bluuebunny/crossref_metadata_2025 huggingface dataset:
1320-P: Raising Prediabetes Awareness and Reducing Type 2 Diabetes Risk through Virtual Care for Overweight and Obesity
Authors: BROFFMAN LAUREN , FEIFEL NATHAN , HANSEN STEPHANIE , QUALLIOTINE KERRY , MA YING , STERN KEVIN , BARNES MELYNDA , SCHMIDT ERIKA
Published: June 2024

Introduction & Objective: A third of the U.S. population has prediabetes but most are unaware. Knowing one’s status can reduce risk of future Type II Diabetes (T2D); current demand for anti-obesity medication is an opportunity to screen for prediabetes, offer counseling, and, when appropriate, initiate weight loss treatment to prevent T2D. We explored characteristics and outcomes of individuals with prediabetic HbA1C values and no prior diagnosis who sought weight management care on a direct-to-patient (DTP) digital health platform.

Methods: Using EMR data from a random sample of 25,000 DTP patients who completed blood work in early 2023, we assessed characteristics of those with prediabetic HbA1C levels and no diagnosis and evaluated the impact of GLP-1 use on the risk of developing T2D in 3 years via a validated algorithm and t-test.

Results: About a fifth (17.6%) of sampled patients had HbA1C levels of 5.7-6.4. Of those, 73.9% had no prior diagnosis. Undiagnosed patients who started GLP-1 therapy and had a 12 week follow-up weight reduced their risk of developing T2D by a mean of 3.3 percentage points (CI = 2.9-3.7, p <.01).

Conclusion: A substantial number of DTP patients had HbA1C levels indicating prediabetes and no prior diagnosis, benefitting from counseling. Those who started GLP-1 therapy meaningfully reduced their body weight and significantly reduced their risk of future T2D after 12 weeks.

Disclosure

L. Broffman: Employee; Ro Health Ventures. N. Feifel: Employee; Ro. S. Hansen: Employee; Ro. K. Qualliotine: Employee; Ro. Y. Ma: Employee; Roman Health Ventures Inc. K. Stern: None. M. Barnes: Employee; Ro. E. Schmidt: None.
1325-P: Applications of Artificial Intelligence–Machine Learning by Using Spectral Analysis of Arterial Pulse to Discriminate the Vascular Effects of Metabolic Syndrome and Prediabetes
Authors: WU LI-WEI
Published: June 2024

Introduction & Objective: Preventing type 2 diabetes and managing its complications is very important because of the many complications it causes and the high cost of treating it. Metabolic syndrome (MetS) and impaired fasting glucose (IFG) represent interrelated risk factors for developing type 2 diabetes and cardiovascular diseases. Alterations in the cardiovascular system can affect the characteristics of peripheral blood vessels in MetS and IFG. The present study aimed to use only noninvasive arterial pulse signals and combine machine-learning-based and self-developed pulse-distribution analysis (PDA) to discriminate the MetS and IFG-induced effects on vascular properties.

Methods: Divided into three groups categorized according to the five MetS factors (Control, Pre-MetS, and MetS), 113 participants receiving geriatric health checkups with standard medical inspection at Tri-Service General Hospital (TSGH) in Taiwan were enrolled in this study. The participants' radial blood pressure waveform (BPW) signal was measured, to which frequency-domain analysis (FDA) was applied. Two classification methods were used and the features of each pulse signal were collected from 40 spectral indices.

Results: BPW signal differed significantly among the three groups. Several pulse waveform indices were significantly lower in Pre-MetS and MetS than in Control. The AUC of PDA (0.83) was better than that of machine learning (AUC=0.66) in discriminating MetS. IFG and MetS factors were verified as having no obvious interference effect on the PDA classification.

Conclusion: Using pulse indices without other clinical parameters performs well discrimination in detecting MetS and IFG. The present findings facilitate a noninvasive, easy-to-use, and objective evaluation technique for the vascular properties, and could hence aid in reducing the cardiovascular risk associated with MetS and IFG.

Disclosure

L. Wu: None.
133-OR: Efficacy of a Culturally Tailored Mediterranean-Like Diet Intervention on Cardiometabolic Risk Factors
Authors: MATTEI JOSIEMER , CHENG CHAO , RODRIGUEZ JOSE F.
Published: June 2024

Introduction & Objective: To determine if adults in Puerto Rico improved cardiometabolic risk factors on a 4-months culturally-tailored Mediterranean-like intervention (vs. standard nutritional advice).

