bluuebunny/crossref_metadata_2025 huggingface dataset:
A synopsis of Convolvulaceae from the Upper Turi-Gurupi region in the Amazon of Maranhão, Brazil
Authors: Oliveira Regigláucia Rodrigues de , Silva Guilherme Sousa da , Pastore Mayara , Nascimento Jeromar Dos Santos
Published: May 2022

A synopsis of Convolvulaceae species from the Upper Turi-Gurupi region, a strategic area for the conservation of Amazonian biodiversity in the state of Maranhão, is presented. Field samples and herbarium collections were analyzed to build a list of species, indicating the most representative taxa and providing data on growth habit, geographic distribution, occurrence in Brazilian phytogeographic domains, and distribution in the Upper Turi-Gurupi region. Twenty-one species and nine genera (Aniseia Choisy, Bonamia Thouars, Camonea Raf., Distimake Raf., Evolvulus L., Ipomoea L., Maripa Aubl., Odonellia K.R. Robertson, and Operculina Silva Manso) were recorded. Ipomoea was the most representative genus, with 10 species, and Ipomoea asarifolia was the most collected species. Maripa scandens Aubl. is a new record for the state of Maranhão and in relation to the last taxonomic work of Convolvulaceae in the Amazon, which covered Maranhão, 10 species are new records for the state. A heterogeneous distribution of the species and sampling gaps of Convolvulaceae were observed in the region, pointing to the need for further surveys. This study contributes to the knowledge of this botanical family in the Amazon territory and stimulates the conservation of the Amazonian flora in Maranhão, since the study area is under strong pressure from environmental degradation and is one of the most threatened in terms of biodiversity loss in the Amazon.
The effects of tropospheric ozone on plant species: New perspectives
Authors: Vella Kirsty , Attard Everaldo
Published: May 2022

The effect of tropospheric ozone on the physiology of plants has been well established using physicochemical analysis and visual assessment. One of the main metabolic processes, in plants that is affected by ozone, is photosynthesis. This in turn affects a number of secondary processes required for the survival of plants. This study focused on two main aspects; the qualitative determination of damage through visual assessment and the quantification of damage through the determination of the content of chlorophyll and other quality parameters using spectrophotometric techniques in a number of plant species. Three distinct setups were considered, mainly rural, urban and semiurban, representing the topography of the islands of Malta and Gozo. It was observed that chlorosis was not the sole factor contributing to the yellowing of the leaves. Another important finding was the correlation between ozone levels (50.18-69.35 ppb) and the anthocyanin content (2.57-28.99 mg/kg) of leaves. From the three plant species that were extensively studied (Nerium oleander, Pinus halepensis and Schinus terebinthifolius), the N. oleander exhibited promising results as a bioindicator for ozone-induced damage. Due to the presence of this ornamental plant in rural and urban areas, it can be used by researchers and authorities as a tool for assessment of tropospheric ozone levels.
Predator-prey: predation strategies of Leptodactylus macrosternum and defensive behavior of Leptodactylus fuscus
Authors: Costa Claylton Abreu , Uchôa Lucas Rafael , Araújo Sâmia Caroline Melo , Oliveira Mariane Silva , Andrade Etielle Barroso
Published: May 2022

Congeneric predation between two Leptodactylus species was recorded and information was collected on the predation strategy of L. macrosternum and the defensive behavior and distress call of L. fuscus. The entire predation event lasted about 90 min and ended when predator tore integument of the prey's ventral region, facilitating swallowing. The distress call description was based on a record of 40 s containing seven calls, consisting of a pulsatile and harmonically complex structure composed of two notes. Although the batrachophagy is well-documented in the genus Leptodactylus, descriptions of predatory and defensive behaviors are not fully described. Thus, the defensive behaviors observed here made predation a physiologically taxing event, while we look at how the predator can use various mechanisms to overcome prey defensive behaviors.
A Expansion of the geographic distribution and conservation status of Paullinia cearensis Somner & Ferrucci (Sapindaceae)
Authors: Nascimento Janilde De Melo , Silva Guilherme Sousa , Da Conceição Gonçalo Mendes
Published: May 2022

Paullinia cearensis Somner & Ferrucci (Sapindaceae) is an endemic species of Northeastern Brazil, hitherto known from the states of Ceará and Piauí, in areas of Caatinga and Atlantic Forest. The species is being recorded for the first time in the state of Maranhão and in the Brazilian Cerrado. It was collected in Morro do Alecrim, a remnant of Cerrado, in Caxias-Maranhão, during a botanical expedition in January 2021, where the species was found with fruits. A morphological description, taxonomic comments, data on geographic distribution, detailed images of the species, and an assessment of its conservation status, categorized as endangered, are presented. This data will contribute to the knowledge and conservation of this species for the northeastern flora.
1000-P: The Effects of Neighborhood Characteristics on Youth with Type 2 Diabetes Mellitus
Authors: NI JENNIFER , ADDALA ANANTA , WILSON DARRELL M. , PRAHALAD PRIYA
Published: May 2022

Type 2 diabetes mellitus (T2D) in youth has become an increasingly pressing issue over the last two decades. Emerging data from adult studies show associations between T2D and neighborhood characteristics; less is known about these effects on the pediatric population. We performed a retrospective study on youth ages 7 to 21 years with T2D seen at our health care system from 1/1/20to 4/1/2021. Utilizing United States government databases, we categorized zip codes of the primary residences based on neighborhood risk factors: food deserts (paucity of healthy food) , food swamps (abundance of unhealthy food) , rural, medically underserved (shortage of primary health care services) , or low-risk. This study included 396 youth; 51% live in an area with at least one neighborhood risk factors. Compared to those living in low-risk neighborhoods (age 14.6 ± 2.6 years, A1c 9.2 ± 2.6 %) , youth living in rural areas tended to be younger at initial diagnosis (14.1 ± 2.9 years) with higher initial A1c (9.4 ± 2.6%) , though the effect size was smaller than what this study was powered to detect. Youth living in food deserts or medically underserved areas also tended to be younger at initial diagnosis (14.2 ± 2.6 years and 14.2 ± 2.9 years, respectively) compared to youth in low-risk neighborhoods. A better understanding of neighborhood risk factors may help to inform public health policies with the goal of mitigating the rise and severity of pediatric T2D.

