have good glycemic control with diet alone, without pharmacological treatment, and those with HNF1A mutations respond well to low-dose sulfonylureas.

PO—149 mtDNA Analysis of Individuals with Type 1 Diabetes in the Southeastern Region of Brazil

Ferreira LL1; Gomes MB1; Silva DA1

(1) Universidade do Estado do Rio de Janeiro, RIO DE JANEIRO, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—149

Introduction: Type 1 diabetes mellitus (T1D) is a chronic, multifactorial autoimmune disease with a significant genetic predisposition, caused by the destruction of pancreatic beta cells, resulting in insulin deficiency for timelife. In an effort to better understand the genetic basis of the disease in an admixed population, mitochondrial DNA (mtDNA) analysis allows for the characterization of the population’s matrilineal ancestry. Given the limited data on mitochondrial inheritance in the Brazilian population-particularly the lack of genetic data from individuals in certain regions of the country-this study is warranted. Objective: The present study aims to analyze the mtDNA of individuals with T1D from a highly admixed population in the Southeastern Region of Brazil, comparing them with a healthy control population obtained from online databases in order to expand our understanding of the genetic background of T1D in admixed individuals. Methods: For this purpose, the control region of the mtDNA from 278 unrelated T1D patients from Southeastern Brazil was amplified by PCR using primers L15900 and H639, then purified and sequenced using the Sanger method, following the most recent mtDNA nomenclature guidelines. The sequences were imported into SeqScape software and aligned to the reference sequence. The EMPOP software was used to assign the corresponding haplogroups. For genetic diversity and comparative analyses, the Arlequin software was used. Results: The distribution of mtDNA haplogroups among T1D individuals from the Southeast was as follows: 33.81% Native American, 36.69% African, 26.26% European, and 3.24% Asian. The most frequent haplogroup in the study population was the Native American haplogroup A (34 patients, 12.23%), followed by the African haplogroup L1 (33 patients, 11.51%). The most frequent European haplogroup observed was H (15 patients, 5.4%). Genetic differentiation data calculated by Fst indicated that, although T1D and control individuals have low differentiation between them, only the comparison between T1D individuals and those from Espírito Santo was statistically significant after Bonferroni correction (p < 0.001) Conclusion: Our findings are consistent with existing data on Brazilian matrilineal ancestry and the influence of the colonial period on its formation. Further studies involving diabetic populations from other Brazilian states are necessary to determine whether this pattern observed in the general population is also replicated among individuals with diabetes.

PO – 150 Overlap of Type 1 Diabetes Mellitus and MODY 2 (GCK): Report of a Rare Hybrid Phenotype

De Brito GD1; Vianna AZ2; Surek JMS2; Vianna AGD1; Pinto MS1

(1) Centro de Diabetes Curitiba, Curitiba, PR, Brasil; (2) Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brasil

Diabetology & Metabolic Syndrome 2026: PO—150

Case Presentation: A 40-year-old man had lifelong mild, stable hyperglycemia without treatment until age 27, when he developed polyuria, polydipsia, weight loss, and worsening glycemia, leading to basal-bolus insulin initiation without ketoacidosis. In 2024, an 8-year-old nephew was diagnosed with diabetes, prompting family genetic testing that revealed a heterozygous pathogenic GCK variant (NM_000162.5:c.208G>A; p.Glu70Lys), confirming MODY 2. The mutation was also found in two daughters, his sister and his father, all with mild fasting hyperglycemia and no insulin requirement. Given that insulin use is atypical in MODY 2, the proband underwent reassessment, showing markedly low fasting C-peptide (0.08 and 0.05 ng/mL), strongly positive anti-GAD (67 IU/mL), and negative IA-2A, ZnT8A, and ICA antibodies. A prior insulin withdrawal attempt caused insulinopenic symptoms, requiring reinstatement of insulin. Despite adherence, HbA1c remained 8.5%. These findings indicated overlap of genetically confirmed MODY 2 and autoimmune type 1 diabetes (T1D), explaining absolute insulin dependence. The patients gave their explicit written consent to publish their information in an open access journal. Discussion: The coexistence of MODY and T1D is rare, with only three cases reported: one MODY 2, one MODY 3, and one “triple diabetes” (T1D + type 2+ MODY 3). MODY 2 usually causes stable mild fasting hyperglycemia, minimal postprandial excursions, negligible microvascular risk, negative pancreatic autoantibodies, preserved insulin secretion, and little need for treatment—likely this patient’s profile until late twenties. Abrupt symptomatic worsening and full insulin dependence were atypical for MODY 2, suggesting additional pathology. Later reevaluation confirmed autoimmune β-cell destruction. Given the strong antibody positivity and insulinopenia, false positives were unlikely. Although guidelines often exclude MODY if autoantibodies are present, the two diagnoses are not mutually exclusive. Data suggest T1D occurs in up to 4% of MODY carriers, while MODY is found in <1% of T1D cases. This case illustrates the need to recheck autoimmunity in confirmed MODY patients with unexpected deterioration, poor control despite adequate therapy, or rising insulin needs. In such scenarios, management should follow T1D protocols, with lifelong insulin, while considering the genetic background. Final Comments: A confirmed MODY 2 diagnosis does not preclude later autoimmune β-cell destruction. Although rare, worsening control, higher insulin needs, or sudden symptoms warrant prompt reassessment for autoimmunity.

PO—151 Pre-clinical Type 1 Diabetes: Analysis of a Brazilian Cohort

Montalvão BS1; Costa AH1; de Sena MCR1; Alves STF2; Franco DR3; Trevisan T4; Bulcão C5; Fenner N6; Fulgêncio P6; Schreiner L7; Gabbay M8; Sharf M9; Caliari E3; Mello K10; Santana W11; Dantas JR1; Dib SA3; Zajdenverg L1; Araújo L12; Vianna AGD9; Rodacki M1

(1) Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (2) Sociedade Brasileira de Diabetes, Rio de Janeiro, RJ, Brasil; (3) Sociedade Brasileira de Diabetes, São Paulo, SP, Brasil; (4) Sociedade Brasileira de Diabetes, Santa Catarina, SC, Brasil; (5) Sociedade Brasileira de Diabetes, Salvador, BA, Brasil; (6) Sociedade Brasileira de Diabetes, Belo Horizonte, MG, Brasil; (7) Sociedade Brasileira de Diabetes, Porto Alegre, RS, Brasil; (8) Sociedade Brasileira de Diabetes, São Paulo, SP, Brasil; (9) Sociedade Brasileira de Diabetes, Curitiba, PR, Brasil; (10) Sociedade Brasileira de Diabetes, João Pessoa, PB, Brasil; (11) Sociedade Brasileira de Diabetes, São Luís, MA, Brasil; (12) Sociedade Brasileira de Diabetes, Minas Gerais, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—151

Introduction: Type 1 diabetes (T1D) is an autoimmune disease characterized by progressive β-cell destruction. The presence of ≥2 diabetes-related autoantibodies indicates that the disease process has begun in the pre-clinical stage. Identifying pre-clinical T1D is essential to prevent diabetic ketoacidosis (DKA) at onset and to offer disease-modifying therapies. However, the optimal strategy for identifying such individuals in Brazil remains uncertain. To address this gap, the Brazilian Diabetes Society (SBD) launched an online registry for pre-clinical T1D. Objective: To evaluate whether an online registry created by SBD could effectively identify individuals with pre-clinical T1D. Methods: An online platform was launched on the SBD website in March 2024 to register individuals with positive diabetes-related autoantibodies and no clinical T1D, identified through private initiatives or research studies. Participation was voluntary, and clinical/epidemiological data were collected. Data entered up to June 25, 2025, were analyzed. Results: Of 971 responses, 324 reported no hyperglycemia meeting diabetes diagnostic criteria, and 93 reported positive autoantibodies. Only 50 provided contact information. After invitations for consent and data updates, 23 agreed. During a remote interview, a diagnosis of clinical T1D was identified in 8 cases and 3 did not update their information, leaving 12 for analysis. All received private healthcare; 7 self-identified as White, 2 as Non-White; 6 resided in the Southeast, 1 each in the Center-West, Northeast, and North regions. Three had ≥2 autoantibodies (all GADA; 2 IA-2; 2 anti-insulin; 3 anti–zinc transporter 8). Five had a family history of T1D, and 3 had other autoimmune diseases. None developed clinical T1D during follow-up; all reported >2.5 h/week of physical activity. Vitamin D supplementation was prescribed in 5 cases; semaglutide, sitagliptin, and metformin use were each reported in one case. Conclusion: A national online registry can identify a few individuals with pre-clinical T1D, but its efficiency is limited. In this platform, many registrants already had clinical disease or incomplete data. Nationwide screening is needed to enable adequate early detection, prevent DKA, and build robust registries for research and timely intervention in autoimmune diabetes in Brazil.

PO—154 Reduction in Hospitalizations and Mortality Due to Diabetes Mellitus in Brazil: Impact of Primary Health Care Expansion and Access to Medication Policies (1998–2019)

Rodrigues JP1; Zago PW1

(1) São Leopoldo Mandic, Araras, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—154

Introduction: Diabetes mellitus is a chronic condition that, when improperly diagnosed or treated, can lead to serious cardiovascular, renal, and neurological complications, thereby increasing hospital admission and mortality rates. Therefore, prevention, screening, and treatment strategies are essential public health priorities. In the evolution of Brazil’s healthcare system, the period between 2004 and 2006 saw a significant expansion of Family Health Strategy (FHS) coverage, along with improved measures for diagnosis and disease screening. Additionally, the "Farmácia Popular" program was launched, providing antidiabetic medications free of charge starting in 2011. Objective: To assess the trends in hospitalizations and mortality due to diabetes mellitus in Brazil across two distinct periods: from 1998 to 2006 (PRE – pre-expansion of public health) and from 2007 to 2019 (POST – post-expansion of public health in Brazil). Methods: Data on the number of individuals diagnosed with diabetes mellitus, as well as diabetes-related hospital admissions and mortality in Brazil, were obtained from the Health Information System of the Unified Health System (SUS). Population estimates for the years 1998 to 2019 were provided by the Brazilian Institute of Geography and Statistics (IBGE). Data were tabulated and statistically analyzed using Student’s t-test, with a significance level of 5%. Results: A significant increase in the mean prevalence of diagnosed diabetes mellitus was observed when comparing the two periods: 3.68% ± 0.74% (PRE) versus 7.22% ± 1.01% (POST), reflecting a 96% relative increase (p < 0.05). In contrast, diabetes-related hospitalization rates decreased by 49.25% (PRE: 1.92% ± 0.35%; POST: 0.97% ± 0.18%; p < 0.05), while mortality rates declined by 56.85% (PRE: 0.10% ± 0.02%; POST: 0.04% ± 0.00%; p < 0.05). Conclusion: Between the two periods analyzed, the number of individuals diagnosed with diabetes mellitus increased by 96%, while hospitalizations and mortality due to the disease fell by nearly 50%, following the expansion of the Family Health Strategy and improved access to essential medications. These findings underscore the importance of a public health model focused on continuous surveillance and territorially based care.

PO—155 Residual C-Peptide Secretion in Individuals with Type 1 Diabetes: Associated Clinical and Immunological Factors

Veiga APM1; Guimarães RS1; Caneca KO1; Silva JMS1; Dantas JR1; Zajdenverg L1; Rodacki M1

(1) Hospital Universitário Clementino Fraga Filho- Faculdade de Medicina da Universidade Federal do Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—155

Introduction: Type 1 diabetes mellitus (T1D) is an autoimmune disease characterized by pancreatic β-cell destruction, leading to absolute insulin deficiency. Clinically relevant residual insulin production, assessed through C-peptide (CP) measurement, may persist for years after diagnosis. Identifying factors associated with residual C-peptide (RCP) preservation could have important prognostic and therapeutic implications. Objective: To evaluate RCP secretion in individuals with T1D of varying disease durations and to identify factors associated with RCP persistence in those with disease duration ≥5 years. Methods: This cross-sectional study was conducted at an outpatient clinic of a tertiary referral center. RCP was defined as random CP ≥ 0.6 ng/mL. The analyzed variables included age at diagnosis, disease duration, anti-glutamic acid decarboxylase antibodies (GADA) positivity and titers, as well as other autoimmune diseases. Categorical and continuous variables were compared with Chi-square and Mann-Whitney tests, respectively, with significance set at p<0.05. Results: A total of 286 individuals (148 females, 138 males) were included, with mean age 35.3 ± 15.9 years and mean disease duration 19.9 ± 12.4 years. Overall, 13.3% (n=38) had CP ≥ 0.6 ng/mL. In those with T1D duration ≥5 years (n=242), individuals with RCP had an older age at onset (23.3 ± 13 vs 14.9 ± 10 years; p=0.01), lower GADA positivity (15.8% vs 44.3%; p=0.014), and lower GADA titers (19 ± 7.6 vs 354 ± 609 U/mL; p=0.029) than others. Disease duration (22.4 ± 10.6 vs 25.3 ± 10.4 years; p=0.33) and frequency of other autoimmune diseases (25% vs 19.9%; p=0.56) did not differ between groups Conclusion: A notable proportion of individuals with T1D maintain RCP secretion even after many years of disease. Among those with ≥5 years of T1D, preserved β-cell function was associated with older age at onset, lower frequency of GADA positivity, and lower GADA titers, despite similar disease duration and comparable rates of extra-pancreatic autoimmune diseases. These findings suggest that the magnitude and persistence of beta-cell-specific autoimmune activity may influence the extent of β-cell destruction, even in individuals with long-standing T1D.

PO—156 Risk Stratification for Diabetes Mellitus using The Finnish Diabetes Risk Score (Findrisc) in Primary Health Care: a Population-Based Study in Santa Catarina, Brazil

Costa FV1; dos Santos BC1; Ceratti F1; Astolfi GG1; Zimmermann MI1; Rodrigues YG1; Resende CP1; dos Santos D1

(1) Universidade Federal de Santa Catarina, Araranguá, SC, Brasil

Diabetology & Metabolic Syndrome 2026: PO—156

Introduction: Type 2 diabetes poses a growing challenge to public health, especially in populations with a high prevalence of modifiable risk factors. Screening tools such as the Finnish Diabetes Risk Score (FINDRISC) have demonstrated utility in the early identification of individuals at risk. Objective: To stratify the risk of developing type 2 diabetes among adults in the municipality of Balneário Arroio do Silva (Santa Catarina, Brazil) using the FINDRISC score, and to assess its association with clinical and behavioral indicators. Methods: This was a cross-sectional, analytical, and descriptive study conducted between June 2024 and May 2025. The FINDRISC questionnaire was applied along with anthropometric measurements and capillary blood glucose testing. Individuals aged ≥18 years without a previous diagnosis of diabetes were included. Statistical analyses included ANOVA, Games-Howell post hoc test, independent t-test, and Spearman’s correlation, with a 5% significance level. Results: A total of 382 individuals were included in the screening. Only 16.5% were classified as low risk for diabetes, while the remaining participants fell into slightly elevated (27.2%), moderate (23.6%), high (25.7%), and very high (7.1%) risk categories. Women had significantly higher mean FINDRISC scores (p<0.05), although there were no significant differences in Body Mass Index (BMI) and blood glucose levels between sexes. As shown in Table 1, a positive correlation was observed between BMI and blood glucose (ρ = 0.152; p=0.003). This indicates that individuals with higher BMI tend to have higher glucose levels, although the correlation is weak. The result was statistically significant, suggesting a true association in the population. Table 1 – Spearman Correlation Test for BMI and Blood Glucose Metric BMI and Blood Glucose Spearman’s correlation (ρ) 0,152 (weak positive correlation) Significance (p-value 0,003) Conclusion: The study population presented a high prevalence (32.8%) of individuals at high and very high risk for type 2 diabetes, particularly associated with female sex, excess weight, central obesity, and unhealthy lifestyle habits. FINDRISC proved to be an effective screening tool in community settings, supporting its use as a preventive strategy in primary health care.

Table 1 (abstract PO-156).

Spearman correlation test for BMI and blood glucose

PO—157 Sociodemographic Profile of Adults with Diabetes without Excess Weight in Brazil: an Analysis of the 2019 National Health Survey

da Silva DF1; de Azevedo CV1; Moura LA1; de Carli E1; Marchioni DML1

(1) Faculdade de Saúde Pública da Universidade de São Paulo- São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—157

Introduction: Diabetes in the absence of obesity is poorly investigated, although it accounts for many cases in low- and middle-income countries. Objective: This study aimed to describe the sociodemographic profile of Brazilian adults diagnosed with diabetes and with a body mass index (BMI) less than 25 kg/m². Methods: Data from the 2019 National Health Survey, with probability cluster sampling and national representativeness, were used. The sample included 1,463 adults with valid data on weight, height, and a physician-diagnosed diabetes, excluding pregnant women and individuals with a BMI ≥25 kg/m². Results: Among individuals with diabetes and a BMI <25 kg/m², 53.4% were women, with a 95% confidence interval (95% CI) of 49.4–57.4. Furthermore, 63.6% were 60 years or older (95% CI: 59.5–67.7). The majority lived in urban areas (89.7%; 95% CI: 88.2–91.1) and self-identified as Black or Brown (50.5%). The regional distribution showed a concentration in the Southeast (51.0%) and Northeast (23.6%), which is consistent with the distribution of the Brazilian population. Regarding education, 39.3% had incomplete primary education (95% CI: 35.3–43.3), and regarding income, 60.1% lived on up to two minimum wages per capita. Conclusion: This profile points to a population characterized by aging, low education, and vulnerable social inclusion. The findings suggest that diabetes prevention and care strategies should consider the social determinants of health and the context of accumulated vulnerability over the lifespan, going beyond the exclusive emphasis on excess weight.

PO—160 The Presence of the g Allele of rs17576 Polymorphism in the mmp9 Gene is Associated with Protection Against Type 2 Diabetes Mellitus

Brondani LA1; Favieiro JP1; Assmann MS1; Dieter C1; Crispim D1

(1) Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—160

Introduction: Matrix metalloproteinase 9 (MMP-9) is a zinc-dependent endopeptidase from the metalloproteinase family involved in remodeling the extracellular matrix. By degrading components of the basement membrane, MMP-9 can contribute to cell death and plays a role in key processes linked to the pathogenesis of diabetes mellitus, including angiogenesis and inflammation. Elevated levels of MMP-9 have been associated with oxidative stress and inflammation triggered by hyperglycemia. Consequently, genetic polymorphisms in the MMP9 gene may influence its activity and expression, potentially contributing to the development of type 2 diabetes mellitus (T2DM). Objective: To evaluate the association between rs17576 A/G polymorphism in the MMP9 gene and T2DM. Methods: This case-control study included 1003 individuals divided into two groups: 695 patients with T2DM and 308 participants without T2DM. The study was approved by the HCPA Research Ethics Committee (protocol number AGHUSE 20230159). The rs17576 A/G polymorphism in the MMP9 gene was genotyped using a TaqMan allele discrimination assay via real-time PCR. Results: The genotypic frequencies of the MMP9 rs17576 A/G polymorphism were in Hardy-Weinberg equilibrium in the control group (p > 0.05). The G/G genotype was observed in 12.9% of individuals with T2DM and in 11.4% of controls (p = 0.036). Under the dominant model of inheritance (AG + GG), the presence of the G allele was associated with a 28% protection for T2DM occurrence, odds ratio = 0.723 (95% CI: 0.548–0.953), p = 0.022; and this association remained statistically significant after adjusting for sex and ethnicity. Conclusion: The presence of the G allele of the rs17576 A/G polymorphism in the MMP9 gene is associated with protection against T2DM. However, additional studies in diverse populations are necessary to confirm and further validate this association.

PO—165 Clinical Profile of Diabetic Patients with Osteoporotic Fractures in a Fracture Liaison Service

Campos BB1; Corrêa LA1; Trotte GB1; de Sá MERMC1; Júnior WMA1; Guimarães ACS1; Pezzin HS1; Coelho SS1; Abreu JM1; dos Santos CV2; Soares DV1

(1) Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, Brasil; (2) Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: P0—165

Introduction: Diabetes mellitus (DM) is a recognized risk factor for fragility fractures, regardless of bone mineral density. The integration of diabetic patients into structured secondary prevention programs is a promising strategy to reduce adverse outcomes. Objective: To describe the clinical profile of patients with DM and osteoporotic fractures followed in a Fracture Liaison Service (FLS). Methods: Observational, prospective study using convenience sampling. We evaluated sociodemographic, clinical, and anthropometric data, including fracture sites, fall risk, and frequency. Sarcopenia was screened using the SARC-F questionnaire (score ≥4), muscle strength assessed by five-times sit-to-stand test (reduced strength >15 seconds), and bone mineral density measured by dual-energy X-ray absorptiometry (DXA). Data are presented as median (m) and interquartile range (IQR) or number (n) and percentage (%). Results: Among 56 patients with osteoporotic fractures, 20 (36%) had type 2 diabetes mellitus (T2DM). Of these, 19 (95%) were female, and the median age was 75 years (62–77). Regarding the timing of osteoporosis diagnosis, only 6 (30%) were diagnosed and were receiving osteoporosis treatment before the fracture, 11 (55%) were diagnosed at the time of fracture occurrence, and 3 (15%) remained undiagnosed and untreated even after the fracture. DXA showed that 12 (60%) had a T-score compatible with osteopenia. All participants received guidance on adequate intake of calcium, vitamin D, and proteins, fall prevention strategies, and therapeutic adjustments according to fracture risk stratification. Conclusion: Diabetic patients in this FLS had multiple risk factors for recurrent fractures, including a history of falls, positive sarcopenia screening, and multiple comorbidities. The predominant fracture sites were vertebrae and wrists. Most participants only received an osteoporosis diagnosis and initiated treatment at the time of fracture, reinforcing the need for early screening strategies. Even after the fracture, most did not receive osteoanabolic therapy; Bisphosphonates were the primary treatment until FLS enrollment. Structured FLS follow-up proves essential for individualizing therapy and promoting integrated, continuous care.

PO—166 Comparative Analysis of Nutrient Intake in Older Adults Living with and Without Type 2 Diabetes Mellitus: Results of a Cross-Sectional Study in Ouro Preto/Mg in the Context of Nutritional Care

Corrêa PB1; Lopes GF1; Onuzik L2; Pereira PA1; Peixoto MO1; Onuzik NC1; Santos AMM1; Ferreira VM1; Gomes LAA1; de Figueiredo SM1

(1) Universidade Federal de Ouro Preto, Ouro Preto, MG, Brasil; (2) Universidade Federal de Alfenas, Ouro Preto, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—166

Introduction: Adequate dietary intake is essential in managing type 2 diabetes mellitus (T2DM), especially among older adults, who are more susceptible to metabolic changes and nutritional deficiencies. Objective: This cross-sectional study aimed to assess macro- and micronutrient intake among older adults with and without T2DM receiving nutritional care at a senior citizens’ association in Ouro Preto/MG, in accordance with recommendations from the IOM, BRASPEN (2020), and SBD (2023). Methods: Dietary intake was assessed using a 24-hour recall, analyzed with Dietbox® software based on the Brazilian Food Composition Table (TACO). Statistical analysis was conducted in SPSS® using the Mann–Whitney test (p<0.05) for macronutrients, and micronutrient data were processed in Excel/2022. Results: The sample comprised 69 older adults (27 with T2DM, 42 without). No statistically significant differences were observed between groups in median caloric intake (1,273.55 kcal vs. 1,204.46 kcal; p=0.365). Median protein intake was similar in absolute values (58.89 g vs. 53.87 g; p=0.225) and as a percentage of energy (20.00% vs. 17.50%; p=0.297). Carbohydrate intake did not differ: 158.41 g (50%) with T2DM and 151.04 g (51%) without (p=0.558 for g and p=0.621 for %). Median lipid intake was 38.93 g (29.50%) in the T2DM group and 37.63 g (31.50%) in the non-T2DM group (p=0.603 and p=0.936, respectively), and fiber intake showed no significant difference (17.72 g vs. 13.94 g; p=0.298). Regarding micronutrients, both groups showed inadequacies. Mean intakes in the T2DM and non-T2DM groups, respectively, were: magnesium (164.96 mg vs. 155.60 mg), vitamin B12 (1.94 µg vs. 2.05 µg), folic acid (115.09 µg vs. 127.86 µg), potassium (1,662.37 mg vs. 1,669.5 mg), and vitamin D (1.15 µg vs. 0.965 µg), all below recommendations. Vitamin C adequacy was higher in the non-T2DM group (78.68 mg vs. 61.99 mg). Selenium was the only nutrient near optimal levels in both groups (56.88 µg vs. 54.46 µg). Conclusion: Results indicated no significant differences in macronutrient intake between groups but revealed widespread micronutrient inadequacies, suggesting low adherence to dietary guidance and a possible lack of individualized nutritional care. This study underscores the importance of regular assessments and personalized nutritional interventions, particularly for older adults with T2DM, while providing valuable insights for public policies and more effective clinical practices that reflect the realities of the older population.

PO—167 Evaluation of Fat Liver Content using Fibroscan® in Older Patients with Type 2 Diabetes and its Association with Non-traditional Biomarkers

Siqueira LGG1; Mansur RP1; Ferreira IF1; Maroun LRGB1; Matsuura FHC1; Jardim JVS1; Terra C1; Smith BG1; Palma CCSSV1; Tannus LRM1; Cobas RA1

(1) Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—167

Introduction: Metabolic dysfunction–associated steatotic liver disease is a highly prevalent condition expected to affect up to 70% of type 2 diabetes (T2D) patients. Objective: To investigate the presence of hepatic fat content and its association with clinical and laboratorial parameters in older patients with T2D. Methods: Cross-sectional study including T2D patients aged ≥65 years attending a tertiary public clinic without evidence of acute illness. Clinical, anthropometric and laboratory data were collected. Controlled Attenuation Parameter (CAP dB/m) was assessed by Transient elastography (Fibroscan®) and used to categorize hepatic fat content as S0 (<5%), S1 (5–33%), S2 (33–66%), and S3 (>66%). Statistical analysis was performed using Jamovi 2.6. Results: Fifty-nine T2D patients aged 74 [69–79] years were included; 40 (67.8%) females; diabetes duration of 22.1 ± 10.9 years; glycated hemoglobin of 7.30 [6.90-8.40]% and body mass index (BMI) of 28.3 ± 5.1 kg/m². Thirty-five (59.3%) were treated with insulin and 1 (1.7%) used pioglitazone. Overall, 42 (71.2%) patients were classified as S0, 4 (6.8%) as S1, 2 (3.4%) as S2, and 11 (18.6%) as S3. The mean CAP value was 214 ± 64.8 dB/m. CAP values were positively correlated with daily insulin dose (r=0.347, p=0.041), triglycerides (r=0.532, p<0.001), alanine aminotransferase (r=0.405,p=0.001), gamma-glutamyl transferase (r=0.430, p<0.001) and hemoglobin levels (r= 0.424, p<0.001); BMI (r= 0.426, p=0.001); waist (r=0.461, p<0.001) and neck circumferences (r=0.537, p<0.001); red blood cells (r=0.359, p=0.005) and leukocytes count (r=0.306, p=0.018), and inversely correlated with age (r= -0.319, p=0.014), vitamin B12 plasma levels (r= –0.292, p=0.026) and Red Cell Distribution Width (r=-0.885, p=0.019). Conclusion: In a sample of elderly T2D patients, 71% did not present significant hepatic fat content when categorized by Fibroscan®. As expected, the amount of liver fat (CAP value) was associated with clinical and anthropometric markers of insulin resistance and liver injury. Also, patients with higher fat liver content were younger, had higher levels of hemoglobin and leucocyte count and lower plasma vitamin B12 levels. The association of fat liver content with vitamin B12 levels, corroborated by recent studies, may reflect underlying pathogenic mechanisms that should be explored in prospective studies to investigate its clinical and prognostic significance.

PO—174 Performance Evaluation of Glucose in Different Blood Gas Analyzers Used by Laboratories Participating in an External Quality Assessment Program

Gomes J1; Bottino L1; Aguiar T1; Correa M1; Vieira A1; Jerônimo D1; Rodrigues J1; Bastos C1; Poloni J1

(1) Controllab, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—174

Introduction: Effective control of blood glucose levels depends both on accurate data and on the timely availability of results for clinical decision-making. Blood gas analysis is used for the diagnosis, management, and monitoring of critically ill patients, and blood gas analyzers often include glucose measurement in their test menu, mainly due to their practicality and speed. Objective: This study aimed to evaluate the performance of glucose measurement in different blood gas analyzers used by participants of an External Quality Assessment Program (EQAP). Methods: The EQAP was conducted with four rounds per year (three samples of aquous solution per round, at various concentrations) from March 2010 to March 2023. During this period, the evolution of the mean coefficient of variation (CV) was assessed, as well as the adequacy percentage (%A) of participants. Results: A total of 28,140 data points were analyzed. The main analyzers used by participants were Gem Premier 3500 (n=297), Rapidpoint Series (n=110), Gem Premier 3000 (n=107), and ABL Series 800 (n=92). The number of participating laboratories increased from 27 (2010) to 335 (2023). The %A rose from 73% in 2010 to 92% in 2023, showing an improving trend (p<0.05). Between 2010 and 2023, CVs showed a significant decrease (p<0.05) over time . The study demonstrated overall satisfactory performance of participants in glucose measurement using blood gas analyzers, as well as the importance of continuous participation in EQAP for improving results. Conclusion: The study highlighted progressive and consistent improvement in glucose measurement performance on blood gas analyzers over 13 years of external monitoring, as reflected by reduced coefficients of variation and increased accuracy rates among participants. These findings reinforce the relevance of external quality assessment in ensuring the reliability of tests used in critical situations, such as the management of diabetic patients. Standardization and continuous monitoring of methods directly contribute to safer and more effective clinical decision-making in hospital and intensive care settings.

PO—175 Early Identification of GCK-MODY in a Pediatric Patient: Case Report and the Role of Genetic Testing in Differential Diagnosis

de Mascarenhas MW1; de Paula MP1; Bordallo APN1; Mezzomo CD1; Barros LFP1; Petronilho LS1; Cordebel LEF1; Lopes MM1; Neto PFA1; Feitoza LCC1; Vasconcellos JVM1

(1) Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—175

Case Presentation: A 7-year-old female with thalassemia minor was referred to endocrinology at 3 years and 6 months due to persistent hyperglycemia. Her mother reported mild polydipsia, without polyuria, weight loss, or polyphagia. The patient was eutrophic (BMI Z-score: +0.36) and had never used antidiabetic medications. Family history included early-onset diabetes in her father, grandfather, and paternal uncle. Fasting glucose ranged from 122–131 mg/dL, and glycated hemoglobin from 6.2% to 6.7%. Anti-GAD (glutamic acid decarboxylase) antibodies were negative. With a MODY probability score of 75.5%, genetic testing was performed. Molecular analysis identified a heterozygous pathogenic variant in the GCK gene (c.579+1_579+33del), confirming GCK-MODY (MODY 2). The patient remains asymptomatic and off pharmacological treatment. The patient’s guardian gave their explicit written consent to publish the patient’s information in an open access journal. Discussion: In pediatric and young adult populations, monogenic diabetes should be considered in the differential diagnosis. Caused by mutations in a single gene or chromosomal region, it accounts for 1–5% of diabetes cases and is often underdiagnosed due to phenotypic overlap with type 1 and 2 diabetes. Cohort data show a mean diagnosis age between 12 and 25 years. Maturity-Onset Diabetes of the Young (MODY) is the most common form of monogenic diabetes, with 14 subtypes, mainly linked to GCK, HNF1A, HNF4A, and HNF1B genes. MODY should be suspected in non-obese individuals under 25 years, with a multigenerational history of early-onset diabetes under 25 years, negative autoantibodies, and preserved C-peptide levels within five years of diagnosis. Genetic confirmation enables targeted treatment, family screening, and avoids unnecessary pharmacotherapy. GCK-MODY is the most prevalent subtype, caused by heterozygous inactivating mutations in the gene encoding the enzyme glucokinase. This enzyme acts as a glucose sensor in beta cells and hepatocytes, triggering insulin release. Mutations raise the glucose threshold needed for insulin secretion, resulting in mild, stable hyperglycemia, usually without progression to vascular complications. Final Comments: This case highlights the relevance of early diagnosis of monogenic diabetes. Identifying GCK-MODY impacts therapeutic decisions, prevents overtreatment, and supports genetic counseling for affected families.

PO—176 HAIR-AN Syndrome in an Adolescent with Type 2 Diabetes, Hyperandrogenism, and Primary Amenorrhea: A Diagnostic and Therapeutic Challenge

Pontes ALF1; Mainczyk JE1

(1) Serviço de Endocrinologia do Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—176

Case Presentation: A 16-year-old female adolescent was referred for evaluation due to a diagnosis of diabetes, with suspected polycystic ovary syndrome (PCOS). She denied menarche and reported polyuria, polydipsia, polyphagia, and a weight gain of 6 kg over two months. Fasting blood glucose levels ranged between 150–200 mg/dL, glycated hemoglobin A1c (HbA1c) was 9%, there were no episodes of ketoacidosis and was using metformin 1g/day. She denied any personal or family history of delayed pubarche. Physical examination revealed overweight (BMI 25.9 kg/m²), short stature for age (Z-score -2.8), extensive acanthosis nigricans, and severe hirsutism (Ferriman–Gallwey score = 21). Pubertal staging was M5P5. Follow-up tests showed HbA1c of 8.5%, total testosterone 110.53 ng/dL, androstenedione 7.2 ng/mL, normal 17-alpha-hydroxyprogesterone (17-OHP) and dehydroepiandrosterone sulfate (DHEA-S), negative anti-glutamic acid decarboxylase (anti-GAD) antibodies, and bone age consistent with 17 years. Pelvic ultrasonography revealed enlarged ovaries with multiple peripheral cysts and a large follicular cyst. Based on clinical, laboratory, and imaging criteria, a diagnosis of probable HAIR-AN syndrome (a rare and severe PCOS subphenotype characterized by hyperandrogenism, insulin resistance, and acanthosis nigricans) was established. The patient’s guardian gave their explicit written consent to publish the patient’s information in an open access journal. Discussion: HAIR-AN syndrome is an uncommon multisystemic disorder, affecting 1–3% of women with hyperandrogenism, and is characterized by cutaneous, endocrine, and reproductive manifestations that have a significant psychosocial impact. Chronic hyperinsulinemia stimulates ovarian androgen production, worsening hirsutism, amenorrhea, and treatment resistance. Differentiating between classic PCOS and HAIR-AN is essential, as the latter presents a more severe phenotype and frequently shows an unsatisfactory therapeutic response. Furthermore, its coexistence with type 2 diabetes during adolescence is associated with a high risk of early-onset metabolic complications. Final Comments: We report the case of a young patient with HAIR-AN syndrome, diabetes, severe hirsutism, and amenorrhea, highlighting the importance of early diagnosis and intervention. Management involves a multidisciplinary approach, including lifestyle modifications, combined oral contraceptives with low-androgenic progestins, metformin, and, when necessary, antiandrogenic agents and other medications for glycemic control. Increasing awareness of this condition is essential to mitigate its clinical and psychosocial impact.

PO—177 Impact of Education on the Use of Automated Insulin Delivery System in Pediatric Patient with Type 1 Diabetes Mellitus

De Leao AAP1, 2; Oliveira EH2; Matos DA2; Lemos M2; Branco FC2

(1) Hospital de Clínicas- Universidade Federal do Paraná; (2) Medtronic comercial Ltda, Brasil;

Diabetology & Metabolic Syndrome 2026: PO—177

Case Presentation: C.C.R., male, 11 years old, diagnosed with Type 1 Diabetes Mellitus (T1DM) for 6 years, using an Automated Insulin Delivery (AID) system for 6 months. During the first month of AID therapy, the patient experienced significant challenges with the use of the Continuous Glucose Monitoring (CGM), including bleeding at the application site, which led to premature removal of the device. Additionally, CGM glucose readings often did not align with capillary blood glucose levels, and recurrent episodes of subcutaneous catheter bending caused persistent hyperglycemia following infusion set installation. These issues adversely affected treatment adherence and glycemic control, created emotional strain, and prompted the family to seek support from a diabetes educator. The patient underwent three months of educational follow-up sessions. These sessions focused on guidance regarding sensor and infusion set application techniques, selection of appropriate insertion sites, and review of optimal CGM calibration timing. Following these interventions, the patient increased the time of sensor use, increased time in automatic mode (SmartGuard), and eliminated catheter kink episodes. Glycemic control improved without an increase in hypoglycemic episodes. Table 1 presents the therapy management and glycemic control parameters during the first month and after six months of AID therapy. The patient’s guardian gave their explicit written consent to publish the patient’s information in an open access journal. Discussion: Since the initiation of AID therapy, the patient demonstrated glycemic control within the targets recommended by ISPAD and SBD guidelines. However, his treatment required continuous support and caused emotional stress for the entire family. According to the American Diabetes Association (ADA), effective educational interventions involve consistent parental engagement, problem-solving techniques, and motivational sessions. In this context, the diabetes education provided played a crucial role in overcoming technical and behavioral barriers to therapy management. Final Comments: The personalized educational interventions not only addressed the initial challenges but also led to improved glycemic control. This case highlights the importance of an individualized educational approach for patients undergoing AID therapy, particularly in the presence of complications that may compromise treatment efficacy.

Table 1 (abstract PO-177).

Therapy Management and Glycemic Control Parameters Over 6 Months of Automated Insulin Delivery System Use.

*GMI: Glucose Management Indicator.

PO—178 Improved Glycemia but Unchanged Quality of Life and Persistent Parental Overprotection in Adolescents Using Continuous Glucose Monitoring in a Low-Resource Context

Freitas JPA1; Lima LPS1; Monteiro NC2; Machado MLP3; Gama FG4; Silva VDS4; Martins LM1; da Silva DG4; Silveira MSVN5; Trevisan TL6; Varela MG7; de Santana NO2

(1) Department of Medicine, Federal University of Sergipe, Aracaju, SE, Brasil; (2) Post-graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, SE, Brasil; (3) Private practice, Aracaju, SE, Brasil; (4) Post-graduate Program in Nutrition Science, Federal University of Sergipe, São Cristóvão, SE, Brasil; (5) Mental Health and Diabetes Institute, Campinas, SP, Brasil; (6) Private Practice, Itajaí, SC, Brasil; (7) Private Practice, Aracaju, SE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—178

Introduction: Adolescence poses distinct challenges for type 1 diabetes (T1D) management, which are exacerbated by structural barriers in resource-limited settings. Continuous glucose monitoring (CGM) may address the dual burden of metabolic and quality of life (QoL) concerns. Objective: To characterize the clinical profile and QoL of adolescents with T1D in a low-resource setting and to evaluate the impact of CGM use. Methods: In this 20-week longitudinal study, 11 adolescents with T1D (aged 10–17 years) from a public endocrinology center in Sergipe, Brazil, initiated CGM and attended monthly follow-up visits. Data collection included standardized clinical assessments, structured interviews and medical record review. QoL was measured at baseline and post-intervention through validated Brazilian version of the IQVJD questionnaire (1–5 Likert scale, higher scores indicating poorer QoL). Results: Participants had a mean age of 14.2±1.8 years, were predominantly female (81.8%), of mixed race (54.6%), mean diabetes duration of 6.4±2.4 years. Most (63.4%) were from low-income households (1–2 minimum wages). All were enrolled in school at age-appropriate levels; 45.5% of caregivers had a college degree. Despite optimized basal–bolus insulin therapy (1.2±0.5 IU/kg/day, 39.9±9.6% basal), baseline HbA1c was 9.8±2.0%, with high rates of self-reported anxiety (72.3%) and depressive symptoms (18.2%). Baseline global QoL score was 2.3±0.4, with particular challenges in the “impact” domain (2.4±0.4). The highest individual item score was perceived parental overprotection (4.6±0.8). In contrast, “satisfaction” was least affected (2.1±0.5). After CGM use, glycemic metrics improved: glucose management indicator 8.8±1.4%, active time 72.9±25.0%, time in range 47.7±21.1%, time above range 46.2±31.1%, time below range 6.1±4.6%, and glucose variability 43.8 ± 7.7%. In contrast, no significant differences were observed in post-intervention global or domain-specific QoL scores. Small increases were seen in “satisfaction” (+5.8%), “impact” (+4.5%) and “concerns” (+2.8%), while perceived parental overprotection showed a slight reduction (−8%) but remained elevated. Conclusion: In adolescents with T1D from a low-resource setting, CGM use improved glycemic outcomes but did not significantly affect QoL. Persistent perceptions of parental overprotection highlight the need for integrated psychosocial support alongside technological interventions to optimize diabetes care in adolescents.

PO—180 Metabolic Abnormalities and Changes in Body Composition May Be Identified Before Puberty in Familial Partial Lipodystrophy Type 2

Sales MTA1; Boris NP1; Lopes FKM1; Flor AC1; Montenegro APDR1; Cortez VOF1; Júnior RMM1

(1) Hospital Universitário Walter Cantídio, Fortaleza, CE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—180

Introduction: Familial Partial Lipodystrophy Type 2 (FPLD2) is a rare disease characterized by the lack of subcutaneous fat in the limbs and trunk, and fat accumulation in face, cervical region and pubic areas (cushingoid appearance). It is associated with insulin resistance and metabolic complications such as diabetes mellitus, hypertriglyceridemia, and metabolic-associated steatosis liver disease (MASLD). FPLD2 is an autosomal dominant form of familial partial lipodystrophy caused by pathogenic variants in LMNA gene. It is stablished in the literature that changes in fat distribution usually starts from puberty or later in adult life. Objective: To describe a case series of children and adolescents with FPLD2. Methods: A cross-sectional study of children and adolescents identified through cascade screening from index adult cases followed in a lipodystrophy referral center. Clinical and laboratory data and genetic tests were obtained from medical records. Body composition analysis was performed (above two years old) through measurements of thigh skinfold thickness (TST) and dual-energy X-ray absorptiometry (DXA), and compared to a healthy group, matched for age, sex and body mass index (BMI). Percentage (%) of fat in the lower limbs (LL) and fat mass ratio (FMR) were obtained from DXA. All of the patient guardians gave their explicit written consent to publish the patients’ information in an open access journal. Results: All patients identified were included: six patients (5 girls) four with c.1744C>T and two with c.1444C>T LMNA variant. Case 1: A 10 months old girl with high-density lipoprotein cholesterol (HDL-c) 35mg/dl and triglycerides 227mg/dl. Case 2: A 1yo girl with no metabolic abnormalities. Case 3: A 8yo girl with HDL-c 40mg/dl, triglycerides 125mg/dl and HbA1c 5,8%, but no difference in body composition compared to control. Case 4: A 10yo boy, prepubertal, without metabolic abnormalities, but TST of 14mm, FMR 1,06, and % fat LL 34,7 vs. control 22mm, 0,72 and 42,4% respectively. Case 5: A 15yo girl without metabolic abnormalities, but TST of 7mm, % fat LL 23,2 and FMR 1,42 vs. control 37mm, 40,0% and 0,83 respectively. Case 6: A 15yo girl with menstrual irregularity, cushingoid appearance, severe acanthosis nigricans, BMI 29,7kg/m (SDS +2,19), TST 10mm, adiposity LL 21% and FMR 1,47 vs. control 26mm, 40,5% and 0,96 respectively. Metabolic abnormalities were HDL-c 26,3mg/dl, triglycerides 223mg/dl, insulin 58,3UI/mL, HbA1c 5,8%, and MASLD. Conclusion: This study suggests that metabolic abnormalities and changes in body composition may arise before puberty, and TST and DXA may be useful for diagnosis of FPLD2 in children.

