Adrenal insufficiency (AI) is potentially life-threatening and accurate diagnosis is crucial. The first-line diagnostic test, the ACTH stimulation test, measures serum total cortisol. However, this is affected in states of altered albumin or cortisol-binding globulin levels, limiting reliability. Salivary cortisol reflects free bioactive cortisol levels and is a promising alternative. However, few studies are available, and heterogenous methodologies limit applicability. This study prospectively recruited 42 outpatients undergoing evaluation for AI, excluding participants with altered cortisol-binding states. Serum (immunoassay) and salivary (LC-MS/MS) cortisol levels were sampled at baseline, 30-minutes and 60-minutes following 250mcg Synacthen administration. AI was defined as a peak serum cortisol level <500nmol/l in accordance with guidelines. The study recruited 21 (50%) participants with AI, and 21 without AI. There were no significant differences in baseline characteristics, blood pressure, or sodium levels between groups. Following Synacthen stimulation, serum and salivary cortisol levels showed good correlation at all timepoints (R2 = 0.74, P<0.001), at peak levels (R2 = 0.72, P<0.001), and at 60-minutes (R2=0.72, P<0.001). A salivary cortisol cut-off of 16.0 nmol/L had a sensitivity of 90.5% and a specificity of 76.2% for the diagnosis of AI. This study demonstrates good correlation between serum and salivary cortisol levels during the 250mcg Synacthen test. A peak salivary cortisol cut-off of 16.0 nmol/L can be used for the diagnosis of AI. It is a less invasive alternative to evaluate patients with suspected AI. Its potential utility in the diagnosis of AI in patients with altered cortisol-binding states should be further studied.

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Background: The Dose Adjustment for Normal Eating (DAFNE) is a type 1 diabetes (T1D) group education program to enable self-management. Shown to improve outcomes in the UK, its application in Asian countries remains uncertain. We assessed the outcomes of Singapore (Sg)DAFNE, which remains the only Asian centre, from 2011-2018. Methods: Prior to DAFNE entry, most had received one-on-one education from DAFNE educators. HbA1c, total daily dose (TDD) of insulin were retrieved at these timepoints: 1y before, at entry, 1y after, latest profile. Paired sample t-tests and Chi square tests were used; data is presented as means±SD. Results: n=115 (33.9% male), age 28.3±8.5y, T1D duration 11.2± 8.4y, follow-up post-DAFNE 3.5 ±2.3y. n=104 completed 1y follow-up post-DAFNE. Mean HbA1c pre-DAFNE fell by entry into DAFNE: pre-vs.-entry: 8.5±1.68% (68 mmol/mol) vs. 7.9±1.4%, p&lt;0.001. This fall was sustained 1y post-DAFNE and at latest follow-up (HbA1c 7.8±1.3%, 7.9±1.3%, all p&lt;0.001). Proportion of those in HbA1c category ≤ 7.5% rose while the proportion in higher HbA1c categories fell post-DAFNE (Figure). TDD insulin fell alongside improvement in glycaemic control (pre-vs.-post-DAFNE: 45.5+14.9 vs. 42.5+12.0, p=0.02). Conclusion: This demonstrates the effectiveness of SgDAFNE. Sustained improved glycaemic control was achieved with reduced insulin dosages, reinforcing that the quality of insulin use matters more than the quantity. Disclosure S. Tan: None. S. Rama Chandran: None. H. Lim: None. K. Adaikan: None. S. Goh: None. D. Gardner: None.