Methods: The Puerto Rican Optimized Mediterranean-like Diet (PROMED) parallel pilot trial randomized 44 adults (25-65y) in Puerto Rico with at least 2 cardiometabolic risk factors to either an intervention (individual nutritional advice for a portion-controlled Mediterranean diet adapted for Puerto Ricans and a supply of vegetable oils and legumes for 2 months) or control group (standard portion-control nutritional advice and cooking utensils). Daily text messages emphasized each group’s nutritional advice for 4 months. Clinical assessments were done at baseline, 2 months, and 4 months. Mean changes per protocol (n=15 intervention; n=13 control) were estimated for the primary outcome of a cardiometabolic improvement score (range 0-10; higher score denotes more improved factors) and secondary outcomes.

Results: At 2 and 4 months, the cardiometabolic improvement score increased from baseline for the intervention (mean±SD: 2.0±1.4 and 1.8±1.5 points) and control groups (1.1±1.5 and 1.1±1.6 points), with no significant differences between groups. At 4 months, the intervention vs. control group had significantly greater decrease in systolic (-8.8±8.5 vs. 5.4±9.2 mmHg; p=0.02) and diastolic blood pressure (-4.4±5.4 vs. 2.7±2.9 mmHg; p= 0.02), non-significant greater decrease in waist circumference (-2.54±2.51 vs. 0.03±0.23 cm; p=0.16) and depressive symptoms score (-8.3±10.2 vs. -0.56±0.8 points; p=0.24), and non-significant greater increase in diet quality score (1.8±2.7 vs. 1.3±2.4 points; p=0.11) at 4 months. Study satisfaction was >90% at 2 months at 100% at 4 months.

Conclusion: PROMED was efficacious in decreasing blood pressure in 4 months. The program’s potential of improving cardiometabolic health and high satisfaction supports its enhancement.

Disclosure

J. Mattei: None. C. Cheng: None. J.F. Rodriguez: None.

Funding

American Diabetes Association (11-22-ICTSN-33); NIH-National Institute of Minority Health and Health Disparities (R01-MD018750)
1336-P: High Prevalence of Complications in Young-Onset Type 2 Diabetes
Authors: SHARMA ANU , LAZARO-GUEVARA JOSE M. , STUCKI DEVORAH , PEZZOLESI MARCUS G.
Published: June 2024

Introduction & Objective: The prevalence of type 2 diabetes (T2D) in young adults (age <45 years) is increasing. There is limited data on the burden of diabetes-related complications in young-onset type 2 diabetes (YOT2D).

Methods: Adults with the diagnosis of T2D (ICD codes 250.xx and E11.xx; n=352 826) were identified from the Utah Diabetes Database, a subset of the Utah Population Database. The cohort was divided based on age at first diagnosis of T2D: YOT2D were first diagnosed between 18-44 years old and later-onset type 2 diabetes (LOT2D) were first diagnosed at ≥45 years old. Those with missing data (n=296 295) or laboratory data consistent with type 1 diabetes (n=204) were excluded.

Results: Of the 56 327 people with T2D included, 33% (n=13 087) had YOT2D and 77% (n=43 240) had LOT2D. The mean age at first diagnosis was 35±7 years in YOT2D vs 62±10 years in LOT2D. Female sex, ethnic minorities (Hispanics, non-Hispanic Black, Asian, Pacific Islanders, American Indians), and a positive family history of T2D were associated with YOT2D (p<0.001). YOT2D had a higher prevalence of obesity (68% vs 62%, p<0.001) and were more likely to have DKA and hypoglycemia despite similar C-peptide concentrations and insulin use compared to LOT2D. Glycemic control was worse in YOT2D, both at diagnosis (HbA1c 7.8±2.5 vs 7.2±2.0%, p<0.001) and at 5 years follow up (HbA1c 7.6±3.0 vs 7.1 ±4.8%, p<0.001). Risk for advanced hepatic fibrosis, as determined by the APRI score >0.7, were equally high in both groups (6.9% vs 6.6, p=0.36). Similarly, frequencies of retinopathy (10%) and foot ulceration (3%) were no different. Overall, significant proportions of each group had moderately increased albuminuria (urine albumin ≥ 30 mg/g: 36% vs 34%, p<0.003), diabetic nephropathy (13% vs 18%, p<0.001), and diabetic neuropathy (17% vs 24%, p<0.001).