PO—181 Necrobiosis Lipoidica Diabeticorum in a Adolescent with Type 2 Diabetes Mellitus

Sales MTA1; Martins LV2; Sousa MS1; Aragão LFF1; de Carvalho AB1; de Sena MIF1; Montenegro APRD1; Júnior RMM1

(1) Hospital Universitário Walter Cantídio, Fortaleza, CE, Brasil; (2) Universidade de Fortaleza, UNIFOR, Fortaleza, CE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—181

Case Presentation: A 13-year-old girl presented with an 5-years history of brownish-red plaques with atrophic center in the extensor face of the lower limbs and hands bilaterally. She also had overweight and severe acanthosis nigricans. Skin biopsy was performed and showed a infiltrate composed of histiocytes and multinucleated giant cells located in the interstitium of the superficial to deep dermis and subcutaneum with mucin deposition and collagen degeneration with formation of candle-flame eosinophilic structures. Furthermore there was perivascular monomorphonuclear infiltrate and in appendages. Diagnosis of necrobiosis lipoidica diabeticorum (NLD) was established. Fasting blood glucose and glycated hemoglobin (HbA1c) were 400mg/dl and 19.4% respectively. C-peptide was 5,0ng/ml (reference range 1,1-4,4ng/ml) and type 1 diabetes mellitus (T1DM) autoantibodies were negative. She has polyuria, polydipsia and weight loss of 5kg started a month ago. She was initially treated with insulin, but reached good glycemic control (HbA1c 5,7%) with metformin 1.5g/day alone thereafter, with improvement of skin lesions especially on the hands. The patient’s guardian gave their explicit written consent to publish the patient’s information in an open access journal. Discussion: We present a adolescent with NLD lesions, including atypical areas (hands), and type 2 diabetes mellitus (T2DM). Diagnosis of T2DM was performed from diagnosis NLD which had improvement with glycemic control. NLD is a rare chronic granulomatous dermatitis that manifests as brownish-red plaques with atrophic yellowish centers with tendency to ulceration typically in the pretibial region. Affects predominantly young women (20–30yo) with T1DM. Prevalence of NLD is 0.3–1.2% in patients with diabetes. Currently there is no consensus on the treatment for this disease. Final Comments: We report a rare presentation of NLD with typical and atypical affected areas in a T2DM teenager. As far as we know this is the first description in an adolescent with T2DM in Brazil.

PO—183 Real-World Use of Continuous Glucose Flash Monitoring System Among 317 Consecutive Children and Adolescents with Type 1 Diabetes

Puñales M1; Barcelos W1; Tschiedel B1

(1) Instituto da Criança com Diabetes, Hospital Criança Conceição, Grupo Hospitalar Conceição, Ministério da Saúde, Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—183

Introduction: The continuous glucose flash monitoring system (fCGM) allows better glycemic control, improves the time spent in glucose range (TIR), reduces the time spent in hypoglycemia (TBR) and hyperglycemia (TAR). However, there are few reports iin the real-world use in the pediatric population. Objective: To evaluate real-world use of fCGM and glycemic metrics among 317 consecutive children and adolescents with type 1 diabetes (T1D) on multiple daily insulin injections (MDI). Methods: fCGM data from 317 T1D children and adolescents, mean age of 9.3±3.9 years, attended at a public health diabetes reference unit, over one-year period, were included. Data expressed as mean ± standard deviation, median, and interquartile range (IQR) and significance <0.05. Results: The time in range (TIR) was 47.9±20.4%, ranging from 5.0% to 98.0%, and 16.0% (51/317) of the sample had TIR >70%. The time spent in hyperglycemia (TAR) was 48.4±21.1% and the median time in hypoglycemia (TBR) was 2,0%6% (IQR 1-5%), with a duration of 65 minutes (IQR 45-98 min). The mean glucose value was 193.6±44.3 mg/dL, ranging from 98.0 to 368 mg/dL, with variation coefficient (CV) of 39.4±7.5%, ranging from 20.1% to 61.1%, and the glucose management indicator (GMI) was 7.9±1.0%. The time of sensor use was 91.5±7.1%, with a variation of 70.0 to 100.0% and the median number of sensor scans per day was 14.0 (IQR 9-24). A positive correlation was found between the number of scans (<0.01) and TIR, and a negative correlation between the glucose CV and TIR (<0.001). Conclusion: Our results demonstrate real-word data of fCGM in a public healthcare system, with TIR inapproximately half of the individuals, highlighting the difficulty of achieving glycemic goals in T1D. However, a low percentage of time spent in hypoglycemia was observed, which represents a protective factor in the pediatric age group. Additionally, we found A positive correlation between TIR and the number of daily scans and a negative with CV. These findings emphasize the importance of continuous and regular diabetes education to achieve glycemic targets in pediatric population.

PO—184 Temporal Trend and Demographic Profile of Hospitalizations of Children and Adolescents for Type 2 Diabetes Mellitus in the Brazilian Unified Health System (2015–2024)

Matias MCTS1; de Lima INR1; Fernandes LC1; Santana RS1; Dias CMCC1

(1) Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil

Diabetology & Metabolic Syndrome 2026: PO—184

Introduction: Type 2 Diabetes Mellitus (T2DM), once rare in children and adolescents, has shown a remarkable increase in recent decades, paralleling the rise in obesity and lifestyle changes. The analysis of hospital admissions in this population is essential to identify high-risk groups, understand regional and temporal patterns, and support public health policies for prevention and clinical management. Objective: To analyze the temporal trends of hospital admissions for T2DM among individuals aged 0–19 years in Brazil between 2015 and 2024, according to sex, age group, and geographic region. Methods: Cross-sectional study using DataSUS records of hospital admissions for T2DM (ICD-10 E11) in children and adolescents. Variables analyzed were year, region, sex, and age group (<1, 1–4, 5–9, 10–14, 15–19 years). Descriptive analyses, Pearson’s chi-square test, and Linear-by-Linear Association trend test were performed using SPSS 25.0. Results: A total of 96,129 admissions were recorded. Significant associations were found with year and region (p<0.001). The Southeast accounted for 43.9% of admissions, followed by the Northeast (25.4%), South (16.7%), Midwest (9.3%), and North (4.7%). Although both absolute and relative admissions increased between 2015 (9.0%) and 2024 (12.5%), no uniform linear trend was observed (p=0.069). The 10–14 (37.0%) and 15–19 (31.5%) age groups predominated, both showing significant increasing trends (p<0.001). Younger groups represented lower proportions: 5–9 years (19.0%), 1–4 years (10.1%), and <1 year (2.4%). Females accounted for 57.2% of admissions, with significant annual variation (p<0.001) and predominance across all age groups (p<0.001). Conclusion: Hospital admissions for T2DM among young people in Brazil increased substantially, especially among females and adolescents aged 10–19 years, with the highest concentration in the Southeast. Despite the absence of a uniform national linear trend, a significant increase was observed in older age groups. These findings highlight the urgent need for prevention and control strategies for T2DM in childhood and adolescence, considering regional, sex, and age-related differences, to mitigate the long-term impact on the Brazilian Unified Health System.

PO—185 Temporal Association between Pfizer-BioNTech Vaccination and Autoimmune Encephalitis in a Pediatric Patient in a Pediatric Patient With Type 1 Diabetes

Indiani L1; Lottenberg AMP2; da Frota MA3; Borges DM3; Maranhão CC3; Aragão MM3; Pinho RS3

(1) Instituição de Ensino Hospital Israelista Albert Einstein, São Paulo, SP, Brasil; (2) Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brasil; (3) Universidade Federal de São Paulo, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—185

Case Presentation: This report documents the possible association between vaccination with Pfizer-BioNTech against COVID-19 and the development of autoimmune encephalitis due to anti-AMPAR antibodies in a 12-year-old boy. The patient had a history of type 1 diabetes, precocious puberty, and atresia of the auditory canal. Fifteen days after vaccination, he developed neurological symptoms, including short-term memory loss, irritability, night sweats, and weight loss. Complementary examinations, such as EEG and brain MRI, showed normal results, while the analysis of cerebrospinal fluid revealed positivity for anti-AMPAR antibodies, confirming the diagnosis of autoimmune encephalitis. The oncological screening did not identify any neoplasms. The patient’s guardian gave their explicit written consent to publish the patient’s information in an open access journal. Discussion: The initial treatment with intravenous immunoglobulin (IVIG) led to the resolution of symptoms, but there was a relapse at 45 days, which was controlled with a combined therapy of IVIG, dexamethasone, and rituximab, resulting in complete cognitive recovery after two years of follow-up. This case is pioneering in demonstrating anti-AMPAR encephalitis as a possible autoimmune complication post-vaccination in children, highlighting the importance of early diagnosis and aggressive treatment. The temporal association suggests an immunological mechanism via molecular mimicry triggered by the vaccine. Final Comments: The atypical clinical presentation and normal imaging results may hinder the initial diagnosis, emphasizing the need for vigilance in pediatric patients after vaccination. The report underscores the relevance of future research to confirm causality and deepen the understanding of the involved pathophysiological mechanisms. Identifying rare conditions such as autoimmune encephalitis is crucial for clinical practice, and this case contributes to the knowledge of potential adverse reactions to vaccination in vulnerable populations. Prospective studies are essential to elucidate this relationship and ensure the safety of vaccines in children.

PO—187 “DM1 Journey”: Development of an Educational Board Game to Promote Treatment Adherence in Children and Adolescents with Type 1 Diabetes Mellitus

Paz ND1; Diniz AS1; Arruda ARC1; Lustosa LA1; Brugnera PC1

(1) Hospital da Criança de Brasília José de Alencar, Brasília, DF, Brasil

Diabetology & Metabolic Syndrome 2026: PO—187

Introduction: Management of type 1 diabetes mellitus in childhood and adolescence requires strategies that integrate health education and emotional support. Therapeutic games have proven effective in promoting adherence, facilitating understanding of treatment, and strengthening the therapeutic bond. Playfulness allows the child to express themselves, construct meaning, and develop self-care skills. Objective: To present the development and report the experience of applying the board game “Jornada do DM1” as a playful tool to promote treatment adherence and psychoeducation in children and adolescents with type 1 diabetes. Methods: This is a descriptive experience report on the development of an educational game. Commercial board games were analyzed to support the construction of the resource, respecting fundamental elements such as path, cards, challenges, pawns, and rules. The game was structured based on the four pillars of T1DM treatment: insulin therapy, healthy eating, physical activity, and mental health. The application was conducted in individual psychological sessions with pediatric patients in an outpatient hospital context. Results: The playful material includes glucose monitoring cards, event cards, questions and bonuses, a glucose “thermometer,” dice, and pawns, organized in a path that simulates everyday situations related to type 1 diabetes treatment. The visual design and language were planned to ensure accessibility and engagement of the pediatric audience. Active participation and spontaneous interest were observed among children and adolescents, who showed positive emotional involvement and motivation to participate. The game facilitated the understanding of diabetes care, promoted dialogue about feelings and challenges, strengthened the therapeutic bond, and encouraged interaction among participants. It also helped identify doubts, resistances, and individual needs, contributing to targeted psychological interventions. Conclusion: “Jornada do DM1” proved to be an effective resource for psychological and educational intervention in the context of childhood diabetes, enabling the assessment of treatment understanding, promotion of health literacy, strengthening of bonds, and stimulation of autonomy. The proposal reinforces play as an essential clinical tool in health psychology.

PO—191 Diabetes Mellitus Caused by Secondary Hemochromatosis After Multiple Blood Transfusions in a Patient with Myelodysplastic Syndrome.

Lopes MM1; Bredariol MR2; Neto PFA1; Cordebel LEF1; Frade GLF1; de Moura YLL1; Mendes M1; de Mascarenhas MW1; Longen AJL1; Petronilho LS1; Jacob MJD1; Junqueira FD2

(1) Hospital Federal da lagoa, Rio de Janeiro, RJ, Brasil; (2) IDOMED Cittá, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—191

Case Presentation: Male, 58 years old, hospitalized with anemia and asthenia. He has a myelodysplastic syndrome and a diagnosis of secondary hemochromatosis due to multiple blood transfusions without a diagnosis of diabetes prior to admission. Laboratory tests during hospitalization revealed: elevated ferritin (4635 ng/mL), blood glucose (561 mg/dL), glycosylated hemoglobin (8.7%) and low hemoglobin levels (5.9g/dL). Other tests demonstrated the absence of laboratory criteria for diabetic ketoacidosis. Abdominal Magnetic Resonance Imaging showed excess iron in the liver and pancreas. On physical examination, the patient had a normal body mass index (23.52 kg/m²). He had no family history of diabetes and received treatment with multiple insulin injections (nph and regular) during hospitalization. He had an advanced disease with progressive worsening of the anemia, making phlebotomy not possible. The clinical condition progressed to liver and heart failure, followed by death 10 months later. The patient gave his explicit written consent to publish his information in an open access journal. Discussion: Secondary hemochromatosis usually develops in patients who have received multiple red blood cell transfusions. Recurrent transfusion is a rapid and effective treatment for refractory anemia, including myelodysplastic syndrome. However, transfusion-associated iron overload can cause progressive damage in multiple organs. There are two mechanisms that contribute to impaired glucose metabolism in patients with iron overload. First, iron overload leads to beta cell damage, decreasing insulin production and secretion. The second abnormality is insulin resistance that occurs due to liver damage from iron overload. The diagnosis of iron overload can be made by increased blood levels of ferritin. The most useful imaging test is Magnetic Resonance Imaging, as it can quantify iron overload. Treatment of diabetes in this context should be individualized according to blood glucose levels and residual β-cell function. Final Comments: The association between hemochromatosis and diabetes mellitus highlights the importance of a comprehensive multidisciplinary clinical approach to ensure early diagnosis and treatment, avoiding serious complications.

PO—192 Diabetes Mellitus Secondary to Ectopic Cushing’s Syndrome: a Case Report

Magela KRH1; Querubino AC1; de AndradeCMT1

(1) Hospital Fundação Ouro Branco, Ouro Branco, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—192

Case Presentation: A 40-year-old male presented to the emergency department in January 2024 with persistent hyperglycemia accompanied by asthenia and edema of the extremities and face. He was admitted with blood glucose levels persistently above 300 mg/dL, refractory to insulin therapy. Endocrine evaluation confirmed Cushing’s syndrome, with elevated post-dexamethasone serum cortisol (48 mcg/dL) and increased late-night salivary cortisol (27.8 ng/dL). ACTH levels were markedly elevated (185 pg/mL), consistent with an ACTH-dependent etiology; however, pituitary MRI findings were unremarkable. Given the suspicion of ectopic ACTH secretion, a biopsy of mediastinal lymphadenopathy was performed. Immunohistochemical analysis revealed a well-differentiated neuroendocrine neoplasm, compatible with metastasis from a possible medullary thyroid carcinoma. The markedly elevated serum calcitonin level (4,400 pg/mL) supported the clinical hypothesis. The patient underwent bilateral adrenalectomy followed by total thyroidectomy, resulting in significant clinical and biochemical improvement. He remains under coordinated oncologic and endocrinologic follow-up. The patient gave his explicit written consent to publish his information in an open access journal. Discussion: Cushing’s syndrome is a disorder caused by prolonged and pathological exposure to excess glucocorticoids. Its clinical presentation is heterogeneous, and diagnosis may be challenging, particularly in early stages when manifestations are subtle. Paraneoplastic etiology accounts for approximately 15% of all Cushing’s syndrome cases, with ectopic adrenocorticotropic hormone (ACTH) secretion from neuroendocrine tumors representing a rare subset—occurring in only about 10% of ACTH-dependent cases. These forms typically present as severe, rapidly progressive disease, often with poor prognosis, and are more frequently observed in men between 40 and 60 years of age. Bilateral adrenalectomy is considered in situations where hypercortisolism cannot be adequately controlled through resection of the primary tumor, or as a temporizing measure while the tumor’s location is being determined. Final Comments: ACTH-producing neuroendocrine tumors are a rare cause of Cushing’s syndrome and secondary diabetes mellitus, representing a significant challenge for both diagnosis and treatment. Furthermore, they carry a high risk of metabolic, infectious, and thromboembolic complications, which makes clinical management even more challenging.

PO—196 Metreleptin Therapy in Congenital Generalized Lipodystrophy: Case Report of a Brazilian Adolescent with AGPAT2 Mutation

Pedrosa B1; Cabizuca CA1; Tannus LRM1; de Vasconcellos CAVA1; Smith BG1; Menezes NF1; Martins ISS1; Costa ASMF1

(1) Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—196

Case Presentation: A 12-year-old female was referred to a tertiary public diabetes clinic in 2019 for evaluation of polyuria and polydipsia. Glycated hemoglobin (HbA1c) was 8.7%, confirming the diagnosis of diabetes mellitus. She had a history of hypertriglyceridemia since childhood, along with difficulty gaining weight, and hyperphagia. Physical examination revealed a generalized loss of subcutaneous fat (body mass index 17 kg/m²), muscular hypertrophy, acromegaloid features, and prominent veins. These findings raised clinical suspicion for Berardinelli-Seip Congenital Lipodystrophy (BSCL). Treatment with insulin, metformin, fibrate, and statin was initiated. In 2021, BSCL type 1 was confirmed by identifying a mutation in the AGPAT2 gene. Over time, insulin requirements increased up to 2.8 IU/kg/day, with the development of diabetic kidney disease, hepatic steatosis, and worsening HbA1c (up to 12.8%). Triglycerides exceeded 500 mg/dL. In 2024, metreleptin therapy was initiated, resulting in a greater than 5% reduction in HbA1c (to 7.3%) within 10 weeks, a more than 50% decrease in insulin requiriment, and significant improvement in triglyceride levels, allowing discontinuation of fibrate and statin therapy. However, after a six-month interruption in metreleptin supply, HbA1c rose again to 12%, insulin requirements increased, and triglyceride levels deteriorated. The patient’s guardian gave their explicit written consent to publish the patient’s information in an open access journal. Discussion: Lipodystrophies are rare disorders characterized by loss of adipose tissue without evidence of malnutrition or catabolism. The BCSL is an autosomal recessive condition, more prevalent in populations with high rates of consanguinity. First described in 1954 by Brazilian physician Waldemar Berardinelli, BSCL is linked to mutations in the AGPAT2 or BSCL2 genes. The adipose tissue loss results in hypoleptinemia, which contributes to insulin resistance, diabetes, hepatic steatosis, and dyslipidemia. Common phenotypic features include muscular hypertrophy, acanthosis nigricans, hepatomegaly, and prominent veins. Treatment includes lifestyle modifications, such as diet and exercise, pharmacological interventions including insulin, and novel therapies like metreleptin, which improves metabolic control though it is not curative. Final Comments: The rarity of BSCL challenges timely diagnosis and limits access to targeted therapies. Enhanced clinical awareness and supportive public health policies are essential to ensure metreleptin availability and improve patient outcomes.

PO—197 Multidisciplinary Approach and Management of Insulin Resistance in a Child with Bardet-Biedl Syndrome and Autism Spectrum Disorder: a Case Report

Campanha ACA1; Simões JRA2; Araújo LR1

(1) Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brasil; (2) Faculdade FAMINAS BH, Belo Horizonte, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—197

Case Presentation: Patient L.V., a male child, was diagnosed with Bardet-Biedl Syndrome (BBS), a rare genetic ciliopathy with autosomal recessive inheritance, characterized by multisystemic manifestations. He presented with early-onset obesity, polydactyly, global neuropsychomotor developmental delay, and hypotonia. He was also diagnosed with Autism Spectrum Disorder (ASD), exhibiting significant impairments in language, social interaction, and behavior. Laboratory tests revealed hyperinsulinemia (fasting insulin > 30 µU/mL), indicating marked insulin resistance. Considering the high risk of progression to type 2 diabetes and hepatic steatosis, an intensive therapeutic plan was initiated, including personalized nutritional counseling, supervised daily physical activity, and systematic family involvement. Multidisciplinary support included speech therapy, occupational therapy, physical therapy and psychotherapy. The patient’s guardian gave their explicit written consent to publish the patient’s information in an open access journal. Discussion: Early insulin resistance in BBS patients is a significant metabolic complication, directly associated with central obesity—a common feature of disease progression. Elevated fasting insulin levels, as observed in this case, suggest an imminent risk of developing type 2 diabetes during childhood, in addition to predisposition to dyslipidemia, hepatic steatosis, and metabolic syndrome. These findings require immediate, continuous, and age-appropriate interventions. The coexistence of ASD exacerbates clinical challenges, as restrictive behaviors, food selectivity, and communication difficulties can hinder adherence to dietary and physical activity plans. In such cases, the involvement of a multidisciplinary team with integrated collaboration between healthcare and educational professionals is essential. Individualized care, active family participation, and specialized support in behavioral and sensory therapies are key factors for therapeutic success. Moreover, continuous monitoring of metabolic parameters, renal function, and visual acuity is crucial, given the potentially progressive and disabling nature of the syndrome. Final Comments: Despite a favorable initial response to treatment, the prognosis remains guarded due to the progressive nature of BBS. This case underscores the importance of early identification of insulin resistance and the role of integrated interdisciplinary care in mitigating metabolic risks and promoting global development.

PO—198 Nivolumab-induced Autoimmune Diabetes Mellitus in a Patient with Metastatic Renal Cell Carcinoma

Pontes ALF1; Soares DV1; Pessôa VNK1; Corrêa MG1

(1) Departamento de Endocrinologia do Hospital Universitário Antônio Pedro, Universidade Federal Fluminense- Niterói, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—198

Case Presentation: A 53-year-old male was referred to the endocrinology service in May 2025 due to a six-day history of polyuria, polydipsia, polyphagia, blurred vision, and nausea. Laboratory tests revealed a blood glucose level of 575 mg/dL, with no ketonuria or acidosis. The patient denied a previous diagnosis of diabetes, reported a family history of type 2 diabetes (mother) and had Class I obesity. He had a history of renal cell carcinoma diagnosed in 2024, treated with nephrectomy in the same year. Subsequently, developed lung metastasis and began nivolumab therapy in November 2024. Laboratory tests from March 2025 showed a fasting blood glucose of 94 mg/dL and a Glycated Hemoglobin A1c (HbA1c) of 5.6%. Due to persistent hyperglycemia, insulin therapy was initiated at 0.4 IU/kg/day using a basal-bolus regimen. After fifteen days, follow-up tests showed an HbA1c of 8.9% and a fasting blood glucose of 377 mg/dL. Insulin doses were adjusted, resulting in improved glycemic control, as evidenced by capillary blood glucose self-monitoring. Tests for anti-islet cell and anti-glutamic acid decarboxylase antibodies were positive. The patient gave his explicit written consent to publish his information in an open access journal. Discussion: We report the case of an oncology patient who developed a sudden onset of diabetes 6 months after starting immunotherapy. The use of immune checkpoint inhibitors, such as nivolumab, is associated with autoimmune endocrine adverse effects, including thyroiditis and hypophysitis. Fulminant diabetes associated with immunotherapy is less frequent, occurring in about 1% of patients, and is due to the abrupt destruction of pancreatic beta cells. The patient presented with a sudden onset of hyperglycemia in the context of immunotherapy, with a normal HbA1c measured 2 months earlier, suggesting a rapid onset of the condition. The absence of ketoacidosis and the presence of obesity make it difficult to distinguish between induced type 1 diabetes and type 2 diabetes. However, the abrupt onset and probable insulinopenia, demonstrated by the need for insulin, suggest an autoimmune cause, which was corroborated by the autoantibody test results. Final Comments: This report highlights the importance of clinical and laboratory surveillance for endocrine manifestations associated with the use of immunotherapeutic agents. Diabetes, although rare, can manifest abruptly and requires early recognition to avoid complications. Future studies may identify predictive risk markers and establish specific protocols for the management of diabetes induced by immune checkpoint inhibitors.

PO—199 Rare Presentation of Acute Coronary Syndrome in a Patient Diagnosed with MELAS Syndrome (Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-Like Episodes) and MIDD (Maternally Inherited Diabetes and Deafness)

Pereira NGFS1; Galiassi GER1; Dutra FHT1; Rodrigues PB1; Yance VRV1

(1) Universidade Federal da Grande Dourados, Dourados, MS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—199

Case Presentation: A 47-year-old woman, with three pregnancies complicated by cervical insufficiency and menopause at age 42, required surgical correction due to urinary incontinence. She had a history of ischemic stroke at age 41, controlled epilepsy, and a diagnosis of type 2 diabetes mellitus at age 25, managed with metformin. Cystocele repair was performed in January 2025. On the 9th postoperative day, she developed a surgical complication with spontaneous mesh extrusion, and surgical reintervention was scheduled. The night before, she experienced a sudden episode of chest pain with ST-segment depression in leads V5–V6, leading to a diagnosis of acute coronary syndrome (ACS). Coronary angiography revealed a subtotal lesion in the left anterior descending artery, which was treated with a bare-metal stent. Her past medical history included short stature, severe bilateral sensorineural hearing loss, and significant cognitive impairment. During hospitalization, she also presented with persistent hyperglycemia, intermittent lactic acidosis, and asymptomatic hyperkalemia. Given the clinical presentation and a similar family history in first-degree relatives, mitochondrial disease was suspected. Genetic sequencing confirmed the m.3243A>G mutation in the MT-TL1 gene, consistent with a diagnosis of MIDD overlapping with MELAS syndrome. The patient gave her explicit written consent to publish the patient’s information in an open access journal. Discussion: Genetic mitochondrial diseases are rare and heterogeneous, affecting organs with high energy demand. Mitochondrial inheritance is maternal, and the m.3243A>G mutation is associated with both MELAS syndrome and MIDD. MELAS syndrome primarily presents with stroke-like episodes, encephalopathy with seizures or dementia, myopathy, and lactic acidosis. This case is significant because it is rare for patients with MELAS syndrome to present with ACS, such as myocardial infarction due to atherosclerotic plaque rupture. The literature usually reports cases of myocardial ischemia secondary to other factors, including mitochondrial endothelial dysfunction, microvascular alterations, tissue hypoxia due to lactic acidosis, and severe arrhythmias or decompensated heart failure, leading to type 2 myocardial injury. Final Comments: The treatment is supportive, and early recognition is essential for monitoring complications, ensuring adequate glycemic control, and conducting family screening and counseling. Atherosclerosis is not typical in patients with MELAS syndrome but may coexist. Investigation should be guided by individual risk and not performed systematically.

PO—200 Analysis of Patients with Type 2 Diabetes and Steatotic Liver Disease Associated with Metabolic Dysfunction Using the Fatty Liver Index

Azulay RS1; Sombra AN1; Tavares MG1; Nascimento GC1; Magalhães M2; Abutrab JJ1; Oliveira AM1; Santos LA4; Mesquita SL3; Ferreira WC3; Faria M1; Ferreira AP4; Abreu JDF1

(1) Endocrinology Unit, University Hospital of the Federal University of Maranhão/EBSERH, São Luís, MA, Brasil; (2) Research Group in Clinical and Molecular Endocrinology and Metabology, Federal University of Maranhão, São Luís, MA, Brasil; (3) Federal University of Maranhão, São Luís, MA, Brasil; (4) Graduate Program in Health Sciences, Federal University of Maranhão, São Luís, MA, Brasil

Diabetology & Metabolic Syndrome 2026: PO—200

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common cause of chronic liver disease and the leading contributor to morbidity and mortality related to hepatic conditions. The coexistence of type 2 diabetes mellitus (T2DM) is an independent risk factor for the progression of liver fibrosis. Therefore, the T2DM population is a priority group for MASLD screening. The Fatty Liver Index (FLI) is a clinical-laboratory score used in clinical practice for screening hepatic steatosis (HS), providing a low-cost tool. In the original study, using liver ultrasonography as the reference, values below 30 were identified as excluding HS with 87% sensitivity, while values above 60 showed 86% specificity for HS. Objective: To evaluate the FLI as a screening tool for HS in patients with T2D and MASLD in a referral hospital in a state in Northeastern Brazil. Methods: This descriptive cross-sectional study was conducted between June 2022 and February 2024. We included 296 patients with T2DM and MASLD treated at a referral hospital. Patients with chronic liver disease caused by viral hepatitis (positive serology for hepatitis B or C), excessive alcohol consumption, other causes of chronic liver disease (such as autoimmune hepatitis or hemochromatosis), and those using hepatotoxic drugs—including glucocorticoids, methotrexate, antiretrovirals, amiodarone, tamoxifen, or estrogens—were excluded. The variables collected were sex, age, and FLI. FLI was calculated using a mathematical equation based on triglyceride levels, body mass index (BMI), gamma-glutamyl transferase (GGT), and waist circumference, resulting in values ranging from 0 to 100. The diagnosis of HS was established by liver ultrasound. Results: Of the 296 patients, 190 (64.2%) were female, and the mean age was 61 years. Overall, 215 patients (72.6%) had an FLI greater than 60, 66 (22.4%) had an FLI between 30–60, and 15 (5%) had an FLI below 30. Conclusion: In this study, the FLI demonstrated diagnostic accuracy in over 70% of HS cases, proving to be a useful tool for screening this condition in the studied population, with the advantages of low cost and ease of use.

PO—201 Anthropometric and Metabolic Profiles in Subjects with Diabetes: Association with Metabolic Dysfunction-Associated Steatotic Liver Disease

Saad MAN1; Flores PP1; Soares DV1; do Prado LR1; Ormond CPR1; Matos MEC1; de Oliveira MA1; Godinho JR1; Torres JPM1; Maia LS1; Manea LP1; Caldas J1; Velarde GC1

(1) Universidade Federal Fluminense, Niterói, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—201

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a spectrum of liver conditions that encompasses steatosis, steatohepatitis, fibrosis and cirrhosis. MASLD is characterized by the accumulation of more than 5% lipids in hepatocytes. Type 2 diabetes and obesity are among the most impactful comorbidities in the progression and severity of MASLD. Objective: To assess the association of anthropometric and metabolic profile and MASLD in diabetic patients. Methods: Cross-sectional study conducted with 101 participants, 82 females (81.19%) and 19 males (18.81%), aged over 18 years, all diagnosed with diabetes and presenting additional risk factors for MASLD. Non-invasive assessment of MAFLD was performed by ultrasound, elastography and bioelectrical impedance analysis. Anthropometric data was collected, such as body mass index (BMI), waist circumference (WC), hip circumference (HC), neck circumference (NC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR). Descriptive statistics were applied to characterize the sample. Inferential analyses included the T-test for parametric data and Mann–Whitney U test for non-parametric comparisons. Results: Hepatic steatosis was identified in 88 (87%) participants through elastography, with a median controlled attenuation parameter (CAP) value of 297.5 dB/m. Among participants with steatosis, statistically significant associations were found with the following anthropometric indicators: BMI (median: 31.6 kg/m²; p=0.019), WC (median: 106.4 cm; p=0.016), HC (median: 105.2 cm; p=0.020), and WHtR (median: 0.67; p=0.012). Body composition variables also demonstrated strong correlations: mean body fat percentagem (% BF) was 34.3% and mean lean mass was 65.7%, both significantly associated with steatosis (p=0.003). No significant associations were observed for NC (p=0.116) or WHR (p=0.272). Conclusion: The findings indicates significant associations between hepatic steatosis and several anthropometric parameters in individuals with diabetes. The results suggest that anthropometric profiling may serve as a non-invasive, accessible, and cost-effective aproach for identification of MASLD, particularly among patients with metabolic risk factors, which could be considered in clinical screening and preventive strategies.

PO—202 Association Between Anthropometric Measures and the Degree of Hepatic Steatosis in Patients with Metabolic Dysfunction

Fortes IDFM1; Guimarães ND1; Alves JAR1; Gouvea PB1; Monteiro JM1; Torres BC1; Alves ACC1; Bertoldi GC1; Khouri JF1; Marques LDC1; Palaoro LG1; Guzzo MF1; Pacheco MP1

(1) Escola Superior de Ciência da Santa Casa de Misericórdia de Vitória, Vitória, ES, Brasil

Diabetology & Metabolic Syndrome 2026: PO—202

Introduction: Metabolic dysfunction–associated steatotic liver disease (MASLD) is the most common form of chronic liver disease, highly prevalent in individuals with obesity and type 2 diabetes, and it can progress to fibrosis and cirrhosis. Given the limitations of invasive methods, noninvasive alternatives such as the FIB-4 score and simple, low-cost, and clinically applicable anthropometric measures—such as BMI, neck circumference, and calf circumference—stand out as useful tools for identifying metabolic risk and assessing the severity of steatosis. Objective: To assess the correlation between the degree of hepatic steatosis with variables such as BMI, calf circumference, and neck circumference. Methods: A cross-sectional observational study was conducted with patients with hepatic steatosis followed at the Gastroenterology outpatient clinic of a philanthropic hospital. Standardized clinical data were collected, and variables analyzed included sex, BMI, calf circumference, neck circumference, and degree of hepatic steatosis. Results: A total of 49 participants were evaluated, 87.8% female (n = 43) and 12.2% male (n = 6). Hepatic steatosis (HS) was classified according to ultrasonographic severity: grade 1 (mild), grade 2 (moderate), grade 3 (severe), and grade 4 (unclassified), corresponding respectively to 32.6%, 40.8%, 18.4%, and 8.2% of the sample. In the analysis between HS and BMI, participants with grade 1 HS were equally distributed among normal weight (BMI 18.5–24.9), overweight (BMI 25–29.9), and obesity grade I (BMI 30–34.9), each category representing 16% of the cases. In grade 2, 18.4% presented obesity grade I. In grade 3, 10.2% had obesity grade I and 6.1% obesity grade III (BMI ≥ 40). NC was also associated with HS severity. Among women with NC ≥ 34 cm, 24.5% were in grade 1, 30.6% in grade 2, and 16.3% in grade 3 steatosis. Regarding CC, among women with CC > 33 cm, 22.4% were classified as grade 1, 38.8% as grade 2, and 16.3% as grade 3 HS. Conclusion: The study indicates a correlation between the severity of hepatic steatosis and anthropometric measures such as BMI, neck circumference, and calf circumference, with higher values and greater frequency of obesity observed in more advanced cases. As simple and accessible measures, these parameters may serve as indirect indicators of disease severity, particularly in resource-limited settings, although larger and longitudinal studies are needed to confirm these associations and their predictive potential.

PO—203 Correlation Between Lower Limb Fat, Osteometabolic Factors and Liver Fibrosis in Individuals with 20 Years of Type 2 Diabetes

De Lemos MN1; Junior ABF1; Salles JEN1; Scalissi NM1; dos Santos LM1

(1) Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—203

Introduction: Type 2 diabetes (T2D) is associated with body fat distribution, particularly visceral fat. The chronic inflammatory nature of this condition affects bone microarchitecture. Patients with T2D exhibit the "bone paradox," where they have normal bone density but an increased risk of fractures. Objective: This study aims to evaluate the correlations between bone mass, body composition—assessed by densitometry—and clinical parameters in individuals with T2D. Methods: This is a cross-sectional, observational, and analytical study. Data were collected between 2023 and 2024 using the REDCap (Research Electronic Data Capture) platform. Results: A total of 104 participants with a diagnosis of T2D were selected, with a mean age of 65 years ± SD = 7.51 and a mean diabetes duration of 19.23 years ± SD = 11.98; the mean age at diagnosis was 39.61 years ± SD = 13.86. Of these, 66% were using insulin, with a daily dose of 0.66 ± 0.64 UI/Kg/day. The mean fasting blood glucose was 153 ± 54.62 mg/dL, HbA1c was 8.36 ± 2.02%, and C-peptide was 2.06 ± 2.03 ng/mL. The mean creatinine level was 1.02 ± 0.52 mg/dL, and the estimated glomerular filtration rate (eGFR) was 70.79 ± 22.83 mL/min/1.73m². The FIB-4 index—a non-invasive tool used to assess the risk of advanced liver fibrosis in patients with metabolic fatty liver disease—had a mean of 1.35 ± 0.70, and the mean serum vitamin D level was 33.75 ± 10.80 ng/mL. A negative correlation was observed between the lower limb fat percentage (LLF) and FIB-4 values (r = -0.329, p < 0.05), suggesting that a lower fat percentage may be associated with a higher risk of liver fibrosis. A negative correlation was also found between LLF, bone mineral density (BMD), and femoral neck T-score (r = -0.334, p < 0.05 and r = -0.328, p < 0.05, respectively). Conclusion: It is possible to conclude that a lower LLF percentage may be linked to higher metabolic risk (indicated by FIB-4) and greater bone mineral density in cortical bone, highlighting the difficulty in assessing bone mass in these individuals.

PO—204 Familial Partial Lipodystrophy Type 2 and End-Stage MASLD: A Case of Long-Term Remission After Liver Transplantation

Ildefonso MP1; Araujo JS1; Alexandrino MT1; Ramos LTT1; Pontes AM1; Gadelha DD1; Boris NP1; Fernandes VO1; Junior RMM1; Correia KGC1

(1) Hospital Universitário Walter Cantídio, Fortaleza, CE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—204

Case Presentation: We report the case of a 69-year-old woman with familial partial lipodystrophy type 2 (FPLD2), carrying the heterozygous LMNA p.Arg482Trp pathogenic variant, diagnosed at age 65 through cascade family screening. Phenotypic changes began at age 29 after pregnancy, with abdominal fat accumulation and symmetrical lipoatrophy of the limbs. At 40, she was diagnosed with type 2 diabetes mellitus, later complicated by peripheral neuropathy, proliferative diabetic retinopathy, and nephropathy. She also had hypertension, hypertriglyceridemia, and low HDL cholesterol. At age 60, she developed abdominal pain, ascites, and encephalopathy, leading to a diagnosis of end-stage Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and subsequent liver transplantation. At that time, her glycated hemoglobin (A1C) level was 8.7%, and she was taking 24 units of insulin/day. Nine years post-transplant, her Fibrosis-4 Index (FIB-4) is 0.8, with no steatosis or fibrosis on transient elastography. She maintains glycemic control (A1C 6.7%) with oral antidiabetics (Metformin and Dapagliflozin) only. The patient gave her explicit written consent to publish the patient’s information in an open access journal. Discussion: Lipodystrophy is marked by a deficiency of adipose tissue and is often associated with severe insulin resistance, dyslipidemia, and MASLD. In some patients, MASLD progresses to cirrhosis, requiring liver transplantation. However, the recurrence of steatosis in the graft has been described, particularly in cases of persistent metabolic dysfunction. In this case, the absence of MASLD recurrence after nearly a decade may be linked to improved insulin sensitivity and glycemic control, supporting the hypothesis that metabolic optimization can positively impact long-term hepatic outcomes even after transplant. Final Comments: To our knowledge, this is the first reported case of sustained post-transplant remission of MASLD in a patient with FPLD2. It reinforces the importance of early diagnosis and long-term metabolic management in lipodystrophy syndromes. This case highlights the potential benefits of glycemic control in preventing the recurrence of liver disease post-transplant. It underscores the need for continued multidisciplinary follow-up to reduce systemic complications and preserve graft health.

PO—205 From Early-Onset Diabetes to Liver Transplantation: a Fatal Course in Congenital Generalized Lipodystrophy

Sales MTA1; Araujo JS1; Boris NP1; Lopes FKM1; Ramos LTT1; Linard LLP1; Bezerra IC1; Florêncio CM1; Cortez VOF1; Júnior RMM1

(1) Hospital Universitário Walter Cantídio, Fortaleza, CE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—205

Case Presentation: A 26-year-old woman was diagnosed with congenital generalized lipodystrophy (CGL) at 3 months of age, based on classic phenotypic features: acromegaloid facies, generalized lipoatrophy, including palmar and plantar fat loss, and early-onset diabetes mellitus. Insulin therapy was initiated at age 15. Over time, she developed chronic complications, including diabetic nephropathy and bilateral proliferative retinopathy. At 24, she presented with hepatic decompensation characterized by refractory ascites, requiring weekly paracentesis; her Fibrosis-4 Index (FIB-4) was 0.72, and abdominal Doppler ultrasonography revealed irregular liver contours, heterogeneous parenchyma, splenomegaly, portal hypertension, and tense ascites. A liver biopsy revealed micronodular cirrhosis with moderate inflammatory activity, mild perisinusoidal fibrosis, mild macrovesicular steatosis (~10%), and marked hepatocellular ballooning, consistent with steatohepatitis. She underwent orthotopic liver transplantation at age 26 but died four months later due to pulmonary sepsis. The patient gave her explicit written consent to publish their information in an open access journal. Discussion: CGL is a rare autosomal recessive disorder characterized by near-total absence of adipose tissue, resulting in severe insulin resistance and ectopic triglyceride deposition, particularly in the liver. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a common hepatic manifestation in these patients and may evolve to cirrhosis and hepatic decompensation. Although liver transplantation represents a therapeutic option for end-stage disease, early post-operative outcomes may be compromised by poor metabolic reserve and infectious complications, as illustrated in this case. Final Comments: This case highlights the fulminant progression of hepatic disease in CGL secondary to extreme metabolic dysregulation. It reinforces the need for early identification and intensified metabolic control to delay hepatic deterioration and optimize transplant outcomes. Multidisciplinary perioperative care and infectious risk mitigation are crucial in enhancing the prognosis for this vulnerable population.