Disclosure

J.Ni: None. A.Addala: None. D.M.Wilson: Advisory Panel; Tolerion, Inc., Other Relationship; Intrexom T1D Partners, Research Support; National Institutes of Health. P.Prahalad: None.
1001-P: BMI Changes in Youth with Type 2 Diabetes during COVID-Shelter-in-Place: The Role of Neighborhood Risk Factors
Authors: NI JENNIFER , PRAHALAD PRIYA , ADDALA ANANTA
Published: May 2022

The California government imposed a shelter-in-place (SIP) order on 3/15/2020 to slow the spread of COVID-19. For many children and adolescents, particularly youth with type 2 diabetes (T2D) , school closures led to major changes in daily routines, affecting physical activity levels and dietary choices. We performed a retrospective descriptive study on youth ages 7 to 21 years with T2D who were seen at our health care system at least one time in the year preceding SIP and again in the year after, allowing us to calculate change in BMI over time during SIP. Utilizing databases from the United States government, we examined the effects of living in an area with at least one risk factor (“food deserts” with a paucity of healthy food, “food swamps” with an abundance of unhealthy food, or rural regions) on BMI change compared to low-risk neighborhoods. We included 78 youth with T2D and 46% lived in at-risk areas. Overall, youth had a slight increase in BMI during SIP (0.± 0.2 kg/m2/month) . Youth living in at-risk areas had a rise in BMI during this time period (0.02 ± 0.2 kg/m2/month) , whereas youth in low-risk areas had a small drop in BMI (-0.± 0.2 kg/m2/month) . As this study was not powered to detect group differences, further investigation of neighborhood risk factors is needed to aid in tailoring community-level interventions to combat obesity in youth with T2D.

Disclosure

J.Ni: None. P.Prahalad: None. A.Addala: None.
1003-P: Incidence of Severe Diabetic Ketoacidosis among Children with Type 1 Diabetes Mellitus Prior to and During COVID-Pandemic: A Meta-analysis
Authors: ALFAYEZ OSAMAH , ALFALLAJ JAWAHER , ALMUTAIRI ABDULAALI R.
Published: May 2022

Aim: The COVID-pandemic has affected access to healthcare services worldwide, including the pediatric population. This systematic review and meta-analysis aimed to estimate the risk of severe diabetic ketoacidosis (DKA) among children with type 1 diabetes (T1DM) during the COVID-pandemic compared pre-pandemic era.

Methods: PubMed, EMBASE, and the Elsevier Coronavirus Research Repository Hub were searched for relevant observational studies. Studies published as an abstract or in non-English language were excluded. The primary outcome is the risk of severe DKA among children with T1DM during the COVID-pandemic compared to the prior-to-COVID-group. The second outcome is the risk of severe DKA among children with newly diagnosed T1DM. A random meta-analysis model was performed using R version 4.0.4 to estimate the relative risk of severe DKA.

Results: A total of 18 studies were included in this metanalysis. Severe DKA risk was 76% (RR 1.76, 95%CI 1.33-2.33, I2=44%) higher during the COVID-pandemic than the pre-COVID-period. Among patients with newly diagnosed T1DM, the risk of severe DKA was 44% higher for the during-COVID-group (RR 1.44, 95%CI 1.26-1.65; I2=64%) . The bias assessment of the included studies using the Newcastle-Ottawa Scale (NOS) showed that all studies had quality indicators (>7 points) . In addition, the results of Eager’s test did not show potential for publication bias.

Conclusions: This study showed that severe DKA risk had increased significantly during the COVID-pandemic compared to the pre-pandemic period.

Disclosure

O.Alfayez: None. J.Alfallaj: None. A.R.Almutairi: None.
1004-P: Executive Dysfunction Predicts Lower Self-Care Readiness in Teens with Type 1 Diabetes
Authors: VITALE REBECCA J. , TINSLEY LIANE J. , VOLKENING LISA K. , LAFFEL LORI M.
Published: May 2022

Aim: Management of type 1 diabetes (T1D) is a complex multi-step process in which executive function (EF) skills (planning, organization, problem solving) are critical for optimal control. In teens with T1D, EF may be important in transitioning from parent-supervised care to self-care.

Methods: In an 18-month study, teens aged 13-17 years with T1D and parents completed the Diabetes Family Responsibility Questionnaire (DFR) and Readiness for Independent Self-Care Questionnaire (RISQ) every 6 months. Teen EF was assessed by parent proxy-report using Behavior Rating Inventory of Executive Function (BRIEF) . T-score ≥60 defined risk of executive dysfunction for the Global EF Composite (GEC) , Behavioral Regulation Index (BRI) and Metacognition Index (MI) . EF, demographic, and T1D treatment variables were used to predict change in RISQ over time using longitudinal mixed models with false discovery rate adjustment.