Conclusion: YOT2D is associated with high prevalence of diabetes-related complications. Precision-focused mitigation strategies are needed to decrease excess adverse outcomes in YOT2D.

Disclosure

A. Sharma: None. J.M. Lazaro-Guevara: None. D. Stucki: None. M.G. Pezzolesi: None.

Funding

American Diabetes Association (7-22-JDFPM-04)
134-OR: The Safety and Efficacy of Virtual Insulin Pump Initiation in Children and Adolescents with Type 1 Diabetes in the United States
Authors: PELLIZZARI MARGARET , NWOSU BENJAMIN U. , PAVLOVIC MAIA , TALIB RASHIDA , SOHAIL RUBAB , CIRON JASON
Published: June 2024

Introduction & Objective: This study aimed to determine the safety and efficacy of virtual insulin pump initiation compared to in-office insulin pump initiation resulting from the COVID-19 pandemic lockdown.

Methods: A longitudinal retrospective study of 112 subjects. Sixty-five percent (n=73), ages 11.2 ± 3.8 years, received in-office training, and 35% (n=39), ages 12.0 ± 4.0 years, received virtual training. Anthropometric, glycemia, and demographic data were collected at insulin pump initiation, 3 and 6 months.

Results: There were no differences in sex, race in the two groups. There were no differences in height, weight, BMI, A1c, and the duration of diabetes between the two groups at 0, 3, and 6 months. A1c and the glucose management indicator (GMI), correlated significantly at all time points. When subjects were stratified by sex, race, age into <10 years and >10 years and by normal-weight (BMI of <85th percentile) or overweight or obese (BMI of ≥85th percentile), there was no difference in A1c and TIR. There was equally no relationship between age at pump initiation and BMI. However, the comparison between A1c and TIR among the races, Whites (n=61) versus non-Whites (n=44), showed a significantly elevated A1c in the non-White group at 6 months only: [7.45% (6.8-8.5) versus 6.9% (6.4-7.6)], p = 0.007.

Conclusion: Virtual insulin pump initiation may be safe and effective in children and adolescents with type 1 diabetes. This approach could bridge the gap in the adoption of diabetes technology in the minority population in the US.

Disclosure

M. Pellizzari: None. B.U. Nwosu: None. M. Pavlovic: None. R. Talib: None. R. Sohail: None. J. Ciron: None.
135-OR: The Effects of the WE-GDM Program for Women with Gestational Diabetes Mellitus and Their Partners on Blood Glucose Levels and Communal Coping—A Randomised Controlled Trial
Authors: GUO MIN , QIN SHIJIA , YANG HAIXIA , ZHANG YIN-PING
Published: June 2024

Introduction & Objective: Gestational diabetes mellitus (GDM) is associated with suboptimal pregnancy outcomes and future health risks. Partner support is important for managing GDM; however, there is limited research on GDM interventions for couples. We developed the WE-GDM program based on communal coping theory and evaluated its effects on blood glucose levels and communal coping.

Methods: A randomised controlled trial was performed. Pregnant women with GDM and their partners were recruited from three hospitals in China and randomly allocated to intervention (IG; n = 70) and control (CG; n = 70) groups. Women in the CG received individual GDM education. Couples in the IG underwent the WE-GDM program (GDM education, shared illness appraisals, initiation of collaborative action, and consolidation of collaborative action). Data were collected at pre-intervention (T1), 1 week post-intervention (T2), and 8 weeks post-intervention (T3). They were analysed using generalised estimating equations.

Results: The average ages of the women and their partners were 31.1 and 32.2 years, respectively. The reductions in 2-hour postprandial blood glucose levels from T1 to T2 and from T1 to T3 were 0.22 and 0.41 higher, respectively in the IG than in the CG (β = -0.22 [-0.44 to 0.00]; β = -0.41 [-0.66 to -0.16]). Significant differences were also noted in the following dimensions regarding communal coping: at T2 and T3, the IG had higher scores for collaboration, instrumental support, and emotional support, as well as lower scores for critical and avoidance behaviors, compared to the CG.