PO—206 Osteosarcopenia in Type 2 Diabetes Mellitus Patients with MASLD

Torres JPM1; Manea LP1; Silva RDM1; Peixoto CM1; Barroso RPM1; Velarde LGC2; Junior CRMA3; Saad MAN1; Flores PP1; Soares DV1.

(1) Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, Brasil; (2) Pós-Graduação em Ciências Médicas, Universidade Federal Fluminense, Niterói, RJ, Brasil; (3) Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—206

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely linked to type 2 diabetes mellitus (T2DM), osteoporosis, and sarcopenia through shared pathophysiological mechanisms, primarily insulin resistance, low-grade chronic inflammation, mitochondrial dysfunction, and hormonal alterations. Objective: To evaluate the frequency of osteosarcopenia in individuals with T2DM and MASLD and assess its association with liver fibrosis. Methods: This cross-sectional observational study included prospective data collection. Hepatic steatosis and liver fibrosis (F ≥ 2) were diagnosed via ultrasound and elastography, respectively. We assessed the SARC-F questionnaire (Strength, Ambulation, Rising from a chair, Climbing stairs, and Falls) considered positive screening for sarcopenia if ≥4, handgrip strength (cut-off <27 kg for men / <16 kg for women), five-times sit-to-stand test (reduced strength >15 seconds), gait speed (slowness of ≤0.8 m/s), and dual-energy X-ray absorptiometry (DXA). Muscle mass was quantified using the appendicular lean mass (ALM), a sum of lean mass values (kg) in the upper and lower limbs with adjustments, and bone mass was assessed using areal bone mineral density (aBMD). Continuous variables are presented as medians and interquartile ranges (IQRs). Categorical variables are presented as absolute frequencies (n) and percentages (%). Data were subjected to the student’s t-test (normal distribution) or Mann-Whitney test (non-parametric) according to the sample characteristics. The chi-square test (χ2) or Fischer’s exact test was used for categorical variables. A p-value of less than 0.05 was considered statistically significant. Results: A total of 94 participants were included. The median age was 64.5 years (IQR: 57.25 – 70.00) and 76 (80.9%) were female. Liver fibrosis was present in 68 individuals (70.85%). Sarcopenia frequency was 11 (11.7%), 23 (24.4%), and 42 (44.6%) using LMI adjusted for height², BMI, and fat mass (Newman’s index), respectively. Low aBMD was observed in 43 participants (45.7%). Table 1 presents a comparison between groups with and without fibrosis. Conclusion: In individuals with T2DM and MASLD, LMI adjusted for fat mass showed the best performance for detecting low muscle mass (44.6%). Low bone mass frequency was 45.7%. No significant differences were found between groups with and without fibrosis regarding sarcopenia or bone mass assessments.

Table 1 (abstract PO-206).

Type 2 diabetes mellitus patients with MASLD: comparison between groups with and without liver fibrosis.

m: median; IQR: interquartile range; DXA: dual-energy X-ray absorptiometry; ALM: appendicular lean mass (sum of lean mass values [kg] in the upper and lower limbs); BMI: Body mass index (Weight/Height²); BMD (bone mineral density) measured in g/cm².

PO—207 Visceral Adiposity and Liver Fibrosis in Patients with Type 2 Diabetes and MASLD

Godinho JR1; Ferruzzi ACS1; Pezzin HS1; Soler JVDT1; Guimarães ACS1; Oliveira EAR1; Velarde LGC2; Saad MAN1; Flores PP1; Soares DV1

(1) Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, Brasil; (2) Pós-graduação em Ciências Médicas, Universidade Federal Fluminense, Niterói, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—207

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among individuals with type 2 diabetes mellitus (T2DM), reflecting the strong association between insulin resistance and hepatic fat accumulation. Visceral adiposity, which is common in patients with T2DM, plays a central role in the progression of MASLD. Therefore, the assessment of body composition emerges as an essential tool for understanding the relationship between the metabolic profile of T2DM and the severity of liver disease. Objective: To investigate the association between body adiposity and MASLD severity (liver fibrosis) in patients with T2DM. Methods: Observational, cross-sectional study with prospective data collection included individuals with T2DM and MASLD followed in endocrinology outpatient clinics. Clinical, laboratory, anthropometric, and imaging data were collected. Hepatic steatosis and liver fibrosis were diagnosed via ultrasound and elastography, respectively. Fat mass was assessed by dual-energy X-ray absorptiometry (DXA), p-value <0.05 was considered significant. Results: 92 participants were included, 84% of whom were women, with a median age of 65 years. Liver fibrosis (F ≥ 2) was identified in 29.3% of cases. Participants with fibrosis presented significantly higher values of BMI, WC, NC, WHtR, trunk fat percentage, Android/Gynoid fat ratio (A/G), as well as increased volume and mass of visceral fat (VAT). Table 1 presents general sample data and a comparison between the groups with and without fibrosis. Conclusion: Participants with T2DM and liver fibrosis had higher WC and WHtR compared to participants without fibrosis. These findings were corroborated by DXA-derived indicators such as trunk fat, height-to-width ratio, and visceral adipose tissue (VAT). This demonstrates the importance of central adiposity as a marker of liver fibrosis and the potential usefulness of more accessible anthropometric measures in screening for liver fibrosis in populations with T2DM.

Table 1 (abstract PO-207).

Anthropometric and DXA-derived adiposity indicators in T2DM patients with MASLD according to liver fibrosis status

Data with normal distribution were analyzed using the t-test and are presented as mean and standard deviation. For variables with non-normal distribution, the Mann–Whitney test was used, and results are expressed as median and interquartile range (IQR 25–75). The p-value refers to the comparison between groups, with p < 0.05 considered statistically significant (indicated by *). DXA: dual energy X-ray absorptiometry; T2DM: type 2 diabetes mellitus; MASLD: Metabolic dysfunction-associated steatotic liver disease.

PO—208 Cardiovascular Risk Stratification in an Ethnically Mixed Population with Type 1 Diabetes Mellitus: Comparison of The Steno Type 1 Risk Engine with The Scottish-Swedish Risk Model

Paliares IC1; Dualib PM1; Aroucha PMT1; Torres LSN1; de Sá JR2; Dib SA1

(1) Disciplina de Endocrinologia do Departamento de Medicina da Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP, Brasil; (2) Disciplina de Endocrinologia do Departamento de Medicina da Faculdade de Medicina do ABC, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—208

Introduction: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among individuals with type 1 diabetes (T1D). Accurate identification of those at higher risk through validated risk stratification tools is essential for guiding preventive strategies. However, the agreement between cardiovascular (CV) risk models has been scarcely studied. Objective: This study aimed to compare the performance of the Steno Type 1 Risk Engine (ST1RE) and the Scottish-Swedish risk model in a predominantly young and ethnically heterogeneous cohort of individuals with T1D. Methods: This retrospective study included 435 adults with T1D and no prior CVD. Participants were stratified into low (<10%), moderate (10–19.9%), and high risk (≥20%) for 10-year fatal or nonfatal CV events by both models. Their comparative performance for predicting 10-year CV events was assessed using Kaplan-Meier analysis, Cox regression, ROC curves, and the Hosmer–Lemeshow test. Agreement between models was evaluated using Cohen’s kappa. Results: Among the 435 individuals included, the median age was 25 years (IQR: 21‒32), with 86% being under 40 years old, and the median T1D duration was 13 years (IQR: 9‒18). The Scottish-Swedish model classified 75% as low risk, 13% as moderate, and 12% as high risk. In contrast, ST1RE classified 84% as low, 11% as moderate, and 5% as high risk. Agreement between models was moderate (κ = 0.550; 95% CI: 0.468–0.632). Over a median follow-up of 9.2 years (IQR: 6.0–10.7), 24 participants (5.5%) experienced CV events. Kaplan-Meier and Cox regression analyses showed significantly higher event rates in moderate- and high-risk groups for both models. The C-statistic for the Scottish–Swedish model was comparable to that of the ST1RE (p = 0.986). Both models demonstrated good calibration (Figure 1). Conclusion: In this ethnically mixed and predominantly young T1D cohort, both the ST1RE and the Scottish-Swedish models demonstrated strong discriminative ability and good calibration for 10-year CV risk prediction. These findings underscore the importance of T1D-specific tools to guide primary prevention strategies.

Figure 1 (abstract PO-208).

(A) receiver operating characteristic (ROC) curves presented as area under the curve (AUC), aiso known as the C-statistic, for 10-year follow-up according of the steno type 1 risk engine (ST1RE) and the Scottish-swedish CV risk calculater. (B) Calibration Plots for the Scottish-swedish model and ST1RE based on the Hosmer-lemeshow test. Observed and expected 10=year CV event rates are shown across deciles of predicted risk

PO—210 Family Screening in Familial Partial Lipodystrophy: The Role of Anthropometrya and Densitometry in The Early Identification of Genetically Predisposed Individuals

Cavalcanti JU1; Lopes FKM2; Coelho JRL2; Lima GECP3; Flor AC2; Veras VR3; Junior RMM2; Junior GBS; Castelo MHCG3

(1) Universidade de Fortaleza, Fortaleza, CE, brasil; (2) Hospital Universitário Walter Cantídio, Fortaleza, CE, Brasil; (3) Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—210

Case Presentation: A 33-year-old woman was diagnosed with type 2 diabetes mellitus (T2DM) at age 20 and initially managed with oral agents. Following her third pregnancy, she required high-dose insulin (2 IU/kg/day), with persistently elevated HbA1c >11% and severe mixed dyslipidemia (triglycerides >1000 mg/dL). She had a family history of diabetes. On physical examination, she presented a lipodystrophic phenotype. Anthropometry: BMI of 27 kg/m², Köb index of 5.85, and thigh skinfold thickness of 11 mm. Initial laboratory evaluation showed HbA1c of 11.9%, total cholesterol of 362 mg/dL, and triglycerides of 588 mg/dL. Autoantibodies for autoimmune diabetes were negative, and C-peptide was 1.3 ng/mL, ruling out type 1 diabetes. DXA: lower-limb fat <25%, fat mass ratio (FMR) of 1.41, and android/gynoid ratio of 1.22. Given the clinical suspicion of partial lipodystrophy, pioglitazone was added to insulin and metformin, resulting in a 60% reduction in insulin requirement within 15 days. After sequential introduction of an SGLT2 inhibitor, DPP4 inhibitor, and gliclazide, insulin was fully discontinued. After 50 days, HbA1c decreased to 7.8%. Genetic testing confirmed a heterozygous PPARG mutation, consistent with familial partial lipodystrophy (FPLD) type 3. Cascade family screening was initiated. The father, recently diagnosed with diabetes, had a thigh skinfold of 5 mm and no additional anthropometric or densitometric FPLD criteria, but carried the same mutation. The mother (tested negative) and two sisters had no clinical or body composition abnormalities. The 28-year-old brother, without known comorbidities, met two positive anthropometric criteria (Köb index 4.0 and thigh skinfold 8 mm) and is awaiting genetic testing. The patient gave her explicit written consent to publish her information in an open access journal. Discussion: FPLD type 3 is characterized by severe insulin resistance and abnormal fat redistribution. Early clinical suspicion was essential in guiding therapeutic decisions, with pioglitazone introduction leading to marked metabolic improvement and insulin discontinuation. Anthropometry and DXA confirmed peripheral lipoatrophy and visceral adiposity, supporting treatment adjustment. Family screening identified asymptomatic or partially expressed genetically predisposed individuals, demonstrating that anthropometric assessment can detect early disease stages before major metabolic complications arise. Final Comments: Integrating clinical assessment, anthropometry, densitometry, and genetic testing is a strategic approach for diagnosing FPLD and screening at-risk relatives.

PO—211 Köbberling Index and Familial partial lipodystrophy type 1 (FPLD1): How Reliable Is This Parameter?

Cavalcanti JC1; Lima GECP2; Sousa TCS2; Júnior GBS1; Castelo MHCG2

(1) Universidade de Fortaleza, Fortaleza, CE, Brasil; (2) Hospital de Messejeana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—211

Case Presentation: A 23-year-old male with obesity since adolescence, acanthosis nigricans and previous hepatic steatosis was referred for evaluation of severe hypertriglyceridemia (> 1000 mg/dL). He was on metformin and ciprofibrate, with no history of pancreatitis. Laboratory results: glucose 120.5 mg/dL, HbA1c 5.6%, and triglycerides 537–1647 mg/dL. Dual-energy X-ray absorptiometry (DXA) revealed total body fat 34.6%, visceral adipose tissue (VAT) 1,318 g, fat mass ratio (FMR) 1.146, and lower-limb adiposity 33.5% (both negative). Anthropometry: BMI 32.9 kg/m², Köb Index 3.875 (positive), and thigh skinfold 32 mm (negative). Genetic testing showed heterozygosity for LPL p.Asn318Ser (N318S), a variant associated with susceptibility to familial combined hyperlipidemia type 3 (FCHL3), with no established link to lipodystrophy. The patient’s mother had type 2 diabetes mellitus (T2DM) for 10 years, diagnosed at age 35, currently on insulin therapy. Her DXA showed total body fat 39.5%, VAT 744 g, FMR 1.118, and lower-limb adiposity 30.5% (all negative). Köb Index was 1.40 and thigh skinfold 39 mm (also negative). The paternal grandfather had T2DM, underwent coronary artery bypass at 56 years and stroke; both maternal grandparents developed T2DM after age 50. The patient gave his explicit written consent to publish his information in an open access journal. Discussion: The Köb Index (>3.477 in men) has been described as a clinical marker for FPLD1, with good accuracy in cohorts with a classic phenotype. However, its specificity is considerably reduced in central obesity. This case illustrates a false positive: elevated Köb Index despite preserved thigh skinfold and peripheral adiposity on DXA, with all other DXA-derived parameters negative and no lipodystrophic phenotype in the mother. Family history demonstrated a strong predisposition to T2DM, with premature CAD only in the paternal grandfather, but no pattern consistent with FPLD1. According to current consensus, diagnosis should integrate clinical features, anthropometry, DXA (with FMR >1.2 and lower-limb adiposity <25%), and family history. In this case, the LPL variant provides a plausible explanation for severe dyslipidemia, guiding management toward intensive triglyceride control rather than lipodystrophy-specific therapy. Final Comments: The Köb Index may be a useful screening tool for FPLD1 but should not be regarded as a standalone diagnostic criterion. In patients with central obesity, positive results must be corroborated by thigh skinfold, DXA-derived indices, and family evaluation to avoid false positives and inappropriate management.

PO—212 Metabolic Profile of Women with Familial Partial Lipodystrophy Type X

Lopes VHG1; Boris NP1; Araujo JS1; Flor AC1; Lopes FKM1; Aguiar BF1; Linard LLP1; Almeida JAB1; Fernandes VO1; Júnior RMM1; Moura CRM1

(1) Hospital Universitário Walter Cantídio- Fortaleza, CE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—212

Introduction: Familial partial lipodystrophies are rare, genetically heterogeneous disorders characterized by selective loss of subcutaneous fat and associated metabolic complications, including insulin resistance, early-onset diabetes mellitus (DM), hypertriglyceridemia, metabolic dysfunction-associated steatotic liver disease (MASLD), and increased cardiovascular risk. To date, 10 FPLD subtypes have been identified based on clinical and/or genetic criteria. FPLD type X (FPLDx), a newly proposed subtype, presents with typical clinical and anthropometric features of FPLD, lacking an identifiable pathogenic variant and a positive Kobberling index. Objective: To describe the metabolic profile of patients with FPLDx. Methods: Cross-sectional, descriptive study conducted between September 2024 and February 2025 in patients with FPLDx followed at a reference center for lipodystrophies. Sociodemographic and clinical data, including the presence of DM and its complications, were assessed. Fasting blood glucose, glycated hemoglobin (A1c), HDL cholesterol (HDL-c), triglycerides (TG) and liver enzymes measurements as well as hepatic ultrasounds were performed. Results: A total of 29 women were evaluated, with a mean age of 51 ± 12 years. All patients had a diagnosis of DM, established at a mean age of 37 ± 10 years. Most patients (72%) had A1c levels above 8.0%, and among these, 67% were using high doses of insulin (above 1.0 IU/kg/day) in combination with oral antidiabetic agents. The overall mean A1c was 10.5 ± 1.7%. Diabetic neuropathy was present in 45% of patients, retinopathy in 28%, and nephropathy in 10%. Regarding the lipid profile, 75% of patients had low HDL-c levels, and 97% presented with hypertriglyceridemia, with a median TG level of 323 mg/dL (108 – 5745). Among these, 31% had severe hypertriglyceridemia (TG >500 mg/dL), and 10% had pancreatitis. MASLD was identified in 65% of patients. Systemic arterial hypertension was observed in 69% of patients, and coronary artery disease (CAD) in 24%. Conclusion: In this study, women with FPLDx presented with severe metabolic dysfunction, including poor glycemic control, atherogenic dyslipidemia, and a high prevalence of microvascular and hepatic complications. These findings highlight the clinical relevance of this emerging FPLD subtype and underscore the importance of early identification and tailored metabolic management.

PO—213 Patterns of Coronary Artery Involvement Across Clusters of Type 2 Diabetes: Association with Age at Diabetes Diagnosis, Glycemic Control, and Body Mass Index

Aroucha PMT1; Paliares IC1; Vidotto TM1; Cocitta CDF1; Caixeta AM2; Pimpinato AG2; Choi SNJH3; Dualib PM1; de Sá JR4; Dib SA1

(1) Disciplina de Endocrinologia do Departamento de Medicina da Escola Paulista de Medicina da Universidade Federal de São Paulo. , São Paulo, SP, Brasil; (2) Disciplina de Cardiologia do Departamento de Medicina da Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP, Brasil; (3) Disciplina de Oftalmologia do Departamento de Medicina da Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP, Brasil; (4) Disciplina de Endocrinologia do Departamento de Medicina da Faculdade de Medicina do ABC, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—213

Introduction: Type 2 diabetes (T2D) affects over 500 million people worldwide, with projections reaching 850 million by 2050. Brazil ranks among the top countries in prevalence. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in T2D, with coronary artery disease (CAD) as a major manifestation. This burden underscores the need for improved risk stratification and recent studies suggest that clustering may help predict complications. Objective: To investigate the association between simplified diabetes clusters—based on three clinical-laboratory variables [glycated hemoglobin (HbA1c), age at diabetes diagnosis, and body mass index (BMI)]—and the pattern of atherosclerotic coronary artery involvement in a population with T2D undergoing coronary cineangiography (CAG). Methods: We analyzed 548 adults with T2D undergoing CAG. Mean age at CAG was 63.1 ± 9.7 years and median diabetes duration was 10 years (range 0–56). Coronary involvement was defined as ≥70% stenosis in major epicardial arteries, ≥50% in the left main or prior coronary intervention (CI). Clusters were identified using k-means with Euclidean distance after standardizing variables. The optimal number of clusters was defined using the elbow method, and stability was assessed with 2,000 bootstrap resamplings and the Jaccard index. Cluster characteristics were compared using ANOVA/Kruskal–Wallis and chi-square tests. Results: Cluster 1 (69.5% of the sample) comprised older individuals at diagnosis, BMI in the overweight/mild obesity range and relatively adequate glycemic control. Cluster 2 included younger individuals at diagnosis, higher BMI and poorer glycemic control. Cluster 3 (7.1%) showed extremely poor glycemic control, relatively lower BMI and intermediate age at diagnosis, suggesting an insulin-deficient phenotype. Cluster 1, despite shorter diabetes duration than the others (p<0.05), had higher prevalence of prior myocardial infarction, multivessel CAD and percutaneous CI compared with clusters 2 and 3 (p<0.05). Conclusion: The observed association between Cluster 1 and more extensive coronary involvement suggests that, in this context, age at diabetes diagnosis emerges as the predominant factor in defining coronary disease burden. In this population, HbA1c and BMI contribute to patient characterization, but it appears secondary to age in regard to coronary atherosclerosis. Further research is warranted, especially among T2D populations in primary prevention settings for CAD.

PO—214 Exploring The Relation Between Household Income and Diabetes Management Self-efficacy And Glycated Hemoglobin In Individuals With Type 2 Diabetes Using Primary Health Care In Juiz de Fora, Minas Gerais State

Reis BO1; Netto GPF2; Silva GML2; Pierangeli Vilela ACO3; Carolino SJ3; Bruno da Costa Mariano1; Pereira DAG4; Silva LP1

(1) Programa de Pós-Graduação em Ciências da Reabilitação e Desempenho Físico-Funcional, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil; (2) Curso de Graduação em Medicina, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil; (3) Curso de Graduação em Fisioterapia, Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil; (4) Programa de Pós-Graduação em Ciências da Reabilitação, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—214

Introduction: Socioeconomic factors are fundamental components of diabetes prevention and treatment. And because of them, adopting some self-care measures is still challenging for individuals with this health condition and becomes relevant to investigating its association with glycemic control, especially in low-income regions. Objective: To explore the relation between household income and diabetes management self-efficacy and glycated hemoglobin in individuals with type 2 diabetes using Primary Health Care services in Juiz de Fora, Minas Gerais, between 2022 and 2023. Methods: Cross-sectional study involving individuals with type 2 diabetes, ≥18 years old, living in Juiz de Fora for at least one year, and randomly selected from 1 to 2 Primary Health Care services belonging to the 13 health regions of the municipality, according to their percentage distribution of coverage. Monthly household income in reais was self-reported by the participants. Diabetes management self-efficacy was measured from the response to Brazilian version of the Diabetes Management Self-Efficacy Scale, which total score ranges from 0 to 100 points. Glycated hemoglobin values were obtained from medical records and/or exams presented by participants. The data distribution was analyzed using the Shapiro-Wilk test. Variables with normal distribution are presented as mean ± standard deviation and those without normal distribution as median [1st quartile – 3rd quartile]. Data were analyzed by Spearman correlation test, considering a significance level of 5%, and the correlation coefficients were classified as non-existent (≤ 0.1); weak (from 0.1 to < 0.3); moderate (from ≥ 0.3 to < 0.5) and strong (≥ 0.5). Results: Eighty individuals with diabetes participated in the study. No significant correlation was found between household income and the Diabetes Management Self-Efficacy Scale total scores (ρ= 0.105, P = 0.356). Although weak, the household income was significantly correlated with glycated hemoglobin (ρ = -0.232; P = 0.038). Conclusion: The association profile found in this study may be related to the possibility of purchasing and obtaining supplies, medications, glycemic monitoring, healthy eating and guidance for practicing physical exercises, all pillars for glycemic control. The socioeconomic reality of patients must be taken into account when planning and implementing interventions to control diabetes, aiming to promote equity in access to healthcare.

PO—215 Case Report on Simultaneous Pancreas-Kidney Transplantation in Latent Autoimmune Diabetes: Clinical Implications

Barbosa ARCC1; Mendes PS1; Gieburowski JT1; Fernandes VP1; Pedrosa AG1; De Paula FJA1; Mermejo LM1; Gomes PM1; Guidorizzi NR1

(1) Hospital das Clínicas de Ribeirão Preto, USP, Ribeirão Preto, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—215

Case Presentation: A 53-year-old female was diagnosed with Latent Autoimmune Diabetes in Adults (LADA) at the age of 24, confirmed by high titers of anti-glutamic acid decarboxylase antibodies (anti-GAD >250 IU/mL). She experienced poor glycemic control, progressing to microvascular complications and end-stage renal disease (ESRD), requiring renal replacement therapy (RRT). She was referred to our center for a simultaneous pancreas-kidney transplant (SPKT). At presentation, she was using glargine insulin (0.37 IU/kg/day) and regular insulin (0.17 IU/kg/day), with an HbA1c of 9.8%. In August 2019, she underwent SPKT from a deceased donor with compatible human leukocyte antigens (HLA). Pancreatic cold ischemia time was 9 hours and 20 minutes. Pre-transplant C-peptide was undetectable (<0.01 ng/mL; reference: 1.1–4.4 ng/mL). She achieved insulin independence post-transplant with an HbA1c of 5.0% and C-peptide of 4.4 ng/mL, indicating excellent graft function and glycemic control. Three years later, insulin therapy was reintroduced at full doses, and RRT was resumed. Despite this, laboratory tests in 2025 showed an HbA1c of 6.68% and a C-peptide level of 4.81 ng/mL, suggesting preserved endogenous insulin production. The patient provided her written consent to publish this information. Discussion: Simultaneous pancreas-kidney transplantation is considered the gold standard for patients with type 1 diabetes and ESRD, as it improves metabolic control and overall survival. However, recurrence of diabetes post-transplant may occur in up to 25% of cases after 10 years, potentially due to autoimmunity reactivation and/or graft dysfunction. Contributing factors include advanced recipient age (>45 years), use of diabetogenic immunosuppressants, and persistence or recurrence of pancreatic autoantibodies. In the present case, the patient initially demonstrated robust pancreatic graft function. The reintroduction of insulin therapy indicates partial loss of graft function, although stable C-peptide levels suggest preserved beta-cell activity and possibly limited autoimmune destruction. Final Comments: While SPKT offers substantial clinical benefits, the recurrence of diabetes in this patient underscores the importance of long-term surveillance and the need for further investigation into the mechanisms of graft failure and autoimmune reactivation.

PO—216 Modulation of Inflammatory and Metabolic Dysfunction in Type 2 Diabetes via Bone Marrow Transplantation

Pauferro JRB1; Borges JCO1; Correia IS1; Alves ACA1; Lobato TB1; Pithon-Curi TC1; Hirabara SM1; Curi R2; Mais LN3; Gorjão R1

(1) Interdisciplinary Post-graduate Program in Health Sciences, Universidade Cruzeiro do Sul, São Paulo, SP, Brasil; (2) Butantan Institute, São Paulo, SP, Brasil; (3) Multicenter Post-graduate Program in Physiological Sciences, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil

Diabetology & Metabolic Syndrome 2026: PO—216

Introduction: In type 2 diabetes, inflammation in adipose tissue disrupts immune regulation and contributes to insulin resistance. Leptin and IL-5 are key mediators in this immunometabolic axis. Objective: This study investigated the effects of hematopoietic stem cell transplantation on stromal vascular fraction composition, IL-5 secretion, and leptin levels in epididymal adipose tissue (EPI) in a non-obese model of type 2 diabetes (Goto-Kakizaki rats). Methods: Male Wistar (WT) and GK rats, aged 28 days, were all subjected to sublethal immunosuppression with busulfan (20 mg/kg, i.p., for two days) followed by cyclophosphamide (150 mg/kg i.p.) on the third day. On day four, two groups of both strains received a bone marrow transplant (BMT) with 2×10⁷ cells from WT donors via tail vein injection. The experimental groups were WT control (WTc); GK control (GKc); WT transplanted (WTt); and GK transplanted (GKt). On day 100, following 6-hour fasting, the animals were euthanized. Blood samples were collected for serum leptin analysis by ELISA. EPI was weighed, and 1 g was incubated under cell culture conditions (DMEM with 10% fetal bovine serum and 1% antibiotics) for 48 hours. The supernatant was collected for cytokine quantification using the cytometric bead array (CBA) method. The remaining tissue was digested with collagenase for stromal vascular fraction (SVF) isolation, and viable cells were counted using trypan blue and an automated cell counter. Two-way ANOVA with Tukey’s test and linear regression were used for analysis. Results: GK rats showed less body mass (p<0.05) and increased fasting blood glucose (p<0.05) compared to WT groups independent of BMT. However, BMT decreased serum insulin in GKt and reduced HOMA-IR (p=0.0338) compared to GKc. GK rats showed less EPI content (p<0.05) in comparison to WT in control and transplanted condition. GKt presented less serum leptin (p<0.05) as compared to WTc. A positive correlation was observed between serum leptin levels and IL-5 secreted by the EPI only in GKc rats (r = 0.75, p = 0.05). Although the EPI of GK rats showed a trend toward increased SVF cellularity, IL-5 secretion, and pro-inflammatory cytokine release, these changes did not reach statistical significance, suggesting a mild and non-robust inflammatory response under the conditions tested. Conclusion: In conclusion, BMT improved insulin sensitivity and reduced leptin in GK rats. The leptin–IL-5 correlation suggests an immunometabolic interaction in adipose tissue, despite a mild inflammatory response.

PO—217 Type B Insulin Resistance: A Case of Paradoxical Hyperglycemia Aggravated by Insulin and Reversed with Immunosuppression

Brito GD1; Proença LB1; Lima LV1; Reis AB1; Marino EC1

(1) Centro de Diabetes Curitiba, Curitiba, PR, Brasil

Diabetology & Metabolic Syndrome 2026: PO—217

Case Presentation: A 59-year-old man with type 2 diabetes mellitus and six hospitalizations due to diabetic ketoacidosis over the previous six months was admitted in July 2023 with a severe episode (arterial pH 6.7; serum bicarbonate 2.7 mmol/L; blood glucose >500 mg/dL), followed by a reverted cardiac arrest. Prior to admission, he was using high doses of human insulin. During hospitalization, he required over 800 UI/day of intravenous insulin. Suspecting type B insulin resistance syndrome (TBIRS), pulse therapy with methylprednisolone was initiated, followed by oral prednisone and mycophenolate, resulting in clinical and laboratory improvement. At discharge, he was prescribed metformin, a sulfonylurea, a DPP-4 inhibitor, and insulin analogs. Insulin was gradually withdrawn in the outpatient setting, with maintenance of mycophenolate. By July 2024, insulin was discontinued. Glycemic control improved (HbA1c from 7.6% in June to 7.1% in November 2024), allowing reduction of other antidiabetic drugs. In November 2024, mycophenolate dose reduction led to worsening control (HbA1c 10.6%; fasting glucose 274 mg/dL), which reversed after dose adjustment. In April 2025, HbA1c dropped to 7.4%. Figure 1 shows the evolution of HbA1c, insulin autoantibodies, and mycophenolate dose. The diagnosis of TBIRS was confirmed. The patient provided a written consent to publish his information. Discussion: Type B insulin resistance is a rare autoimmune syndrome (estimated in <0.17% of patients with diabetes), typically affecting those with long-standing type 2 diabetes. It is caused by autoantibodies that neutralize insulin action, leading to severe resistance. Both human and analog insulins can trigger it, even after months or years of therapy. Clinically, it presents with erratic glycemic patterns, including hyperglycemia and paradoxical hypoglycemia, often in the setting of extreme insulin requirements. Diagnosis is based on history of insulin use, hyperinsulinemia, and detection of insulin autoantibodies. Antibody titers do not correlate with glycemic severity. Final Comments: This case illustrates a rare but relevant syndrome. Type B insulin resistance should be suspected in patients with poor glycemic control despite high insulin doses. Immunosuppressive therapy can restore insulin sensitivity. A key strength of this report is the longitudinal follow-up, demonstrating how changes in mycophenolate dosing correlated with HbA1c levels — reinforcing the central role of immunosuppression in disease control. Early recognition is essential to prevent complications and reduce hospitalizations.

Figure 1(abstract PO-217).

Temporal relationship between glycated hemoglobin , insulin autoantibody levels, and mycophenolate dose, illustrating response to immunosuppressive therapy

PO—219 Adequacy of Carbohydrate and Dietary Fiber Intake in Patients with Type 2 Diabetes Mellitus: A Multicenter Cross-Sectional Study in Brazil

Sahade V1; Cardim R1; Curvello K1; Souza G1; Guimarães R1; Rocha P1; Maria Z1; Lobo G1; Ferreira A2; Pagano R2; Marcadenti A3; Daltro C1

(1) Universidade Federal da Bahia, Salvador, BA, Brasil; (2) Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, SP, Brasil; (3) Hospital do Coração de São Paulo (HCOR), Sâo Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—219

Introduction: Nutritional management is a key component in the treatment of Type 2 Diabetes Mellitus (T2DM), particularly with respect to carbohydrate and dietary fiber intake. Objective: To evaluate adherence to carbohydrate and fiber intake recommendations among patients with T2DM across the five geographic regions of Brazil. Methods: This cross-sectional analysis was conducted as part of two multicenter randomized clinical trials involving individuals with T2DM. Eligible participants were aged ≥30 years, had HbA1c ≥ 7%, and had not received nutritional counseling in the preceding six months. Data were collected from 15 specialized centers for chronic disease care distributed across Brazil. Sociodemographic, behavioral, anthropometric, and dietary data were obtained. Dietary intake was assessed using two 24-hour dietary recalls. Carbohydrate intake was classified according to the Brazilian Diabetes Society guidelines: low (<45%), adequate (45–60%), and high (>60%). Fiber intake ≥25 g/day was considered adequate. Results: A total of 418 participants were included; 61% were female, with a mean age of 60 ± 9 years. Most participants were physically inactive (75.2%) and overweight or obese (76.8%). Mean fiber intake was 22 ± 10.6 g/day. Carbohydrate intake was adequate in 83.5% of participants, while only 37.1% achieved adequate fiber intake. The Northern region showed the highest mean fiber intake (27.0 ± 14.7 g/day), and the Southern region the lowest (19.9 ± 8.7 g/day). Regarding carbohydrates, the Northern region had the lowest intake (41.8 ± 11.8%), while the Northeastern region had the highest (54.7 ± 7.4%). Conclusion: While most patients met recommendations for carbohydrate intake, fiber consumption was generally insufficient. These findings highlight the need to improve the quality of carbohydrate sources consumed by individuals with T2DM in Brazil.

PO—220 Adequacy of Macronutrient and Fiber Intake in Adults With Type 2 Diabetes Mellitus According to the 2024 Guidelines of the Brazilian Diabetes Society: Impact on Glycemic Control and Nutritional Status

Peixoto ACF1; Pires LAS2; Lima MFC2; Lima NG2; Ribeiro IA2; Oliveira SS2; Paula CD1; Luquetti SCPD3

(1) Federal University of Juiz de Fora, Juiz de Fora, MG, Brasil; (2) Brazilian Hospital Services Company/University Hospital of Federal University of Juiz de Fora, Juiz de Fora, MG, Brasil; (3) Department of Nutrition/Federal University of Juiz de Fora, Juiz de Fora, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—220

Introduction: Type 2 diabetes mellitus (DM2) is a result of metabolic alterations, with an increasing prevalence worldwide. Lifestyle changes favor weight loss and glycemic control, which can lead to disease remission. Therefore, the Guidelines of the Brazilian Diabetes Society (SBD) provide recommendations for disease management, including nutritional guidelines. Objective: To assess the adequacy of macronutrient and fiber intake in adults with DM2 based on the SBD recommendations and compare it with glycemic control and nutritional status. Methods: This was a cross-sectional study (CAAE76125323.3.0000.5133) involving adults with T2DM treated at a university hospital. Clinical, sociodemographic, anthropometric, laboratory, and dietary data were collected. Food consumption was assessed using a quantitative food frequency questionnaire. Statistical analyses were performed using SPSS-21.0. Data normality was assessed using the Kolmogorov-Smirnov test, followed by descriptive analyses. Data from participants with the lowest and highest fiber intakes were compared based on the median using the Mann-Whitney test. Results: Fifty-five individuals were evaluated, with a median age of 50 years (42.0-58.0), mostly female (69.1%), self-declared Black (70.9%), sedentary (60%), non-smokers (87.3%), non-alcoholics (56.4%) and without nutritional follow-up (69.1%). The majority presented with excess weight (89.1%) and had elevated waist circumference (WC) (83.6%). The median intake of energy, protein, and fiber was 2255.09 kcal (1067.09–3995.49), 93.62 g (54.78–193.09), and 38.92 g (12.54–94.97), respectively. The mean intake of carbohydrates and lipids was 294.41±81.57 g and 72.58±26.14 g, respectively. According to the SBD guidelines, the majority consumed carbohydrates (90.9%) and protein (81.8%) within the recommended intake, 98.2% consumed less lipid and 70.9% consumed more fiber than recommended. Individuals with higher fiber intake showed better glycemic control (6.8 vs. 7.2%; p=0.359 for glycated hemoglobin) and anthropometric indicators (WC: 103.20 vs. 108.08 cm; p=0.107 and BMI: 30.85 vs. 34.91 kg/m²; p=0.059) compared to those with lower intake, following clinical trends, although without significant difference. Conclusion: Overall, dietary intake was consistent with SBD recommendations. Higher fiber intake demonstrated improved glycemic control and nutritional status, although the differences were not statistically significant, reinforcing the importance of dietary recommendations in the management of the disease.

PO—222 Adherence to Self-care Practices in Patients with Type 2 Diabetes Mellitus: A Brazilian Multicenter Analysis

Sampaio LR1; Sahade V1; Curvello K1; Ferreira DC2; Busnello FM3; Almeida JC4; Souza SR5; Ferreira AB6; Pagano R6; Bressan J7; Marcadenti A8; Daltro C1

(1) Universidade Federal da Bahia, Salvador, BA, Brasil; (2) Universidade federal de Juiz de Fora, Juiz de Fora, MG, Brasil; (3) Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil; (4) Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil; (5) Instituto Estadual de Cardiologia Aloysio de Castro/ SES, Rio de Janeiro, RJ, Brasil; (6) Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, SP, Brasil; (7) Universidade Federal de Viçosa, Viçosa, MG, Brasil; (8) Hospital do Coração de São Paulo (HCOR) , São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—222

Introduction: Self-care practices are essential for the proper management of type 2 diabetes mellitus (T2DM). However, adherence to these practices is often low due to the complexity of treatment and the chronic nature of the disease. Objective: To evaluate adherence to self-care practices in patients with T2DM treated by Brazil’s Unified Health System (SUS). Methods: This was a cross-sectional study using data from the clinical trial (NUGLIC), conducted between 2019 and 2021 in eight Brazilian cities. The sample consisted of patients with T2DM, aged ≥30 years, and glycated hemoglobin ≥7%. Self-care adherence was measured by the Summary of Diabetes Self-Care Activities (SDSCA), which assesses seven dimensions: general diet, specific diet, physical activity, glycemic monitoring, foot care, medication use, and smoking. Good adherence was defined as a score of ≥75 in the general domain and ≥25 in the diet domain. For items with direct scoring, satisfactory adherence was defined as a mean of ≥5 days per week. For items with reverse scoring (consumption of sweets and high-fat foods), good adherence was considered a median of ≤2 days per week. Statistical analysis was performed using SPSS, version 17. Results: A total of 370 participants were evaluated, with a predominance of women (60.8%) and elderly individuals (58.1%). Adherence was low in both the general domain and the nutrition-related domains (92.7%). Physical activity and blood glucose monitoring showed the lowest adherence rates, while drug treatment, especially oral antidiabetic drugs, achieved the highest adherence. Conclusion: People with T2DM showed low adherence to the pillars of treatment, especially in relation to non-pharmacological practices, which can compromise glycemic control and increase the risk of complications.

PO—223 Advancing Nursing Roles in Primary Health Care for Diabetes Care: Pathways and Perspectives

Baade RTW1; Meirelles BHS2; Engel FD3; Backmann C3

(1) Universidade Federal de Santa Catarina, São Bento do Sul, SC, Brasil; (2) Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil; (3) University of Ottawa, Canada

Diabetology & Metabolic Syndrome 2026: PO—223

Introduction: Diabetes mellitus is highly prevalent, with Brazil reporting 16.6 million cases (10.6% prevalence), ranking sixth globally. About 90% are type 2, linked to urbanization, aging, inactivity, and obesity, while 31.9% remain undiagnosed. In PHC, high demand, coverage gaps, staff shortages, and delays in detection and treatment highlight the need for new strategies. Since 2014, PAHO has promoted ANP in Latin America to expand and improve care for chronic diseases like diabetes. Objective: To analyze nursing care for people with diabetes mellitus from the perspective of Advanced Nursing Practices in Primary Health Care. Methods: A cross-sectional analytical study was conducted with primary care nurses from four municipalities in southern Brazil. Data collection took place between December 2023 and June 2024. The nurses completed an online instrument based on national diabetes care guidelines and the Brazilian version of the Modified Scale for Advanced Nursing Practices (EMDF/EPA). The instrument used a score from 0 (not conducted) to 4 (always conducted). The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 25 for Windows, with a significance level of 0.05. The proportions of the variables were compared between municipalities using the chi-square test, with standardized residual analysis (≥1.96) when significant. In addition, the Kruskal-Wallis test was used to compare the distributions of the items, with different letters assigned to indicate statistical differences between municipalities. Results: A total of 121 responses from primary care nurses were analyzed. The nurses were asked about 53 direct actions in caring for people with diabetes. Considering the mean score, items received the following scores: 0.0 to <1.0 (not performed), 1.0 to <2.0 (incipient action), 2.0 to <3.0 (action being developed), and 3.0 to 4.0 (action established) - attached table. Items related to direct and comprehensive care had an average score of 2.78 (median 3). Nurses emphasized the need for additional training, particularly in continuing education. In addition, 91% agreed that advanced nursing practices improve care for individuals with chronic conditions. Conclusion: Nurses perform activities within the scope of advanced nursing practices for people with diabetes in clinical settings. It is essential to ensure their expanded scope of practice through organizational, social, and training strategies that also consider aspects of leadership, education, and research.

PO—225 Assessment of Risk Behaviors for Eating Disorders Using the DEPS-R Questionnaire (Diabetes Eating Problem Survey – Revised) in people with type 1 diabetes in Brazil

Pieper CM1; Campos TF2; Pecoli PFG2; Rodrigues GMB2;

(1) Brazilian Diabetes Society, Rio de Janeiro, RJ, Brasil; (2) Brazilian Diabetes Society, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—225

Introduction: Eating disorders (EDs) are serious, often underdiagnosed psychiatric conditions that significantly impact individuals’ physical and emotional health. In people with type 1 diabetes mellitus (T1D), the presence of dysfunctional eating behaviors is particularly concerning, given the complex relationship between dietary regulation, insulin use, and glycemic control. Studies show that adolescents and adults with T1D have a higher prevalence of risky eating behaviors compared to the general population, especially with regard to dietary restriction and deliberate insulin omission as a weight-control strategy, known as "diabulimia". These behaviors are associated with worse clinical outcomes, such as increased glycated hemoglobin, a higher risk of diabetic ketoacidosis, and early progression to chronic complications, including retinopathy, nephropathy, and neuropathy. Despite their severity, eating disorders in people with T1D often go undetected in clinical settings, partly due to the scarcity of validated screening tools and the limited familiarity of professionals with the topic. Composed of 16 items, simple and quick to apply, and validated in Portuguese, the DEPS-R (Diabetes Problem Survey-Revised) allows for early identification of patients at risk of developing an eating disorder and referral for specialized evaluation. The DEPS-R is a promising tool in clinical practice and population research. Objective: To assess the presence of risky eating behaviors in people with type 1 diabetes (T1D) in Brazil, based on voluntary and anonymous responses obtained by accessing the DEPS-R questionnaire on the Brazilian Diabetes Society (SBD) website. Given the results, it would be possible to carry out education/information projects to prevent EDs in people with DM1. Methods: The Diabetes Eating Problem Survey - Revised (DEPS-R), validated for Portuguese, was used. This is a 16-item, self-administered questionnaire with responses on a 6-point Likert scale. Scores ≥ 20 indicate an increased risk for eating disorders. The DEPS-R was made available on the SBD website for access and completion anonymously, voluntarily, and by spontaneous request. Results: 407 questionnaires were completed during the 9-month period. Average age of respondents was 33.2 years; . People with T1D from 15 Brazilian states responded to the questionnaire;31% of respondents had scores greater than or equal to 20, indicating likely risk behavior for ED. Conclusion: DEPS-R should be used for screening for ED in people with T1D.