Results: 169 teens (54% male) participated with baseline age 15.9±1.3 years, T1D duration 8.4±3.7 years, HbA1c 8.6±1.2%, 74.6% insulin pump use, and 21.3% continuous glucose monitor (CGM) use. 31.4% of teens had a parent-reported GEC score ≥60. After adjusting for age, gender, and parent-reported DFR (pDFR) , those with GEC ≥60 had parent-reported RISQ (pRISQ) 4.1 points lower than those with GEC <60, p=0.016. BRI (adjusted for age, CGM use, pDFR, and HbA1c) did not predict change in pRISQ while MI (adjusted for age, gender, and pDFR) did; those with MI ≥60 had pRISQ 5.3 points lower than those with MI <60, p<0.001. In models using teen-reported DFR and RISQ (tRISQ) , GEC and MI similarly predicted lower tRISQ. In all models, lower age (p<0.05) and greater parent involvement (p<0.001) also predicted lower RISQ.

Conclusion: EF, especially metacognition, appears important for acquisition of self-care behaviors for teens with T1D. Evaluating EF during adolescence may identify teens with executive dysfunction who may need extra support during the transition process.

Disclosure

R.J.Vitale: None. L.J.Tinsley: None. L.K.Volkening: None. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc.

Funding

NIH T32DK007529NIH P30DK036836NIH R01DK095273JDRF 2-SRA-2014-253-M-B
1007-P: Health Disparities in the Effect of the COVID-Pandemic on Loss-to-Follow-Up Rates among High-Risk Pediatric Patients with Type 1 Diabetes (T1D)
Authors: GUPTA MEENAL , CARLIN KRISTEN , ROBERTS ALISSA J. , MALIK FAISAL , DESAI ARTI
Published: May 2022

Objective: Historically marginalized groups have higher rates of poor glycemic control linked to barriers in access to care. We sought to examine whether there was a differential effect of the COVID-pandemic on loss-to-follow-up (LTFU) rates among high-risk youth with T1D based on language for care, race, and ethnicity.

Methods: Retrospective cohort study of pediatric patients with T1D (HbA1c ≥9%) seen at a tertiary care diabetes clinic between 1/1/18-2/29/20 (pre-COVID period) and 3/1/20-1/31/21 (COVID period) . LTFU was tracked monthly and defined as patients not seen in the preceding 6 months. Preferred language for care, race, and ethnicity data were obtained from visit registration data. Generalized estimating equations were used to examine associations between time-periods (pre-COVID versus COVID) and LTFU rates, adjusted for patient age. In two models, separate interaction terms for (1) language for care and (2) race and ethnicity were introduced to assess for effect modification.

Results: 1359 patients were included (9.5% with language other than English [LOE]; 33.5% from historically marginalized racial and ethnic groups) . We found a 1.27 higher odds (95% CI: 1.08, 1.49) of LTFU after the onset of the pandemic, with differential effects based on language for care. Among patients with LOE, the odds of LTFU in the COVID period was 4.14 higher (95% CI: 2.35, 7.29) compared to the pre-COVID period. LTFU rates did not significantly differ between time periods among English-speaking patients (OR 1.12 [95% CI: 0.95, 1.33]) . Patient’s race and ethnicity did not modify the effect of the COVID-pandemic on LTFU rates.

Conclusion: The COVID-pandemic has exacerbated LTFU rates in high-risk youth with T1D and disproportionately impacted patients whose preferred language for care is a LOE. Interventions to improve LTFU rates should include targeted efforts to reduce health disparities in access to care in this high-risk population.

Disclosure

M.Gupta: None. K.Carlin: None. A.J.Roberts: None. F.Malik: n/a. A.Desai: None.
101-LB: Utility and Safety of Backup Insulin Regimens Generated by the Bionic Pancreas—A Randomized Study
Authors: MAURAS NELLY
Published: May 2022

The bionic pancreas (BP) is initialized with body weight only, makes all insulin dosing decisions autonomously, and uses meal announcements without carbohydrate counting. In the event of device malfunction, BP users may need guidance for managing their glucose. The BP generates and continuously updates a table with back-up insulin doses for either injection or pump users, including a long-acting insulin dose, a four-period basal insulin profile, short-acting meal doses for breakfast, lunch, and dinner depending on meal size (Usual, Less, More) , and a glucose correction factor. At the end of the 13-week Pivotal RCT of the BP in type 1 diabetes, participants in the BP group (6-83 years old) were randomized 1:1 to their Pre-study Insulin Regimen (N=148) or BP Guidance (N=149) , and took insulin by injection or pump according to their pre-study modality, for a 2-4 day Transition Phase. There was high adherence to the regimen in the BP Guidance group and no episodes of severe hypoglycemia or DKA. Glycemic outcomes in the BP Guidance group were similar to those the Pre-study Insulin Regimen group, and comparable to their own pre-randomization baseline. Both groups had higher mean glucose and less time in range in the Transition Phase than while using the BP during the RCT (Table) . A back-up insulin regimen automatically generated by the BP can be safely implemented if need arises to discontinue use of the BP.

Disclosure

N. Mauras: Research Support; AbbVie Inc., Beta Bionics, Inc., Novo Nordisk, Pfizer Inc.

Funding

Funding from National Institute of Diabetes and Digestive and Kidney Diseases (grant #1UC4DK108612-01) Funding and bionic pancreas devices from Beta Bionics, Inc. Fast-acting insulin aspart and insulin aspart provided by Novo Nordisk Insulin lispro by Eli LillyBlood glucose meters and test strips (Contour?Next One Blood Glucose Monitoring System) provided by Ascensia Diabetes Care, Basel, CH. Continuous glucose monitor sensors and transmitters were purchased from Dexcom, Inc. at a discounted price.
101-OR: Cell-Specific Role of Insulin in a Model of Restenosis in Insulin-Sensitive and Insulin-Resistant Conditions
Authors: GONZALEZ MAREL , LIU ZHIWEI , WANG JOHNY Z. , ZHANG CINDY X. , GIACCA ADRIA
Published: May 2022