Conclusion: The WE-GDM program effectively improved partner participation in GDM management and was beneficial for controlling blood glucose levels in pregnant women. This innovative program offers a new approach for couples managing GDM, as well as a reference for applying communal coping theory to other illnesses.

Disclosure

M. Guo: None. S. Qin: None. H. Yang: None. Y. Zhang: None.

Funding

China Scholarship Council [grant number 20210628183]; Key Research and Development Projects of Shaanxi Province [grant number 2023-YBSF-083].
1350-P: Incidence of Diabetic Kidney Disease (DKD) by Country of Birth among Immigrants and Long-Term Residents of Canada
Authors: MOHAMED SEBAT , LIPSCOMBE JENNIFER , LIPSCOMBE LORRAINE , KENASZCHUK CHRIS , THIRUCHELVAM DEVA , FAZLI GHAZAL S. , SHAH BAIJU R. , ROSELLA LAURA , KE CALVIN
Published: June 2024

Introduction and Objective: It is unclear whether DKD incidence varies by world region of birth. We examined whether the incidence of DKD (defined as the Kidney Disease Improving Global Outcomes (KDIGO) categories 2-4) differs between immigrants and long-term residents (LTRs) with T2D in Ontario, Canada.

Methods: This retrospective cohort study used population-based linked databases to examine age-sex standardized incidence rates of DKD based on the most recent creatinine and urinary albumin-creatinine ratio (ACR) during the baseline (2012-16) and observation (2017-21) periods among adults aged 20-80 years with pre-existing T2D. We used the gamma distribution method to test for significant differences between immigrants and LTRs.

Results: We included 647,210 individuals (mean age 61.6 years, 44.9% female, 152,778 immigrants). Overall standardized incidence varied (category 2: 76.4; 3: 31.0; 4: 15.9 per 1000 person-years). Immigrants from Southeast Asia had significantly higher incidence of categories 2 and 3 (91.1, 36.4 respectively; p<0.05) and a similar incidence of category 4 (16.6) versus LTRs. Incidence of categories 2-4 was lower among immigrants from East Asia (62.2, 18.5, 7.2 respectively) and several other regions versus LTRs (p<0.05). Disparities in incidence narrowed as KDIGO category increased.

Conclusion: DKD incidence varies substantially by world region of birth.

Disclosure

S. Mohamed: None. J. Lipscombe: None. L. Lipscombe: Other Relationship; Novo Nordisk Canada Inc. C. Kenaszchuk: None. D. Thiruchelvam: None. G.S. Fazli: None. B.R. Shah: None. L. Rosella: None. C. Ke: Advisory Panel; Sanofi. Speaker's Bureau; AstraZeneca.

Funding

Novo Nordisk Network for Healthy Populations
1355-P: Association between Seasonal Fluctuations in Liver Enzymes and Long-Term Glycemic Control in Patients with Type 2 Diabetes Mellitus
Authors: TOKI RYOTA , SAKAMOTO MASAYA , IIDA MIHO , YUKI MASAHIRO , TAKEBAYASHI TORU
Published: June 2024

Background: The importance of assessing liver function in patients with type 2 diabetes (T2DM) has been well established, but few studies have examined this from a time-series view. We investigated the effect of seasonal fluctuations in liver function on long-term glycemic control on T2DM.

Method: A total of 9,949 individuals (20-80 yo) were enrolled in a large registry study of T2DM in Japan from Jan 2014 (baseline) to Dec 2020. After excluding missing data on covariates, 9,438 were included in the analysis. Seasonal fluctuations of AST/ALT was defined as the amplitude of the seasonal component of each individual extracted by STL decomposition after multiple imputations. HbA1c at the final visit of each individual (final-visit A1c) was used as the index of glycemic control. Multivariate regression analysis was performed using standardized seasonal fluctuations in AST/ALT as explanatory variables and final-visit HbA1c as the objective variable. Covariates included sex, follow-up time, and age at baseline, BMI, HbA1c, log-transformed AST or ALT, drinking and smoking habits, diabetes duration, and insulin use. A sensitivity analysis was performed by adding seasonal BMI fluctuation during follow-up to the above model.