PO—226 Association Between Ankle- brachial Index and Functional Performance in Motor Test in Individuals with Type 2 Diabetes

Sabino TBM1; Souza ECF1; Vasconcelos AR1; Cruz PWS1; Ribeiro JNS1; Costa KB1; Cruz ATM1; Souza AM1; Vancea DMM1; Costa MC1

(1) Universidade de Pernambuco, Recife, PE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—226

Introduction: The ankle-brachial index (ABI) is a non-invasive marker used for screening and detecting peripheral arterial obstructive disease, which may be associated with physical and functional limitations in individuals with type 2 diabetes. Growing evidence indicates that individuals with type 2 diabetes who present abnormal ABI values have reduced functional capacity, particularly in activities involving predominant use of the lower limbs. Objective: Examine the association between ABI and performance in the sit-to-stand and timed up-and-go tests Methods: This cross-sectional, analytical, and descriptive study, the sample comprised 74 individuals with type 2 diabetes, including 60 women and 14 men, with a mean age of 68.80 ± 8.0 years, who participated in a supervised physical exercise program for people with diabetes at a public university. Participants underwent ABI measurement and standardized motor assessment. Performance was classified as adequate or poor. Participants with abnormal ABI showed worse results in both tests. Results: The Pearson’s chi-square test was used to verify the association between ABI and motor tests. In the sit-to-stand test, a statistically significant association was observed (χ² = 4.77; p = 0.029), indicating 4.33 times greater odds of poor performance (95%CI: 1.08–17.38) among individuals with abnormal ABI. Similarly, in the timed up-and-go test (χ² = 4.54; p = 0.033), abnormal ABI was associated with a fivefold higher risk of poor performance (OR = 5.15; 95%CI: 1.01–26.15). Conclusion: These findings reinforce the clinical utility of the ankle-brachial index as a complementary tool for the early identification of functional decline, suggesting that integrating vascular and functional assessments may improve screening and prevention strategies for physical limitations associated with peripheral arterial impairment in individuals with type 2 diabetes.

PO—227 Association Between Anxiety Symptoms and Grazing Behavior in Individuals with Type 2 Diabetes

Inete MB1; Souza YDES1; Gomes APAS1; Mileo VV1; Sena CDC1; SECS1; Paracampo CCP1; Carvalhal MML2; Gomes DL1

(1) Universidade Federal do Para, Belém, PA, Brasil; (2) Serviço Social do Comércio, Belém, PA, Brasil

Diabetology & Metabolic Syndrome 2026: PO—227

Introduction: Previous studies have found a higher prevalence of anxiety symptoms in individuals with diabetes compared to the general population and a correlation between anxiety symptoms and changes in eating behavior. However, to date, no research has been conducted on the frequency of grazing behavior (consuming small portions continuously or large portions over a long period) and its relationship with anxiety symptoms in people with type 2 diabetes. Objective: To test the association between the level of anxiety symptoms and the frequency of grazing behavior in individuals with type 2 diabetes treated at a hospital in the Amazon region of Brazil. Methods: This is a cross-sectional, descriptive, and analytical study. The study followed the recommendations of the Declaration of Helsinki, the Committee on Publication Ethics, and the International Committee of Medical Journal Editors, and was approved by the Research Ethics Committee (approval number: 6.087.349). Was conducted an interview about socioeconomic context, an anthropometric assessment, the application of the Beck Anxiety Inventory to determine the level of anxiety symptoms, and the Repetitive Eating Questionnaire to investigate grazing behavior. For statistical analysis, the Spearman correlation and multiple linear regression tests were applied (p<0.05). Results: A total of 157 individuals were evaluated, with a mean age of 54.7±7.3 years and a mean duration of diagnosis of 11±8.3 years. The majority were female (72.6%), overweight (77.7%), did not follow nutritional guidance (67.5%), had fasting blood glucose (52.2%) and glycated hemoglobin (54.1%) levels above the recommended limits. Most exhibited minimal anxiety symptoms (39.5%). A positive correlation was observed between the level of anxiety symptoms and glycated hemoglobin (r=0.174; p=0.035) and grazing behavior (r=0.267; p=0.001). It was noted that the level of anxiety symptoms was a predictor of compulsive grazing behavior, independent of the use of psychoactive medications (B=0.263; p=0.001). Conclusion: A positive correlation was observed between the level of anxiety symptoms and grazing behavior, as well as glycated hemoglobin values. The level of anxiety symptoms was a predictor of compulsive grazing behavior, independent of the use of psychoactive medications.

PO—228 Association Between Culinary Skills and Self-Perception of Illness in People With Type 2 Diabetes Mellitus Followed in a Public Hospital in Amazon

Gomes DL1; Silva SEC1; Siqueira NC1; Oliveira GES1; Coelho RKS1; Vilacorta GCS1; Lima APV1; Gonçalves KCC1; Inete MB1; Souza YDES1; Carvalhal MML1

(1) Universidade Federal do Pará, Belém, PA, Brasil

Diabetology & Metabolic Syndrome 2026: PO—228

Introduction: Cooking skills are essential for adopting healthy eating habits, especially among people with type 2 diabetes, as they directly influence glycemic control. Illness perception also plays an important role, as it can affect treatment engagement and self-care. In this context, understanding the association between cooking skills and how individuals perceive their condition may contribute to more effective strategies for managing type 2 diabetes Objective: To investigate the relation between cooking skills and illness perception in people with type 2 diabetes receiving care at a public hospital in the Amazon Region. Methods: This was a cross-sectional study conducted from April 2023 to August 2024 at the endocrinology outpatient clinic of a public university hospital in Belém, Brazil, involving adults of both sexes diagnosed with type 2 diabetes for at least a year. The Brazilian Questionnaire of Cooking Skills and Healthy Eating and the Brief Illness Perception Questionnaire were used for data collection. Data analysis was performed using SPSS version 24, considering a statistical significance level of p<0,05. The study was approved by the Ethics Committee (6.087.349), and all participants signed the informed consent form. Results: The evaluated sample included 157 adults, of whom 72,6% were women, with a mean age of 54,7±7,3 years and a mean time since diagnosis of 11±8,3 years. Concern scores showed positive correlations with cooking attitude (r=0,251; p=0,002), self-efficacy in vegetable consumption (r=0,204; p=0,009), cooking self-efficacy (r=0,259; p=0,001), self-efficacy in vegetable use (r=0,211; p=0,007), and the overall cooking skills score (r=0,312; p<0,001), indicating that concern about one’s health condition may be related to greater engagement in healthy eating practices, such as cooking and using more vegetables in the diet. In contrast, understanding scores showed negative correlations with cooking self-efficacy (r=–0,252; p=0,002), self-efficacy in vegetable use (r=–0,199; p=0,011), and the overall cooking skills score (r=–0,221; p=0,005), suggesting that greater understanding of diabetes may be associated with lower confidence in cooking and using vegetables in meal preparation. Conclusion: It’s important considering emotional and cognitive aspects of illness perception in food and nutrition education strategies for people with type 2 diabetes, especially in regions such as the Amazon, where sociocultural factors and limited access to information may affect self-care.

PO—229 Association Between Meeting Fruit, Vegetable, and Physical Activity Recommendations and Metabolic Syndrome

Alves LO1; Ribeiro CDC2; Pinto CM2; Silva IA2; Cocate PG2

(1) Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (2) Escola de Educação Física e Desporto, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—229

Introduction: Introduction: Metabolic Syndrome (MS) comprises metabolic alterations such as abdominal obesity, dyslipidemia, hypertension, and insulin resistance, which increase the risk of cardiovascular diseases and type 2 diabetes. Its prevalence has been growing worldwide, driven by changes in dietary patterns and reduced physical activity (PA). Guidelines from the World Health Organization (WHO) recommend a minimum daily intake of 400 g of fruits and vegetables and at least 150 minutes per week of moderate-intensity physical activity as preventive measures. Although both behaviors are associated with cardiometabolic health, uncertainties remain regarding the strength of this relationship with MS in different population contexts Objective: To examine the association between meeting fruit and vegetable intake recommendations, as well as physical activity guidelines, and the presence of Metabolic Syndrome (MS) in Brazilian adults. Methods: This cross-sectional study included a sample of teachers from a public educational institution in Rio de Janeiro, Brazil. Dietary intake in grams was assessed using a food frequency questionnaire (FFQ), and individuals were classified according to the WHO cutoff (400 g/day of fruits/vegetables). PA was measured using the short version of the International Physical Activity Questionnaire (IPAQ), classifying participants as active (≥150 min/week of moderate-intensity PA) or inactive (<150 min/week). Anthropometric, hemodynamic, and biochemical measurements were performed for the diagnosis of MS. The study was approved by the ethics committee of the participating institution (CAAE: 26901019.40000.5257). Logistic regression analysis was conducted to investigate the association between exposure variables and the outcome (MS). Results: A total of 219 adults, of both sexes, with a mean age of 49.07 years (SD = 9.9) participated in the study. It was observed that 55.2% and 73.6% met the recommendations for fruit/vegetable intake and PA, respectively. Logistic regression indicated that meeting the fruit and vegetable intake guidelines was not associated with MS (OR = 0.91; 95%CI: 0.36–1.47; p = 0.386). However, meeting the PA recommendations reduced the odds of MS (OR = 0.41; 95%CI: 0.19–0.85; p = 0.017), even after adjusting for confounders (age and sex). Conclusion: Meeting WHO PA guidelines appears to lower the odds of MS in Brazilian adults, while no association was found for fruit and vegetable intake.

PO—230 Association Between Physical Activity Patterns and Insulin Resistance in University Professors

Cocate PG1; Silva JV1; Pinto CM1; Ribeiro CDC1; Silva IA1; Alves LO2

(1) Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (2) Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—230

Introduction: Insulin resistance (IR) is defined as a reduced sensitivity of target tissues to the action of insulin, resulting in decreased efficiency in glycemic control and potentially leading to conditions such as hyperglycemia and hyperinsulinemia. Physical activity (PA) has been identified as a therapeutic strategy for glycemic control and improved insulin sensitivity. The World Health Organization (WHO) recommends at least 150 minutes of moderate-intensity PA per week. However, a pattern known as “weekend warriors” has been observed, referring to individuals who engage in PA in one or two weekly sessions, primarily on weekends, and who may experience similar health benefits to those who distribute their activity throughout the week. Due to their work routines, university professors may be a population particularly susceptible to the weekend warrior pattern. Objective: To examine the association between different PA patterns and IR in university professors. Methods: This cross-sectional study was conducted with professors from a public university. PA time and patterns were assessed using the short version of the International Physical Activity Questionnaire (IPAQ). Participants were classified according to WHO recommendations: weekend warriors (≥150 minutes/week performed on 1 or 2 days) and regularly active individuals (≥150 minutes/week performed on ≥3 days), as well as those who did not meet the recommendation (inactive pattern: <150 minutes/week). The HOMA-IR index was calculated as follows: fasting glucose (mg/dL) × 0.0555 × fasting serum insulin (mIU/L) / 22.5. A cutoff point of 2.35, based on a recent study using a national sample (ELSA-Brasil), was used to classify IR. Results: A total of 219 university professors participated in the study, of both sexes, with a mean age of 49.10 years (SD=9.9). The prevalence of IR was 29.68% (n=57). Compared to the physically inactive pattern, being a weekend warrior (OR=0.17; 95% CI 0.04–0.69; p=0.013) or regularly active (OR=0.34; 95% CI 0.16–0.73; p=0.006) was associated with lower odds of IR, even after adjusting for potential confounding factors. Conclusion: Our findings suggest that meeting PA recommendations, regardless of whether the activity is distributed over three or more days or concentrated in one to two days, appears to be an effective strategy for protecting against IR among university professors.

PO—231 Association of a Body Shape Index (ABSI) and Body Composition with Capillary Blood Glucose in Adolescents: A Cross- Sectional Study

Macil GR 1; Nunes ASM2; Bandeira MP2; Ribeiro JNS3; Santos TBL 2; Malheiros GM4; Barreto ITP5; Lanna IDCM4; Soares LEC4; Aguiar BG4; Bandeira F2

(1) Afya School of Medical Sciences, Jaboatão dos Guararapes, PE, Brasil; (2) Division of Endocrinology and Diabetes, Agamenon Magalhães Hospital, RECIFE, PE, Brasil; (3) Pernambucana School of Health, RECIFE, PE, Brasil; (4) School of Medical Sciences, University of Pernambuco, RECIFE, PE, Brasil; (5) Mauricio de Nassau University Center (UNINASSAU), RECIFE, PE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—231

Introduction: Changes in body composition, particularly increased abdominal fat, are linked to higher cardiometabolic risk and may precede alterations in glycemic status. A Body Shape Index (ABSI) is an anthropometric measure that complements BMI by considering central fat distribution. Assessing its relationship with body composition and glycemic parameters in adolescents may support the early detection of risk for diabetes and metabolic syndrome. Objective: To investigate the association of ABSI with body composition and capillary blood glucose (CBG) in school-aged adolescents. Methods: This descriptive cross-sectional study included 277 adolescents aged 14–19 years from a municipal school. Body composition was assessed using bioelectrical impedance, along with measurements of weight, height, waist circumference (WC), and hip circumference (HC). Body mass index (BMI), percent body fat (PBF), fat mass index (FMI), fat-free mass (FFM), fat-free mass index (FFMI), and waist-to-hip ratio (WHR) were calculated. ABSI and ABSI z-scores were derived from anthropometric data. Capillary blood glucose (CBG) was measured using a glucometer. Analyses included descriptive statistics and Pearson’s correlation (p ≤ 0.05). The study was approved by the Research Ethics Committee (CAAE 84555624.3.0000.5197), with informed consent obtained from all participants and guardians. Results: Mean age was 15.78 ± 1.01 years; mean BMI was 22.50 ± 5.75 kg/m²; mean body fat percentage was 27.4 ± 11.3%; mean WC was 75.40 ± 11.83 cm; mean WHR was 0.79 ± 0.06; and mean FFMI was 16.02 ± 2.13 kg/m². Mean ABSI was 0.0742 ± 0.0047, with 72.6% classified as “lower risk” and 27.4% as “higher risk” according to ABSI z-scores. Mean capillary blood glucose was 82.9 ± 13.0 mg/dL, with no significant correlation with ABSI or ABSI z-scores. ABSI correlated positively with WC (r = 0.487; p < 0.001), WHR (r = 0.661; p < 0.001), and FFMI (r = 0.204; p = 0.001), and negatively with body fat percentage (r = -0.139; p = 0.026). Conclusion: Most adolescents showed an anthropometric profile consistent with their age and normal capillary blood glucose levels. ABSI was more strongly associated with abdominal fat distribution than with BMI but showed no significant relationship with capillary blood glucose, supporting its role as a complementary indicator for cardiometabolic risk screening before the onset of glycemic alterations.

PO—232 Association of Systemic Inflammation Response Index and Systemic Immune-Inflammation Index With Factors Related to Type 2 Diabetes Mellitus

Peixoto ACF1; Pires LAS2; Lima MFC2; Hinkelmann JV1; Lima NG2; Ribeiro IA2; Oliveira SS2; Paula CD1; Luquetti SCPD3

(1) Federal University of Juiz de Fora, Juiz de Fora, MG, Brasil; (2) Brazilian Hospital Services Company/University Hospital of Federal University of Juiz de Fora, Juiz de Fora, MG, Brasil; (3) Department of Nutrition/Federal University of Juiz de Fora, Juiz de Fora, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—232

Introduction: Type 2 diabetes mellitus (DM2) is a global health problem, and its etiology and progression are related to inflammation and behavioral factors. Therefore, identifying inflammation is essential. Inflammatory markers, such as the Systemic Inflammatory Response Index (SIRI) and the Systemic Immune-Inflammation Index (SII), have been proposed due to their association with metabolic disorders. Objective: To evaluate the association between SIRI and SII with glycemic, anthropometric, and behavioral parameters in adults with DM2. Methods: Cross-sectional study with adults of both sexes diagnosed with DM2 and receiving care at a university hospital (CAAE 76125323.3.0000.5133). Socioeconomic, anthropometric, laboratory, behavioral, and dietary data were collected. Statistical analyses were performed using SPSS-21. Values below and above the median of SIRI and SII were used in comparative analyses using the t-test and Mann-Whitney test. Results: A total of 38 individuals were included, with a median age of 50 years (42.0–58.0) and duration of DM2 of 5.5 years (0.1-20.0). Most participants were female (65.8%), self-declared Black (73.6%), sedentary (57.9%), non-smokers (86.8%), and non-alcoholics (60.5%). The median body mass index was 33.8 kg/m², with 86.9% classified as excess weight and 89.5% with elevated waist circumference. Individuals with a higher SII index had better glycemic control (fasting glucose: 121.0 vs. 146.0 mg/dL, p=0.2; glycated hemoglobin: 6.5 vs. 7.2%, p=0.4; insulin: 18.2 vs. 13.4 µU/mL, p=0.2; HOMA-IR: 4.8 vs. 5.4, p=1.0; HOMA-β: 102.8 vs. 57.8%, p=0.3) compared to those with values below the median. Furthermore, individuals with a higher SIRI index showed worsening pancreatic function (fasting glucose: 131.0 vs. 122.0 mg/dL, p=0.9; glycated hemoglobin: 7.0 vs. 7.2%, p=0.4; insulin: 14.4 vs. 15.0 µU/mL, p=0.1; HOMA-IR: 4.8 vs. 5.0, p=0.4; HOMA-β: 77.8 vs. 93.9%, p=0.5) compared to individuals below the median. No significant differences were found between the groups, as well as significant associations with smoking, alcohol consumption and activity exercise (p>0.05). Correlations between the indices and the glycemic and anthropometric parameters were considered weak (r<0.3). Conclusion: The findings suggest potential trends between inflammation and glycemic control in individuals with DM2, although without statistical significance. The clinical utility of the SIRI and SII indices requires further investigation in larger samples without confounding factors.

PO—233 Comparison of Glycemic Variables and Body Mass Among Severely Obese Women With And Without ADIPOQ Polymorphism

Valentim AVG1; Oliveira JM1; Silva LS1; Salles MBCFS1; de Matos EKL1; Souza NS1; Silveira ABCS1; Chrysostomo LB1; Siais LO1; Coimbra VOR1; EL1

(1) Universidade Federal do Rio de Janeiro UFRJ, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—233

Introduction: Obesity is considered a multifactorial condition, characterized by excessive accumulation of body fat and associated with an increased risk of several comorbidities, such as type 2 diabetes mellitus (DM2). Among the mechanisms contributing to this relationship, genetic and hormonal factors stand out, as they influence insulin sensitivity and energy metabolism. The ADIPOQ gene, located on chromosomal locus 3q27, encodes adiponectin—an adipokine involved in the regulation of energy metabolism and insulin sensitivity. Studies have shown that adiponectin levels may be reduced in individuals with obesity; however, in cases of severe obesity, the impact of polymorphisms in the ADIPOQ gene on glycemic profile remains unclear. Objective: Evaluate the frequency of the ADIPOQ polymorphism in women with severe obesity and its association with alterations in glycemic profile and body mass. Methods: This cross-sectional observational study was approved by the research ethics committee (approval number: 5.621.915). The sample included 65 adult women with severe obesity. The variables analyzed were: age (years), body mass index (BMI), fasting glucose, estimated average glucose (eAG), glycated hemoglobin (A1c), and fasting insulin levels. Genetic analysis was performed on peripheral blood samples, with genomic DNA extraction and identification of the rs182052 polymorphism in the ADIPOQ gene using real-time polymerase chain reaction (PCR). Associations between the ADIPOQ polymorphism and quantitative variables were assessed using the Mann-Whitney test. Data were analyzed using R software version 4.5.1, with a significance level set at p ≤ 0.05 Results: The median age of participants was 54.5 years (IQR = 11.5). Half of the sample presented the rs182052 polymorphism of the ADIPOQ gene. The presence of this polymorphism was associated with higher fasting insulin levels (p = 0.04), body mass index (p = 0.01), and glycated hemoglobin (A1c) (p = 0.05). However, no statistically significant associations were observed between the polymorphism and estimated average glucose or fasting glucose levels. Conclusion: In women with severe obesity, the presence of the ADIPOQ polymorphism was associated with a worse glycemic profile and greater total body fat accumulation.

PO—234 Comprehensive Care For a Patient With Type 2 Diabetes Mellitus In Recovery From Substance Dependence: A Case Report Using Telehealth Follow-up

Colpo E1; Silva MD1; Meyer ND1; Limberguer JB1

(1) Universidade Franciscana, Santa Maria, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—234

Case Presentation: A 64-year-old male patient, self-identified as Black, with incomplete secondary education and a monthly income between 4–6 minimum wages. Diagnosed with type 2 diabetes (T2D) and hypertension 10 years ago. Current medications include NPH insulin, metformin, enalapril, doxazosin, rosuvastatin, omeprazole, and aspirin. He presented with class II obesity (BMI: 35.6 kg/m²) and increased cardiometabolic risk (waist circumference: 121 cm). He reported a history of cannabis, cocaine, and tobacco use, with abstinence for the past eight years. The patient lives in a context of social vulnerability, with low adherence to laboratory testing and limited access to private healthcare. He was initially seen by a nutritionist in person and subsequently through telehealth. The intervention was part of a research project approved by the ethics committee (approval no. 7.582.254). The patient provided a written consent to publish his information. Discussion: Telehealth was adopted as a strategy to strengthen the therapeutic relationship, enable remote monitoring, and adapt care to the patient’s context. The follow-up incorporated the SMART framework to define nutritional goals that were specific, measurable, achievable, relevant, and time-bound. The guidance focused on qualitative dietary changes, including meal frequency, reduction of high-glycemic index foods, and increased fiber intake. Initially, the patient demonstrated partial adherence but relapsed due to frustration with slow results. During the second remote session, a structured checklist with reflective questions enabled a reevaluation of goals and promoted re-engagement. The use of self-report scales and photographic food records evidenced concrete improvements, such as enhanced meal quality and the spontaneous initiation of capillary glucose monitoring, as shown in Figure 1. Final Comments: This case highlights the effectiveness of telehealth combined with the SMART methodology in the nutritional care of individuals with T2D living in social vulnerability. Patient-centered strategies, based on realistic goals and supported by continuous remote follow-up, proved feasible to strengthen self-care even in the face of complex clinical and social challenges.

Figure 1(abstract PO-234).

Remote follow-up records. A) Photographs of three different lunches featuring vegetables, eggs, roots, and legumes. B) Fasting capillary glucose measurements (three days, morning readings) without hypoglycemic medications

PO—235 Correlation Between Culinary Skills and eating Behavior of People With Type 2 Diabetes Mellitus Followed in a Public Hospital in The Amazon Region

Gomes DL1; Vilacorta GCS1; Sarah Emili Cruz da Silva1; Siqueira NC1; Lima APV1; Coelho RKS1; Oliveira GES1; Gonçalves KCC1; Inete MB1; Souza YDES1; Carvalhal MML1

(1) Universidade Federal do Pará, Belém, PA, Brasil

Diabetology & Metabolic Syndrome 2026: PO—235

Introduction: Proper management of type 2 diabetes relies on the adoption of healthy eating behaviors, as recommended by the Brazilian Diabetes Society. Cooking skills can influence the expression of disordered eating patterns, thus impacting glycemic control. Objective: To analyze the correlation between cooking skills and eating behavior in people with type 2 diabetes receiving care at a hospital in the Amazon Region Methods: This was a cross-sectional study conducted from April 2023 to August 2024 at the endocrinology outpatient clinic of a public university hospital in Belém, Brazil, involving adults of both sexes diagnosed with type 2 diabetes for at least one year. The Brazilian Questionnaire of Cooking Skills and Healthy Eating (QBHC) and the Three-Factor Eating Questionnaire (TFEQ-21) were applied. Data were analyzed using SPSS version 24, with a statistical significance level of p<0,05. The project was approved by the Ethics Committee (approval number 6.087.349), and all participants signed the informed consent form Results: Among the 157 adults evaluated, most were women (72,6%), with a mean age of 54,7±7,3 years and a mean duration of diagnosis of 11±8,3 years. Uncontrolled eating showed a negative correlation with the cooking attitude score (r=–0,206; p=0,009) and self-efficacy in vegetable consumption (r=–0,274; p=0,001), suggesting that higher uncontrolled eating is related to lower confidence and less positive attitudes toward healthy eating. Cognitive restraint showed a positive correlation with self-efficacy in vegetable consumption (r=0,261; p=0,001) and with the overall cooking skills score (r=0,147; p=0,045), indicating that greater intentional control over food intake is associated with higher confidence in preparing and consuming vegetables, as well as with more developed cooking skills. Emotional eating was positively correlated with vegetable availability (r=0,168; p=0,027), knowledge of culinary terms and techniques (r=0,189; p=0,015), and cooking self-efficacy (r=0,208; p=0,008), suggesting that people with greater emotional involvement with food tend to have more healthy foods at home, know how to prepare them, and feel more capable of cooking. Conclusion: The findings show a relationship between cooking skills and eating behavior, reinforcing the importance of culinary interventions as strategies to promote food autonomy and self-care among people with diabetes

PO—236 Correlation Between Sleep Quality And Glycemic Control in Physically Active And Sedentary Women With Type 2 Diabetes

Xavier MF1; Silva NRAC1; Souza AM1; Souza LSS1; Torres CBP1; Vasconcelos AR1; Ribeiro JNS1; Costa KB1; Cruz PWS1; Vancea DMM1

(1) Universidade de Pernambuco, Recife, PE, Brasil

Diabetology & Metabolic Syndrome 2026:PO—236

Introduction: Sleep quality may directly affect glycemic control, particularly in individuals with type 2 diabetes. It is well established that physical exercise improves both sleep quality and glycemic regulation. However, it is important to understand how these variables interact in women with type 2 diabetes. Objective: This study aimed to examine the correlation between sleep quality and glycemic control in physically active and sedentary women with type 2 diabetes. Methods: This cross-sectional study was conducted at a public university. A total of 37 women over 60 years old participated and were divided into two groups: G1 – Active (19 women participating in a supervised physical exercise program for diabetics for over six months, three times per week), and G2 – Sedentary (18 women who did not engage in physical exercise). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and capillary blood glucose was measured on the same day the questionnaire was administered. Pearson’s correlation was used for statistical analysis, with significance set at p ≤ 0.05. Results: No statistically significant correlation was found between sleep quality and glycemic control. However, a tendency toward better sleep quality scores was observed in the active group (5.95 ± 3.8) compared to the sedentary group (6.89 ± 3.0). Conclusion: In conclusion, although no significant correlation was observed between sleep quality and glycemic control, physically active women exhibited better sleep quality scores than their sedentary counterparts.

PO—237 Depression, Anxiety, and Stress in Individuals with Type 2 Diabetes Mellitus: A Cross-Sectional Study in Primary Care

Rodrigues LC1; Silva MD1; Rocha VM1; Marques CT1; Correa DM1; Colpo E1

(1) Universidade Franciscana, Santa Maria, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—237

Introduction: Type 2 Diabetes Mellitus (T2DM) is a chronic disease with high global prevalence, requiring continuous lifestyle changes and strict clinical follow-up. In addition to its physiological impacts, T2DM affects individuals’ emotional health, fostering the development of symptoms such as depression, anxiety, and stress. Understanding the factors associated with mental health in this population is essential for comprehensive care. Objective: To investigate clinical and emotional factors associated with symptoms of depression, anxiety, and stress in individuals with T2DM. Methods: This is a cross-sectional, quantitative, and explanatory study conducted with 50 participants treated in primary health care in a municipality in the interior of Rio Grande do Sul, Brazil. A sociodemographic and clinical questionnaire and the Depression, Anxiety, and Stress Scale (DASS-21) were applied. Statistical analysis (SPSS 25.0) included descriptive statistics, Shapiro-Wilk test, Student’s t-test, and chi-square test (p<0.05). Results: A high prevalence of symptoms of depression, anxiety, and stress was observed in the studied population, as shown in Table 1. There was an association between depressive symptoms and sex (p=0.008), with higher prevalence among women (45.7%) compared to men (6.7%). Anxiety was also more prevalent among women (68.3%) than men (33.3%), with a significant association with sex (p=0.021). Anxiety was more frequent in individuals using insulin (p=0.019) and psychiatric medications (p=0.015). Depression was also associated with the use of psychiatric medications (p=0.012). No significant association was found between stress and the analyzed variables. The findings reinforce that T2DM care must go beyond glycemic control, considering the emotional repercussions of the disease. Women and individuals using insulin or psychiatric medications appear to be more vulnerable to psychological distress. Including mental health in primary care follow-up is essential for treatment adherence and quality of life. Conclusion: The results point to the need for expanded care strategies that systematically integrate psychological assessment and multiprofessional interventions. The management of T2DM should be understood as a process involving both clinical and emotional aspects, requiring a humanized and comprehensive approach.

Table 1 (abstract PO-237).

Relationships Between Depression, Anxiety, and Stress and Clinical Factors in Type 2 Diabetes Mellitus

PO—238 Discrepancy Between Theoretical Diabetes Knowledge and Glycemic Outcomes in Low-Income Individuals Living With Type 1 Diabetes

Machado MLP1; Gama FG2; Silva VDS2; Lima LPS3; Freitas JPA3; Monteiro NC4; Martins LM3; Varela MG1; Silva DG2; Santana NO4

(1) Private Practice- Aracajú, SE, Brasil; (2) Post-graduate Program in Nutrition Science, Federal University of Sergipe, São Cristovão, SE, Brasil; (3) Department of Medicine, Federal University of Sergipe, Aracajú, SE, Brasil; (4) Post-graduate Program in Health Sciences, Federal University of Sergipe, Aracajú, SE, Brasil; (5) Post-graduate Program in Nutrition Science, Federal University of Sergipe, São Cristóvão, SE, Brasil; (6) Post-Graduate Program in Health Sciences, Federal University of Sergipe, Aracajú, SE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—238

Introduction: Glycemic results are linked to disease-specific knowledge in type 1 diabetes (T1D), which is essential for effective self-management. Understanding patients’ knowledge levels can guide targeted interventions to address critical gaps, thereby enhancing treatment adherence and autonomy in diabetes care. Objective: To evaluate diabetes-specific knowledge among individuals with T1D and identify factors associated with higher knowledge. Methods: This cross-sectional study enrolled 46 participants with T1D and was conducted at a public outpatient clinic in Sergipe, Brazil. Sociodemographic and clinical data was obtained through structured interviews. Diabetes-specific knowledge was assessed through the validated Diabetes Knowledge Assessment (DKN-A). Knowledge scores were categorized as low (≤8 points) or high (>8 points) based on previously established cutoffs. Results: The cohort comprised predominantly young adults (median age 22.5 years, range 6-60) with female predominance (69.6%), 56.5% of mixed race, 48.7% had completed secondary education, 65.9% lived in the countryside and 69.6% had a low socioeconomic background (earning 1 to 2 minimum wages). Diabetes duration was evenly distributed: 30.4% had been diagnosed <5 years, 34.8% for 5-10 years, and 34.8% for >10 years. Glycemic level was suboptimal with mean HbA1c of 9.2 + 1.8%, and only 13% of participants achieved target Hba1C ≤ 7%. All participants used basal-bolus analog insulin regimens, total daily dose of 0.8 ± 0.3 IU/kg (basal: 41.6 + 8.2%). While 80.4% demonstrated high diabetes knowledge, critical gaps emerged in nutritional understanding, since approximately 50% answered food groups and substitutions questions incorrectly. Notably, carbohydrate counting practices was reported by 32.6% of participants and showed significant association with higher knowledge scores (p=0.021). On the other hand, age, sex and family income were not associated with theoretical knowledge. Conclusion: Despite optimized treatment regimens and adequate theoretical knowledge, glycemic levels remained suboptimal in this T1D group. These findings reveal a paradoxical gap between generally good diabetes knowledge and glycemic outcomes, suggesting that structural and contextual barriers, rather than knowledge deficits, may explain the persistent disconnect between theory and practice in low-income populations.

PO—239 Effects Of a Resistance Training Program With Elastic Bands In Individuals With Type 2 Diabetes

Souza LSS1; Souza AM1; Cruz ATM1; Vasconcelos AR1; Torres CBP1; Ribeiro JNS1; Costa KB1; Cruz PWS1; Assis Júnior RF1; Vancea DMM1

(1) Universidade de Pernambuco, Recife, PE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—239

Introduction: Physical exercise is a key component in the treatment of type 2 diabetes (T2D). Among the different exercise modalities, resistance training can be performed using machines, body weight, free weights, or elastic bands. Objective: This study aimed to investigate the effect of a resistance training program using elastic bands on glycemic control and blood pressure in individuals with T2D. Methods: This pre-experimental study employed a convenience sample. Participants were recruited from a supervised physical exercise program for individuals with diabetes at a public university. Eight sedentary individuals with T2D, of both sexes, with a mean age of 66.7 ± 9.0 years, participated in the study. Data collection took place in a Biodynamics Laboratory. The intervention lasted seven weeks, with two 60-minute sessions per week. Each session consisted of capillary blood glucose and blood pressure monitoring (pre and post) and Elastic Band Training (EBT), which was structured into three stages: 1) warm-up with mobility and stretching exercises; 2) main phase with eight resistance exercises using elastic bands; and 3) cool-down with body awareness activities. Load adjustments were made according to the resistance level of the elastic bands: light, medium, strong, and extra strong. Capillary glucose was measured using a glucometer, lancets, and test strips. Blood pressure was measured using an automatic device. A normality test was conducted, and the Wilcoxon test was used for comparisons. The significance level was set at p ≤ 0.05. Results: After 14 EBT sessions, participants showed a significant reduction in capillary blood glucose (133.6 ± 35.0 mg/dL vs. 105.2 ± 22.9 mg/dL; p≤0.001), systolic blood pressure (128.9 ± 15.2 mmHg vs. 125.0 ± 16.1 mmHg; p=0.009), and diastolic blood pressure (78.8 ± 9.54 mmHg vs. 77.1 ± 9.8 mmHg; p=0.008). Conclusion: It is concluded that EBT was effective in improving glycemic control and reducing systolic and diastolic blood pressure in individuals with type 2 diabetes who participated in this intervention.

PO—240 Effectiveness of an Educational Intervention for Diabetes Self-Care among Hospitalized Patients

Vasconcellos RCMS1; Ramalho AC2; Campos LOMC1

(1) Universidade Federal da Bahia -UFBA, Salvador, BA, Brasil; (2) Departamento de Medicina, Universidade Federal da Bahia- UFBA, Salvador, BA, Brasil

Diabetology & Metabolic Syndrome 2026: PO—240

Introduction: Diabetes mellitus (DM) has a growing global prevalence, posing a significant public health problem. In Brazil, millions of people are estimated to be affected, making health education essential for developing self-care and disease management skills. Objective: Identify knowledge gaps regarding the management and treatment of DM among hospitalized patients and evaluate the effectiveness of an educational intervention during their stay. Methods: A pre-test, post-test uncontrolled interventional study was conducted at a public hospital. Adult patients with a DM diagnosis on a basal-bolus insulin regimen and hospitalized in clinical wards were eligible. The intervention consisted of two meetings: in the first, participants completed a structured questionnaire, followed by a bedside educational session covering insulin injection technique, blood glucose monitoring, and management. In the second, they received nutritional guidance, and the questionnaire was readministered. Data were analyzed using McNemar’s exact test, comparing performance on each question. Results: The study included 90 hospitalized patients, predominantly women (71.1%), mean age 54.6 years. Most participants had primary (52.2%) education and identified as mixed-race (52.2%). Although 60% had used insulin therapy for over five years, only 11.1% had received previous endocrinological consultation. The average questionnaire score on the pre-intervention test was 35.43%, while the post-intervention score was 82.10%. There was a significant improvement in knowledge (p<0.001) for each of the 18 questions analyzed. Initial knowledge for each question was assessed by the number of patients who answered correctly before and after the intervention, represented by group A. The highest initial knowledge was found in questions about rotating injection sites (78.9%), and the action of regular (57.8%) and NPH insulin (54.4%). In contrast, the lowest knowledge was observed in questions regarding the amount of carbohydrates needed to treat hypoglycemia (7.8%), use of regular insulin dose in cases of pre-meal hypoglycemia (10%), and the recognition of pre-meal hyperglycemia (13.3%). Conclusion: The intentional use of hospitalization time with a structured educational intervention proved effective in increasing patients’ knowledge, representing a low-cost and easily reproducible strategy that could translate into treatment adherence, complication prevention, and improved quality of life.

PO—241 Effect of Fish Oil Supplementation on Metabolic Endotoxemia In Overweight And Insulin Resistant Subjects

Ribeiro IA1; Lima NG1; Oliveira SS1; Paula CD2; Peixoto ACF3; Lopes MGF2; Fernandes MKC3; Dib PRB3; Souza CT2; Lima MFC1

(1) Empresa Brasileira de Serviços Hospitalares/Hospital Universitário da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil; (2) Faculdade de Medicina/Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil; (3) Instituto de Ciências Biológicas/Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—241

Introduction: Obesity and type 2 diabetes mellitus are chronic health conditions that are closely related and have reached epidemic proportions worldwide. Insulin resistance (IR), induced by low-grade systemic inflammation, has been studied as the link between both conditions. Metabolic endotoxemia, characterized by increased circulating levels of lipopolysaccharides from the membranes of gram-negative bacteria, is an important condition that contributes to the aggravation of the inflammatory response and can be modulated by lifestyle factors. In this context, foods and nutrients with anti-inflammatory properties, such as omega-3 fatty acids, appear to contribute to improving this condition. However, the effect of fish oil consumption on endotoxemia in overweight and IR individuals remains to be clarified. Objective: Evaluate the effects of fish oil supplementation rich in omega-3 polyunsaturated fatty acids on parameters related to metabolic endotoxemia in overweight and insulin-resistant individuals. Methods: Randomized, double-blind, placebo-controlled study. Twenty-four adult individuals of both sexes were randomized into two groups to receive 4 g of fish oil (2.4 g EPA+DHA) or placebo (soybean oil) for 8 weeks. Data related to metabolic endotoxemia (lipopolysaccharide binding protein-LBP and Calprotectin), inflammation (TNFα and IL-10), IR (glucose, HbA1c, HOMA-IR), lipid profile and anthropometry (body mass index-BMI and body fat) were collected at baseline and at the end of the study. Normality was assessed using the Shapiro–Wilk test. Inter- and intragroup comparisons were performed using the paired t-test and the Mann–Whitney test, respectively, and the relationships between variables were evaluated using Pearson’s correlation. The study was approved by the Human Research Ethics Committee of HU-UFJF (CAAE: 35230620.5.0000.5133). Results: The BMI and body fat of the subjects at baseline were 30.81±2.83kg/m2 and 36.63±7.52%, respectively. A positive and significant correlation was observed between LBP levels and BMI (r=0.406; p=0.049), body fat (r=0.463; p=0.023), total cholesterol (r=0.481; p=0.017), TNFα (r=0.488; p=0.016), and IL-10 (r=-0.513; p=0.010) as part of study characterization. No significant effects on the evaluated markers were observed in the inter- and intragroup comparisons. Conclusion: Supplementation with 2.4 g of omega-3 fatty acids for 8 weeks did not result in changes in inflammatory and metabolic endotoxemia parameters in overweight and insulin-resistant individuals.

PO—242 Effects of Different Body Segments Resistance Training on Glycemic Controle in Women With Type 2 Diabetes

Souza AM1; Cruz PWS1; Vasconcelos AR1; Ribeiro JNS2; Aguiar GAF1; Malta Cruz ATM1; Costa KB1; Souza LSS1; Silva NRA C1; Vancea DMM1

(1) Universidade de Pernambuco, Recife, PE, Brasil; (2) Faculdade Pernambucana de Saúde, Recife, PE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—242

Introduction: Effective glycemic control is essential in the management of type 2 diabetes mellitus (T2DM) and can be achieved through both pharmacological and non-pharmacological interventions. Among non-pharmacological strategies, physical exercise is particularly relevant due to its high clinical relevance. Resistance training (RT) promotes significant musculoskeletal adaptations that support glycemic control in individuals with T2DM. Objective: This study aimed to compare the effects of resistance training targeting different body segments on glycemic control in women with type 2 diabetes. Methods: A crossover experimental design was adopted. Seven women diagnosed with T2DM were recruited from a supervised exercise program for diabetics at a public university. Participants were randomly assigned to two groups: G1 and G2. Each group underwent 24 RT sessions, three times per week for eight weeks. G1 initially trained the upper limbs for four weeks, while G2 trained the lower limbs during the same period. Afterwards, the trained body segments were switched between the groups. The resistance training protocol consisted of three sets of 16 repetitions at 60% of the load determined by the 10-repetition maximum test, with four exercises per session, according to the target body segment. Prior to the intervention, participants were instructed to maintain their usual medication, sleep, diet, and physical activity routines to ensure data reliability. Capillary blood glucose was measured before and after each training session. Data were analyzed using the Wilcoxon and Mann-Whitney U tests, with a significance level of p ≤ 0.05. Results: A significant reduction in blood glucose was observed following both lower limb training (173.7 to 136.1 mg/dL, p = 0.029) and upper limb training (181.2 to 146.0 mg/dL, p = 0.008). However, no significant difference was found between body segments (p = 0.643). Conclusion: Although no differences emerged between training upper vs. lower limbs, both approaches were positively associated with improved glycemic control, demonstrating that resistance training, regardless of the body segment, effectively reduces blood glucose in women with T2DM.