Angioplasty and stenting are widely used in the treatment of atherosclerosis. However, these procedures may fail due to post-angioplasty restenosis, which remains a problem for patients with diabetes. Currently, the vascular role of insulin is unclear. Its role on endothelial cells (EC) is vasculoprotective, whereas its effects on vascular smooth muscle cells (SMC) are mainly mitogenic according to in vitro data. We have previously shown a suppressive effect of insulin treatment on neointimal growth in rodent models of restenosis in insulin sensitive conditions that was abolished in insulin resistant conditions. The objective of this study was to determine the EC-and SMC-specific effects of insulin treatment on neointimal growth in a murine model of restenosis in insulin sensitive and insulin resistant conditions. Mice were generated by crossing insulin receptor (IR) floxed mice with tamoxifen inducible Cre recombinant mice under the control of Cdh5 (vascular endothelial cadherin) or SMMHC (smooth muscle heavy chain) promoters. Mice were fed with a low-fat (LFD) or a high-fat-high-sucrose (HFSD) diet and implanted with insulin pellet (0.U/day) or vehicle (control) prior to femoral artery wire injury. We found that compared to IR-floxed controls, tamoxifen-induced IRf/f-Cdh5-Cre+ or IRf/f-SMMHC-Cre+ mice showed a 94% and 80% decrease in IR expression in ECs or SMCs, respectively. In LFD-fed insulin sensitive conditions, insulin decreased neointimal area (NA) and intima-to-media ratio (I/M) in controls (Cdh5 and-SMMHC-floxed and wildtype-Cre+ mice) but not in endothelial and SMC IR deficient mice. In HFSD-fed insulin resistant conditions, insulin had no effect in either controls or endothelial and SMC IR deficient mice. These data demonstrate that insulin action in both ECs and SMCs is required for the anti-restenotic effect of insulin in insulin sensitive conditions, which is abolished but not reversed in insulin resistance even when endothelial IR is deficient.

Disclosure

J.Z. Wang: None. C.X. Zhang: None. A. Giacca: None.
1013-P: Risk Factors for Hyperglycemic and Hyperketotic Emergencies in COVID+ Youth with Type 1 Diabetes (T1D)
Authors: TSAI SARAH , TALLON ERIN M. , FERRO DIANA , ZARSE ERICA , WILLIAMS DAVID D. , SHYU CHI REN , CLEMENTS MARK A.
Published: May 2022

Recent studies report increased frequency of hyperglycemic and hyperketotic emergencies in youth with T1D and coronavirus disease 20 (COVID-19) . Morbidity and mortality risk may be increased in individuals who develop diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar syndrome (HHS) with concurrent COVID-infection.

Using a Cerner RealWorld DataTM COVID-dataset with de-identified information from 490,373 individuals with COVID- (12/2019-9/2020) from 87 U.S. healthcare systems, we examined demographic and clinical characteristics of youth with established T1D and suspected or confirmed COVID-infection. We then used generalized mixed models to evaluate the association of body mass index (BMI) , race and ethnicity, and hemoglobin A1c (HbA1c) to two outcomes: (1) DKA and (2) concurrent DKA and HHS (DKA+HHS) . We used a validated cohort selection algorithm to identify 383 youth (<18 years old; 50.7% female) with T1D. Of these, 35.8% were non-Hispanic White, 27.4% were Hispanic, and 14.9% were non-Hispanic Black/Other (NHB/O) . The most common comorbid conditions were fluid and electrolyte disorders, documented for 64.2% of the cohort. Other frequent comorbid conditions included cardiac arrhythmias (19.3%) , chronic pulmonary disease (17.2%) , and depression (16.2%) . Thirty-nine percent of youths in the cohort experienced DKA only, 1.0% experienced HHS only, and 4.2% experienced DKA+HHS. After adjustment, we found HbA1c to be the only factor associated with increased odds of DKA alone (adjusted odds ratio [AOR]: 1.22; 95% CI (1.09,1.36) ; p<0.001) . Odds of DKA+HHS were markedly increased in NHB/O individuals (AOR: 4.47; 95% CI (1.07,18.72) ; p=0.04) .

Demographic and clinical care factors that associate with increased risk of DKA or DKA+HHS differ among youth with T1D and COVID-infection. Whether risk factors associated with DKA, HHS or DKA+HHS differ among youth with T1D with or without COVID-infection requires further study.

Disclosure

S.Tsai: Stock/Shareholder; Dexcom, Inc. E.M.Tallon: None. D.Ferro: None. E.Zarse: None. D.D.Williams: None. C.Shyu: n/a. M.A.Clements: Consultant; Glooko, Inc., Research Support; Abbott Diabetes, Dexcom, Inc.
1031-P: Psychosocial Problems in Indonesian Children and Adolescents with Type 1 Diabetes (T1D) during COVID-Pandemic
Authors: FADIANA GHAISANI , SOESANTI FRIDA , PULUNGAN AMAN
Published: May 2022

Objectives: The COVID-pandemic has presented challenges for individuals with chronic diseases in resource-limited settings. Lockdowns and restrictions have decreased access to health care and disrupted medical support. Those challenges might affect the psychological status of children and adolescents with T1D.

Methods: The study was conducted with ethics approval in the Endocrinology Clinic Cipto Mangunkusumo Hospital, Jakarta, Indonesia June 2020-June 2021. Demographic background, COVID-knowledge, challenges and psychosocial problems were assesed using a questionnaire. Surveys were given in person and online.