Result: During the follow-up of 6.0 ± 1.8 yrs, AST/ALT tended to be lower in summer and higher in winter. Multivariate analysis showed that the seasonal fluctuations of AST/ALT were significantly associated with final-visit A1c, with an estimated effect of +0.044% [95% CI: 0.017, 0.071] and +0.028% [0.002, 0.054] per 1SD increase, respectively. The results of the sensitivity analysis remained consistent.

Conclusion: This study indicated that seasonal fluctuations in liver enzymes might be a risk factor for poor glycemic control independent of traditional risk factors, as well as BMI fluctuation in Japanese patients with T2DM. Our results suggest that year-round assessment of liver enzymes may be important in clinical practice.

Disclosure

R. Toki: None. M. Sakamoto: None. M. Iida: None. M. Yuki: None. T. Takebayashi: None.
1374-P: Unrecognized Dysglycemia in a Nonurban Pediatric Population in Madagascar
Authors: MARZIALE NAUSICA , MAIZZA BENEDETTA , MARGHERITA MASSIMINO ANNA , MARIA MENGA LUCA , PARATORE GIULIA , PITTARELLO MATILDE , PROFETA LORENZO , FIORINA PAOLO , LANIA ANDREA
Published: June 2024

Introduction & Objective: Madagascar has a predominantly young population and a high burden of malnutrition. The potential relationship between nutritional and glycemic status and the consequences of underdiagnosed dysglycemia-related diseases motivated this study. In the context of a medical student’s volunteering experience, we aimed at identifying dysglycemias and highlighting possible correlations with demographic factors and nutritional status in a pediatric population of Madagascar.

Methods: Glycemia was assessed on a population of 430 outpatients aged 0-12 years old by single fast fingerstick glycemic measurements. No exclusion criteria were set. General and nutritional information was collected. Data analysis was performed using R software, Python and WHO child growth standard software.

Results: Malnutrition had a 50% prevalence in the study population. 17 children (3.9% of the total) exhibited glycemic levels significantly deviating above the mean of the group with a healthy nutritional status, adjusted for the time elapsed since their last meal. These children, classified as outliers, were notably older. Most importantly, acute-on-chronic malnutrition (wasting-on-stunting) increased by almost 10 times the risk of the child being an outlier.

Conclusion: Acute-on-chronic malnutrition correlated with a state of dysglycemia, possibly confirming literature findings that a malnourished status might negatively impact pancreatic hormonal balance and beta cell functionality. The study holds both practical and epidemiological significance. It has increased awareness on dysglycemia and facilitated early recognition of possibly peculiar presentation in low-income countries. Epidemiologically, our study appears to encourage targeted glycemic screening in acutely on-chronic malnourished children and help resource allocation.

Disclosure

N. Marziale: None. B. Maizza: None. A. Massimino: None. L. Menga: None. G. Paratore: None. M. Pittarello: None. L. Profeta: None. P. Fiorina: None. A. Lania: None.
1389-P: Association between Serum Metabolomic and Overall Mortality among Individuals with Type 2 Diabetes
Authors: GAN LU , YANG SHUTING , ZHAO BIN , ZHOU ZHIGUANG , HUANG JIAQI
Published: June 2024

Patients with Type 2 diabetes (T2D) demonstrate a remarkable increased risk of mortality. Yet, underlying metabolomic profiling and relevant biochemical alterations are not fully elucidated. We conducted a prospective metabolomic study of T2D mortality risk in 152 case-control pairs within the National Newly Onset Diabetes Cohort (2015-2017), which recruited nearly 18,000 newly diagnosed T2D patients from 46 centers in China. Using incidence-density sampling method, controls were selected from the cohort who were alive at the time of case death and individually matched to cases by age, sex, assessment center, and date of blood draw. Median time from baseline fasting serum collection to death for cases was 4.8 years. We identified 736 known metabolites through the Ultrahigh-performance LC-MS/GC-MS platform. Conditional logistic regression models were used, adjusting for age, sex, body mass index, smoking status, systolic and diastolic blood pressure, HbA1c, and triglyceride. Based on a false discovery rate (FDR) of 0.05, 86 metabolites were found to be associated with risk of mortality among T2D. Integrating approaches of LASSO, forward and stepwise logistic regression, eight metabolites were identified to be independently related to risk of mortality among T2D, including perfluorooctanoate, 5α-pregnan-3β,20α-diol monosulfate, maltose, N-palmitoyl-sphingosine (d18:1/16:0), eicosenedioate (C20:1-DC), behenoyl dihydrosphingomyelin (d18:0/22:0), deoxycholic acid glucuronide, and 16-hydroxypalmitate. Multivariate ROC regression estimated an AUC of 0.63 (referent model: above-mentioned adjusted covariates) versus 0.80 (extended model: additionally adjusted for the eight selected metabolites) (Wald test for comparison: P<0.0001). Our data demonstrated that several serum metabolites are independently associated with mortality risk in T2D, which may provide novel insight on the molecular basis of progression and development among individuals with T2D.