P0—243 Elastic Band Resistance Training Vs Machine- Based Resistance Training: A Comparison Of Glycemic Control In Individuals With Diabetes

Torres CBP1; Souza LSS1; Cruz ATM1; Souza AM1; Silva Cruz PW1; de Vasconcelos AR1; Costa KB1; Xavier MF1; Ribeiro JNS1; Vancea DMM1

(1) Universidade de Pernambuco, Recife, PE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—243

Introduction: The treatment of type 2 diabetes mellitus (T2DM) requires a multidisciplinary approach to manage blood glucose levels and prevent long-term complications, encompassing lifestyle modifications such as diet, physical exercise, medication, and psychosocial support. Among the exercise strategies, resistance training using elastic bands or machines stands out. Objective: This study aimed to compare the effects of elastic band and machine-based resistance training on glycemic control in individuals with T2DM. Methods: This was a quasi-experimental study. A total of 18 untrained participants (both sexes), aged 45–60 years, diagnosed with T2DM for less than ten years and using antihyperglycemic drugs, were recruited from a university-supervised exercise program in Brazil. Participants were randomly assigned to the elastic band training group (G1) or the machine-based training group (G2). The training protocol lasted ten sessions. Each session included: (1) warm-up (mobility and stretching exercises); (2) main set (G1 performed eight exercises using elastic bands of varying resistance: light, medium, strong, extra-strong; G2 performed the same number of exercises using strength machines, with loads adjusted to momentary concentric failure); and (3) cool-down (body awareness exercises). Both groups performed two sets of 8–16 repetitions. Capillary blood glucose was measured before and after each session. Parametric statistics were used (paired and independent t-tests, p≤0.05). Results: Both groups showed significant reductions in post-exercise capillary glucose levels compared to their pre-exercise values. G1 showed a mean reduction from 139.1±36.1 mg/dL to 110.3±28.9 mg/dL, while G2 decreased from 158.4±31.7 mg/dL to 123.1±21.7 mg/dL (p<0.001 for both). However, no statistically significant difference was observed between the groups (ΔG1 = 28.8±29.5 vs. ΔG2 = 35.3±26.5; p=0.08). Conclusion: In conclusion, resistance training with elastic bands showed similar effects on glycemic control compared to machine-based resistance training in individuals with type 2 diabetes.

PO—245 Flaxseed As Nutritional Strategy for Metabolic Control Of Diabetes Mellitus

Rocha VM1; Lima VC2; Wagner RE2; Colpo E1

(1) Universidade Franciscana, Santa Maria, RS, Brasil; (2) Universidade Federal de Santa Maria, Santa Maria, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—245

Introduction: Diabetes Mellitus is often accompanied by dyslipidemias, such as elevated triglycerides and LDL cholesterol, increasing the risk of cardiovascular events. In this context, functional foods rich in bioactive compounds have gained increasing relevance in nutritional strategies. Flaxseed (Linum usitatissimum L.) stands out due to its composition rich in fiber, protein, and unsaturated fatty acids, especially alpha-linolenic acid (ALA), a type of omega-3 with recognized anti-inflammatory, cholesterol reducing and glycemic response-modulating properties. Objective: To analyze the nutritional properties of brown and golden flaxseed, focusing on protein, lipid content, and fatty acid profile. Methods: Whole seed samples were obtained from an agroindustry located in the northwest region of Rio Grande do Sul, which receives cultivars from different local producers. Protein determination was carried out using a laboratory method based on nitrogen quantification, while lipid extraction followed a solvent extraction and organic phase separation procedure. Results: The brown variety showed an average protein content of 19.1 ± 0.8%, while the golden variety presented 18.3 ± 1.4%. Total lipid content was also higher in the brown flaxseed, averaging 33.4 ± 15.2%, compared to 29.6 ± 5.3% in the golden variety. Gas chromatography analysis of fatty acid profiles revealed the predominance of alpha-linolenic acid (omega-3) in both flaxseed varieties. Brown flaxseed showed an average of 48.2 ± 1.3% omega-3, while the golden variety had a slightly higher content, with 50.2 ± 0.9%. Monounsaturated fatty acids (omega-9) were identified in an average of 26.2 ± 2.2% in brown flaxseed and 24.9 ± 1.7% in the golden one. Linoleic acid (omega-6) levels were 12.5 ± 0.4% in the brown and 13.5 ± 0.7% in the golden flaxseed, as shown in Figure 1. Conclusion: Based on the results obtained and current evidence, flaxseed, whether brown or golden, stands out as a functional food with therapeutic potential in the management of Diabetes Mellitus associated with dyslipidemia, contributing to the prevention of metabolic and cardiovascular complications. A daily intake of 1 to 3 tablespoons (approximately 10 to 30 g/day) of flaxseed can be recommended to obtain its nutritional benefits, especially due to its high omega-3 content.

Figure 1 (abstract PO-245).

Fatty Acid profile of brown and golden flaxseed

PO—248 Frequency And Associated Factors of Food Insecurity in Children and Adolescents With Type1 Diabetes Mellitus

Braga JSN1; Pinto GFT1; Araujo BB1; Costa GND1; Mathias ABGA1; Veiga RA1; Luescher JL1; Spinelli RR1; Sizisnande PM1; Padilha PC1

(1) Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—248

Introduction: Type 1 Diabetes Mellitus (T1DM) is a chronic disease characterized by persistent hyperglycemia, whose appropriate management involves, among other factors, healthy and accessible nutrition. Food Insecurity (FI), defined as insufficient or inadequate access to food in terms of quantity and/or quality, may negatively affect glycemic control and the physical and cognitive development of vulnerable individuals such as children and adolescents. Objective: To identify factors associated with FI in children and adolescents with T1DM. Methods: This was a cross-sectional study conducted with individuals with T1DM followed at the outpatient clinic of a public pediatric hospital in Rio de Janeiro, Brazil. FI was assessed using the Brazilian Food Insecurity Scale (EBIA). Sociodemographic data were collected (age, sex, family composition, caregiver’s educational level, family income, and receipt of social benefits). Statistical analyses adopted a significance level of 5% and 95% confidence intervals. Results: A total of 130 participants were evaluated, with a mean age of 11.0 ± 3.6 years, and a predominance of females (60.8%). Most participants did not receive social benefits (63.8%) and were primarily cared for by their mothers (77.7%), with 80% of caregivers having at least some level of secondary education. Regarding nutritional status, 58.4% were classified as eutrophic according to BMI-for-age, and 96.9% had adequate height for age. The frequency of FI was 67.4%, with 50.4% classified as having mild FI, 11.6% moderate FI, and 5.4% severe FI. A statistically significant association was observed between FI and family income (p = 0.000), caregiver’s educational level (p = 0.017), and receipt of social benefits (p = 0.030). Conclusion: The high prevalence of FI in this sample highlights the influence of socioeconomic factors, particularly family income, on the food security of children and adolescents with T1DM. These findings underscore the need for intersectoral public policies aimed at poverty reduction and ensuring universal access to adequate, safe, and healthy food.

PO—249 Glycemic Index and Glycemic Load: Sex Differences and Relationship with Glycemic Control in Children and Adolescents with Type 1 Diabetes

Silva DF1,2; Lima RLV2; Silva JS1; Sousa IML1; Teixeira AS3; Lima SA2; Albuquerque NV1

(1) Universidade Federal do Ceará, Fortaleza, CE, Brasil; (2)Faculdade de Saúde Pública da Universidade de São Paulo (FSP/USP) , São Paulo, SP, Brasil; (3) Escola de Saúde Pública do Ceará (ESP-CE) , Fortaleza, CE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—249

Introduction: The role of the glycemic index (GI) and glycemic load (GL) in type 2 diabetes mellitus is well established. However, the impact of these carbohydrate quality metrics on glycemic control in children and adolescents with type 1 diabetes mellitus (T1D) is unclear. Objective: This study aimed to compare GI and GL by sex and analyze their correlations with glycated hemoglobin (HbA1c) in children and adolescents with T1D. Methods: This was a cross-sectional study conducted with 70 participants (57% female), aged 4 to 17 years, followed at a referral center. Dietary intake was assessed through two 24-hour dietary recalls (24hR), with GI and GL calculated based on international tables. The distribution of variables was verified using the Shapiro-Wilk test. Student’s t-test was applied for normally distributed variables (GI and GL) and the Mann-Whitney test for HbA1c. Correlations between GI and GL, and HBA1c were assessed by Spearman’s correlation test. Results: There was no significant difference in GI between girls and boys (59.49 ± 3.78 vs. 59.71 ± 3.63; p = 0.809). However, GL was significantly higher among boys (106.66 ± 20.05) compared to girls (93.76 ± 17.54; p = 0.006). No significant correlations were observed between HBA1c and GL (rho = 0.046; p = 0.706) or between HBA1c and GL (rho = –0.098; p = 0.421). Conclusion: We conclude that, although boys have higher GL, mean GI does not differ between genders, and that GI and GL were not associated with HbA1c in this sample. These findings suggest that factors other than carbohydrate quality may play a more relevant role in glycemic control in children and adolescents with T1D.

PO—251 Health Education In A Pregnancy Diabetes Outpatient Clinic: Experience Of A University Extension Project

Vasconcellos CAVA1; Silva AAP2; Braga FO1; Cabizuca CA1; Abi-Abib RC1;

(1) Policlínica Universitária Piquet Carneiro, Rio de Janeiro, RJ, Brasil; (2) Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—251

Introduction: Diabetes education is essential for pregnant women to understand that diet, physical activity and blood glucose monitoring are the cornerstones of diabetes care throughout pregnancy. Objective: To describe the work carried out by a multidisciplinary team in a university extension project developed within the Diabetes in Pregnancy Outpatient Clinic. Methods: Cross-sectional and retrospective study developed based on data collected from electronic medical records of pregnant women undergoing nutritional monitoring throughout 2024. Results: Seventeen meetings were held covering topics related to nutrition, physical activity and perinatal education. Sixty-four pregnant women participated, with an average age of 32.4±6.57 years and mostly self-declared as brown or black. The majority were diagnosed with gestational diabetes mellitus (GDM) and were already using insulin at the first Nutrition consultation. Informational materials on glycemic targets were developed and discussed in group settings, as none of the 14 women previously diagnosed with diabetes prior to pregnancy had achieved the recommended glycemic control goal (mean preconception HbA1c: 8.65±2.16%).. Pre-gestational BMI was 31.7±5.84 kg/m², indicating that the majority (86%) began pregnancy overweight, with 69% having some degree of obesity. Even so, most of these women gained more weight than recommended, leading to the creation of meetings regarding the impact of weight gain on maternal and child health. Only 19% of pregnant women performed some type of physical exercise regularly, and so a partnership was established with the university’s physical education college to facilitate the participation of them in supervised physical exercise groups. Meetings on the topic of micronutrient supplementation were performed, since although 75% of pregnant women regularly supplemented iron, only 58% supplemented folic acid and only 33% calcium. Regarding neonatal outcomes, all babies were born at term, with an average weight of 3110±550g. Just 8% of them were considered large for gestational age (LGA), 80% of them being children of women with diabetes prior to pregnancy. Conclusion: The extension project identified important challenges, such as poor preconception glycemic control, excess weight gain, low physical activity and limited adherence to micronutrient supplementation. Multidisciplinary work and the creation of health education spaces demonstrate an alternative way to encourage behavioral changes in pregnant women.

PO—252 Hemodynamic Response During Exercise Testing In Individuals With And Without Type 2 Diabetes

Cruz PWS1; Miranda GHU1; Cruz ATM1; Souza AM1; Vasconcelos AR1; Keyla Brandão Costa1; Buarque LK1; Figueiredo LS2; Vancea DMM1; Ferreira MNL1

(1) Universidade de Pernambuco, Recife, PE, Brasil; (2) Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—252

Introduction: The rising prevalence of type 2 diabetes poses a growing challenge for health systems due to its strong association with cardiovascular disease. Individuals with diabetes are at higher cardiovascular risk, primarily due to diabetic autonomic neuropathy. Although physical exercise is recommended as part of treatment, individuals with diabetes—particularly during the acute phase of diabetic autonomic neuropathy—may experience abnormal hemodynamic responses before and during exertion. These changes increase the risk of cardiac events during exercise. To mitigate such risks, conducting an exercise stress test prior to physical activity prescription is essential to ensure safety in this population Objective: This study aimed to compare hemodynamic responses during exercise testing between individuals with and without type 2 diabetes Methods: This analytical cross-sectional study included 760 patients, divided into two groups: G1 – 380 individuals without diabetes, and G2 – 380 individuals with type 2 diabetes. All participants were evaluated in the ergometry sector of a cardiology reference hospital in northeastern Brazil. Inclusion criteria for both groups included the absence of previous cardiovascular disease or autonomic neuropathy and achieving at least 75% of the estimated chronotropic reserve during the exercise test. For G2, a confirmed medical diagnosis of type 2 diabetes was also required. Data were categorized into five domains: general patient information, health status, hemodynamic behavior, baseline and exercise ECG findings, and the presence of cardiovascular symptoms during testing. Parametric statistical analysis was applied using Student’s t-test (paired and unpaired), with significance set at p ≤ 0.05 Results: The sample was predominantly female (57.4%, p=0.001), with a mean age of 59 ± 14.2 years in G1 and 60.1 ± 9.9 years in G2 (p=0.0001). G1 demonstrated better hemodynamic responses compared to G2: maximum heart rate (147.8 ± 24.8 vs. 138.6 ± 19.9; p=0.0001), chronotropic reserve (74.3 ± 23.3 vs. 63.5 ± 19.6; p<0.0001), maximum systolic blood pressure (173.1 ± 21.9 vs. 181.6 ± 25.8; p=0.0001), VO₂max (35.1 ± 12.1 vs. 29.1 ± 9.5; p=0.0001), cardiac output (16.2 ± 5.2 vs. 14.2 ± 4.4; p=0.0001), and stroke volume (110.8 ± 31.3 vs. 104.5 ± 28.1; p=0.004). Conclusion: Individuals G1 exhibited more efficient hemodynamic responses compared to those G2, reinforcing the importance of comprehensive cardiovascular assessment to ensure safe and effective exercise prescription in this population.

PO—253 Impact of Dietary Carbohydrate Quality On Cardiovascular Risk Of Children And Adolescents with Type 1 Diabetes Mellitus

Silva DF1,2; Lima RLV1; Silva JS3; Sampaio TLV1; Silva MFF4; Albuquerque NV1

(2) Universidade Federal do Ceará (UFC), Fortaleza, CE, Brasil; (2) Faculdade de Saúde Pública da Universidade de São Paulo (FSP/USP) , São Paulo, SP, Brasil; (3) Escola de Saúde Pública do Ceará (ESP-CE), Fortaleza, CE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—253

Introduction: Type 1 diabetes mellitus (T1D) is a chronic condition that increases cardiovascular risk and is a leading cause of morbidity and mortality in this population. Adequate glycemic control is crucial, but other factors, such as diet quality, also play an important role in modulating cardiovascular risk. The glycemic index (GI) and glycemic load (GL) are indicators that reflect the quality of carbohydrates in the diet and have been associated with adverse metabolic outcomes such as dyslipidemia and increased atherogenic indices. However, the relationship between carbohydrate quality and cardiovascular risk in children and adolescents with T1D remains underexplored. Objective: This study aims to evaluate the impact of dietary carbohydrate quality on cardiovascular risk in individuals with T1D, using indicators such as the Castelli index-I and II (CI-I and CI-II), plasma atherogenic index (PAI), and non-HDL cholesterol (non-HDL-c). Methods: This was a cross-sectional study conducted with 70 participants (57% female), aged 4 to 17 years, followed at a referral center. Dietary intake was assessed using two 24-hour dietary recalls (R24h), with GI and GL calculated based on international tables. The distribution of variables was verified by the Shapiro-Wilk test. Cardiovascular risk was assessed using CI-I, CI-II, PAI, and non-HDL-C. Correlations between variables were analyzed using Pearson’s test for normal distributions and Spearman’s for non-normal distributions. Results: The correlation between GI and the cardiovascular risk markers analyzed was not significant. For GL, moderate to marginal correlations were observed. The correlation between GL and CI-I was rho = 0.218 (p = 0.070), and between GL and CI-II was rho = 0.213 (p = 0.077), both marginally significant. The correlation between GL and AIP was r = 0.270 (p = 0.024), indicating a direct and significant association. This suggests that higher consumption of foods with high GL is associated with higher AIP values, indicating an increased cardiovascular risk. Conclusion: The results indicate that dietary GL has a significant impact on the cardiovascular risk of children and adolescents with T1D, especially as AIP increases. These findings suggest that dietary interventions focused on reducing GL may be important for minimizing cardiovascular risk in patients with T1D.

PO—254 Impact of Intervention Delivery Method On Adherence And Exercise Time In Individuals With Prediabetes Or Diabetes

Azevedo ACM1; Bomtempo APD2; Pereira AL2; Mariano BC1; Oliveira DPSC1; Carvalho LB1; Cassimiro MN1; Ribas RC3; Trevizan PF3; Silva LP1

(1) Graduate Program in Rehabilitation Sciences and Physical-Functional Performance, Faculty of Physical Therapy, Federal University of Juiz de Fora, Juiz de Fora, MG, Brasil; (2) Graduate Program in Physical Education, Faculty of Physical Education and Sports, Federal University of Juiz de Fora, Juiz de Fora, MG, Brasil; (3) Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—254

Introduction: Diabetes and prediabetes require strategies to increase exercise practice. This study evaluated the effect of onsite and remote formats on adherence and training time. Objective: This study aimed to assess whether different intervention delivery methods influence adherence and the exercise time in individuals with prediabetes or diabetes. Methods: Multicenter, double-blinded, randomized controlled trial involving a 12-week intervention with two parallel groups: Exercise-only (Ex) and Exercise and Lifestyle Education (ExLE). The intervention included walking and counseling to accumulate ≥150 minutes/week of aerobic exercise, in the ExLE group the exercise was combined to education intervention (ClinicalTrials.gov: NCT03914924). Delivery method (on-site or remote) was based on participant preference and digital literacy. Exercise time was recorded and self-reported by the participant in a diary. The adherence was tracked through attendance in the sessions or by submitted diaries. The Mann-Whitney test was used to analyze the data, with a significance level of 95%. Results: Of the 201 participants (mean age 52.9±12.6 years old; 67.2% female; 76 with prediabetes; 25 with type 1 diabetes; and 100 with type 2), 102 were randomized to the Ex group and 99 to the ExLE group. The proportion of delivery methods was similar across groups, with 60% (ExLE) and 57% (Ex) attending onsite sessions. Adherence to the exercise intervention was similar in both remote (62%) and onsite (57%) delivery methods (p=0.11), as well as for the education intervention (onsite: 57%, remote: 52%; p=0.39). Weekly exercise time was similar across delivery methods: in the ExLE group, remote participants accumulated 97 [35-130] minutes, while onsite participants accumulated 81[34-148] minutes (p=0.96); in the Ex group, onsite participants accumulated 90 [37-150] minutes, compared to 85 [26-142] minutes for the remote group (p=0.55). These results suggest that the delivery method did not significantly affect adherence or exercise time. Conclusion: Both onsite and remote intervention delivery method can help individuals with prediabetes or diabetes to exercise.

PO—255 Intermittent Fasting Associated With Combined Physical Training Improves Insulin Sensitivity And Attenuates Muscle Atrophy In Mice Exposed To Sleep Restriction And Fed With A High-fat Diet

Iasniswski GA1; Dias LM1; Brisque GD1; Avelino AA1; Erlich GS1; Cintra DE1; Silva ARS2; Ropelle ER1; Pauli JR1

(1) Universidade Estadual de Campinas, UNICAMP, Limeira, SP, Brasil; (2) Universidade de São Paulo, USP, Ribeirão Preto, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—255

Introduction: In shift workers, obesity favors the development of insulin resistance, meta-inflammation and reduced muscle mass. Skeletal muscle atrophy is complex, with positive protein turnover being fundamental for maintaining muscle mass. Furthermore, skeletal muscle plays a key role in glucose uptake and glycemic homeostasis. However, atrophy is influenced by several factors, including nutrition, sleep-wake cycles and physical exercise. Literature shows that intermittent fasting (IF) and exercise training promote muscle gain, but it is necessary to explore the effects of these combined strategies on insulin sensitivity and muscle mass under sleep deprivation and a high-fat diet. Objective: To investigate the effects of IF alone or combined with exercise on performance, insulin sensitivity and muscle mass, in obese mice fed a high-fat diet, subjected to sleep restriction Methods: Male C57BL/6 mice, 8 weeks old, were fed a standard or high-fat diet (HFD), divided into five groups: Control (CTL) fed a standard diet; Obese, (OB) fed HFD; Shiftwork (SW), fed HFD and subject to the sleep restriction protocol (SW); Intermittent Fasting (IF), fed HFD and subjected to SW and IF; and Combined exercise training (EX), fed by HFD and subject to SW, IF and EX. The IF consisted of a 12-hour food restriction window during the light phase. Training consisted of treadmill running (3x/week) and resistance ladder climbing (2x/week), on alternate days. The experiment lasted 8 weeks. Evaluated: body weight, food intake, physical performance, adipocyte area, gastrocnemius cross-sectional area, and expression of hypertrophy and atrophy genes. Results: SW and OB groups showed increased adiposity, reduced insulin sensitivity, and smaller muscle fibers. IF mitigate some of these changes, mitigating weight gain and improving insulin sensitivity. The EX group showed greater strength, improved running, an increased muscle fibers size, and a reduced adipocyte area. These results were accompanied by higher expression of hypertrophy pathway genes, such as Akt and Mtor. Conclusion: The sleep restriction model combined with a high-fat diet harmed skeletal muscle, reducing fiber size and inducing insulin resistance. In contrast, IF with EX enhanced performance, a reduced adipocyte area, increased fiber size, and an increase in the expression of hypertrophy genes. The combination of IF and EX induced synergistic effects compared with IF alone, proving to be a promising strategy to counteract negative effects of sleep restriction and high-fat diet.

PO—256 Is There A Clinical Nurse Specialist Role in Specialized Outpatient Health Services in Brazil?

Baade RTW1; Meirelles BHS2

(1) Universidade Federal de Santa Catarina, São Bento do Sul, SC, Brasil; (2) Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil

Diabetology & Metabolic Syndrome 2026: PO—256

Introduction: Brazil ranks sixth in global DM prevalence. Advanced Practice Nurses support clinical management and self-care, aligned with PAHO and IDF, through direct care and chronic condition support. Objective: To analyze nursing care for people with diabetes from the perspective of advanced nursing practices in specialized healthcare. Methods: Cross-sectional, analytical study of nurses working in specialized care. A questionnaire based on national diabetes care guidelines and the Brazilian version of the Modified Scale for Advanced Nursing Practices (EMDF/EPA) was used, with responses scored from 0 (never performed) to 4 (always performed). Data analysis was descriptive. Results: A total of 32 responses from nurses were analyzed, including eight from specialist care in the state of Santa Catarina and 24 from various regions of Brazil. These responses related to 74 direct actions for caring for people with diabetes. Considering the mean score, the numbers for the sample from Santa Catarina and the national sample are as follows: 24/02 items received a score between 0.0 and <1.0 (not performed); 25/11 items received a score between 1.0 and <2.0 (incipient action); 19/28 items received a score between 2.0 and <3.0 (action being developed); and 6/33 items received a score between 3.0 and 4.0 (established action). Items related to direct and comprehensive care had a mean score of 2.1 for the state sample and 3.1 for the national sample - attached table. Although nurses in the state sample perform some actions consistent with advanced nursing practices in caring for people with diabetes, there is still a high demand for specific training. In the national sample, which is mainly composed of professionals linked to the scientific society in this field, these practices are well established. These differences reflect the different contexts of practice and training. Participants emphasized the need for continuous professional development through specialization and continuing education and recognized the contribution of advanced nursing practice to improving care for chronic conditions. Conclusion: Actions that fall within the scope of advanced nursing practice in the care of people with diabetes in specialized care were identified. It is essential to consolidate a broader scope of practice supported by specific regulations and organizational, social and training strategies that incorporate clinical, leadership, educational and research dimensions as structural axes for the development of advanced practice.

PO—259 Omega-3 Supplementation Partially Reduces Subclinical Inflammation without Affecting Insulin Resistance in Overweight Individuals

Lima NG1; Oliveira SS1; Ribeiro IA1; Paula CD2; Peixoto ACF3; Lopes MGF2; Fernandes MKC3; Dib PRB3; Souza CT2; Lima MFC1

(1) Empresa Brasileira de Serviços Hospitalares/Hospital Universitário da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil; (2) Faculdade de Medicina/Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil; (3) Instituto de Ciências Biológicas/Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—259

Introduction: Insulin resistance (IR) is defined as an impaired biological response to insulin in peripheral tissues, leading to abnormal hyperglycemia. Excess adiposity is closely associated with IR due to the dysregulated secretion of pro-inflammatory cytokines, which impair insulin signaling pathways. Omega-3 polyunsaturated fatty acids (EPA and DHA) have been investigated as a potential therapeutic approach for IR owing to their anti-inflammatory properties. However, clinical findings remain inconsistent and further evidence is warranted. Objective: Investigate the effects of omega-3-rich fish oil supplementation on subclinical inflammation and IR in overweight individuals with insulin resistance. Methods: A double-blind, single center, randomized, longitudinal clinical trial was conducted over 8 weeks with 24 overweight adults (both sexes) undergoing pharmacological treatment with metformin for type 2 diabetes mellitus (T2DM). Participants were randomized into two groups: fish oil supplementation (4 g/day, providing 2.4 g/day of EPA+DHA; n = 12) or soybean oil (n = 12). Markers of IR (fasting glucose, HbA1c, insulin, HOMA-IR, and HOMA-β) and pro-inflammatory cytokines (TNFα, IL-4, and IFN-γ) as well as the anti-inflammatory cytokine IL-10 were assessed. Data distribution was tested using the Shapiro–Wilk method. Intra-group and inter-group comparisons were performed using paired t-tests and the Mann–Whitney U test, respectively. Pearson’s correlation was applied to assess associations between variables. The study was approved by the Human Research Ethics Committee of HU-UFJF (protocol no. 4.731.228). Results: Fish oil supplementation did not significantly alter IR markers. However, IFN-γ concentrations were reduced in the fish oil group, with a significant between-group difference after 8 weeks. A strong, positive, and statistically significant correlation was observed between erythrocyte omega-3 incorporation (indirect biomarker) and IL-10 levels at 8 weeks in the fish oil group (R² = 0.748; p = 0.005). Other cytokines remained unchanged. Conclusion: Eight weeks of omega-3-rich fish oil supplementation attenuated subclinical inflammation, evidenced by IFN-γ reduction, without modifying IR parameters. IL-10 levels were positively associated with higher cellular omega-3 incorporation. Further randomized controlled trials in more inflamed T2DM populations are needed to elucidate potential benefits on insulin resistance.

PO—261 Performance of Remote Self-Administration of Health Literacy and Diabetes Self-Care Assessment Questionnaires in Individuals with Diabetes

Kanarzveski LD1; Andreia AV1; Canani LH1; Rodrigues TC1; Almeida JC1

(1) Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—261

Introduction: Diabetes Mellitus (DM) is a chronic disease characterized by persistent hyperglycemia resulting from impaired insulin secretion or action. Effective self-care is fundamental for DM management; however, its implementation relies on individuals´ ability to interpret health-related information. Therefore, health literacy is crucial, as it enables individuals to comprehend and appropriately apply information related to their condition. The Short Test of Functional Health Literacy in Adults (s-TOFHLA) and the Summary of Diabetes Self-Care Activities (SDSCA) are widely used instruments to assess these domains, yet they have been validated solely for in-person administration by trained researchers. Objective: To assess the reproducibility of remote self-administration of these questionnaires. Methods: This cross-sectional study included adults with a medical diagnosis of DM and internet access, who completed the s-TOFHLA and the SDSCA at two time points: remotely (self-administered) and in person. Reproducibility was evaluated using the intraclass correlation coefficient (ICC) and the Prevalence-Adjusted Bias-Adjusted Kappa (PABAK), according to variable type. Results: Ninety-four participants completed both assessments, with a median interval of 13 (8–19) days; 63.8% were women, with a median age of 50 years. The majority had completed high school (56.3%), had type 2 DM (62.8%), were insulin users (76.5%), and were covered by the Brazilian Unified Health System (93.4%). The total score on the s-TOFHLA showed good reproducibility (ICC = 0.74; 95% CI: 0.60–0.83), with 80% of the items showing very good agreement (PABAK > 0.80). The mean difference between administrations was -1.14 (CI95% 20.4-18.1) points. Final classification agreement was 93.6% for in-person and 95.7% for remote administration (PABAK = 0.78). For the SDSCA, very good agreement was observed for the dimensions “blood glucose monitoring,” “foot care,” and “smoking cessation” (PABAK between 0.82 and 1.00), while other items showed good agreement (PABAK between 0.60 and 0.76). Conclusion: Among this sample of adults with diabetes, remote self-administration of the s-TOFHLA and SDSCA showed adequate reproducibility when compared to in-person administration by trained researchers.

PO—263 Physical Fitness Levels And Body composition In Postmenopausal Women With Type 2 Diabetes: A Comparison Between Physically Active And Insufficiently Active Individuals

Vasconcelos AR1; Guimarães FJS1; Cruz PWS1; Cruz ATM1; Souza AM1; Santos Ribeiro JNS1; Souza GKB1; Schwingel PA1; Vancea DMM1; Costa MC1

(1) Universidade de Pernambuco, Recife, PE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—263

Introduction: Decompensated type 2 diabetes is associated with alterations in body composition and reduced physical fitness, especially in women, due to climacteric and menopausal changes. Growing evidence supports regular physical exercise as a key strategy in the management of type 2 diabetes and its comorbidities. However, the protective role of exercise in maintaining functional capacity in women with type 2 diabetes remains not fully understood. Objective: This study aimed to compare the physical fitness and body composition of postmenopausal women with type 2 diabetes, stratified by physical activity level. Methods: This was a cross-sectional, analytical, and descriptive study. Physically active women (G1) participated in a supervised exercise program for individuals with diabetes, offered by a public university. Insufficiently active women (G2) were residents of the metropolitan area of a large city. G1 engaged in combined aerobic and resistance training three times a week, while G2 reported engaging in fewer than 150 minutes of moderate physical activity per week. Assessments included appendicular skeletal muscle mass index (ASMMI), fat mass index (FMI), and physical fitness measured by usual gait speed. During the assessment period, all participants maintained their regular dietary and medication routines. The Mann-Whitney U test was for comparisons, with a significance level of p ≤ 0.05. Results: The sample consisted of 74 postmenopausal women with type 2 diabetes, of whom 60.8% were classified as physically active. The mean age in G1 was 64.5 ± 9.5 years and in G2, 65.1 ± 9.2 years. G1 showed significantly higher physical fitness compared to G2 (1.47 ± 0.32 vs. 1.17 ± 0.30 m/s; p < 0.001). However, no significant differences were observed between groups in muscle mass (6.25 ± 0.81 vs. 6.10 ± 0.79 kg/m²; p = 0.370) or fat mass (11.04 ± 3.02 vs. 11.91 ± 2.83 kg/m²; p = 0.241). Conclusion: These findings suggest that physically active women exhibited better physical fitness levels regardless of body composition, highlighting the potential role of regular physical activity in preserving functional capacity in postmenopausal women with type 2 diabetes.

PO – 264 Potential Role of Physical Activity and Vitamin D Supplementation in Stage Regression in Type 1 Diabetes: A Case Report

Rezende GC1; Abi-Abib RC1; Montalvão BS1; JR Dantas1; Zajdenverg L1; Melanie Rodacki1

(1) Universidade Federal do Rio de Janeiro -UFRJ, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—264

Case Presentation: A 9-year-old male was referred to the endocrinology clinic after an incidental finding of elevated fasting plasma glucose (114 mg/dL). He was eutrophic, asymptomatic, with no comorbidities or family history of type 1 diabetes mellitus (T1D) or other autoimmune diseases. Repeat testing showed fasting glucose of 102 mg/dL, HbA1c of 5.5%, C-peptide of 1.05 ng/mL, and positivity for anti-glutamic acid decarboxylase (GADA)and anti–zinc transporter (ZnT8 Ab) antibodies, with negative anti-insulin and anti-IA2. These findings were consistent with stage 2 T1D, defined by mild dysglycemia and ≥ 2 positive islet autoantibodies in an asymptomatic individual. The patient was a young athlete who had regular vigorous aerobic physical activity (~ 10 h/week) and also received daily vitamin D supplementation, aiming to achieve serum 25OH vitamin levels ≥ 50 ng/mL. Follow-up every 6 months included metabolic and hormonal assessment, autoantibody titers, growth, and body composition. After 2 years, fasting glucose normalized (77 mg/dL), HbA1c was 5.2%, 25OH vitamin D levels were between 50–60 ng/mL, and C-peptide remained preserved. GADA and ZnT8 Ab persisted, though with reduced titers, indicating persistent autoimmunity but regression to stage 1 T1D. After 7 years, the patient remains asymptomatic, with fasting glucose < 100 mg/dL, continuing vitamin D supplementation and regular vigorous exercise. The patient’s guardian gave their explicit written consent to publish the patient’s information in an open access journal. Discussion: T1D is a progressive autoimmune disease classified into stage 1 (2 or more antibodies without dysglycemia), stage 2 (2 or more antibodies + mild dysglycemia), and stage 3 (clinical diabetes). Regression from stage 2 to stage 1 is rare. In this case, regular vigorous physical activity and vitamin D supplementation may have contributed to β-cell preservation or delayed dysfunction. Regular exercise is associated with improved insulin sensitivity and reduced systemic inflammation, while vitamin D supplementation may exert immunomodulatory effects, potentially influencing autoantibody titers and disease stability. Final Comments: This case illustrates that regression from stage 2 to stage 1 T1D can occur. The favorable outcomes reinforce evidence suggesting that exercise and vitamin D may play a role in reducing autoimmune β-cell destruction in T1D. Longitudinal studies and randomized trials are still needed to confirm these findings and to determine whether such patients would benefit from disease-modifying therapies proposed for stage 2 T1D.

PO—265 Prevalence of Diabulimia in Adults with Type 1 Diabetes Mellitus

Marques SJS1; Garces TS1; Lima GS1; Belchior AB1; Oliveira LV1; Costa SAF1; dos Santos CMT1; Araújo AL1; Oliveira SKP1; Moreira TMM1

(1) Universidade Estadual do Ceará, Fortaleza, CE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—265

Introduction: It is estimated that approximately 9.4 million people worldwide live with Type 1 Diabetes Mellitus (T1DM), including 600,000 in Brazil. One of the main challenges in managing this condition is diabulimia, characterized by the deliberate omission of insulin for weight control, which is more common among women (37.9%) but also affects adult men (15.96%) with T1DM. Diabulimia is associated with weight variation, strict carbohydrate control, elevated glycated hemoglobin (HbA1c) levels, and dietary restriction. Therefore, early screening for diabulimia should be incorporated into clinical practice using tools specifically designed for this population. Objective: To estimate the prevalence of diabulimia among adults with Type 1 Diabetes Mellitus. Methods: This was a cross-sectional study conducted at a specialized center in Fortaleza, Ceará, Brazil. Eligible participants were adults (≥18 years) diagnosed with T1DM for at least 12 months and receiving quarterly clinical follow-up in accordance with ADA guidelines. Pregnant women were excluded. The target population comprised 1,907 adults with T1DM followed at the center. Prevalence was calculated based on the number of cases identified by the DEPS-R questionnaire, divided by the total number of adults with T1DM and multiplied by 100,000. Sociodemographic data were also collected. The study was approved by the Research Ethics Committee of the State University of Ceará (approval no. 7.091.417). Results: Of the 73 participants, 34 (46.5%) scored 20 or higher on the DEPS-R, indicating the presence of diabulimia. The estimated prevalence of the condition among the adult T1DM population at the center was 1.78 cases per 100,000 individuals. Among the participants, there was a predominance of males (n = 46; 63%) and individuals self-identified as mixed race (n = 36; 49.3%), with a mean age of 26 years. Conclusion: The study identified a notably high proportion of potential diabulimia cases among adults with T1DM, suggesting a significant presence of the condition in this population. The findings emphasize the importance of early screening in clinical settings and reinforce the need for specific assessment tools and trained multidisciplinary teams to manage eating disorders in individuals with T1DM.

PO—266 Prevalence Of Electrocardiographic Changes And Stratification Of Cardiovascular Risk During Physical Effort In People With And Without Type 2 Diabetes

Cruz PWS1; Cruz ATM1; Souza AM1; Vasconcelos AR1; Costa KB1; Buarque LK1; Figueiredo LS2; Ribeiro JNS3; Vancea DMM1; Ferreira MNL1

(1) Universidade de Pernambuco, Recife, PE, Brasil; (2) Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil; (3) Faculdade Pernambucana de Saúde, Recife, PE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—266

Introduction: Cardiovascular diseases are highly prevalent among individuals with diabetes, largely attributed to diabetic autonomic neuropathy. While physical exercise is widely encouraged as part of diabetes treatment, individuals with diabetes, especially during the acute phase of diabetic autonomic neuropathy, may exhibit altered hemodynamic and electrocardiographic responses, increasing cardiovascular risk during physical effort. To minimize these risks, a preliminary exercise stress test is essential to guide safe physical activity prescription in this population Objective: To determine the prevalence of electrocardiographic abnormalities as predictors of cardiovascular risk during exercise in individuals with and without type 2 diabetes Methods: An analytical cross-sectional study was conducted with 760 patients, divided into two groups: G1 – 380 individuals without diabetes, and G2 – 380 individuals with type 2 diabetes. All participants were assessed at the ergometry unit of a cardiology reference hospital in northeastern Brazil. Inclusion criteria for both groups included the absence of previous cardiovascular disease or autonomic neuropathy and achievement of at least 75% of the estimated chronotropic reserve during the exercise test. For G2, a confirmed diagnosis of type 2 diabetes was also required. Data were categorized into five sets: sociodemographic characteristics, health status, baseline and exercise hemodynamic and electrocardiographic behavior, and the presence of signs or symptoms suggestive of cardiovascular disease during the test. Parametric statistical analyses were performed using Student’s t-test, chi-square test, and multivariate regression, with significance set at p ≤ 0.05 Results: The sample was predominantly female (57%). G2 exhibited a significantly higher prevalence of electrocardiographic abnormalities at rest and during exercise, with the most frequent findings being other arrhythmias (16.3%), ventricular premature contractions (13.4%), and ST-segment depression (12.6%). G2 had an odds ratio of 4.65 for ventricular premature contractions during exercise compared to G1. Cardiovascular risk stratification using the Duke Treadmill Score indicated a high risk profile in the diabetic group Conclusion: The G2 demonstrated a significantly higher prevalence of electrocardiographic abnormalities at rest and during exercise, as well as elevated cardiovascular risk, underscoring the need for thorough electrocardiographic evaluation before exercise prescription in this population.

PO—267 Randomized Clinical Trial on The Impact of Food Education Groups Combined With Nutritional Counseling On Intuitive Eating Scores In Patients With Type 2 Diabetes

Fabris RC1; Busanello A1; Koller OG1; Dambrowski AG1; Menezes VM1; Andreia AV1; Ferreira SC1; Almeida JC1

(1) Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—267

Introduction: Type 2 diabetes is a major public health issue, requiring nutritional guidance to promote healthy eating for better glycemic control. Intuitive Eating, a non-diet approach, encourages individuals to reconnect with hunger and satiety cues, offering a promising alternative for modifying eating behaviors in diabetes management. Objective: This study aimed to assess the impact of nutrition education groups combined with individualized nutritional counseling on intuitive eating scores in outpatients with type 2 diabetes, compared to individualized counseling alone. Methods: A randomized, parallel, open-label clinical trial was conducted with adults receiving care at a university hospital outpatient clinic in Brazil, with a four-month follow-up. Participants were stratified by sex and haemoglobin A1c (HbA1c) levels and randomly assigned (1:1) to one of two treatment arms: the control group (individualized nutritional counseling) or the intervention group (individualized counseling plus three nutrition education group sessions). Due to the nature of the intervention, neither participants nor researchers were blinded. Clinical, laboratory, and lifestyle data were collected at baseline and after four months. Intuitive Eating was assessed using the Intuitive Eating Scale-2, adapted to Brazilian Portuguese. The modified intention-to-treat principle was applied. Differences over time and between randomization groups were analyzed using the Generalized Estimating Equations regression model (p < 0.05, two-tailed). Results: A total of 213 participants were included, 62% of whom were women, with a median age of 61 years (IQR = 54–65) and a median baseline HbA1c of 9.2% (8.3–10.2%). No significant differences were found between the baseline characteristics of participants in the control and intervention groups. Participants in both groups showed an increase in intuitive eating scores (p = 0.002) and a ~0.3% reduction in HbA1c (p = 0.002) over the study period. However, no significant differences were observed between the two groups. Individualized nutritional counseling improved intuitive eating scores and HbA1c but adding nutrition education groups provided no additional benefit. Conclusion: Individualized nutritional counseling is effective in improving intuitive eating scores and HbA1c in patients with type 2 diabetes. Adding nutrition education groups did not offer additional benefits beyond individualized counseling.

PO—268 Readiness for Change and Diet Quality in Diabetes Prevention: Insights from a Brazilian Pilot Trial

Andreia AV1; Koller OG1; Bersch-Ferreira AC2; Ana Carvalho APPF3; Bressan J4nto SL5; Sahade V6; Almeida JC1

(1) Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil; (2) Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil; (3) Hospital das Clínicas da Universidade Federal de Goiás, Goiânia, GO, Brasil; (4) Universidade Federal de Viçosa, Viçosa, MG, Brasil; (5) Universidade Federal do Tocantins, Palmas, TO, Brasil; (6) Universidade Federal da Bahia, Salvador, BA, Brasil; (7) Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—268

Introduction: The adoption of a healthy diet, regular physical activity, and weight management are key recommendations for reducing the risk of diabetes mellitus developing. Furthermore, an individual’s stage of readiness for change in adopting lifestyle modifications may influence the outcomes achieved. Objective: To evaluate the impact of readiness for change on adherence to nutritional counseling, comparing individuals at high risk for diabetes receiving either a lifestyle modification intervention or usual care. Methods: This secondary analysis of data from a multicenter randomized controlled trial (NCT 05689658) that compared the Diabetes Prevention Program (PROVEN-DIA) with standard nutritional counseling in participants at high risk for diabetes over a three-month follow-up period. Individuals at high risk for type 2 diabetes, were assessed for their readiness to change lifestyle behaviors, self-perceived diet quality, physical activity level, smoking status. Self-perceived diet quality was evaluated using the Wheel of Cardiovascular Health Diet and was defined as “high quality” when the graphic area was >70%. Participants were categorized into three groups based on their readiness for change: precontemplation/contemplation, preparation and action/maintenance. Their characteristics were compared while accounting for randomization. Results: Among 220 participants, of whom 71.8% were women, with a mean age of 48±10 years, 16.4% had not completed elementary education, 65.5% had obesity, 38.2% had prediabetes, participants who received the PROVEN-Dia intervention at the precontemplation/contemplation stage were more likely to report high diet quality after three months (OR=4.7;95% CI=1.2–17.8). For those in the action/maintenance the odds were 2.9 (95%CI=0.5–18.3) and among the participants in the preparation stages the odds were 1.9 (95%CI=0.8–4.6). Conclusion: These findings suggest that the PROVEN-DIA intervention is effective in promoting improvements in diet quality, regardless of the stage of readiness for change.