Results: There were 148 respondents (23 adolescents, 1parents, 14 relatives) . Median age was 13 (3-18) , 51% female. During the pandemic, median A1C was 8.2% and complications that occurred were frequent hyperglycemia (23%) , hypoglycemia (14%) , and ketoacidosis (8%) . Most patients used national health insurance (90%) in public hospital (80%) . Most of the respondents reported being affected by lockdowns in their area (73%) , although many could still visit healthcare facilities (44%) . Despite getting exemption for healthcare visit in lockdown period, about almost half of them felt that their check-up routines were disrupted (41%) mainly due to fear of getting infected with COVID-during visit (34%) . Many children had some psychological problem (51%) such as irritability (26%) , distress (12%) , anxiety (11%) and insomnia (10%) . As many as 37% of them needed psychological support from either health care workers or their relatives.

Conclusions: The COVID-pandemic has presented new challenges for diabetes management in children and adolescents living in resource-limited settings. Patients’ routine visits, access to essential diabetes care and psychological states have been affected. Given the ongoing nature of waves during the pandemic, further studies about the impact of COVID-pandemic on psychological well-being are needed.

Disclosure

G.Fadiana: None. F.Soesanti: None. A.Pulungan: None.
1040-P: Associations between Sleep Characteristics and Changes in Body Weight and Fat from 6–8 Weeks to 6 Months Postpartum in Black and White Women
Authors: WANG XUEWEN , KISHMAN ERIN
Published: May 2022

The literature indicates Black women tend to lose less weight after pregnancy than White women. Sleep duration and quality have been associated with body weight and fat in other populations. Thus, the purpose of this study was to determine whether associations between sleep characteristics and changes in body weight and fat during postpartum in Black and White women were different. Black (n=29) and White (n=76) women who gave birth to a singleton infant at ≥37 weeks gestation participated in the study. They were instructed to wear an actigraph monitor to measure sleep at 6-8 weeks, 4 months, and 6 months postpartum for 7 days, and to complete a sleep diary. Total sleep time, wake time after sleep onset, and the sleep fragmentation index (an estimate of sleep disruption) were determined. Percent body fat (by dual-energy X-ray absorptiometry) and body weight were determined at 6-8 weeks and 6 months postpartum. A race by sleep characteristic interaction term was included in linear regression models to determine whether Black and White women had different bivariate correlations between sleep characteristics at each time point and changes in body weight and percent body fat from 6-8 weeks to 6 months. Results indicate significant interaction terms of sleep fragmentation index at 6-8 weeks and race for both weight and fat change (p=0.006, and 0.028, respectively) . Specifically, in Black women, sleep fragmentation index at 6-8 weeks were negatively associated with changes in percent body fat and weight (p= 0.027 and 0.032, respectively) , so that greater sleep disruption at 6-8 weeks was associated with less reduction in weight and percent body fat. In White women, these significant associations were absent.

In conclusion, these results suggest different contributions of sleep characteristics to postpartum weight and fat changes in Black and White women. The reasons for the differences need further investigation.

Disclosure

X.Wang: None. E.Kishman: None.

Funding

National Institutes of Health (R21MD012740)
1041-P: Differences in Meeting Trimester-Specific HbA1c Goals in T1D Pregnancies Utilizing CGM vs. SMBG in a T1D Specialty Clinic
Authors: MALECHA EMILY , GAO VALERIE , WESTFELDT ELIZABETH , SNELL-BERGEON JANET K. , POLSKY SARIT
Published: May 2022

Glycemic control significantly affects the risk for developing adverse gestational health outcomes in pregnancies affected by type 1 diabetes (T1D) . Utilizing continuous glucose monitoring (CGM) in T1D pregnancies has been shown to improve maternal glucose control. We examined the effect of CGM use in meeting HbA1c goals by trimester in T1D pregnancies in a real-world setting.We did a retrospective chart view to identify T1D pregnancies managed at the Barbara Davis Center (BDC) for T1D with either CGM therapy (n=82) or self-monitoring of blood glucose (SMBG) (n=78) over a 6.5-year period (1/1/14 to 8/31/20) . CGM use was defined as >60% wear in the 2nd and 3rd trimesters. HbA1c goals were defined as ≤6.5% in Trimester 1 (T1) and ≤6% in Trimester 2 (T2) and Trimester 3 (T3) , per guidelines by the American Diabetes Association. Baseline characteristics and HbA1c were obtained from the electronic medical record system.CGM users had a significantly higher rate of commercial insurance use (Table) , while other baseline characteristics were similar between groups. CGM users were more likely to meet HbA1C goals in all trimesters (Table) . More than half of SMBG users did not meet HbA1C goals in any trimester (Table) .CGM use significantly increased the likelihood of meeting trimester-specific HbA1c goals in each trimester throughout pregnancy among women with T1D in this real-world study.

Disclosure

E.Malecha: None. V.Gao: None. E.Westfeldt: n/a. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc. S.Polsky: Advisory Panel; Medtronic, Other Relationship; diaTribe, Research Support; Dexcom, Inc., Eli Lilly and Company, Leona M. and Harry B. Helmsley Charitable Trust, Medtronic, National Institute of Diabetes and Digestive and Kidney Diseases, Sanofi-Aventis U.S.

Funding

National Institutes of Health (P30-DK116073)
1043-P: Association between Maternal COVID-Infection and Gestational Metabolic Dysfunction in an Urban Academic Center
Authors: FORREST ALEXANDRA D. , CHANDRASEKARAN SUCHITRA , HIGGINS MELINDA , FERRANTI ERIN
Published: May 2022

Objective: Nonpregnant individuals with diabetes mellitus (DM) or hypertension (HTN) experience greater complications of COVID-infection. Gestational DM (GDM) and hypertensive disorders of pregnancy (HDP) confer increased maternal and fetal morbidity; but whether the association of DM and HTN with COVID-illness in the non-pregnant state also exists in pregnancy is unclear. Therefore, we investigated associations between COVID-and GDM and HDP in a large urban inner-city population.

Study Design: We performed a case control study among women with and without COVID-infection; controls were matched for gestational age and time of COVID-test between 3/2020 and 10/2020. Maternal demographic and clinical data including COVID-infection status were abstracted. Chi-square, logistic and linear regression were used for analysis.

Results: A total of 87 women with and 9women without COVID-infection were included in the study. There was no significant association between COVID-infection and GDM (10.3% COVID positive, 9.9% COVID negative, p=0.89) . Similarly, there was no association between COVID-infection and HDP (37.9% COVID positive, 37.3% COVID negative, p=0.911) . Despite no associations between COVID-infection and GDM or HDP, subjects with COVID-infection were more likely to be obese based on pre-pregnancy BMI (p = 0.047) .

Conclusions: Unlike in the non-pregnant state, COVID-infection was not significantly associated with GDM or HDP in our diverse, urban inner-city population. Our data suggest that beyond gestational metabolic dysregulation, maternal obesity alone may increase a woman’s vulnerability to COVID-infection in pregnancy. Given that the COVID-pandemic is still rampant, and that obesity affects one third of reproductive age women, future studies are essential to elucidate the mechanisms underlying this association.

Disclosure

A.D.Forrest: None. S.Chandrasekaran: None. M.Higgins: None. E.Ferranti: None.
1044-P: Impact of Pregnancy on Microvascular and Cardiac Outcomes in Youth-Onset Type 2 Diabetes
Authors: TRYGGESTAD JEANIE B. , KELSEY MEGAN M. , ARSLANIAN SILVA A. , CHERNAUSEK STEVEN , DREWS KIMBERLY , ESCANAME ELIA N. , GEFFNER MITCHELL , ISGANAITIS ELVIRA M.
Published: May 2022

This analysis compared microvascular and cardiac outcomes from women in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study, originally diagnosed with youth-onset Type 2 diabetes between the ages of 10-17 yrs, who experienced a pregnancy lasting 20 wks during the course of the study vs. those without. Pregnancy information was obtained prospectively by self-report followed by medical record review. Neuropathy and nephropathy were assessed annually. Retinopathy, echocardiography, and arterial stiffness were assessed twice during the study. Women with a history of pregnancy prior to the initial assessment were excluded. Of the 4women in TODAY, 116 reported a pregnancy lasting ≥ 20 weeks, with 67 having a single pregnancy and 49 with multiple pregnancies. The mean age at first pregnancy was 21.6 yrs. and mean diabetes duration 8 yrs. At study entry, women who reported a pregnancy during the trial were older (14 yrs. vs. 13.6 yrs., p=0.05) with lower household income (51.5% vs. 37.8% below $25,000, p=0.002) . Primary study outcome, defined as HbA1c >8% or inability to wean from insulin, was similar between the two groups. In Cox regression models adjusted for participant characteristics from study entry including age, race/ethnicity, household income, diabetes duration, HbA1c (>6%) , and BMI, women with a pregnancy had an increased risk of hyperfiltration, 2.76 (1.38-5.49) , p=0.0vs. those without a pregnancy. No differences were observed in rates of retinopathy, neuropathy, or macro- and microalbuminuria in women with vs. without a history of pregnancy. In fully adjusted models, history of pregnancy did not impact echocardiographic measures or arterial stiffness obtained prior to the reported pregnancy versus the measures after the pregnancy. These results suggest that pregnancy increases the risk of hyperfiltration in women with youth-onset T2D, but not other micro or macrovascular complications.

Disclosure

J.B.Tryggestad: None. M.M.Kelsey: Other Relationship; Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Rhythm Pharmaceuticals, Inc. S.A.Arslanian: Advisory Panel; Eli Lilly and Company, Novo Nordisk, Other Relationship; AstraZeneca, Research Support; Eli Lilly and Company, Novo Nordisk. S.Chernausek: None. K.Drews: None. E.N.Escaname: None. M.Geffner: Advisory Panel; Novo Nordisk, Pfizer Inc., Research Support; Novo Nordisk. E.M.Isganaitis: Research Support; AstraZeneca, Dexcom, Inc., Insulet Corporation.

Funding

U01-DK61212, U01-DK61230, U01-DK61239, U01-DK61242, and U01-DK61254
1053-P: Prevalence, Predictors, and Consequences of Unplanned Pregnancy in Women with Preexisting Diabetes
Authors: OKIGBO CHINELO C. , MCLAUGHLIN CLAIRE , KIRKMAN M. SUE
Published: May 2022

Objective: Women with diabetes who have unplanned pregnancies are more likely to have poor glycemic control in early pregnancy which is associated with poor maternal and fetal outcomes. We assessed the prevalence, predictors, and consequences of unplanned pregnancy among women with preexisting diabetes.

Methods: We used EHR data of 486 women aged 18-49 with preexisting type 1 or 2 diabetes who received pregnancy care at a university hospital in North Carolina between 10/2015 and 02/2020. The outcome was unplanned pregnancy while the predictors were maternal demographic, socioeconomic, and health factors. The consequences assessed were maternal infection, cesarean delivery, postpartum contraception, preterm delivery, NICU admission, macrosomia, LBW, fetal abnormality, and fetal death. We estimated statistical associations as odds ratios (OR) and 95% confidence intervals (CI) .

Results: Of the 554 pregnancies that occurred in the sample, 32% were documented as unplanned, 25% as planned, and 43% had no documented intention. The predictors of unplanned pregnancy were age younger than 25 (OR 2.7; CI 1.5-5.0) , African American race (OR 2.7; CI 1.6-4.5) , being single (OR 1.9; CI 1.3-2.9) , having 2+ comorbidities (OR 2.1; CI 1.2-3.7) , and having 3+ previous pregnancies (OR 2.1; CI 1.2-3.9) . Adjusting for maternal factors including early pregnancy HbA1c, unplanned pregnancy increased the odds of macrosomia (OR 2.2; CI 1.2-4.2) and fetal death (OR 1.8; 95% CI 1.1-3.0) , but not maternal infection, cesarean delivery, preterm delivery, NICU admission, LBW, or fetal abnormality. Women with unplanned pregnancies were more likely to receive postpartum contraception (OR 1.7; CI 1.1-2.6) .