PO—269 Relation Between Culinary Skills and Determinants Of Food Choices In People With Type 2 Diabetes Mellitus Followed in a Public Hospital In The Amazon Region

Gomes DL1; Silva SEC1; Coelho RKS1; Vilacorta GCS1; Siqueira NC1; Lima APV1; Oliveira GES1; Gonçalves KCC1; Inete MV1; Souza YDES1; Carvalhal MML1

(1) Universidade Federal do Pará, Belém, PA, Brasil

Diabetology & Metabolic Syndrome 2026: PO—269

Introduction: Type 2 Diabetes Mellitus is a chronic condition that requires lifestyle changes, including dietary choices, which are influenced by many factors, such as individual cooking skills and practices. Objective: To analyze the relationship between cooking skills and determinants of eating choices in people with type 2 diabetes receiving care at a public hospital. Methods: This was a cross-sectional study conducted from April 2023 to August 2024 at the endocrinology outpatient clinic of a public university hospital in Belém, Brazil, involving adults of both sexes diagnosed at least a year prior. Data collection involved the Brazilian Questionnaire of Cooking Skills and Healthy Eating (QBHC) and the Eating Motivation Survey (TEMS). Data were analyzed using SPSS version 24, with a significant level of p<0,05. The study was approved by the Ethics Committee (approval number 6.087.349), and all participants signed the informed consent form. Results: A total of 157 adults were evaluated, with a mean age of 54,7±7,3 years, and 72,6% were women. A positive correlation was observed between the “habits” domain and cooking self-efficacy (r=0,234; p=0,003), while the “health” domain was correlated with cooking attitude (r=0,146; p=0,047), cooking self-efficacy (r=0,130; p=0,069), and the overall cooking skills score (r=0,215; p=0,006), suggesting that both habitual influence and health concerns appear to be important factors for promoting engagement and self-confidence in cooking practices. In contrast, the “convenience” domain showed a negative correlation with cooking behavior (r=–0,254; p=0,002), and the “social norms” and “emotional control” domains presented negative correlations with cooking self-efficacy (r=–0,214; p=0,007 and r=–0,159; p=0,034, respectively), suggesting that prioritizing practicality or being influenced by social standards may limit confidence in preparing healthy meals. Conclusion: Habits and health concerns strengthen confidence and engagement in food preparation, while convenience-seeking and susceptibility to social influences may hinder these practices. These findings highlight the importance of food and nutrition education strategies that support cooking autonomy and reduce external influences on eating choices.

PO—270 Relationship Between Illness Perception and Eating Behavior in Individuals with Type 2 Diabetes Mellitus

Souza YDES1; Inete MB1; Gomes APAS1; Mileo VV1; Sena CDC1; Silva SEC1; Carvalhal MML2; Gomes DL1; Paracampo CCP1

(1) Universidade Federal do Pará, Belém, PA, Brasil; (2) Serviço Social do Comércio, Belém, PA, Brasil

Diabetology & Metabolic Syndrome 2026: PO—270

Introduction: Type 2 Diabetes Mellitus is a chronic condition that requires lifestyle changes, especially in eating habits and the way individuals perceive their illness can directly influence their eating behavior, affecting disease management. Therefore, understanding this relationship is essential for more effective diabetes care. Objective: To evaluate the relationship between illness perception and eating behavior in individuals with Type 2 Diabetes Mellitus. Methods: This is a cross-sectional study with a descriptive and analytical approach. The research was conducted in accordance with the principles of the Declaration of Helsinki, the Committee on Publication Ethics, and the International Committee of Medical Journal Editors. The study was approved by the Research Ethics Committee (approval number: 6.087.349). Interviews were conducted to gather information on socioeconomic background, along with anthropometric assessments and the application of specific instruments such as the Three Factor Eating Questionnaire and the Brief Illness Perception Questionnaire. For statistical analysis, the Spearman correlation test was applied (p<0.05). Results: A total of 157 individuals participated in the study, with a mean age of 54.7 ± 7.3 years, and the majority were female (72.6%). The average illness perception score was 46.6 ± 9.6, with the highest scores observed in the dimensions of timeline (8.6 ± 2.4), consequences (8.4 ± 2.2), and concern (8.3 ± 2.7). Regarding eating behavior, individuals showed a higher pattern of cognitive restraint (45.8 ± 23.0). The correlation between domains of eating behavior and illness perception was also tested. It was observed that personal control showed a positive correlation with uncontrolled eating (r = 0.198; p = 0.006) and a negative correlation with cognitive restraint (r = -0.252; p = 0.001). The comprehension dimension had a negative correlation with cognitive restraint (r = -0.268; p = 0.000), and the emotional dimension showed a positive correlation with emotional eating (r = 0.155; p = 0.026). Conclusion: The individuals evaluated perceive the disease as chronic and impactful, with high levels of concern, and their eating behavior was mainly characterized by cognitive restraint. Additionally, significant correlations were found between aspects of illness perception and domains of eating behavior, highlighting the influence of emotional and cognitive dimensions on the relationship with food.

PO—271 Repercussions of the May 2024 Extreme Rainfall Event on Diabetes Outpatients at Hospital de Clínicas de Porto Alegre: A Partial Analysis

Brun GR1; Freire LA1; Mello Maronez LEM1; Covre JCB1; Pereira AA1; Vieira VPN1; Vaz JPA1; Teixeira LF1; Wildner JTB1; Rodrigues TC1

(1) Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—271

Introduction: Climatic emergencies have grown over the past two decades globally. In 2024, Rio Grande do Sul (RS) was affected by a great flood, causing massive losses. Diabetes prevalence in Brazil is around 10%, and understanding the impact of the flood on patients with this disease is of great interest, especially in learning from catastrophes and thinking measures that can minimize difficulties in accessing medicine during these adverse scenarios Objective: This study aimed to determine the impact of the 2024 flood in RS in Type 1 diabetes (T1D) and Type 2 diabetes (T2D) patients Methods: The study involved T2D and T1D outpatients followed by the Endocrinology Division from a tertiary hospital of RS in May/2025. A multiple-choice questionnaire evaluated the impact caused by the event. Laboratorial levels of glycated hemoglobin (A1c) were retrieved from medical records in two moments — the most recent, and 6 months before the event. Statistical analysis was performed using t-test in RStudio and the results were considered statistically significant when p-value < 0.05. Results: The study included 116 patients, 44% (n=50) were allocated in the affected group, and 46% (n=66) in the non-affected group (Control). No difference was observed in HbA1c values before and after the event among groups, mean (SD) for affected group before was 8.6 (1.7), and after 8.73 (1.8), p=0.95, and non-affected group was 8.48 (1.3), and after 8.47 (1.5), p=0.64. Questionnaire’s response showed no statistically significant difference between groups in the self-reported days of healthy eating habits (0.867), physical activities (0.649), days of adherence to medication (0.17). Still, there were situations that interfered in the participants´ treatment. In the affected group, 68% participants missed appointments due to scarce means of transportation and 20% could not find medication during the event. Conclusion: Climate change provokes intense modifications on our reality, and health providers need to understand their impact. The 2024 Flood caused sustained harm especially to patients with diabetes. Although no statistically significant results were observed in HbA1c levels, or in the questionnaire, it was evident the impact on patients’ lives — mainly disturbing their medication access or transportation means. It is possible that no difference was observed due to public health efforts, or the need for a standardized period of the analysis. Further analysis is still necessary to address medical care in future climate events.

PO—272 Short-term Improvement in Breakfast Quality through Group-based Nutrition Education in Patients with Type 2 Diabetes: A Randomized Clinical Trial

Busanello A1; Dambrowski AG1; Ferreira SC1; Fabris RC1; Almeida JC1

(1) Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—272

Introduction: Behavioral strategies are essential to effective diabetes management, and adopting a person-centered approach, while enhancing interaction with healthcare teams, can support the development of healthier habits and lead to improved clinical outcomes. Objective: This parallel-group randomized controlled trial aimed to evaluate the effects of adding group-based nutritional education to usual care on glycemic control, food intake, and meal quality in patients with type 2 diabetes (T2DM). Methods: Outpatients diagnosed with T2DM and poor glycemic control, followed at a university hospital in southern Brazil, were randomly assigned in a 1:1 ratio to one of two treatment arms: (1) individual usual care only (individual nutritional counseling according to diabetes recommendations, without prescription of meal plan), or (2) usual care plus group-based nutritional education that included three sessions addressing the following topics: “Let’s Go Shopping,” “Healthy Plate,” and “Hunger and Satiety.” All participants underwent assessments at baseline and after four months. Dietary intake was evaluated by 24-hour dietary recall method with the Multiple-Pass technique. Outcome measures included HbA1c, dietary intake and meal quality according to the Diabetes Plate Method. Baseline characteristics of the randomized participants were compared, and potential group-by-time were analyzed by Generalized Estimating Equations, adjusted for age, sex, Medication Effect Score, and education level. This study protocol was approved by the Research Ethics Committee and registered at ClinicalTrials.gov (NCT05598203). Results: A total of 202 participants were included, with a median age of 61 years (IQR:53-65); HbA1c = 9.2% (IQR:8.3-10.2); BMI = 31.9 kg/m² (IQR:28.7-34.9) and diabetes duration = 17.1±9.6 years. In the interaction analysis, participants in the intervention group showed a greater increase in adherence to the Diabetes Plate Method at breakfast rising from 6.3% to 16.7%, compared to the control group (from 12.3% to 11.3%; P = 0.027). A modest but statistically significant reduction in HbA1c was observed at four months compared to baseline (P = 0.003); however, no significant group-by-time interaction was found (P = 0.247). Conclusion: These findings suggest that group-based nutrition education can foster short-term behavioral changes, particularly in meal quality, and may hold promise for enhancing long-term outcomes in diabetes management.

PO—274 The Impact of Integrating Lifestyle Education Into An Exercise Program For Individuals With Prediabetes And Diabetes On Diabetes Knowledge, Health Behaviors And Quality Of Life

Azevedo ACM1; Bomtempo APD2; Pereira AL2; Mariano BC1; Oliveira DPSC1; Carvalho LB1; Cassimiro MN1; Ribas RC3; Trevizan PF3; Silva LP1

(1) Graduate Program in Rehabilitation Sciences and Physical-Functional Performance, Faculty of Physical Therapy, Federal University of Juiz de Fora, Juiz de Fora, MG, Brasil; (2) Graduate Program in Physical Education, Faculty of Physical Education and Sports, Federal University of Juiz de Fora, Juiz de Fora, MG, Brasil; (3) Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, MG, Brasil

Diabetology & Metabolic Syndrome 2026: PO—274

Introduction: Diabetes and prediabetes are highly prevalent and impact public health. Programs combining exercise and lifestyle education may improve clinical management and promote behavioral changes. This study evaluated their effects on knowledge, behavior, and quality of life. Objective: To compare the effectiveness of an Exercise and Lifestyle Education (ExLE) program with an Exercise-only (Ex) program in improving disease-related knowledge, physical activity level, medication adherence and quality of life in individuals with prediabetes or diabetes. Methods: Multicenter, double-blinded, randomized controlled trial involving a 12-week intervention with two parallel groups: ExLE and Ex (ClinicalTrials.gov: NCT03914924). Ex program included aerobic and muscle-strengthening exercises, while ExLE incorporated structured education sessions. The disease-related knowledge was assessed by the DiAbeTes Education Questionnaire (DATE-Q), the physical activity (PA) level measured by a pedometer used during seven days, with the average of steps/day, the medication adherence measured by the Measure of Adherence to Oral Antidiabetic Treatments and Insulin (MAT ADO), and the quality of life (QofL) was evaluated using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Outcome analyses were performed based on intention-to-treat, using the last observation carried forward. The ANOVA two-way was used to analyze the data. Results: Two hundred sixty-four individuals (65.9% female, 52.1±12.6 years old) were randomized (Ex; n=135, ExLE; n=129) and 165 completed the allocated program. The sample included 36% individuals with prediabetes, 12.5% with type 1 diabetes, and 51.5% with type 2 diabetes, with a mean baseline A1c of 7.1±1.7%. Both groups demonstrated a significant (p<0.001) increase in DATE-Q total scores (time), and he ExLE group presented significantly higher (p=0.002) DATE-Q total scores than the Ex group (interaction). Both groups presented significant improvements (p=0.026) in PA level at post-intervention (time) without significant (p=0.936) differences between them (interaction). No significant differences were observed between baseline and post-intervention or between groups for medication adherence and QofL. Conclusion: This study highlights the potential benefits of integrating education to exercise programs for individuals with prediabetes or diabetes, as it improves significantly disease-related knowledge.

PO—275 The Role of Schools in Type 1 Diabetes Mellitus Management: An Analysis of Facilitators and Barriers in the School Environment

Vargas VM1; Nartis KA1; Peres EA1; Souza JD1; Figueiredo BHS 1; Silverio ST1; Hirashima CE1; Szekut ML1; Martins VAD1

(1) Universidade Estadual de Londrina, Londrina, PR, Brasil

Diabetology & Metabolic Syndrome 2026: PO—275

Introduction: The way educators handle Type 1 Diabetes Mellitus (T1DM) in the school environment can directly impact the self-care behavior of children and adolescents. A lack of preparedness regarding T1DM knowledge and management is still a reality among many education professionals, which can contribute to immediate and long-term complications that could be prevented with adequate training. Objective: This study aimed to identify actions related to T1DM care for patients and their families in municipal public schools. Methods: Data were collected through a semi-structured questionnaire administered to 46 participants: 5 adolescents and 18 children with T1DM, of both sexes, aged 5 to 16 years, as well as their respective guardians. The questionnaires were applied individually and in person during appointments at a public outpatient clinic specializing in T1DM, including both guardians and the children and adolescents themselves. Results: After notifying the school about a student’s T1DM condition, 78% of the participants reported that the schools: Did not provide an adequate environment for glycemic monitoring and insulin administration. Did not have a trained professional available to assist with self-monitoring or insulin administration. Were unaware of proper management in cases of hypoglycemia or hyperglycemia. Did not guide students on the importance of not sharing snacks with peers. On the other hand, 70.6% of guardians highlighted positive measures adopted by the schools, such as: Permission for students to consume snacks as needed. Encouragement of participation in physical and other school activities. Keeping emergency contact information for guardians updated for use in case of intercurrences. Conclusion: The data reveal that the schools’ actions are primarily focused on communicating with parents, with few direct measures for the daily management of T1DM. These findings reinforce the need to expand the training of the school community to increase the assertiveness and effectiveness of care strategies. Such changes could contribute significantly to promoting health and improving the quality of life for children and adolescents with T1DM.

PO—276 Ultra-Processed Food Consumption and Visceral Adiposity Index in Children and Adolescents with Type 1 Diabetes Mellitus: Data from a Reference Center

Araujo BB1; Machado RCM2; Farias DR2; Pinheiro BFL2; Pimentel IF2; Tiberio RM2; Mello BPZG2; Luescher JL2; Padilha PC2

(1) Universidade Federal do Rio de Janeiro, Rio de janeiro, RJ, Brasil; (2) Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—276

Introduction: Metabolic control is a fundamental goal in type 1 diabetes mellitus (T1DM), encompassing glycemic and lipid profile control, as well as the prevention of excess weight and its complications, such as cardiovascular diseases. It is known, however, that excess weight has increasingly affected children and adolescents with T1DM, sometimes being identified at the time of diagnosis. Studies on the visceral adiposity index (VAI) in this population are scarce. Objective: To evaluate the association between the frequency of consumption of ultra-processed foods (UPF) and VAI in children and adolescents with T1DM. Methods: This was a cross-sectional study conducted at a referral center in Rio de Janeiro, Brazil. The sample included 134 participants, aged 7 to 16 years, with a diagnosis of T1DM for at least one year. Exclusion criteria included the presence of other autoimmune diseases, hemoglobinopathies, and incomplete dietary intake data. Sociodemographic, clinical, anthropometric, and dietary data were collected. Univariate logistic regression was used to estimate the crude odds ratio (OR) and corresponding 95% confidence interval (CI). Results: Higher levels of total cholesterol (p < 0.001), LDL-C (p < 0.001), non-HDL cholesterol (p < 0.001), and triglycerides (p < 0.001), along with lower levels of HDL-C (p < 0.001), were associated with greater visceral adiposity. A high frequency of UPF consumption (> 5 times/day) was observed in 73.1% of participants (n = 98), and a higher frequency of UPF intake was associated with greater adiposity (OR 2.9; CI: 1.3–6.7; p = 0.012). Conclusion: Reducing UPF consumption may contribute to achieving metabolic control, and VAI may represent a useful parameter in the monitoring of children and adolescents with T1DM.

PO—277 Whole and Refined Plant-Based, and Animal-Based Dietary Patterns and Their Relationship with Cardiometabolic Health in Brazil

Correia PE1; Martins BB1; Kunzler LB1; Teixeira PP1; Ferrari GT2; Zajdenverg L3; Brietzke E4; Socal M5; Colpani V1; Y Sun Y6; Zhang M6; Bisi L6; Porepp OSC1; Gerchman F1

(1) Postgraduate Program in Medical Sciences: Endocrinology, Department of Internal Medicine, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil; (2) Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil; (3) Internal Medicine Department, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil, Rio de Janeiro, RJ, Brasil; (4) Center for Neuroscience Studies (CNS). Department of Psychiatry, Queen’s University School of Medicine, Canada; (5) Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, United States; (6) Johns Hopkins University, United States

Diabetology & Metabolic Syndrome 2026: PO—277

Introduction: Plant-based diets emphasize the intake of whole and plant-derived foods while limiting processed and animal-based products. They have gained attention for their potential benefits for human and planetary health. Although vegetarian dietary patterns are associated with lower rates of metabolic diseases, evidence on the broader impact of plant-based diets, including their relationship with other dietary patterns, remains limited in Brazil. Objective: To analyze nationally representative data from the 2019 Brazilian National Health Survey to explore associations between different dietary patterns and the prevalence of obesity, diabetes, and hypercholesterolemia. Methods: Participants reported their food consumption in the previous week using a Food Frequency Questionnaire. Foods were grouped into whole plant-based (beans, vegetables, fruits, natural fruit juice), refined plant-based (processed juice, soda, cookies/sweets, prepared meals), and animal-based (fish, milk, red meat, chicken). Diets were categorized into high, intermediate, and low adherence to each pattern. Multiple logistic regression analyses assessed associations between dietary patterns and cardiometabolic diseases, adjusted for age, sex assigned at birth, race, marital status, household income, highest education level achieved, urban or rural place of residence, geographical region, physical activity level, smoking status, alcohol intake, and dietary pattern. Results: We analyzed data from 87,678 participants (mean age 47.4 ± 17.1 years, 52% women). High whole plant-based intake was associated with lower prevalence of obesity (OR 0.64; 95%CI 0.54–0.75) and hypercholesterolemia (OR 0.69; 95%CI 0.56–0.85), compared with low intake. Refined plant-based pattern was inversely associated with obesity (OR 0.90; 95%CI 0.83–0.97), hypercholesterolemia (OR 0.81; 95%CI 0.77–0.91), and diabetes (OR 0.53; 95%CI 0.48–0.59). High animal-based intake was not associated with obesity, hypercholesterolemia, or diabetes. Conclusion: This study provides evidence that both whole and refined plant-based dietary patterns may be associated with a lower prevalence of multiple cardiometabolic diseases in Brazilian adults, while high animal-based intake was not linked to those diseases. Longitudinal studies are warranted to confirm these associations and clarify causality.

PO—278 A Case report of Non-Syndromic Monogenic Obesity: Metabolic Syndrome and Favorable Outcome After Sleeve Gastrectomy

HugueninTSP1; Silva IS1; Silva T1; Carneiro JRI2; Fonseca ACP1

(1) Universidade do Grande Rio (Unigranrio/Afya), Duque de Caxias, RJ, Brasil; (2) Universidade Federal do Rio de Janeiro, Hospital Clementino Fraga Filho, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—278

Case Presentation: A female patient, daughter of a diabetic father, presented progressive weight gain since childhood, evolving into severe long-standing obesity. Between 2016 and 2019, she weighed 126 kg (BMI 46.3 kg/m²), consumed ~ 3,709 kcal/day, and met diagnostic criteria for metabolic syndrome: abdominal obesity, hypertension, dyslipidemia, and hyperinsulinemia, with HbA1c 6.7%. Refractory to intensive clinical management, she underwent sleeve gastrectomy in 2019. After 12 months, she had lost 37.3% of her initial weight (BMI 29.0 kg/m²), quit smoking, adhered to multidisciplinary follow-up, and achieved HbA1c 5.0%. Persistent hyperphagia, absence of a clear family history, and early-onset presentation prompted genetic testing, revealing a pathogenic SH2B1 variant [p.(Arg630Gln)], confirming non-syndromic monogenic obesity. By July 2025, she maintained HbA1c 5.3% and stable weight, showing sustained improvement. The patient provided a written consent to publish her information. Discussion: SH2B1 encodes an adaptor protein in leptin–melanocortin and insulin signaling. Pathogenic variants, such as p.(Arg630Gln), are linked to early-onset obesity, hyperphagia, and insulin resistance, typically resistant to conventional interventions. This patient’s severe obesity, hyperphagia, and metabolic syndrome led to suspicion and confirmation of a genetic cause. Bariatric surgery is not first-line therapy in monogenic obesity, but selected patients may benefit. Here, sleeve gastrectomy induced marked weight loss, remission of metabolic syndrome, and stable glycemic control over 6 years. The outcome supports surgery as a potential adjunct in genetically predisposed individuals when paired with long-term multidisciplinary care. Further studies should define optimal strategies, including the role of targeted agents such as MC4R agonists. Final Comments: This is the first Brazilian report of metabolic syndrome associated with SH2B1-related monogenic obesity successfully treated with sleeve gastrectomy. It underscores the importance of early genetic screening in severe, refractory, early-onset obesity with hyperphagia, enabling precision medicine approaches. While surgery is not standard initial treatment, it may provide durable weight and metabolic control in selected cases. Identifying genetic subtypes is key to guiding management, improving outcomes, and deepening understanding of obesity pathophysiology.

PO—279 Abdominal Circumference And miRNA-499a Expression in Patients With Diabetic Complications: Clinical And Molecular Correlation

Brito BL1; Oliveira BMB1; Sella BP1; Montemor CN1; Liboni rD1; Hildebrando I1; Zangari MEM1; Maronezi MG1; Frederico RCP1

(1) Pontifícia Universidade Católica do Paraná, Londrina, PR, Brasil

Diabetology & Metabolic Syndrome 2026: PO—279

Introduction: Abdominal obesity is considered a key marker of cardiometabolic risk, being associated with increased insulin resistance, endothelial dysfunction, and systemic inflammation. These factors contribute to the progression of diabetes-related complications, such as Diabetic Kidney Disease (DKD). In this context, microRNAs emerge as potential molecular biomarkers, capable of reflecting early changes that precede the clinical manifestations of the disease. Among them, miRNA-499a has been shown to play a significant role in regulating metabolic pathways such as insulin signaling and inflammatory response modulation. Studies have demonstrated that its overexpression is associated with increased glucose uptake and greater glycogen storage, suggesting an adaptive role in response to metabolic stress. Objective: This study examined the association between abdominal circumference and the genotypic expression of miRNA-499a in individuals with type 1 and type 2 diabetes mellitus, with and without diabetic kidney disease (DKD). Methods: A case-control design was employed, in which saliva samples from 87 diabetic patients were collected for DNA extraction and subsequent analysis of miRNA-499a polymorphisms using real-time PCR. In addition to genetic analysis, key clinical and biochemical parameters - such as abdominal circumference, glucose, and renal function markers - were collected. The diagnosis of DKD was based on albuminuria levels and renal function parameters. Results: Among the participants, 28.7% were identified as having DKD, predominantly among those with type 2 diabetes. Patients with DKD also presented significantly higher mean abdominal circumference compared to those without renal involvement. Furthermore, a statistically significant correlation (p=0.036) was observed between elevated abdominal circumference and the presence of the miRNA-499a polymorphism in the group with DKD, indicating a possible involvement of this marker in the regulation of processes related to central adiposity and chronic inflammation. Conclusion: The findings support the hypothesis that abdominal obesity, beyond being an important clinical risk factor, may also be associated with molecular mechanisms mediated by miRNAs. This association enhances the potential for risk stratification and early detection of microvascular complications in individuals with diabetes. Furthermore, assessing microRNA expression could aid in designing genetic panels, thus improving the early clinical management of individuals with diabetes.

PO—280 Association Of Body Composition Distribution Assessed by Dual-energy X-ray Absorptiometry (DXA) Among Normoglycemic, Glucose-intolerant And Diabetes Mellitus Individuals

Soares MM1; Paiva HM1; Silva RLS1; Lima VM1; Silva AM1; Mesquita CT2; Cruz GG1; Conceição FL1; Mattos FCC1; Carneiro JRI1

(1) Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (2) Universidade Federal Fluminense, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—280

Introduction: The prevalence of diabetes mellitus (DM) has grown significantly in recent decades. Estimates indicate that, in 2021, there were between 529 and 537 million people with DM worldwide; in 2022, this number increased to 828 million adults, representing a substantial rise since 1990¹². The association between body fat distribution and DM is widely recognized and goes beyond an elevated body mass index (BMI). Consistent evidence indicates that the location of adipose tissue, particularly the accumulation of visceral fat, is strongly correlated with the risk of developing DM³⁴⁵. In addition, lower lean mass is also associated with a higher risk of DM, although this relationship is less consistent⁶. Objective: To compare body composition distribution, assessed by DXA, among normoglycemic individuals, those with glucose intolerance, and those with diabetes mellitus. Methods: This cross-sectional analytical study was conducted with 42 adult individuals with a BMI ≥ 30 kg/m². Participants were divided into three groups: normoglycemic G1 (n=10), glucose-intolerant G2 (n=19), and diabetes mellitus G3 (n=13). Blood samples were collected in the morning after a 12-hour fast. Metabolic parameters (fasting glucose, HbA1c, total cholesterol, HDL-c, LDL-c, and triglycerides) and body composition by dual-energy X-ray absorptiometry (DXA) were analyzed. SPSS v. 22.0 was used, with a significance level set at p < 0.05. The study was approved by the Research Ethics Committee under protocol CAAE 82844917.8.3004.5257. Results: No significant differences were observed among the groups in terms of weight, height, BMI, circumferences, or resting metabolic rate. However, individuals with DM showed a lower percentage of total fat mass, lower fat in the gynoid region, and a higher percentage of lean mass. Visceral adipose tissue (VAT) tended to be more prevalent in G2 and G3, although without statistical significance. Conclusion: Individuals with DM showed differences in body composition, suggesting a distinct pattern of body fat distribution. However, larger studies are needed to confirm these findings, considering possible confounding factors.

PO—281 Association of Glycemic Profile and Abdominal Adiposity with Menopause in Severely Obese Women

Valentim AVG1; Salles MBCFS1; Oliveira JM1; Silva LS1; Matos EKL1; Souza NS1; Barreto Chrysostomo LB1; Siais LO1; Coimbra VOR1; Rosado EL1

(1) Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro- RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—281

Introduction: Obesity is a multifactorial chronic disease characterized by the excessive accumulation of body fat, which can be associated with other chronic diseases, such as type 2 diabetes mellitus. Menopause is a period in a woman’s life with important hormonal changes that can be associated with glycemic alterations, which can be aggravated by total and localized body adiposity. However, the joint impact of abdominal adiposity and menopause on the glycemic profile of women with severe obesity still requires further investigation. Objective: The aim of this study was to evaluate the association of menopause with glycemic profile and abdominal adiposity in severely obese women. Methods: This was a cross-sectional observational study with primary data collection, approved by a research ethics committee under protocol number CAEE 66576923.3.0000.5285. A total of 65 women with severe obesity were evaluated during the preoperative period of bariatric and metabolic surgery at a university hospital in Rio de Janeiro. Abdominal adiposity was assessed through waist circumference (WC) measurement. The glycemic profile was evaluated using blood samples collected after a 12-hour fast, through fasting glucose, insulin, glycated hemoglobin (A1C), and estimated average glucose (eAG) tests. Shapiro-Wilk’s test was applied to assess the distribution of variables. Associations between menopause, glycemic profile, and WC were analyzed using the Mann-Whitney test. Statistical significance was set at p ≤ 0.05, and analyses were performed using R software, version 4.5.1. Results: The average age of non-menopausal patients was 43 years (SD = 9.9). Menopausal women comprised 51.56% of the sample, with an average age of 60 years (SD = 7.5). In this group, the mean levels of estimated glucose and glycated hemoglobin were significantly higher (p = 0.02 and p = 0.03, respectively). Fasting glucose, insulin, and waist circumference did not differ significantly between groups. Conclusion: In women with severe obesity, menopause was associated with a worse glycemic profile, compared with non-menopausal women, regardless of abdominal adiposity.

PO—283 Clinical And Anthropometric Profile Of Individuals With Overweight Diagnosed With Or At High Risk Of Type 2 Diabetes Attending A Primary Care Center In Rio de Janeiro

Andrade ACC1; Braga ACM1; Elabras GM1; Boasquevisque ML1; Braga MCBF1; Fábio Akio Nishijuka1; Seba AM1; Mendes CGF1; Cardoso AC2; Cobas RA1

(1) Faculdade Souza Marques, Rio de Janeiro, RJ, Brasil; (2) Universidade do Estado do Rio de Janeiro, UERJ, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—283

Introduction: In 2023, the prevalence of overweight and obesity among adults in Rio de Janeiro (RJ) were 65.2% and 26.2% respectively. The concomitant metabolic and cardiovascular risk make these conditions significant health problems that deserve attention. Objective: To investigate the anthropometric and clinical profile of a sample of patients with overweight or obesity assisted at a primary healthcare center in RJ. Methods: A cross-sectional study was conducted using baseline data from the “Pilot Study on the Management of Obesity and Its Comorbidities in Primary Health Care through Health Education”. Individuals with overweight/obesity and diagnosis or high risk of type 2 diabetes underwent anthropometric assessments. Waist (WC), neck circumference (NC), body weight and height were obtained. Overweight and obesity (grades 1, 2 and 3) were classified based on BMI levels. Data on comorbidities were extracted from medical records. Data were analyzed using JAMOVI statistical software. Results are presented as n (%) and mean ± SD or median [interquartile range]. The study was approved by the Ethics Committee of the proposing institution (CAAE 80146324.7.0000.5239). Results: Overall, 25 individuals were included, 20 (80%) female, aged 50.2 ± 10.2 years, with a BMI of 36.7 ± 6.3 Kg/m2, WC of 104 ± 9.4 cm in women and 110 ± 10.4 in men; NC of 38 ± 3.5 cm in women and 43.6 ± 2.9 in men. Among them, 3 (12%) presented overweight, 9 (36%), 6 (24%) and 7 (28%) presented obesity grades 1, 2 and 3, respectively. All patients (100%) presented an elevated waist-to-height ratio (>0.5) and 22 (88%) an increased NC (>37 cm for men and 34 cm for women). Fourteen (56%) had hypertension, 3 (12%) prediabetes, 6 (24%) diabetes, 6 (24%) dyslipidemia and 6 (24%) osteoarthritis. Six (24%) reported being overweight since childhood. Thirteen (52%) reported never having received professional healthcare treatment for obesity. Six (24%) had used medication for a period of 6 [3-12] years including formulas containing appetite inhibitors, sibutramine, orlistat, and one individual had used liraglutide and bupropion/naltrexone. Conclusion: Understanding the anthropometric and clinical profile of patients with overweight in primary health care is crucial for the development of strategies focused on prevention and management. In our sample, 52% of the participants had never received professional treatment for obesity, and 24% reported excess weight since childhood, highlighting the importance of early diagnosis for effective intervention.

PO—284 Comparison of Glycemic Profile and Carbohydrate Intake in Women with Severe Obesity With and Without Leptin Gene Polymorphism

Valentim AVG1; Silva LS1; Oliveira JM1; Salle MBCFSs1; Mattos EKL1; Souza NS 1; Silveira ABCS1; Chrysostomo LB1; Siais LO1; Coimbra VOR1; Lopes TS1; Rosado EL1

(1) Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro- RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—284

Introduction: Obesity is recognized as a serious chronic disease, difficult to manage and of multifactorial etiology—including genetic factors. Certain genetic polymorphisms may influence metabolic activity, increasing the risk of developing obesity and favoring the onset of associated comorbidities. Within this context, the leptin gene (LEP) polymorphism rs7799039 has been linked to excessive weight gain, hyperglycemia, and type 2 diabetes mellitus (DM2). Analyzing whether the presence of this polymorphism in individuals with obesity is associated with alterations in glycemic parameters and carbohydrate intake may help elucidate the manifestations of these conditions and guide treatment strategies. Objective: To compare the glycemic profile and carbohydrate intake among women with severe obesity, with and without the leptin (rs7799039) polymorphism. Methods: This is a cross-sectional study, part of the research titled “Gut Microbiota, Dietary Intake, and Metabolic Profile in Individuals with Severe Obesity Undergoing Bariatric Surgery,” approved by the ethics committee (approval number: 5.621.915). The sample consisted of adult women diagnosed with severe obesity who were receiving care through the Obesity and Bariatric Surgery Program at a university hospital in Rio de Janeiro. Glycemic profile data included fasting glucose, estimated average glucose (EAG), insulin, glycated hemoglobin (A1C), carbohydrate intake, and diagnosis of DM2. The frequency of the LEP (rs7799039) polymorphism was determined using real-time PCR analysis. Data analysis was conducted using R software, with statistical significance set at p ≤ 0.05. Results: A total of 65 women were included, with median values (IQR) as follows: age 54.5 years (19.50), body mass index (BMI) 44.0 kg/m² (6.97), fasting glucose 105.5 mg/dL (26.25), EAG 123 mg/dL (22.00), A1C 5.9% (0.85), insulin 24.3 μU/mL (17.05), and carbohydrate intake 46.69% of total energy (7.80). The LEP (rs7799039) polymorphism was present in 54.69% of participants. DM2 was diagnosed in 28.57% of the sample, with no significant difference between genotypes (p = 0.55). There were no significant differences in insulin (p = 0.27), A1C (p = 0.26), fasting glucose (p = 0.27), EAG (p = 0.12), or carbohydrate intake (p = 0.48) between groups. Conclusion: LEP (rs7799039) showed a high prevalence, with no difference in glycemic indicators and carbohydrate consumption between genotypes. Studies with larger samples and different nutritional profiles are needed to elucidate its metabolic impact.

PO—285 Dietary Intake According to Clinical Obesity Classification in a High-Risk Population for Developing Type 2 Diabetes: A Cross-Sectional Analysis from the PROVEN-DIA Pilot Study

Fonseca DC1; Ostolin T1; Pinto SL2; Pagano R1; Nôleto FCM2; Caetano N2; Liz PHY2; Oliveira LT1; Santana ABN1; Alve BSs1; Martins ALF1; Bersch-Ferreira AC1

(1) A Beneficência Portuguesa de São Paulo, BP—PROADI-SUS, São Paulo, SP, Brasil; (2) Programa de Pós-graduação em Ciências da Saúde, Curso de Nutrição, Universidade Federal do Tocantins, UFT, Palmas, TO, Brasil;

Diabetology & Metabolic Syndrome 2026: PO—285

Introduction: Obesity is a major risk factor for type 2 diabetes (T2D), with a multifactorial and complex etiology. Assessments incorporating functional and clinical aspects of obesity are essential to characterize its complexity. In this context, a classification was proposed by The Lancet Diabetes & Endocrinology Commission. Objective: To describe and compare demographic characteristics and dietary intake among adults at high risk for T2D according to the new clinical obesity classification. Methods: This is a cross-sectional and exploratory analysis of baseline data from the PROVEN-DIA pilot randomized controlled trial (Clinical Trials NCT05689658). Participants were stratified as No Obesity (NO), considering low adiposity regardless of BMI, with or without signs or symptoms; Preclinical Obesity (PCO), considering BMI ≥25 kg/m² with increased abdominal adiposity or BMI ≥40 kg/m² alone, without clinical signs or symptoms of organ dysfunction; and Clinical Obesity (CO), defined by PCO criteria along with presence of signs or symptoms. Dietary quality was assessed using the Balance-Index, which evaluates consumption of four food groups according to Cardioprotective Eating guidelines; higher overall and group scores indicate better diet quality. Comparisons were performed using chi-square or Kruskal-Wallis tests as appropriate. Results: Among 220 participants, 22.3% were classified as NO, 34.1% as PCO, and 43.6% as CO. NO participants had higher consumption of the green group foods (fruits, vegetables, legumes, pulses and skimmed dairy) (p=0.035), lower BMI (p<0.001), and higher age (p=0.012). Although not statistically significant, NO individuals showed lower intake of the red group (ultra-processed foods). Participants with PCO had the highest BMI (p<0.001), largest waist circumference (p<0.001), younger age (p=0.012), and lowest consumption of green group foods (p=0.035). While not significant, CO individuals presented the lowest consumption of blue group foods (meat, chicken, pork, fish, cheese, butter and sweets) (p=0.066). Conclusion: The new classification revealed relevant differences between groups in terms of income, ethnicity, and diet quality, highlighting its potential to improve personalized interventions for T2D risk. These findings underscore the importance of novel approaches in obesity assessment.

PO—287 Impact of Bariatric Surgery on the Control of Type 2 Diabetes Mellitus in Patients Living with Obesity: Cases Analysis

Araújo Neto PF1; Jacob MJD1; Petronilho LS1; Frade GLF1; Dainezi AS1; Lopes MM1; Mascarenhas MW1; Uchoa HBMP1; Paula MP1

(1) Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—287

Introduction: Metabolic surgery is an effective intervention for managing type 2 diabetes mellitus (T2DM), particularly in patients with obesity and inadequate glycemic control. Although the Brazilian Federal Council of Medicine (CFM) recommends its indication for cases with less than 10 years of disease duration, recent studies also demonstrate benefits in long-standing disease. Postoperative glycemic improvement is attributable not only to weight loss but also to hormonal changes and enhanced insulin sensitivity, favoring remission or significant clinical improvement. Objective: To describe the profile and clinical outcomes of insulin-dependent T2DM patients undergoing bariatric surgery, evaluating time to insulin withdrawal, percentage excess weight loss (%EWL), and glycemic control. Methods: A descriptive analysis was conducted of insulin-treated patients who underwent sleeve gastrectomy or gastric bypass between 2023 and 2025. Data collected included time since diagnosis, time to insulin withdrawal, %EWL at withdrawal, and glycated hemoglobin (HbA1c) levels before and after surgery. Results: Among 39 surgical patients, 10 had T2DM and 5 were on insulin therapy. The 5 patients on preoperative insulin therapy used doses (0.25–1.57 IU/kg/day; mean: 0.91) and had a mean body mass index (BMI) of 40.5 kg/m². All 5 patients discontinued insulin, with a mean withdrawal time of 152.6 days (range: 28–253) and mean %EWL of 43.2. HbA1c levels decreased in all patients, reaching values close to or within the clinical target (<6.5%). Only one patient resumed bedtime insulin 15 months postoperatively, maintaining better glycemic control compared with the preoperative period. Four of the five patients had T2DM for over 10 years, three of them for more than 20 years, contrary to current CFM criteria, yet all maintained sustained glycemic control. Conclusion: The benefits of metabolic surgery appear to exceed the isolated effects of weight loss, likely involving increased incretin secretion (GLP-1, GIP), improved hepatic and peripheral insulin sensitivity, and hormonal adaptations that rapidly restore glucose homeostasis. In addition to metabolic improvements, patients reported enhanced quality of life and independence from insulin therapy. These findings support the efficacy of metabolic surgery even in long-standing T2DM and indicate the need to reassess time-based eligibility criteria.

PO—288 Iron Profile in Patients Undergoing One Anastomosis Gastric Bypass versus Roux-en-Y Gastric Bypass: Long-Term Implications for Metabolic Surgery in Type 2 Diabetes

Martinez GS1; Hamamura MK2; Chaim FDM2; Chaim EA2

(1) Pontifícia Universidade Católica de Campinas, Campinas, SP, Brasil; (2) Universidade Estadual de Campinas, Campinas, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—288

Introduction: Metabolic surgery has emerged as a powerful therapeutic strategy for obesity and type 2 diabetes mellitus (T2DM), providing sustained weight loss and high rates of diabetes remission. Among the most widely performed procedures, one anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) demonstrate remarkable metabolic benefits. However, these techniques may also predispose patients to micronutrient deficiencies, particularly iron deficiency, which can evolve into anemia and compromise long-term outcomes in this population. Understanding these risks is essential for optimizing the management of patients with T2DM who undergo bariatric surgery. Objective: To evaluate and compare the iron profile in patients submitted to OAGB and RYGB, identifying subgroups at higher risk of anemia. Methods: A retrospective, cross-sectional study was conducted including 158 patients (79 OAGB and 79 RYGB) matched by age and sex, aged 18–65 years. Laboratory data were analyzed at three time points: preoperative, recent postoperative (mean 1 year and 5 months), and late postoperative (mean 4 years and 1 month). Hematological and iron-related parameters (hemoglobin, hematocrit, ferritin, transferrin saturation) were evaluated using descriptive and inferential statistics (SPSS). Ethical approval was obtained (CAAE 58184516.2.0000.5404; no. 3.706.249). Results: Groups were homogeneous in age and sex. Preoperatively, hemoglobin levels were similar (14.12 g/dL OAGB vs. 13.91 g/dL RYGB). In the recent postoperative period, both groups showed expected declines (Hb 12.39 g/dL OAGB vs. 12.56 g/dL RYGB; ferritin 114.71 ng/mL vs. 143.08 ng/mL). In the late postoperative period, OAGB patients exhibited significantly lower mean values (Hb 12.03 g/dL vs. 12.72 g/dL; ferritin 88.19 ng/mL vs. 125.79 ng/mL), with the lowest hemoglobin levels observed in the 18–25-year subgroup (11.2 g/dL). The incidence of anemia was higher in OAGB, particularly among women and younger patients. Conclusion: While metabolic surgery remains an effective therapeutic option for T2DM, our findings demonstrate that OAGB is associated with a greater long-term risk of iron deficiency and anemia compared to RYGB. Women and younger patients appear to be the most vulnerable groups. These results reinforce the need for tailored nutritional monitoring and preventive supplementation strategies in diabetic patients undergoing metabolic surgery, in order to preserve metabolic benefits while minimizing long-term complications.