Conclusion: Unplanned pregnancies remain common among women with preexisting diabetes and are associated with adverse pregnancy outcomes independent of maternal HbA1c at the start of the pregnancy. Further efforts are needed to expand preconception care and support pregnancy planning in these women.

Disclosure

C.C.Okigbo: None. C.Mclaughlin: None. M.Kirkman: Research Support; Bayer AG, Novo Nordisk.

Funding

Society of Family Planning Research Fund (SFPRF13-ES12)
1057-P: The Prevalence of Gestational Diabetes Mellitus and Large-for-Gestational-Age Infants across the United States from 2012 to 2018
Authors: HERNANDEZ-ZEPEDA MIRIAM L. , GARG BHARTI , VALENT AMY M.
Published: May 2022

Background: With the increasing rates of GDM and variations in screening guidelines, this study sought to investigate the relationship between GDM and LGA across the U.S.

Methods: This is a retrospective cohort study using National Vital Statistics data (2012-2018) . We included singleton, non-anomalous births with gestational age of 23-42 weeks and excluded women with pre-existing diabetes. The states were divided into four regions (Northeast, Midwest, South, and West) . Chi-square test and multivariable logistic regression models were used.

Results: In the cohort of 24,938,357 births, 14.5% were in Northeast, 21.7% in Midwest, 39.2% in South and 24.6% in West. Midwest had higher prevalence of GDM (6.4%) as well as LGA (10.9%, Figure 1) . After adjusting for maternal race, age, education, BMI, prenatal care, smoking status, hypertension, and year of delivery, risk of LGA is highest in women from South with GDM (aOR=1.16, 95%CI:1.14-1.18) as compared to women from West with GDM.

Conclusions: Further studies are needed to determine factors associated with rising rates of LGA.

Disclosure

M.L.Hernandez-zepeda: None. B.Garg: None. A.M.Valent: None.
107-LB: Progression of Position of Basal Insulin in the Treatment of Type 2 Diabetes—A Real-World Analysis
Authors: SCHAPIRO DAVID , MEEKS ALEXANDRA , LIU DONGJU , GELSEY FELICIA , JUNEJA RATTAN , PEREZ-NIEVES MAGALY , HUANG AHONG
Published: May 2022

Background: In the past 5 years, type 2 diabetes practice guidelines have shifted to prioritize agents with cardiovascular (CV) and renal benefit. This study assessed whether real-world medication use has changed in line with these evolving guidelines.

Methods: We retrospectively examined the treatment patterns (12 months pre and post) of people with T2D (PwT2D) who initiated basal insulin (BI) in either 2015 (cohort 1) , 2017 (cohort 2) , or 2019 (cohort 3) using IBM® MarketScan® Databases. Between-group differences were analyzed via t-test or chi-square as appropriate.

Results: In the study period, 6,396,441 PwT2D were identified. The number of PwT2D initiating BI was 17,801/948,805 (1.88%) in 2015 vs. 10,870/622,455 (1.75%) in 2019 and a progressively larger share of BI initiators had prior GLP-1RA use (14.8% in cohort 1 vs. 25.2% in cohort 3; p < 0.001) or SGLT-2i use (11.4% in cohort 1 vs. 20.5% in cohort 3; p < 0.001) . Furthermore, in patients without prior GLP-1RA, SGLT-2i, or bolus use who initiated GLP-1RA or SGLT-2i in the first year of BI, time to first GLP-1RA (132.4 days in cohort 1 vs. 120.5 days in cohort 3; p = 0.02) or SGLT-2i (131.5 days in cohort 1 vs. 113.3 days in cohort 3; p = 0.002) decreased.

Conclusions: Real-world data suggests growing and earlier use of GLP-1RA and SGLT-2i among BI users, and a growing proportion of PwT2D on BI-GLP-1RA combination treatment, in line with changing practice guidelines.

Disclosure

D. Schapiro: Employee; Eli Lilly and Company. A. Meeks: Employee; Eli Lilly and Company. D. Liu: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. F. Gelsey: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. R. Juneja: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. M. Perez-nieves: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. A. Huang: None.

Funding

Eli Lilly and Company
1082-P: Cardiovascular Effectiveness of SGLT-2 Inhibitors and GLP-1 Receptor Agonists in Routine Care of Frail People with Type 2 Diabetes
Authors: KUTZ ALEXANDER , GOPALAKRISHNAN CHANDRASEKAR , KIM DAE H. , PATORNO ELISABETTA
Published: May 2022

Frailty is important in diabetes management but its impact on the cardiovascular (CV) effectiveness of SGLT-2i and GLP-1 RA as used in routine care is unexplored. Using Medicare claims data, we identified three pairwise 1:1 propensity score (PS) matched cohorts of people with type 2 diabetes who initiated a SGLT-2i, a GLP-1 RA, or a DPP-4i between 04/2013-12/2018. The primary outcome was a composite of major adverse CV events (MACE) including acute myocardial infarction, ischemic stroke, hospitalization for heart failure, or all-cause mortality. We estimated hazard ratios (HR) and absolute rate differences (RD) per 1`000 person-years, with their 95% CI, in each PS-matched cohort by level of frailty, using a validated claims-based frailty index (3 strata: non-frail, <0.15; pre-frail, 0.15-0.24; frail, ≥0.25) , controlling for >150 baseline covariates. We used the Wald test for homogeneity to assess treatment heterogeneity across strata. The HR for MACE associated with SGLT-2i vs. DPP4i (n=91`141 PS-matched pairs) was 0.82 (95% CI 0.72 to 0.93) in frail, 0.71 (0.67 to 0.75) in pre-frail, and 0.78 (0.71 to 0.86) in non-frail people (p for homogeneity=0.033) . The HR for MACE associated with GLP-1 RA vs. DPP4i (n=90`988 pairs) was 0.84 (0.76 to 0.93) in frail, 0.77 (95% CI 0.73 to 0.81) in pre-frail, and 0.82 (0.74 to 0.91) in non-frail people (p for h.=0.150) . The HR for MACE associated with SGLT-2i versus GLP-1 RA (n=67`067 pairs) was 0.87 (0.75 to 1.01) in frail, 0.93 (95% CI 0.87 to 1.01) in pre-frail, and 0.90 (0.79 to 1.03) in non-frail people (p for h.=0.692) . Compared to DPP-4i, the absolute benefit of either SGLT-2i or GLP-1 RA was largest in frail people [RD, -25.0 (-42.1 to -7.9) , p for h.<0.001, NNT=20; and RD, -24.9 (-39.0 to -10.7) , p for h.<0.001, NNT=21; respectively]. While, compared to DPP4i, SGLT-2i and GLP-1 RA were associated with similar relative risk reductions in MACE among people with and without frailty, their absolute benefits were largest in frail people.

Disclosure

A.Kutz: Research Support; Novo Nordisk. C.Gopalakrishnan: None. D.H.Kim: None. E.Patorno: Research Support; Boehringer Ingelheim International GmbH, National Institutes of Health, Patient-Centered Outcomes Research Institute.

Funding

National Institute on Aging (K08AG055670)
1098-P: Impact of Health Factors on Incident Cardiovascular Disease (CVD) According to Glucose Tolerance Status
Authors: IIJIMA TAKANOBU , FUJIHARA KAZUYA , YAMADA MAYUKO H. , YAMAMOTO MASAHIKO , OSAWA TAEKO , MATSUBAYASHI YASUHIRO , SATO TAKAAKI , YAGUCHI YUTA , IWANAGA MIDORI , YAMADA TAKAHO , KODAMA SATORU , SONE HIROHITO
Published: May 2022

Breslow’s Health Practice Index (HPI) includes recommendations for a healthy lifestyle and is composed of 7 simple lifestyle factors (sleep, breakfast, snacks, body mass index (BMI) , physical activity, drinking alcohol, and smoking status) . Cardiovascular health metrics (CVHMs) defined according to the American Heart Association are composed of lifestyle factors and clinical laboratory values (smoking status, BMI, physical activity, diet, systolic blood pressure <120 mmHg and diastolic blood pressure <80 mmHg, total cholesterol <200 mg/dl, and fasting blood glucose <100 mg/dl) . To clarify the impacts of HPI or CVHMs on incident CVD according to glucose tolerance status, we analyzed a nationwide claims-based database of 128,290 people included from 2008-aged 20-72 y in Japan (86,279 with normal glucose tolerance; 36,1with prediabetes; 5,9with diabetes) . HPI and CVHMs were divided into three categories (high, middle, and low) based on the number of ideal health factors present (Table) . Multivariate Cox regression analysis showed that people with prediabetes with an HPI of ≥5 or people with prediabetes and diabetes who had ≥5 CVHMs had no increased risks for CVD compared with those in the high HPI/CVHMs category for normal glucose tolerance (Table) .

In summary, not only to follow a healthy lifestyle but to achieve laboratory treatment targets may be essential in people with diabetes.

Disclosure

T.Iijima: None. T.Yamada: None. S.Kodama: None. H.Sone: Research Support; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Takeda Pharmaceutical Company Limited. K.Fujihara: None. M.H.Yamada: None. M.Yamamoto: None. T.Osawa: None. Y.Matsubayashi: None. T.Sato: None. Y.Yaguchi: None. M.Iwanaga: None.
110-OR: Excellent Outcome of Solitary Pancreas Transplant Recipients with Brittle Diabetes and without Advanced Nephropathy
Authors: GRUESSNER ANGELIKA
Published: May 2022

Introduction: In contrast to non-pancreatic transplantation, where nephrologists refer patients for kidney and hepatologists for liver transplantation, endocrinologists only rarely refer patients with brittle diabetes for solitary pancreas transplantation. While most pancreas transplants are performed in combination with a kidney graft, solitary pancreas transplants (PTA) without a previous kidney transplant accounted for only 6-7% of pancreas transplants per year although a PTA is the best treatment option to achieve long-term insulin-independence in patients with severe brittle diabetes.

Methods: The change in demographics and outcome of 1,636 primary PTAs were analyzed between 20 and 2020 in 5-year intervals. Graft survival was defined as complete insulin-independence. Multivariate analysis was performed to assess factors that impacted outcome and the potential need for a subsequent kidney transplant.

Results: Over time, recipient age increased, but donor age and preservation time decreased significantly. Most recipients received induction therapy and maintenance immunosuppression. These changes resulted in significant improvement in patient and pancreas graft survival. Three-year patient survival increased from 92% in 2001-to 96% in 2016-20. Three-year pancreas graft survival improved from 60% in 2001-to 77% in 2016-20 (p<0.0001) . The most influential factors for this decrease were older recipient age and better immunosuppression. The rate of a subsequent kidney transplant declined significantly. It was primarily contingent on native graft function at the time of transplant. If the GFR was as >70ml/min only 1% of patients required a kidney graft.

Conclusion: The results of PTA have significantly improved over the past 20 years. A PTA should be strongly considered in brittle diabetic patients before the development of advanced nephropathy.

Disclosure

A.Gruessner: None.