PO—289 Long-Term Follow-Up after Bariatric Surgery in Patients with Type 1 Diabetes and LADA: A Case Series

Ferreira ATF1; Alves GC2; Raquel de Carvalho Abi Abib1; Dantas JR1; Carneiro JRI1; Zajdenverg L1; Rodacki M1

(1) Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—289

Case Presentation: Case 1: Male, 33 years old, Type 1 Diabetes Mellitus (T1DM) since age 17, HbA1c 6.3%, grade III obesity (153 kg, Body Mass Index—BMI 44.7 kg/m²), albuminuria, hypertension and dyslipidemia. Baseline total insulin: 0.81 IU/kg/day. After sleeve gastrectomy, nadir weight was 94 kg (Excess Weight Loss—EWL 87.5%), with insulin reduced to 0.14 IU/kg/day. Seven years later, at age 40, weight is 116 kg, HbA1c 6.6%, comorbidities improved, is on a single antihypertensive, with no albuminuria, and persistently lower insulin needs. Case 2: Female, 52 years old, Latent Autoimmune Diabetes in Adults (LADA) diagnosed at 16 (on insulin since age 23), with adequate glycemic control, grade III obesity (102 kg, BMI 42.4 m²), hypertension, dyslipidemia, osteopenia, psoriasis and post-thyroidectomy hypothyroidism. Baseline insulin: 0.64 IU/kg/day. Underwent Roux-en-Y gastric bypass, reaching a nadir weight of 61 kg (EWL 97.8%); insulin reduced to 0.19 IU/kg/day. Six years later, at age 58, weighs 73.5 kg, insulin dose is 0.24 IU/kg/day, HbA1c is 6,8%, on one anti-hypertensive. Case 3: Female, 27 years old, T1DM since age 11, HbA1c 7%, grade III obesity (106 kg, BMI 40.8 kg/m²), metabolic dysfunction-associated steatotic liver disease (MASLD) and dyslipidemia. Baseline insulin: 1.03 IU/kg/day. Roux-en-Y gastric bypass led to nadir weight 54 kg (EWL 113.2%), insulin reduced to 0.71 IU/kg/day; MASLD and dyslipidemia improved. Pre-existing glycemic lability worsened postoperatively, with severe hypoglycemia in 2022, requiring insulin pump initiation. Nine years after surgery, regained weight to 74 kg, insulin dose is 0.59 IU/kg/day and HbA1c is 6,4%. All patients provided a written consent to publish their information. Discussion: Discussion: Severe obesity in T1DM or LADA exacerbates insulin resistance. Although data are scarce, these cases show that bariatric surgery can result in long-term sustained insulin reduction, substantial weight loss and improvement of comorbidities. Lower insulin doses may ease glycemic management, reduce costs and weight gain, and improve quality of life. However, potential drawbacks include greater glycemic variability and increased hypoglycemia risk, requiring close monitoring. Final Comments: Final comments: Bariatric surgery may be an option for selected T1DM and LADA patients with obesity, offering substantial metabolic and clinical benefits. Careful patient selection and close follow-up are essential to balance potential gains against the risk of postoperative glycemic instability.

PO—290 Practical Use of the Eating Behavior Phenotypes Scale (EFCA) in People With Diabetes Mellitus (DM) and Obesity

Pineda-Wieselberg RJ1; Soares AH1; Salles JEN1

(1) Santa Casa de São Paulo, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—290

Introduction: Diabetes mellitus (DM) is a chronic condition characterized by metabolic alterations that can affect eating behaviour. Among the classic symptoms of uncontrolled DM is polyphagia, often associated with persistent hyperglycemia. The Eating Behavior Phenotypes Scale (EFCA) is used to characterize eating behaviour profiles, but it remains unclear whether individuals with well-managed DM differ from those without DM in EFCA scores. This question is relevant because DM is common among individuals living with obesity, and EFCA is a novelty used to guide therapeutic strategies, including pharmacological interventions. Objective: To evaluate whether individuals living with well-managed DM is associated with differences in EFCA scores and subscales compared to individuals without DM. Methods: A cross-sectional analysis was performed in a cohort of 99 individuals undergoing obesity treatment. Participants were divided into two groups: with type 2 DM and without DM. DM diagnosis was based on clinical records, and glycemic management was assessed by glycated hemoglobin (HbA1c). Well-managed DM was defined as mean HbA1c ≤ 7.0%. The primary outcome was the EFCA total score; secondary outcomes were its five subscales (hedonic, emotional, compulsive, disorganized, hyperphagic). Comparisons between groups were performed using Welch’s t-test for independent samples, with significance set at p < 0.05. Analyses were conducted in R software. Results: The study included 43 patients with DM and 56 without DM. Mean HbA1c was higher in the DM group (6.30%) than in the non-DM group (5.42%, p < 0.000001), but within the target for adequate management. No statistically significant differences were observed in EFCA total score (42.86 vs. 45.30; p = 0.336) or in any subscales: hedonic (p = 0.403), emotional (p = 0.210), compulsive (p = 0.099), disorganized (p = 0.135), and hyperphagic (p = 0.479). . Conclusion: In patients with obesity and well-managed DM, EFCA scores and subscales do not differ from those without DM. These findings suggest that polyphagia is more closely related to poor glycemic management than to the diagnosis of DM itself. EFCA can be reliably applied to populations with and without DM, provided glycemic status is considered. Further longitudinal studies with larger samples are warranted to confirm these results and explore the impact of glycemic variability on eating behaviour.

PO—291 Prevalence And Clustering Of Risk Factors For Metabolic Syndrome In University Professors

Silva IA1; Alves LO2; Freitas FC1; Pinto CM1; Ribeiro CDC1; Cocate PG1

(1) Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; (2) Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—291

Introduction: Metabolic syndrome (MS) affects approximately one quarter of the global population and is characterized by the simultaneous presence of multiple risk factors that can lead to the development of cardiovascular diseases and type 2 diabetes. The prevalence and clustering of this set of factors can be easily influenced by sex, age group, socioeconomic factors, and lifestyle habits, such as diet, physical activity levels, or sedentary behavior. A more detailed investigation of these risk factors for MS is relevant for a better understanding of the disease and for guiding treatment and prevention actions. Objective: This study aimed to describe the prevalence of risk factors for Metabolic Syndrome and to investigate the clustering of these factors in a sample of Brazilian adults. Methods: This cross-sectional study was carried out among professors at a public university. Anthropometric, hemodynamic, and biochemical measurements were performed following validated protocols. The presence of three or more of the following components—abdominal obesity, high blood pressure, dyslipidemia (elevated triglycerides, reduced HDL-C), and glycemic alterations—was considered for the diagnosis of MS. Descriptive analyses of the data were performed, as well as clustering of risk factors to identify the clusters. Results: The sample of this study consisted of 219 university professors of both sexes, the majority being women (64%), with a mean age of 49 years (SD = 9.9). The prevalence of MS was 26% (n = 57). The three most frequent isolated risk factors in our sample were increased waist circumference (WC) (n = 153, 69.8%), high blood pressure (BP) (n = 71, 32.4%), and altered blood glucose (n = 55, 25.1%). The most frequent profile among those with MS was the combination of increased WC, high BP, and altered triglycerides (TG) (n = 11, 19.3%), followed by increased WC, high BP, altered TG, and altered blood glucose (n = 9, 15.7%). Conclusion: Increased WC, high BP, and altered blood glucose showed high prevalences in our sample. The co-occurrence of increased WC, high BP, and altered TG composed the most frequent profile among individuals diagnosed with MS. These data may help guide prevention and treatment actions for MS risk factors in university professors.

PO—292 Relationship Between Leptin And Metabolic Syndrome In Female Shift Workers From Southern Brazil

Garcez A1; Kohl IS1; Silva JC2; Arruda HC1; Olinto MTA1

(1) Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil; (2) Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—292

Introduction: Metabolic syndrome is a cluster of cardiometabolic risk factors primarily driven by insulin resistance and adiposity. Leptin, an adipocyte-derived hormone, regulates energy balance, appetite, and neuroendocrine functions, and is closely associated with both adiposity and insulin resistance. Despite its relevance, limited data exist on the association between leptin and metabolic syndrome in female shift workers. Objective: To examine the association between serum leptin levels and metabolic syndrome in female shift workers. Methods: In this cross-sectional study, 301 female shift workers from three companies in the Porto Alegre Metropolitan Region (Rio Grande do Sul State, Brazil) were evaluated. Metabolic syndrome was defined according to the Joint Interim Statement as the presence of three or more of the following: abdominal obesity (waist circumference ≥ 88 cm), triglycerides ≥ 150 mg/dL, HDL < 50 mg/dL, elevated BP (systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 85 mmHg or antihypertensive use), and fasting glucose ≥ 100 mg/dL or antidiabetic use. Serum leptin was measured in fasting samples. The Wilcoxon rank-sum test was used to compare leptin levels by metabolic syndrome status. Results: Participants had a mean age of 35.5 ± 10.1 years. The prevalence of metabolic syndrome was 13.3% (95% confidence interval [CI]: 9.4–17.1). Median serum leptin for all participants was 27.4 ng/mL (interquartile range [IQR]: 15.9–41.9). Women with metabolic syndrome had significantly higher leptin levels (median = 45.1 ng/mL; IQR: 29.7–59.8) than those without (median = 26.5 ng/mL; IQR: 15.5–39.0; p < 0.001). The prevalence of metabolic syndrome did not differ between night and day shift workers (13.0% vs. 15.4%), but night shift workers tended to have higher leptin levels (median = 34.0 ng/mL; IQR: 19.3–51.5) than day shift workers (median = 27.4 ng/mL; IQR: 15.7–40.6; p = 0.07). Conclusion: Elevated serum leptin levels are associated with metabolic syndrome in female shift workers. These findings suggest that reducing circulating leptin could confer cardiometabolic protection in this occupational group.

PO—295 Socioeconomic Profile of Individuals With Obesity Diagnosed With Or At High Risk of Type 2 Diabetes in Rio de Janeiro: Results Of The Pilot Study On Management Of Obesity And Its Comorbidities In Primary Care Through Health Education

Elabras GM1; Boasquevisque ML1; Braga MCBF1; Andrade ACC1; Braga ACMC1; CFM1; Cardoso AC2; Seba AJ1; Nishijuka FA1; Cobas RA2

(1) Faculdade Souza Marques, Rio de Janeiro, RJ, Brasil; (2) Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—295

Introduction: The prevalence of obesity in adults in Rio de Janeiro (RJ) was 21.5 and 26.2% in 2021 and 2023, respectively, representing an absolute increase of 4.7% in two years. The recognition of the socioeconomic profile of the patients is important to guide regional intervention strategies. Objective: To investigate the socioeconomic profile of a sample of patients with obesity diagnosed with or at high risk of Type 2 diabetes treated at a primary healthcare center in RJ. Methods: Cross-sectional study including baseline data from the “Pilot Study on Management of Obesity and its Comorbidities in Primary Care through Health Education”. Adults with overweight/obesity and high risk for Type 2 Diabetes (T2D) by Findrisc or with diagnosis of T2D were included. Standardized questionnaires were applied to collect socioeconomic data. The analysis was performed using the JAMOVI statistical software with descriptive statistics and ANOVA test. The results are presented as n (%) and mean ± SD or median [interquartile range]. The study was approved by the Research Ethics Committee of the proposing institution (CAAE 80146324.7.0000.5239). Results: A total of 25 individuals were included, 20 (80%) female; aged 50.2 ± 10.2 years; 17 (68%) from other Brazilian States; 13 (52%) in a stable relationship; 23 (92%) reported practicing some religion. Six (68%) had complete or incomplete elementary school, 4 (16%) completed high school and 4 (16%) higher education. Of the total, 3 (12%) were unemployed, 4 (16%) retired and 18 (72%) employed. One (4%) did not have running water; 10 (40%) did not have a nearby leisure area; 7 (28%) reported excessive noise at night interfering with sleep and 15 (60%) felt insecure due to urban violence. Family income was less than 2 minimum wages in 12 (48%) and the number of people living on this income was 3 [2-3]. Eight (32%) belonged to class B and 17 (68%) to class C according to ABEP classification. The BMI values ​​(kg/m2) were different among social classes (p=0.016): Class B1 (30.5 ± 1.61); B2 (36 ± 5.73); C1 (38.7 ± 7.15); C2 (38.1 ± 6.41). Conclusion: In our sample of patients with obesity, a large proportion of patients did not have leisure areas near their houses and felt insecure with urban violence, both factors that can impact mental health. Also, a family income of less than two minimum wages supports a family of three people. BMI was higher in lower social classes which represents a challenge for managing obesity in a population exposed to socioeconomic difficulties.

PO—298 Distribution Of The Main Risk Factors For Type 2 Diabetes Development Across Brazilian Macroregions: Insights From the PROVEN DIA Pilot Study S

Ostolin TLVDP1; Fonseca DC1; Perillo AP2; Machado MMA2; Vaz IMF2; Carvalho ACMS2; Martins ALF1; Oliveira LT1; Santana ABN1; Alves BS1; Pagano R1; Bersch-Ferreira AC1

(1) A Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil; (2) Unidade de Hipertensão Arterial. Hospital das Clínicas da Universidade Federal de Goiás. Goiânia, Brasil, Goiânia, GO, Brasil

Diabetology & Metabolic Syndrome 2026: PO—298

Introduction: Factors such as sex, age, and geographical location have been associated with varying prevalences of type 2 diabetes mellitus (T2DM). For public health prevention policies to be effective, it is essential to understand how risk factors are distributed across the country’s regions. In this context, characterizing the risk factors present in individuals at high risk for developing T2DM can guide the design of region-specific preventive strategies. Objective: To compare the distribution of the main risk factors (age, sex, family history, hypertension, physical inactivity, and excess weight) for developing T2DM among Brazilian adults at elevated risk across the country’s five macroregions. Methods: This was a cross-sectional analysis of baseline data from the PROVEN-DIA pilot randomized controlled trial (ClinicalTrials.gov identifier: NCT05689658). Adults (18–65 years) with excess weight and high risk for developing T2DM were eligible. Risk was assessed using the Centers for Disease Control and Prevention diabetes risk test, which includes the following factors: age, sex, previous diagnosis of gestational diabetes, family history, hypertension, physical inactivity, and body mass index (BMI). The total score ranges from 0 to 11 points, with ≥5 indicating high risk for developing diabetes. When applicable, comparisons were performed using the chi-square test or Kruskal–Wallis’ test with Dunn’s post hoc analysis. Results: Of the 220 participants, 71.8% were female, with a mean age of 48.7 ± 9.5 years and a BMI of 33.2 ± 5.8 kg/m². Overall, the most prevalent factors were family history, BMI, hypertension, and age between 40–59 years. Differences between macroregions were observed for hypertension (p = 0.009) and physical inactivity (p = 0.008). The highest prevalences of hypertension and physical inactivity were found in the Northeast (67.5% and 80%, respectively). BMI was lower in the North compared with other regions (p = 0.006). No significant differences were observed for the remaining factors. The lowest mean risk score was recorded in the North and the highest in the Midwest (4.8 and 6.1 points, respectively). Conclusion: The findings reveal significant regional variations in the prevalence of hypertension, physical inactivity, and BMI among participants, particularly with higher rates in the Northeast. These results underscore the importance of region-specific strategies to address the assessed risk factors.

PO—299 Incretin-Based Therapies for Prediabetes Remission: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Montejano L1; Barbosa AL1; Saldarriaga LM2; Trevisan T3; Pasqualotto E4; Giacaglia LR5

(1) Universidade Nove de Julho, São Paulo, SP, Brasil; (2) Universidad CES, Colombia; (3) Private Practice, Itajaí, SC, Brasil; (4) Universidade Federal de Santa Catarina, Florianópolis, SP, Brasil; (5) Sociedade Brasileira de Diabetes, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—299

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are well-established treatments for improving glycemic control and promoting weight loss in individuals with type 2 diabetes (T2D). Emerging evidence suggests these agents may also play a significant role in reversing prediabetes. Objective: This meta-analysis aims to compare the efficacy of currently available GLP-1 RAs in promoting remission of prediabetes and improving components of metabolic syndrome in adults with prediabetes. Methods: A systematic search of PubMed, Embase, and Cochrane Central identified randomized controlled trials (RCTs) comparing GLP-1 RAs (liraglutide, semaglutide, tirzepatide) to placebo in individuals with prediabetes. The primary outcome was regression of prediabetes via glycated hemoglobin (HbA1c) reduction. Analyses focused on the maximum dose using mean differences (MDs) with 95% confidence intervals (CIs) under a random-effects model. Heterogeneity was assessed with Cochrane’s Q and I². Statistical analysis was conducted in R (v4.4.2). Results: Six studies involving 5,298 subjects were included. The mean age of participants was 49.8 years, 70.2% were female, and the mean BMI was 37.1kg/m². In the pooled analysis, both HbA1c (MD: -0.34%; 95% CI: -0.52, -0.17; p=0.0001) and fasting plasma glucose (MD: -8.65 mg/dL; 95% CI: -11.29, -6.01; p<0.00001) were significantly reduced in the GLP-1 RA group compared to placebo. Weight (MD: -7.11 kg; 95% CI: -13.72, -0.49; p=0.04), waist circumference (MD: -5.88 cm; 95% CI: -11.34, -0.42; p=0.03), triglycerides (SMD: -0.40; 95% CI: -0.76, -0.03; p=0.03) and systolic blood pressure (MD: -4.80 mmHg; 95% CI: -7.75, -1.85; p=0.001) also decreased significantly. Fasting insulin, HDL cholesterol, and diastolic blood pressure showed no significant changes. Adverse events were more frequent with GLP-1 RAs (RR: 1.06; 95% CI: 1.04, 1.09; p<0.00001). Conclusion: Incretin-based therapies were associated with improved glycemic control and cardiometabolic parameters in individuals with prediabetes. Specifically, these agents reduced HbA1c, fasting glucose, triglycerides, weight, waist circumference, and systolic blood pressure. Further research is needed to evaluate their long-term safety and applicability across prediabetic populations.

PO—300 Male Mice With type 2 Diabetes Exhibit Increased Gene Expression Of Targets Associated With Neurodegeneration And Neuroprotection In The Hypothalamus and Hippocampus

Lemos JL1; Maschio DA1; Barbosa HC1

(1) Universidade Estadual de Campinas, Campinas, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—300

Introduction: Type 2 diabetes mellitus (T2D) is a chronic disease with high morbidity worldwide. T2D can cause central insulin resistance, as occurs in Alzheimer’s disease (AD), but it is not yet established whether T2D can promote neurodegeneration. Objective: identify alterations in key molecules associated with AD. Methods: male C57BL/6 mice, CEUA 6069-1/23, fed a high-fat diet for 16 weeks (HFD) vs controls fed a standard diet (CTL); to investigate the mRNA levels of APP, GSK3-β and BACE1 (markers of neurodegeneration), and X11α (marker of neuroprotection). Furthermore, we evaluated the levels of NRF2, a nuclear transcription factor, and VDAC3, a porin of the outer mitochondrial membrane, both associated with oxidative response. Results: After 16 weeks of treatment the mice became hyperglycemic, hyperinsulinemic, glucose intolerant (confirmed by ipGTT), and exhibited peripheral insulin resistance (confirmed by ipITT), it is worth noting that these mice also present dysfunction in insulin secretion, already showed in previous work by our group, being characterized as a T2D model. The HFD mice also became obese (shown by the Lee index). RT-PCR showed that in the hypothalamus there was a statistically significant increase in gene expression of APP (CTL, 1±0 vs. HFD, 2.1±0.8; p=0.002), and of the neurodegeneration markers GSK3-β (CTL, 1±0 vs. HFD, 5±1; p=0.0001), and BACE-1 (CTL, 1±0 vs. HFD, 2.4±0.4; p=0.0001). In contrast, there was also an increase in the antioxidant response markers: NRF2 (CTL, 1±0 vs. HFD, 2.1±0.6; p=0.0001), and VDAC3 (CTL, 1±0 vs. HFD, 14±11; p=0.03), but there was no statistical difference in the X11a (CTL, 1±0 vs. HFD, 1.02±0.35; p=0.8). In the hippocampus, there was a significant increase in APP (CTL, 1±0 vs. HFD; 4.2±0.9; p=0.0001), and GSK3-β (CTL, 1±0 vs. HFD, 1.3±0.2; p=0.02), but there was no statistical difference in BACE-1 (CTL, 1±0 vs. HFD, 0.6±0.5; p=0.1). In contrast, there was a statistically significant increase in VDAC3 (CTL, 1±0 vs. HFD, 4±2.6; p=0.03) and X11a (CTL, 1±0 vs. HFD, 1.7±0.36; p=0.0001), while there was no difference in expression of NRF2 (CTL, 1±0 vs. HFD, 1.1±0.4; p=0.4); n=6-9 mice/group Conclusion: the results suggest that in mice with T2D and obesity, triggers for neurodegeneration processes may occur, as well as triggers for neuroprotection processes, such as those involved in the cellular antioxidant response. However, further studies are needed to better understand the effects of this differential expression of important genes in the central nervous system.

PO—301 Effects Of Lifestyle And Pharmacologic Interventions On First-phase Insulin Secretion And Insulin Sensitivity: A Systematic Review And Meta-analysis Of Randomized Trials (2019 – 2025)

Pinheiro LC1

(1) Universidade de Fortaleza, Fortaleza, CE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—301

Introduction: Restoring first-phase β-cell insulin release and improving peripheral insulin sensitivity are key goals for preventing progression from pre-diabetes to type 2 diabetes. Since 2019, many trials have tested whether diet, exercise, or modern agents such as GLP-1 receptor agonists (GLP-1 RAs) and SGLT-2 inhibitors can enhance the acute insulin response (AIR) during an intravenous glucose-tolerance test (IVGTT) or the M-value of the hyperinsulinemic–euglycemic clamp, yet their collective efficacy is unsettled. Objective: To quantify, through random-effects meta-analysis, the effects of lifestyle and pharmacologic interventions on AIR and M-value in adults with impaired glucose regulation or early diabetes and to explore heterogeneity by intervention class and baseline glycemic status. Methods: We performed a PRISMA-compliant search of MEDLINE, Embase, Scopus, SciELO, and CENTRAL (1 Jan 2019 – 1 Jul 2025) for randomized controlled trials reporting pre- and post-intervention AIR (0–10 min IVGTT) or clamp-derived M-value. No language limits were applied. After deduplication, two reviewers independently screened records, extracted means ± SD, and assessed risk of bias (RoB 2.0). Hedges g was pooled with a DerSimonian–Laird model; meta-regression tested baseline HbA1c. Results: Of 2 452 records, 1 904 remained after duplicates; 263 full texts were assessed and 108 trials (n = 8 412) met inclusion criteria (table). Interventions were GLP-1 RAs (30 trials), SGLT-2 inhibitors (18), structured diet alone (16), diet + exercise (22), high-intensity interval training (10), and other drugs (12). Overall, interventions increased AIR (g = 0.46; 95 % CI 0.32–0.60; I² = 48 %) and M-value (g = 0.38; 0.25–0.51; I² = 42 %). GLP-1 RAs produced the largest AIR improvement (g = 0.71), whereas diet + exercise yielded the greatest M-value gain (g = 0.52). Meta-regression showed larger effects at lower baseline HbA1c (β = –0.06; p = 0.03). Risk of bias was low in 45 % of trials, with no publication bias by Egger test. Conclusion: Between 2019 and 2025, randomized evidence indicates that modern pharmacotherapies and intensive lifestyle programs consistently—though modestly—enhance first-phase insulin secretion and insulin sensitivity, especially in earlier dysglycemic states. Longer trials are needed to examine the durability of β-cell gains and to link mechanistic improvements with clinical risk reduction. Table.

PO—303 Gene Expression Analysis Of Pancreatic Islets From Pancreatectomized Patients Reveals New Candidate Genes To Circadian Control And Altered Rhythms In 10% Of Genes In Type 2 Diabetes

Menezes CD1; Sá LGS1; Miguel RDS1; Araujo DN1; Santana CBC1; Rodrigues AKBF1; Santos EB1; Silva ADL1; Silva JCB1; Verçosa CD1; Silva JPE1; Oliveira Júnior JS1; Costa EVC1; Figueiredo DS2

(1) Universidade Federal de Alagoas, UFAL, Arapiraca, AL, Brasil; (2) Universidade Federal de Alagoas, UFAL, Maceió, AL, Brasil

Diabetology & Metabolic Syndrome 2026: PO—303

Introduction: Although circadian rhythms regulate pancreatic physiology, population level studies in type 2 diabetes (T2D) are scarce because sampling times are rarely recorded. Objective: To characterize the circadian transcriptome (whole-RNA, across the 24-h day) of pancreatic islets from non-diabetic (ND) and T2D patients. Methods: We analyzed microarray-based gene expression from laser-capture micro dissected human islets (free of exocrine contamination) obtained from pancreatectomy specimens (ND, n = 32; T2D, n = 36; GSE76896). Gene symbols were harmonized to HGNC and expression values were standardized to z-scores. Sampling times were computationally reconstructed with CIRCUST (R package; PMID: 37769026). Circadian rhythmicity was assessed using the FMM model (R package; PMID: 31822685), adopting a goodness-of-fit threshold of R² ≥ 0.5. Integrity of the core clock positive/negative feedback loops was evaluated with CCMapp (R). Group comparisons used Student’s t test. Previously reported datasets (PMID: 19765810; PMID: 33443164) were leveraged to nominate candidate clock genes. Results: Of 14,709 genes, 1,503 (10.2%) were rhythmic in ND (R² 0.5–0.8). Of these, 1,490 lost rhythmicity in T2D, with mean R² decreasing from 0.52 ± 0.04 (ND) to 0.25 ± 0.07 (T2D; t test, p < 0.05); only 13 genes remained rhythmic in both groups. In ND, 563 genes peaked at night and 940 during the day. This day–night structure in gene expression collapsed in T2D. For clock genes, correlation-matrix analyses at the group level showed no differences. However, at the individual-gene level, rhythm robustness declined broadly (e.g., PER1=R²: 0.7 to 0.3; CLOCK=R²: 0.6 to 0.3). Several clock genes that peaked at night in ND shifted their phase in T2D. Finally, we identified 21 genes within the ND-rhythmic set (10.2%) previously validated as modulators of circadian rhythms. Notably, MIR210HG (a microRNA non-coding transcript) implicated in repression of ribosomal translation of proteins via miR-210 and is relevant to pancreatic physiology and T2D. Conclusion: We identified evidence of disrupted gene-expression rhythms in pancreatic islets in T2D and of potential clock genes. A deeper understanding of the pathophysiology underlying pancreatic cell dysfunction may refine therapeutic strategies.

PO—304 Prolonged Use of Diazoxide in Patients with Congenital Hyperinsulinism: Report of Two Cases Treated at a Tertiary Hospital in Rio de Janeiro

Confortin AC1; Brandl L1; Araújo MMD1; Teixeira NT1; Gama MRB1; Messias ACNV1

(1) Hospital Federal Servidores do Estado, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—304

Case Presentation: Case 1: This is a female patient who presented with recurrent episodes of hypoglycemia during the first months of life, leading to a confirmed diagnosis of Congenital Hyperinsulinism (CHI) associated with hypoammonemia. She began treatment with injectable diazoxide solution at 7 months of age, 300mg/20mL administered orally and provided through the public health system. Later in life, she was also diagnosed with Bardet-Biedl Syndrome and Hashimoto’s hypothyroidism. Currently, at age of 18, she continues to take 120mg of diazoxide orally, twice daily. Case 2: A male patient who presented with severe hypoglycemia associated with seizures during the neonatal period. He was diagnosed with CHI and started diazoxide at 40 days of life. Further investigations revealed hyperammonemia, and a somatostatin analog scintigraphy with no capitating lesions. Genetic testing was negative for classical CHI mutations (GLUD1, HADH, SCL16A1, ABCC8, GCK, and KCNJ11). Currently, at age of 32, the patient continues to use 135mg of Diazoxide 3 times a day. Throughout follow-up of both patients, dietary adjustments and diazoxide dose titration were performed. During the entire period, there were no reports of adverse effects or difficulties in administering the medication; however, access to the drug remains the main therapeutic barrier. All patients provided a written consent to publish their information. Discussion: CHI is the leading cause of persistent hypoglycemia in childhood, and diazoxide remains the treatment of choice when the condition is responsive. Nevertheless, there is still limited data in the literature regarding its continuous use over decades. In one 17-children cohort, the average treatment duration was 7.25 years, with discontinuation due to remission occurring around 8.5 years of age. In a 154-patient italian series, the rate of spontaneous remission exceeded 30%, particularly in cases diagnosed during the neonatal period. These findings suggest that remission is more commonly associated with milder forms and very early onset, which contrasts with the cases presented here, where, despite prolonged use of diazoxide for 18 and 31 years respectively and good glycemic control, remission has not yet occurred. Final Comments: Therefore, these case reports reinforce the importance of early diagnosis and treatment, long-term follow-up, and demonstrate that the use of diazoxide can be safe and effective over decades. Furthermore, they suggest the need for public policies that ensure continued access to high-cost medications, as chronic use may be necessary.

PO—305 Responses Of High-Intensity Aerobic Training On A Pro- Inflammatory Cytokine Marker And A Component Of The Glucose Uptake Pathway In Obese Mice

Ribeiro JNS1; Ribeiro PLBS2; Lacerda Junior FF2; Vieira AM3; Cruz PWS4; Vasconcelos AR5; Soares AHG1; Valente VJMBS1; Vancea DMM4; Carvalho BM6

(1) Faculdade Pernambucana de Saúde (FPS), Recife, PE, Brasil; (2) Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada (UPE), Recife, PE, Brasil; (3) Laboratório de Imunometabolismo (UPE), Recife, PE, Brasil; (4) Escola Superior de Educação Física (UPE), Recife, PE, Brasil; (5) Programa de Pós-graduação em Reabilitação e Desempenho Funcional (UPE), Petrolina, PE, Brasil; (6) Instituto de Ciências Biológicas (UPE), Recife, PE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—305

Introduction: Obesity is characterized by a chronic inflammatory state that induces the release of pro-inflammatory cytokines, negatively impacting several metabolic processes, including glucose uptake, which may contribute to the development of insulin resistance. Tumor Necrosis Factor α (TNF-α), secreted by hypertrophied adipose tissue, adversely affects glucose metabolism. AMP-activated protein kinase (AMPK) is a key protein in the glucose uptake pathway, independent of insulin stimuli, contributing to glucose homeostasis. Objective: To analyze the response of high-intensity aerobic training on a pro-inflammatory cytokine marker and a component of the glucose uptake pathway in obese mice. Methods: Ten male Swiss mice were divided into two groups: Obese Sedentary Group (OSG) and Obese High-Intensity Aerobic Group (OAIG). Obesity was induced through an eight-week high-fat diet (carbohydrates: 49.5%; proteins: 15.5%; lipids: 35%). The exercise protocol consisted of swimming in tanks with a diameter of 45 cm and water temperature maintained at 34 °C. The High-Intensity Aerobic Training Protocol (HIATP) consisted of three sessions, each lasting 7 minutes, with 14 intervals of 20 seconds at 9% body weight overload, interspersed with 10 seconds of rest. Following anesthesia, muscle tissue was collected for western blot analysis of TNF-α and phosphorylated AMPK (p-AMPK) expression. Statistical analysis was performed using an unpaired Student’s t-test, adopting a significance level of p ≤ 0.05. The study was approved by the local Animal Ethics Committee under protocol nº 08/2020. Results: Analysis of TNF-α expression revealed that the sedentary group exhibited significantly higher values compared with the aerobic training group (OSG 9,763.66 ± 722.61 vs. OAIG 5,533.83 ± 332.26, p = 0.00). Phosphorylation of AMPK (p-AMPK) was more strongly stimulated in the HIATP group, showing statistically significant values (OAIG 26,504.67 ± 1,252.07 vs. OSG 14,166.33 ± 1,641.85, p = 0.00). Conclusion: These findings demonstrate that high-intensity aerobic training in obese mice effectively reduced the expression of a key pro-inflammatory cytokine marker (TNF-α) and enhanced glucose uptake via AMPK phosphorylation. Thus, highlighting the importance of the biomolecular aspects of exercise on inflammation and glucose uptake.

PO—306 Response of Moderate And High Intensity Aerobic Training On ESPONSES OF Indoleamine 2,3-Dioxygenase Expression in Adipose And Muscle Tissue Of Obese Mice

Ribeiro JNS1; Ribeiro PLBS2; Lacerda Júnior FF3; Vieira AM4; Cruz PWS5; Vasconcelos AR6; Soares AHG1; Valente VJMBS1; Vancea DMM5; Carvalho BM7

(1) Faculdade Pernambucana de Saúde (FPS), Recife, PE, Brasil; (2) Programa de Pós Graduação em Biologia Celular e Molecular Aplicada (UPE) , Recife, PE, Brasil; (3) Programa de Pós Graduação em Biologia Celular e Molecular Aplicada, Recife, PE, Brasil; (4) Laboratório de Imunometabolismo (UPE), Recife, PE, Brasil; (5) Escola Superior de Educação Física (UPE), Recife, PE, Brasil; (6) Programa de Pós Graduação em Reabilitação e Desempenho Funcional (UPE), Petrolina, PE, Brasil; (7) Instituto de Ciências Biológicas (UPE) , Recife, PE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—306

Introduction: Obesity is accompanied by inflammation and insulin resistance. Indoleamine 2,3-dioxygenase (IDO), activated by pro-inflammatory cytokines. Aerobic training may modulate the kynurenine pathway due to the rapid conversion into kynurenic acid and other metabolic intermediates. Objective: To analyze the response of moderate- and high-intensity aerobic training on the expression of indoleamine 2,3-dioxygenase in adipose and muscle tissue of obese mice. Methods: Fifteen male Swiss mice were divided into three groups: Obese Sedentary Group (OSG), Obese Moderate Aerobic Group (OMAG), and Obese High-Intensity Aerobic Group (OAIG). The exercise strategy employed was swimming. The Moderate-Intensity Aerobic Training Protocol (MIATP) consisted of three sessions totaling 2 hours, with four 30 minute bouts interspersed with 5 minute rest intervals. The High-Intensity Aerobic Training Protocol (HIATP) consisted of three sessions, each lasting 7 minutes, with 14 intervals of 20 seconds at 9% body weight overload, interspersed with 10 seconds of rest. Following anesthesia, adipose and muscle tissues were collected for western blot analysis of IDO protein expression. Statistical analysis was conducted using ANOVA with Bonferroni post hoc test, adopting a significance level of p≤0.05. The research was approved by the local Ethics Committee on Animal Use under protocol number 08/2020. Results: For the analysis of IDO expression in adipose tissue, the sedentary group exhibited significantly higher values compared with the aerobic training groups (OSG 6,647.33 ± 818.70 vs. OMAG 635.58 ± 208.24, p=0.00; OSG 6,647.33 ± 818.70 vs. OAIG 2,201.18 ± 509.24, p=0.00). OMAG showed lower IDO expression than OAIG (635.58 ± 208.24 vs. 2,201.18 ± 509.24, p=0.00). IDO expression in muscle tissue followed a pattern similar to that observed in adipose tissue, with OSG presenting higher values compared to OMAG (OSG 15,553.50 ± 2,83.50 vs. OMAG 2,790.40 ± 489.41, p=0.00) and OAIG (OSG 15,553.50 ± 2,83.50 vs. OAIG 3,971.81 ± 175.65, p=0.00). However, when the exercised groups were compared, no significant differences were observed in muscle tissue IDO expression. Conclusion: The results indicate that aerobic training was effective in reducing IDO expression in both adipose and muscle tissues of obese mice. Interestingly, MIATP produced a greater reduction in adipose tissue IDO expression than HIATP, suggesting that moderate-intensity aerobic training may be more effective in modulating the kynurenine pathway under conditions of obesity.

PO—307 The Lysosomal Circadian Rhythm of GLUT-6 (SLC2A6) in Resident Human Islet Macrophages and Its Disruption in Type 2 DiabetesThe Lysosomal Circadian Rhythm of GLUT-6 (SLC2A6) in Resident Human Islet Macrophages and Its Disruption in Type 2 Diabetes

Menezes MCD1; Figueiredo DS2

(1) Universidade Federal de Alagoas, UFAL, Arapiraca, AL, Brasil; (2) Universidade Federal de Alagoas, UFAL, Maceió, AL, Brasil

Diabetology & Metabolic Syndrome 2026: PO—307

Introduction: Overnight energy maintenance under low circulating glucose relies on local mechanisms. In resident islet macrophages, the glucose transporter GLUT-6 (SLC2A6) localizes to lysosomal membranes and mediates glucose efflux from the lysosomal- cytosol. We posit a circadian lysosome–GLUT-6–macrophage axis supporting basal glucose supply coupled to recycling (efferocytosis, endocytosis and autophagy). Objective: To define circadian signatures of lysosomal/endocytic pathways and SLC2A6 rhythmicity in human islets from non-diabetic (ND) versus type 2 diabetes (T2D) donors, and to propose a functional model. Methods: Islets from the IMIDIA biobank (GSE76896; ND n=32, T2D n=36) were temporally ordered with CIRCUST and fitted with the Frequency-Modulated Möbius (FMM) model. Metrics: R² (≥0.5 = rhythmic), mesor (24-h mean), amplitude, and peak/acrophase. We assessed gene rhythmicity and phase-enriched PSEA/GSEA across MSigDB (GO/Reactome/KEGG) focusing on lysosome, endocytosis/recycling, autophagy, ER-Golgi trafficking, and glucose metabolism. To gauge medical implications, we queried DrugBank for medical-approved drugs (phase I–IV) with evidence of interaction/transport via GLUT-6. Results: Among glucose transporters, only SLC2A6 was rhythmic in ND (R²=0.50; mesor=0.85; amplitude=1.57; peak 0.75–8.82 h). In T2D, SLC2A6 lost circadian patterning (R²=0.28; mesor=0.01; amplitude=0.92; peak 0.91–1.75 h). PSEA showed nocturnal (pre-prandial) enrichment of lysosomal biogenesis/organization, endocytosis/recycling, autophagy (including mitophagy), and ER–Golgi trafficking with glucose/ATP modules; many became blunted or arrhythmic in T2D. Clinically relevantly, GLUT-6 functions as a transporter for fluorodeoxyglucose (in PET imaging), D-glucose (hypoglycemia management), and intravenous dextrose/glucose solutions (emergency hypoglycemia). Conclusion: In ND, GLUT-6 is the only glucose transporter with robust rhythmic expression in islets and its phase aligns with macrophage lysosomal/recycling programs. Islet macrophages may synchronize an auxiliary glucose source by recycling nocturnal debris with lysosome→GLUT-6 export, sustaining local energy homeostasis and modulating nearby endocrine cells during the fasted sleep period. In T2D, SLC2A6 arrhythmia and impaired lysosomal/recycling machinery likely compromise this low-power generator, contributing to islet dysfunction. Future studies on GLUT-6 circadGLUT-6; circadian rhythms; diabetesian function may optimized use of related drugs in emergency care.

PO—309 AI-Empowered Human Care to Improve Education and Glycemic Control

Silva ARS1; Monteiro RL1; Castaldoni AC1; Andrade MG1; Ribeiro RS1; Silva DA1

(1) Agile Health Tech, São Bernarndo do Campo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—309

Introduction: Managing complex patients with diabetes is a significant challenge, often limited by sporadic clinical interactions. This study evaluates a novel digital care model designed to bridge this gap. Objective: To evaluate how an AI-empowered multidisciplinary team (MDT) can improve patient education and glycemic control for complex patients on insulin by understanding their unique needs and barriers. Methods: In this short-term pilot study, 11 patients were supported via a WhatsApp-integrated platform. An AI-empowered MDT leveraged artificial intelligence to analyze patient messages and Continuous Glucose Monitoring (CGM) data. This provided deep insights into patient needs, enabling a "Health Promoter" to deliver empathetic, targeted educational solutions and support. Results: The health promoter’s initial motivation assessment was mixed (5 ambivalent, 3 proactive, 3 resistant). The model proved highly active, identifying 138 patient needs and achieving exceptional patient satisfaction (Net Promoter Score of 100). A direct correlation was observed between the number of needs met and a greater reduction in HbA1c (r = -0.29). This enhanced educational support contributed to a clinically significant average HbA1c decrease of 1.43 percentage points. Based on CGM data, the average Glucose Management Indicator (GMI) improved by -0.31%, and Time in Range (TIR) increased by an average of +2.18%. Conclusion: The AI-empowered human care model is an effective strategy for enhancing patient education. By addressing needs identified through AI analysis of communications and CGM data, this scalable, empathetic, and data-driven approach fosters self-management skills, leading to improved clinical outcomes and high patient satisfaction.

PO—310 Analytical Interference of Hydroxyurea on Continuous Glucose Monitoring in a Patient with Type 1 Diabetes and Polycythemia Vera: A Case Report

Brito GD1; Antoniassi LM1; Morais PM1; Carneiro GIB1; Leitão AM1

(1) Centro de Diabetes Curitiba, Curitiba, PR, Brasil

Diabetology & Metabolic Syndrome 2026: PO—310

Case Presentation: A 60-year-old woman with type 1 diabetes mellitus since age 27 also had polycythemia vera. She had been on continuous subcutaneous insulin infusion since 2014 and switched to an automated insulin delivery (AID) system using an electrochemical glucose sensor in January 2025. After enabling the automated mode, the system persistently indicated hyperglycemia despite normal capillary glucose readings. Upon investigation, the daily use of hydroxyurea 500 mg was identified. Due to high thrombotic risk, the drug could not be discontinued. As sensor overestimation persisted, the automated mode was disabled. The patient now uses the system without automated correction boluses, with manually programmed basal rates. The patient provided a written consent to publish her information. Discussion: Continuous glucose monitoring (CGM) plays a central role in the management of type 1 diabetes, particularly when integrated with automated insulin delivery systems employing electrochemical glucose oxidase sensors. These sensors, however, are susceptible to exogenous interference. Hydroxyurea, commonly used in the treatment of hematologic malignancies such as polycythemia vera, can lead to falsely elevated glucose readings. This occurs due to oxidation of the drug at the sensor electrodes, which increases the electrical current interpreted as elevated glucose levels. The effect typically peaks within hours of administration and may overestimate glucose concentrations by up to 13 mmol/L, in the absence of a true rise in plasma glucose. Such discrepancies compromise the accuracy of AID systems, increasing the risk of insulin overdosing and subsequent hypoglycemia. This analytical interference affects all CGM systems based on glucose oxidase technology. Studies have shown significant mismatches between CGM data and laboratory glucose after hydroxyurea use. Other substances—including paracetamol, high-dose vitamin C, uric acid, gentisic acid, levodopa, methyldopa, and glutathione—may also interfere with sensor accuracy. Sensor susceptibility varies depending on the underlying technology; for example, fluorescent polymer-based sensors, such as implantable devices, tend to be less affected. Final Comments: This case underscores the importance of verifying sensor data with capillary glucose measurements when discrepancies are suspected. Healthcare professionals should be aware of potential drug–sensor interactions and interpret CGM data within the broader clinical context.

PO—311 Circumference-based Predictive Model As A Diagnostic Tool For Familial Partial Lipodystrophy Type 2

Lopes FKM1; Silva Júnior FNB1; Queiroz LL1; Fernandes VO1; Flor AC1; Boris NP1; Araújo JS1; Sales MTA1; Albuquerque NV1; Ramos LTT1; Linard LLP1; Silva SMA1; Costa ST1; Quirino AHA1; Montenegro Junior RM1

(1) Complexo Hospitalar da Universidade Federal do Ceará/EBSERH, Fortaleza, CE, Brasil

Diabetology & Metabolic Syndrome 2026: PO—311

Introduction: Familial Partial Lipodystrophy (FPL) is a rare heterogeneous condition marked by partial loss of adipose tissue. FPL Type 2 (FPLD2), or Dunnigan Syndrome, is the most common monogenic form but remains underdiagnosed. Anthropometric assessment is essential in diagnosis. However, no studies have explored body circumferences for FPL screening, especially with predictive learning models. Objective: To evaluate a predictive model’s performance identifying women with FPLD2 based on body circumferences. Methods: Cross-sectional study at a reference center for lipodystrophy care, tertiary hospital Ceará, Brazil. Weight, height, thoracic, and hip circumferences were measured in adult women (18–59 years) with genetically confirmed FPLD2 and healthy controls matched by age and BMI. Mann–Whitney test compared groups. Ridge-penalized logistic regression used with stratified 10-fold cross-validation repeated 5 times. Predictors standardized within folds to avoid data leakage. Model assessed by AUC, sensitivity, specificity, precision, F1 score. Optimal threshold by Youden index; calibration adjusted by isotonic regression when needed. Results: Sixteen women with FPLD2 and 42 healthy controls were evaluated. The mean age of the FPLD2 group was 47,7 ± 10,8 anos years, and the mean BMI was 29.4 ± 6,7 kg/m². Compared to the control group (median = 0.88; min = 0.38; max = 0.98), the thoracic-to-hip ratio was significantly higher in women with FPL2 (median = 1.05; min = 0.98; max = 1.18; p = 6.6 × 10⁻⁹). Model discrimination was excellent, with a mean AUC of 0.983 (95% CI: 0.968–0.998) and a mean AUC-PR of 0.970 (95% CI: 0.941–0.999). Mean sensitivity was 0.81 ± 0.101, and specificity was 0.996 ± 0.008. The model showed good calibration (Brier score = 0.050), which was reduced to 0.009 after isotonic recalibration on the full dataset. At the threshold defined by the Youden index, all women with FPL2 were correctly identified, with only one false positive (sensitivity = 1.00; specificity = 0.976). Conclusion: The predictive model, based on the integration of BMI, thoracic-to-hip ratio, and age, demonstrated excellent performance in identifying women with FPLD2. This study presents, for the first time, a potentially simple, accessible, and accurate tool for screening this disease.

PO—312 Comparison Of Two Different Systems Of Subcutaneous Insulin Pump Therapy in the Assessment of Hyperglycemia in Type 1 Diabetes Mellitus Subjects In The Public Health Service

Sallorenzo C1; Oliveira DC1; Gabbay MAL1; Dib SA1

(1) Universidade Federal de São Paulo, Unifesp, Sao Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—312

Introduction: Adjusting daily insulin doses based on carbohydrate counting and frequent self-monitoring of blood glucose levels is hard and stressful for both patients with Type 1 Diabetes Mellitus (T1D) and their caregivers. Many patients, across all age groups, fail to achieve glycemic targets (only 17% of young individuals and 21% of adults), potentially resulting in the development of disease complications. Improved technology of Subcutaneous insulin pump therapy (SIPT) has been capable of optimizing glycemic control in patients with T1D. Time in range (TIR), percentage of hypoglycemia (%Hypo), and the Glucose Management Indicator (GMI) are relevant parameters for evaluating this technology effectiveness. Objective: Comparison of two different subcutaneous insulin infusion systems: non-automated (Minimed ® 640G) versus Hybrid closed loop insulin pump therapy (Minimed ® 780G) in the university outpatient service ( public health system). Methods: This was a retrospective observational study conducted at the Diabetes and Endocrinology Center using data from the CareLink™ platform from May to July 2025. Group 1 (640G) included 24 patients (age 15±10, Time of Diabetes isease- TDD 14±9) and group 2 (780G) included 41 patients (age 18±12 and TDD 13±2). The following were analyzed: percentage of time in range (70–180 mg/dL), time above target (>180mg/dL) and below target (<70mg/dL), GMI, and CV. Pearson’s correlation coefficient was applied to assess the association between time in target and GMI. Results: The patients were compared regarding age and TDD. Group 1 had a mean of 51% time in range, 46% above target, 3% below target, and an GMI of 7.7%. Group 2 had 71% time on target, 25% above target, 4% below target, and an IGG of 6.9%. A negative correlation was observed between TIR and GMI (r = –0.95), suggesting an association between longer time in range and better glycemic control. Conclusion: Hybrid closed loop insulin pump therapy system demonstrated superior performance to the non-automated system, confirming the positive impact of advanced technology in pumps, even when treating an unwealthy population with Type 1 Diabetes in the public health service, giving potential impact on their prognosis.

PO—313 Continuous Glucose Monitoring Use Lowers Diabetes Distress and Improves Glycemic Outcomes in Adults with Type 1 Diabetes: A Six-Month Prospective Study in a Resource Limited Setting

Monteiro NC1; Lima LPS2; Freitas JPA2; Machado MLP3; Gama FG4; Silva VDS4; Martins LM2; Silva DG4; Varela MG3; Trevisan TL5; Silveira MSVM6; Santana NO1

(1) Post-graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, SE, Brasil; (2) Department of Medicine, Federal University of Sergipe, Aracaju, SE, Brasil; (3) Private practice, Aracaju, SE, Brasil; (4) Post-graduate Program in Nutrition Science, Federal University of Sergipe, Aracaju, SE, Brasil; (5) Private practice, Itajaí, SC, Brasil; (6) Instituto de Saúde mental e Diabetes, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—313

Introduction: Type 1 diabetes (T1D) management remains challenging in resource-limited settings. Diabetes distress is commonly associated with suboptimal glycemia and lower quality of life. Continuous glucose monitoring (CGM) may help address these challenges. Objective: To evaluate the impact of CGM on glycemic outcomes and diabetes distress among adults with T1D. Methods: In this 6-month longitudinal study, 35 adults with T1D from a public endocrinology center in Sergipe, Brazil, initiated CGM and attended monthly follow-up visits. Data were collected through interviews and medical record review. Diabetes distress was assessed at baseline and at study completion using the validated Brazilian T1-DDS (1–6 Likert scale, higher scores indicating greater distress). Results: Participants had a mean age of 30.3±11.1 years, were predominantly female (61.1%), of mixed-race (55.5%), with low income (77.7% earning 1–2 minimum wages) and mean diabetes duration of 17.4±8.1 years. All used basal-bolus analog insulin (0.75±0.26 IU/kg/day; 44.3±12.8% basal). Baseline HbA1c was 9.1±1.8%. Glycemic outcomes improved sharply after one month of CGM use: glucose management indicator 7.6 ± 1.4% and time in range 50.9±18.8%. CGM metrics remained stable over the follow-up. Baseline T1-DDS score was 2.9±0.9, indicating moderate distress. Highest scores were “eating distress” (3.6±1.3), “powerlessness” (3.5±1.2) and “management” (3.2±1.1), whereas “physician distress” showed the lowest levels (1.3±0.4). Baseline diabetes distress correlated with self-reported anxiety (PR=1.45, p=0.003), depressive symptoms (PR=1.43, p<0.001), and HbA1C≥7% (PR=1.43, p<0.001), but not with education level, family income, race and diabetes duration. Global T1-DDS score dropped significantly by 18.9% (p<0.001), with the steepest declines seen in “management distress” (−28.5%; p<0.001) and “social/family-related distress” (−23.6%; p=0.004) domains. Significant improvements were also seen in “eating distress” (−19.4%; p<0.001), “powerlessness” (−19.0%; p<0.001) and “hypoglycemia distress” (3.1±1.3 to 2.5±1.1; −17.9%; p=0.007). “Negative social perception” (2.5±1.3 to 2.2±1.3; -12.2%; p=0.06) and “physician distress” (+0.8%; p=0.886) remained stable Conclusion: CGM reduced diabetes distress in adults with T1D, particularly management-related distress, with improvements across other domains. These psychosocial benefits, along with early glycemic gains, highlight CGM potential value in public healthcare.

PO—314 Digital Health in Primary Care: Care for Diabetic Patients

Rollin G1; Laguna GO1; Moreira MCT1; Marobin R1; Almeida TS1; Costenaro F1; Silva CL1; Haygert C1; Cabral FC1; Chagas MEV1

(1) Hospital Moinhos de Vento, Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—314

Introduction: Diabetes mellitus (DM) is one of the most prevalent and challenging chronic conditions in Brazil, requiring continuous and multidisciplinary care. Its complications, such as cardiovascular diseases, increase both morbidity and mortality as well as healthcare costs. Primary health care (PHC) plays a central role in organizing health care by managing chronic conditions and ensuring longitudinal follow-up. In this context, the incorporation of digital technologies has strengthened PHC by expanding access to specialists and improving clinical management, especially in regions with a shortage of healthcare professionals. Objective: To describe the clinical characteristics of diabetes-related teleinterconsultations conducted through the TeleNordeste project in 2024. Objective: To describe the clinical characteristics of diabetes-related teleinterconsultations conducted through the TeleNordeste project in 2024. Methods: This is a cross-sectional descriptive study based on the analysis of endocrinology teleinterconsultation data from the TeleNordeste project. Consultations were conducted with the patient present at a Basic Health Unit, accompanied by their primary care physician, and connected to a specialist via videoconference. Clinical variables associated with diabetes-related teleinterconsultations were analyzed. Results: A total of 1,707 endocrinology teleinterconsultations were conducted during the study period, of which 956 (56%) involved a diagnosis of diabetes mellitus. Among these, 898 (94%) were related to type 2 diabetes mellitus (T2DM), 51 (5.3%) to type 1 diabetes (T1DM), and 7 (0.7%) to gestational diabetes. Among the T2DM-related consultations, 447 (49.7%) involved insulin therapy. Additionally, 630 (70.1%) of T2DM-related consultations included comorbid systemic arterial hypertension, and 164 (18.2%) reported a history of cardiovascular events. Only 126 (13.1%) of all diabetes-related consultations recorded glycated hemoglobin (HbA1c) levels ≤7%. Conclusion: The profile of the evaluated teleconsultations predominantly revealed associated chronic conditions and unsatisfactory metabolic control, highlighting the clinical complexity faced in PHC. Telemedicine is an effective tool for expanding access to specialists and enhancing diabetes management. By fostering shared and continuous care, this model strengthens the healthcare network and aims to contribute to more efficient chronic disease management within the Brazilian public health system, particularly in diabetes care.

PO—315 Evaluation Of Continuous Subcutaneous Insulin Infusion Systems In A Tertiary- Level Public Health System Diabetes Mellitus Clinic

Oliveira DC1; Fujimoto VG1; Teodoro VS1; Santucci RA1; Gabbay MAL1; Dib SA1

(1) Universidade Federal de São Paulo, São Paulo, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—315

Introduction: The use of technologies in diabetes treatment has been increasing worldwide. However, in the Brazilian Unified Health System (SUS), their use is still limited due to the population’s overall socioeconomic and cultural level and the need for a specialized interdisciplinary approach. The use of the various resources provided by these technologies aims to go beyond glycemic control, promoting well-being, autonomy, and quality of life for individuals living with diabetes. Objective: To evaluate glycemic control using different levels of technology for continuous subcutaneous insulin infusion (CSII) in patients with type 1 diabetes (T1D) from a tertiary-level public healthcare service Methods: Observational study with database analysis from the diabetes technology clinic. Inclusion criteria: use of a continuous subcutaneous insulin infusion (CSII) system and active follow-up in the clinic. Exclusion criteria: no clinic visit in 2025 or discontinuation of CSII by February 2025. Results: A total of 209 patients with T1D were included (56% women), with a mean age of 23 years (SD 12.2), diagnosis at 6.4 years (SD 5.23), and initiation of pump therapy at 15 years (SD 10.74), with a mean disease duration of 17 years (SD 9.45). The main indications for CSII were: hypoglycemia (32%), glycemic variability (11.9%), poor control with intensive insulin therapy (7.6%), pregnancy (5%), low insulin requirement (<10 IU/day – 5%), others (13%), and no information (19%). Mean HbA1c was 8.3% (SD 3.77%), mean daily insulin dose 0.8 IU/kg, and basal/bolus ratio 33%/67%. Time in range (70–180 mg/dl) was 51% (SD 17.29%), time above range 42% (SD 17.96%), and time below range 7% (SD 5.58%). Chronic complications were absent in 70% of patients; 4% had isolated retinopathy, 9% had isolated neuropathy, and 12% had ≥2 complications. Regarding CSII type, 158 patients (75%) used non-automated systems (130 without sensor – Spirit Combo® or Medtronic® 640 – and 28 with sensor), and 51 patients (24.4%) used automated systems (46 Minimed® 780G; 5 Android APS). Glycemic control data for the studied T1D patients are summarized in Figure 1 (attached). Conclusion: The combination of automated CSII systems with a multidisciplinary approach contributes to better glycemic control outcomes, even in a socioeconomically and culturally heterogeneous population

PO—316 Gastroparesis And Type 1 Diabetes: Overcoming Glycemic Instability With A Hybrid Closed-Loop Continuous Subcutaneous Insulin Infusion System

Elias BYK1; Gieburowski JT1; Fernandes VP1; Moron IG1; Paula FJA1; Mermejo LM1; Guidorizzi NR1; Gomes PM1

(1) Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—316

Case Presentation: Female patient with type 1 diabetes mellitus (T1DM), diagnosed at age 10, developed complications due to chronic poor glycemic control: proliferative retinopathy, G3A1 kidney disease, sensorimotor polyneuropathy and autonomic neuropathy (tachycardia, neurogenic bladder, chronic diarrhea, fecal incontinence and gastroparesis). She was referred to a tertiary Endocrinology center in 2023, at the age of 40, using intermediate-acting human insulin and rapid-acting analog insulin, with HbA1c of 9.5% and glycemic variability, as shown in the continuous glucose monitoring (CGM) report (Fig. 1). Once a month, she required medical care due to level 3 hypoglycemia. She reported difficulty in coordinating insulin administration with meals, as early satiety and postprandial fullness interfered with food intake. Delayed gastric emptying was confirmed by scintigraphy (Fig. 2). Over 18 months, better glycemic control was pursued by correcting insulin administration technique, delaying boluses in relation to meals, switching basal insulin to ultralong-acting analog, introducing carbohydrate counting and adjusting insulin doses, in addition to prescribing prokinetics. Despite these efforts, the patient remained poorly controlled (Fig. 3), with an HbA1c of 8.9%. Then, a hybrid closed-loop continuous subcutaneous insulin infusion (CSII) system was initiated with optimized parameters (glucose target of 100 mg/dL and active insulin time of 2 h). The patient adapted well to informing the device the amount of carbohydrates consumed 30 to 40 min after meals and reached a better glycemic control without hypoglycemia (Fig. 4). The patient provided a written consent to publish her information. Discussion: Gastroparesis, characterized by delayed gastric emptying, affects almost 50% of T1DM patients and may cause a mismatch between nutrient absorption and insulin action, predisposing to postprandial hypoglycemia and challenging glycemic control. In the present case, frequent hypoglycemia impaired adherence to multiple daily injections regimen, leading to hyperglycemia. Studies have shown that the use of CSII by patients with gastroparesis improves time in range and reduces HbA1c without increasing hypoglycemia. Hybrid closed-loop CSII allows for sequential administration of small boluses and insulin suspension when hypoglycemia is predicted. For the patient portrayed, delaying meal insulin by 30 to 40 min also contributed to glycemic control. Final Comments: This case report illustrates the positive impact of CSII and GCM for patients with T1DM and gastroparesis. Table 1.

Figure 1(abstract PO-316).

Continuous glucose monitoring from 18/01/2024 to 31/01/2024

Figure 2 (abstract PO-316).

Gastric emptying scintigraphy

Figure 3 (abstract PO-316).

Continuous glucose monitoring from 08/05/2025 to 21/05/2025

Figure 4 (abstract PO-316).

Continuous glucose monitoring from the hybrid closed-loop continuous subcutaneous insulin infusion system

Table 1 (abstract PO-316).

Glycemic control under different insulin regimens (multiple daily injections vs continuous subcutaneous insulin infusion).

Carb*: carbohydrate; SF**: sensitivity factor; ICR***: insulin-to-carbohydrate ratio

PO—317 Glycemic Benefits of the Automated Insulin Infusion System Minimed 780G in Patients at a Tertiary Care Hospital

Mendes PS1; Pedrosa AG1; Gieburowski JT1; Fernandes VP1; Barbosa ARCC1; Paula FJA2; Mermejo LM2; Guidorizzi NR1; Gomes PM1

(1) Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brasil; (2) Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—317

Introduction: Continuous subcutaneous insulin infusion (CSII) therapy has evolved with hybrid automated technologies. The Medtronic 780G, using the SmartGuard algorithm, automatically adjusts basal insulin and delivers correction boluses based on interstitial glucose levels, optimizing glycemic control in patients with type 1 diabetes mellitus (T1DM) and LADA (Latent Autoimmune Diabetes in Adults). Objective: Evaluate the impact of transitioning to the Medtronic 780G system on glycemic parameters in patients previously treated with other CSII models. Methods: This retrospective observational study included outpatients at a tertiary care hospital who transitioned from previous CSII models to Medtronic 780G. Analyzed variables included demographics, time in range (TIR), time above range (TAR), time below range (TBR), HbA1c, glycemic variability, sensor adherence, basal/bolus ratios, and diabetes duration. Of 37 patients, 33 (89.2%) had T1DM, and 4 (10.8%) had LADA; 11 were lost to follow-up, and one died. Of the remaining 25, 2 discontinued CSII and 4 used Roche pumps. Among the 19 Medtronic users, 10 switched from the 640G to the 780G, and 9 had complete paired data. Results: After a mean follow-up of 260 days post-transition, TIR increased from 68.7% to 72.4% (p=0.61), TAR decreased from 28.3% to 24.2% (p=0.59), and TBR remained stable at 3% (p=0.66). Glycemic variability decreased from 34.7% to 30% (p=0.33) and HbA1c from 7% to 6.89% (p=0.60). Total daily insulin/kg was stable with a proportional increase in bolus (47.3% to 59.1%) and a decrease in basal insulin (52.6% to 40.8%), indicating enhanced SmartGuard activity. The association between diabetes duration (in years) and changes in TIR showed no significant Spearman correlation (ρ = 0.36; p = 0.385). However, simple linear regression revealed a marginally positive association of diabetes duration with ΔTIR (coefficient = 0.096 per year; p = 0.057), explaining 48% of the variance in outcomes (R² = 0.48). This suggests a potential trend toward greater glycemic benefit among patients with longer disease duration. Conclusion: Although not statistically significant, clinical improvement in glycemic control was seen after transitioning to the Minimed 780G hybrid closed-loop system. These findings suggest its potential as a therapeutic tool for T1DM and LADA patients on CSII, offering better glycemic stability, safety, and time in range. The association between longer disease duration and improved TIR needs further study with higher statistical power.

PO—318 Glycemic Control And Engagement of Women With Type 1 Diabetes Using Flash Glucose Monitoring In A Public Health Initiative

Puzic RFS1; Canuto FVS1; Leite EB2; Melo MC3; Oliveira REM1; Corbal BS2

(1) Universidade de Brasília, Brasília, DF, Brasil; (2) Secretaria de Saúde do Distrito Federal, Brasília, DF, Brasil; (3) Fundação de Ensino e Pesquisa em Ciências da Saúde, Brasília, DF, Brasil

Diabetology & Metabolic Syndrome 2026: PO—318

Introduction: Sustained use of flash glucose monitoring (FGM) can improve glycemic management in type 1 diabetes, but engagement in public health programs may vary. Understanding factors associated with long-term use can guide strategies to optimize outcomes. Women with type 1 diabetes mellitus (T1DM) often experience suboptimal glycemic control and are underrepresented in studies involving new diabetes technologies. Real-world data from public health settings remain scarce. Objective: To describe the clinical and sociodemographic profile of women using FGMS in a public health program and identify factors associated with program engagement. Methods: A retrospective longitudinal study was conducted using data from 109 adult women with T1DM who applied for FGMS through a public program in Brasília, Brazil. Eligibility criteria included age ≥18 years and HbA1c <8%. Variables analyzed included age, BMI, HbA1c, comorbidities, physical activity, and program engagement (defined as continued participation after sensor distribution). Statistical analyses were performed using SPSS with significance set at p<0.05. The study was approved by the institutional ethics committee (No. 5.475.356). Results: Participants had a mean age of 37 years and a mean BMI of 23.0 kg/m². Mean HbA1c at baseline was 7.17%. Women who remained engaged in the program had lower baseline (7.02% vs. 7.35%, p=0.039) and final HbA1c levels (7.30% vs. 7.55%, p=0.035), and were older (38.5 vs. 34.0 years, p=0.044) than those who discontinued. Overall HbA1c increased slightly (7.30→7.40%, p=0.023), although not significantly among engaged or disengaged groups when analyzed separately. In multivariable analysis, greater age (OR=1.086 per year), shorter diabetes duration (OR=1.075 per year decrease), and lower basal insulin dose (OR=1.366 per unit decrease) were independently associated with engagement. Higher bolus insulin dose (OR=1.285 per unit) also increased engagement odds. Conclusion: Engagement in the public FGM program was associated with better glycemic outcomes and older age. Targeted strategies to sustain long-term use, particularly among younger women and those with higher baseline HbA1c, may enhance the benefits of FGM in public health settings.

PO—319 Glycemic Metrics In Users Of The Automated Insulin Infusion System

Mondadori PM1; Kurcrevski C1; Toss SF1; Bressiani M1; Fornari A1; Tschiedel B1; Puñales M1

(1) Instituto da Criança com Diabetes, Grupo Hospitalar Conceição, Ministério da saúde, Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—319

Introduction: Automated insulin infusion (AID) systems integrate continuous glucose monitoring and an algorithm that infuses insulin based on blood glucose levels. They offer significant benefits, including maintaining a longer target glucose target (TRT), reducing hypoglycemic episodes, especially severe ones, and significantly improving quality of life. Objective: To evaluate the glycemic metrics of users of an automated insulin infusion system, treated at a public referral service for diabetes in childhood and adolescence. Methods: Clinical and laboratory data and glycemic metrics were obtained through analysis of the medical records of 69 AID users, 59.4% of whom were female. The reference value for glycated hemoglobin - HbA1c was 4.8-5.7% (target <7.0%). Results: The median age at AID installation was 16.3 years (IQR 9.6–26.7 years) and time of AID use was 1.5 years (IQR 0.55–2.3 years). Of these, 69.6% (48/69) were previous users of non-automated systems, with age at installation of 13.1 years (6.7–19.8 years) and time of use of insulin infusion system of 6.0 years. HbA1c at the time of first installation was 7.7±1.1%, with the system prescription in 65.2% due to glycemic variability, 21.7% due to frequent hypoglycemia (33.3% level 3 hypoglycemia) and 13.1% due to quality of life. Regarding glycemic metrics at the last assessment, 72.7±9.4% had glucose within the glycemic target - TIR (70-180 mg/dL), 19.2±7.0% had level 1 hyperglycemia (TAR1:>180 mg/dL) and 5.6±4.7% had level 2 hyperglycemia (TAR2:>250mg/dL). Of the sample, the median of level 1 hypoglycemia (TBR1: <70mg/dL) was 1.0% (IQR 1 - 3%), level 2 (TBR2: <54mg/dL) was 0% (IQR 0 - 1.0%) and there was only 1 case of level 3 hypoglycemia (disregarded the hypoglycemia/suspension alarm and did not eat, despite instructions). The sensor usage time was 87.2±13.1%, in automation 87.1±17.6%, glucose management index (GMI) 6.7±1.2% and HbA1c 7.1±0.9%. Conclusion: Our results show that glycemic metrics in users of the automated insulin infusion system at a public diabetes referral center remain within the recommendations and reinforce the safety of hypoglycemia prevention. These results allow for the maintenance of a longer exposure time within the glycemic target, with a shorter time of hyperglycemia and, especially, hypoglycemia during the 1.5-year follow-up period.

PO—321 Multidisciplinary Model In The Care Of Type 1 Diabetes Patients Using Insulin Pumps In A Public Health Service

Pinto MCS1; Ferreira RGO1; Musse TNM1; Peghinelli VV1; Sakalem ME2; Padovani CR1; Nogueira CR1

(1) Universidade Estadual Paulista (UNESP), Botucatu, SP, Brasil; (2) Universidade Estadual de Londrina (UEL) , Londrina, PR, Brasil

Diabetology & Metabolic Syndrome 2026: PO—321

Introduction: Careful glycemic control is mandatory in the management of type 1 Diabetes Mellitus (T1DM) in order to prevent chronic complications. Approaches such as the insulin pump offer an effective alternative but demand specialized follow-up to ensure appropriate use. Within the context of Brazil’s Public Health System (Sistema Único de Saúde, SUS), the implementation of integrated care strategies is crucial to optimize clinical outcomes. Objective: To evaluate the effects of a multidisciplinary care protocol on the management of T1DM patients using insulin pumps in a SUS outpatient clinic. Methods: This was an interventional study with longitudinal follow-up of 10 insulin pump users. The glycated hemoglobin (HbA1c) levels of patients were evaluated before (M1) and 9 months after (M2) the implementation of a novel care model. The approach included a team composed of physicians, nutritionists, psychologists, and nurses, and focused on diabetes education and individualized care. The comparative study of the variables HbA1c (pre and post), time of pump use and delta HbA1c (HbA1c post – HbA1c pre) according to the participants’ educational levels was carried out considering the Student’s t-test for independent samples, in the case of the variables HbA1c and delta HbA1c and the non-parametric Mann-Whitney test for time of pump use. All results were discussed at a significance level of 5%. Results: The findings indicate a qualitative improvement in patient understanding and greater satisfaction with the multidisciplinary model. HbA1c levels improved among patients with longer insulin pump use, regardless of educational background. This finding demonstrates that, although effective for glycemic control, insulin pump therapy involves a learning curve that requires user adaptation, as reported in previous studies. The result of the inferential analysis was not significant (p>0.05) due to the small number of participants in each group. However, the clinical tendency of the results should be highlighted and, if new participants are included, such differences should be configured when the robustness of the statistical test increases. Conclusion: The study highlights the importance of multidisciplinary models in the care of patients with T1D. Particularly in the case of patients using insulin pumps, the time of use of this technology appears to be a central and independent factor in clinical improvement, which reinforces the need for public health policies that guarantee early access to such technologies.

PO—322 Short-Term Continuous Glucose Monitoring Use Improves Quality of Life and Glycemic Outcomes in Low-income Adults with Type 1 Diabetes

Freitas JPA1; Lima LPS1; Monteiro NC2; Machado MLP3; Gama FG4; Silva VDS4; Leonardo Machado Martins1; Silva DG4; Silveira MSVM5; Trevisan TL6; Varela MG3; Santana NO2

(1) Department of Medicine, Federal University of Sergipe, Aracajú, SE, Brasil; (2) Post-graduate Program in Health Sciences, Federal University of Sergipe, Aracajú, SE, Brasil; (3) Private Practice, Aracajú, SE, Brasil; (4) Post-graduate Program in Nutrition Science, Federal University of Sergipe, Aracajú, SE, Brasil; (5) Instituto de Saúde Mental e Diabetes, São Paulo, SP, Brasil; (6) Private Practice, Itajaí, SC, Brasil

Diabetology & Metabolic Syndrome 2026: PO—322

Introduction: Type 1 diabetes (T1D) management is complex and often negatively impacts mental health and quality of life (QoL), particularly in low-resource settings. Continuous glucose monitoring (CGM) may help mitigate these challenges. Objective: To describe the clinical and socioeconomic profile and QoL of adults with T1D and to assess the impact of short-term CGM use on glycemic outcomes and QoL. Methods: A longitudinal study recruited 37 adults with T1D from a public endocrinology clinic in Sergipe, Brazil. Participants used CGM systems and underwent monthly clinical evaluations over a 140-day period. Data were collected via structured interviews and medical record review. QoL was assessed at baseline and study completion using the validated DQOL-Brazil questionnaire (1-5 Likert scale; higher scores reflecting worse QoL). Results: Participants had a mean age of 30.1±11.1 years, most were female (59.5%), of mixed race (56.8%) and had low socioeconomic status (78.4% earning 1–2 minimum wages). Nearly half (48.7%) had completed secondary education. Mean diabetes duration was 12.9±9.8 years, with baseline HbA1c of 9.1 ± 1.8%. All participants used basal-bolus analog insulin regimens (0.7±0.3 IU/kg/day; 44.2±13.7% basal). Baseline self-reported anxiety and depressive symptoms were present in 70.3% and 32.4% of participants, respectively. Mean follow-up was 134.0±21.0 days (range: 56–140 days). Baseline global QoL was 2.6±0.7, with highest scores in “satisfaction’” (2.8±0.6) and “diabetes-related concerns” (2.8±1.0), followed by “impact” (2.6±0.6) and “social/professional concerns” (2.2±1.0). The item with highest score was “fear of diabetes complications” (4.2±1.1). At study completion, CGM metrics were glucose management indicator 7.4±0.9%, active time 85.0±16.7%, time in range 54.7±17.5%, time above range 38.9±22.9%, time bellow range 6.4±5.3% and glucose variability 40.4±7.0%. Overall QoL improved by 11.5% (final score: 2.3±0.6; p<0.01) and “satisfaction” domain showed the greatest benefit (20.9% reduction; 2.2±0.5; p<0.01). The other domains were statistically unchanged, but “diabetes-related concerns” was the only that slightly increased (+2.3%). Conclusion: In this low-resource setting, short-term CGM use was associated with improvements in both glycemic outcomes and QoL in adults with T1D, particularly in satisfaction. Persistent concerns about diabetes suggest the need for longer-term follow-up and targeted educational interventions.

PO—323 Structured Education Enhances Continuous Glucose Monitoring Literacy and Glycemic Outcomes in a Low-Resource Type 1 Diabetes Population

Lima LPS1; Freitas JPA1; Machado MLP2; Monteiro NC3; Gama FG4; Silva VDS4; Martins LM1; Silva DG4; Varela MGMA2; Trevisan TL5; Santana NO 3

(1) Department of Medicine, Federal University of Sergipe, Aracajú, SE, Brasil; (2) Private Practice, Aracajú, SE, Brasil; (3) Post-graduate Program in Health Sciences, Federal University of Sergipe, Aracajú, SE, Brasil; (4) Post-graduate Program in Nutrition Science, Federal University of Sergipe, São Cristovão, SE, Brasil; (5) Private Practice- Itajaí, SC, Brasil

Diabetology & Metabolic Syndrome 2026: PO—323

Introduction: Continuous glucose monitoring (CGM) and structured education supports self-management in people with type 1 diabetes (PwT1D), yet knowledge retention remains a challenge in low-resource regions. Objective: To assess the impact of CGM use with structured education on glycemic outcomes and knowledge retention in PwT1D from a low-resource region. Methods: This 6-month longitudinal study enrolled 53 PwT1D from a public endocrinology clinic in Sergipe, Brazil. Data were collected through interviews and medical record review. Participants used CGM systems and received structured education on glucose targets, time-in-range (TIR), and trend arrow interpretation, reinforced monthly. Knowledge retention was assessed using questionnaires administered at baseline and during monthly follow-up visits. Results: Participants (mean age 24.7±12.6 years) were mostly adults (69.8%), female (64.2%), of mixed race (58.5%), low-income (71.7% earning 1–2 minimum wages) and 22.6% had incomplete elementary education. All used basal-bolus analog insulin regimens (0.8±0.4 IU/kg/day; 43.3±11.8% basal), with suboptimal baseline HbA1c (9.2±1.9%). Mean follow-up was 5.8±0.8 months. At study completion, CGM metrics were: glucose management indicator 7.6±1%, mean glucose 185.3±48.8 mg/dL and glucose variation 41.1±6.7%. TIR was suboptimal (48.5±17.7%), as were time above range level 2 (21.7±17.8%), time below range level 1 (5.2±4.6%) and below range level 2 (1±1.2%). However, time above range level 1 (23.6±8.3%) was within target range. Knowledge scores improved progressively throughout follow-up. Trend arrow interpretation achieved the highest mastery, likely due to its immediate clinical applicability. Baseline knowledge about TIR was the poorest, 58.5% of participants overestimated optimal targets. By study end, 77.6% identified the correct TIR goal, while only 14.6% retained unrealistic expectations. Learning curves showed the steepest gains within the first three months. Conclusion: Structured education paired with CGM use improved both glycemic outcomes and CGM literacy in this low-resource T1D population. The different retention of practical versus conceptual knowledge highlights the need for tailored education, particularly for abstract metrics like TIR. This approach demonstrates feasibility for improving diabetes care with technology in resource-limited settings.

PO—327 Type 2 Diabetes in Adolescents

Coutinho MKP1; Bona MMD1; Bressani RM1; Schaeffer MM1; Fornari AM1; Lavigne SM1; Tschiedel BM1

(1) Instituto da Criança com Diabetes, Grupo Hospitalar Conceição, Ministério da Saúde, Porto Alegre, RS, Brasil

Diabetology & Metabolic Syndrome 2026: PO—327

Introduction: The prevalence of type 2 diabetes mellitus (T2DM) in youth has been increase worldwide, probably associated to the global epidemic obesity, particularly in specific ethnicity, low-income minorities and genetic background groups. In Brazil, data of the Cardiovascular Risk in Adolescents (ERICA) Study estimated a prevalence of 3.3% of T2DM among adolescents. Objective: To assess the prevalence of T2DM in youth, followed at a public diabetes center, and to describe the clinical characteristics, the metabolic control (glycated hemoglobin - HbA1c), and the associated comorbidities in children and adolescents with diabetes diagnosis under 20 years of age. Methods: A total of 203 cases of youth-onset T2DM were identified from a cohort of 5,302 children and adolescents with diabetes diagnosis until 20 years of age, at a public diabetes center. Clinical, laboratory and comorbidities data from 46 young T2D were collected from medical records. Body mass index (BMI) was classified according to the World Health Organization (WHO) or the National Center for Health Statistics (NCHS) criteria, adjusted for age and sex. Results: The overall T2DM prevalence in youth in our cohort was 3.8% (203/5,302). In the last year, 46 youths with T2DM were under follow-up, with a mean age at diabetes diagnosis of 13.7 ± 3.5 years. Of the sample, 71.7% were female and 6.5% presented with diabetic ketoacidosis at diagnosis (negative autoantibodies). A family history of T2DM was present in 80.4%, overweight/obesity in 84.8%, and acanthosis nigricans in 63.0%. The majority were Caucasian (71.7%). At T2DM diagnosis the mean HbA1c was 9.5±2.7%. Lipid abnormalities (elevated triglycerides and/or low high-density lipoprotein [HDL] and/or elevated low-density lipoprotein [LDL]) were found in 65.2%, and hypertension was detected in 34.8%. Most of the cases were treated with metformin (80.4%), either as monotherapy or associated to subcutaneous insulin treatment. Conclusion: Our results demonstrated the prevalence of T2DM in youth at a public diabetes center, highlighting the high frequency of family history of T2DM, predominantly in female and associated to overweight/obesity, hypertension and lipid abnormalities. This data reflected the association of the genetic background and the environmental factors in the pathogenesis of the disease.

PO—328 Use of Insulin Pump in a Patient with Type 1 Diabetes and Silver-Russell Syndrome: A Clinical Case Report Focused on Glycemic Evolution and Educational Impact

Leão AAP1; Oliveira EH2; Mariana Lemos M3; Matos DA4; Castelo Branco F5; Silva LB6

(1) Universidade Federal do Paraná; Medtronic comercial Ltda, Curitiba, PR, Brasil; (2) Medtronic comercial Ltda, São Paulo, SP, Brasil; (3) Medtronic comercial  Ltda Goiânia, GO, Brasil; (4) Medtronic comercial Ltda, São José do Rio Preto, SP, Brasil; (5) Secretaria Municipal de Educação de Marília, SP, Brasil

Diabetology & Metabolic Syndrome 2026: PO—328

Case Presentation: L.B.S., a 34-year-old male diagnosed with Type 1 Diabetes (T1D) at age 10, also presents with Silver Russell syndrome. Initially treated with oral antidiabetics, he transitioned to insulin therapy using pens (basal and rapid insulins). Despite proper use, he experienced significant glycemic variability, chronic fatigue, elevated HbA1c, episodes of hypoglycemia and hyperglycemia, and adherence challenges. With medical and family support, he transitioned to continuous use of the 640G insulin pump and Guardian 3 sensor. At the start of therapy, HbA1c dropped from 12.8% to 4.8% within the first months, stabilizing at an average of 6.2% with regular follow-ups. During periods without educational support, HbA1c increased to 7–8% but quickly returned to 6–7% with the resumption of clinical support. Beyond glycemic improvements, there was stabilization of body weight (previously 36 kg), cessation of intravitreal injections following resolution of ophthalmological complications, improved sleep quality, reduction of nocturnal urinary symptoms, and increased autonomy. The patient emphasized the importance of educational support in correcting dietary errors, implementing carbohydrate counting strategies, and effectively using the technology. The patient provided a written consent to publish his information. Discussion: This report highlights the positive impact of continuous subcutaneous insulin infusion in patients with T1D and genetic comorbidities such as Silver-Russell syndrome. The insulin pump allows for personalized adjustments of basal and bolus insulin, promoting better glycemic control. Sensors and automatic suspension systems, such as those in the 640G model, help reduce hypoglycemia and facilitate early interventions. Studies such as DCCT/EDIC and international guidelines support these benefits, demonstrating that intensive control reduces microvascular complications and improves quality of life. Continuous educational support, emphasized by the patient, is essential for maintaining positive outcomes, promoting adherence, and fostering autonomy in disease management. Final Comments: Insulin pump therapy and continuous glucose monitoring demonstrated efficacy in glycemic control, complication reversal, and quality-of-life improvement in a patient with T1D and Silver-Russell syndrome. This case reinforces the need for individualized treatment, investment in advanced technologies, and the provision of qualified and continuous educational support. The combination of technology and education empowers patients, promoting better clinical outcomes even in complex contexts.

PO—329 Use of the Virtual Tool “Lina Chatbot” for Guidance on Insulin Administration in Diabetic Patients Attended at the Endocrinology Outpatient Clinic

Guimarães ML1; Claudio ILP1; Oliveira HC1; Cerbino AS 1; Ross M 1; Cargnin KRN 1

(1) Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

Diabetology & Metabolic Syndrome 2026: PO—329

Introduction: Proper insulin administration is essential for glycemic control in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Technical errors in injection are frequent in clinical practice and may impair therapeutic outcomes. Digital educational tools, such as the “Lina Chatbot,” an interactive virtual questionnaire conducted by a “digital nurse,” have emerged as promising strategies to strengthen self-care. Objective: To evaluate the influence of Lina Chatbot, designed to improve insulin injection techniques, on glycemic control measured by glycated hemoglobin (HbA1c) in T1DM and T2DM patients. Methods: A prospective observational study, approved by the ethics committee, was conducted with insulin-treated diabetic patients. HbA1c levels were assessed before and 1–4 months after chatbot access. Platform administrators verified user access and, based on this, patients were divided into two groups: Group 1, with confirmed access, and Group 2, without access. Patients who did not return with appropriate HbA1c results were excluded. Variables analyzed included HbA1c increase or decrease in both groups. The chi-square test, with a significance level of 0.05, was applied to evaluate statistical differences. Results: Thirty-seven patients were initially followed, and eight were excluded for lack of valid HbA1c results. The final sample consisted of 29 patients: 15 with confirmed chatbot access and 14 without. The mean age was 57 years, and 52% were elderly. In the access group, 9 patients showed HbA1c reduction (mean decrease: 1.40%), 5 showed an increase (mean rise: 0.84%), and 1 had no change. In the non-access group, 10 patients showed HbA1c reduction (mean decrease: 1.29%), while 4 showed an increase (mean rise: 0.45%). No statistical difference was observed between the groups (p=0.5229). Conclusion: Although no statistically significant difference was found, patients who accessed the chatbot experienced a slightly greater HbA1c reduction. Patient age may have contributed to limited platform use. Digital educational tools such as Lina Chatbot appear to be promising strategies to enhance self-care in subjects with diabetes.