Disclosure

L. Gan: None. S. Yang: None. B. Zhao: None. Z. Zhou: None. J. Huang: None.

Funding

National Natural Science Foundation of China (82100949)
1393-P: Potential Endocrine Disrupting Chemical Exposures among Rural Americans Using Remotely Collected Biosamples
Authors: QUINTERO ARIAS CAROLINA , FLORES TAMMY A. , YI HAESEUNG , MOTOLA HALEY L. , HEIDER MATTHEW , SMITH MOLLY , WISE NATHAN N. , THORPE LORNA , TRASANDE LEONARDO , LEE DAVID C.
Published: June 2024

Introduction & Objective: Rural residents experience higher rates of diabetes than their urban counterparts. Main identified causes to date include poor diet and physical inactivity. Given limited access to fresh foods, however, rural residents are also known to have high rates of canned food intake, potentially resulting in more exposure to bisphenols, which have been linked to diabetes.

Methods: To examine dietary chemical exposures, we collected urine samples among rural residents both in-person and remotely to measure bisphenols level. Day 0 samples were immediately frozen and transported on dry ice to prevent any chemical degradation. Rural residents then remotely collected three consecutive days of urine samples, froze samples at home, and mailed them back using insulated cold packs. We examined daily levels among 30 study participants and performed a preliminary investigation of whether bisphenol levels correlated with HbA1c results.

Results: Daily average bisphenol A (BPA) levels were 0.391 ng/mL on Day 0, 0.620 ng/mL on Day 1, 1.300 ng/mL on Day 2, and 1.088 ng/mL on Day 3. The intraclass correlation coefficient (ICC) for bisphenol A was 0.063 demonstrating very low correlation between daily values among study participants. We similarly found low ICC for bisphenol S at 0.238 and for bisphenol F at 0.095. We also found that all three study participants with a mean BPA higher than 2.00 ng/mL had prediabetes.

Conclusion: We found no significant degradation of bisphenols between immediately frozen Day 0 samples and those mailed on Day 1 to 3, demonstrating the feasibility of collecting biosamples remotely. The low correlation between daily levels suggests the need to collect several samples given high daily variability and short half-lives of these chemicals. Our preliminary analysis finds a possible association between high BPA exposure and poor glycemic control among rural Americans that merits further exploration in a larger study.

Disclosure

C. Quintero Arias: None. T.A. Flores: None. H. Yi: None. H.L. Motola: None. M. Heider: None. M. Smith: None. N.N. Wise: None. L. Thorpe: None. L. Trasande: None. D.C. Lee: None.

Funding

National Institutes of Diabetes and Digestive and Kidney Disease (R01DK124400)
1398-P: Emulating Target Trials Using Instrumental Variables to Inform Care—Add-on Therapy to Metformin
Authors: ADLER AMANDA I. , LUGO-PALACIOS DAVID G. , BIDULKA PATRICK , CARROLL ORLAGH , BASU ANIRBAN , O'NEILL STEPHEN , GRIEVE RICHARD
Published: June 2024

Introduction & Objective: Guidelines now rely on studies using routinely-collected clinical data to emulate a ‘target trial’, a hypothetical randomized controlled trial (RCT) one would wish to do. A key question remains what drug to add to metformin to improve glycemic control in people with type 2 diabetes (T2D). To inform care for people excluded from RCTs, we developed a target trial comparing add-on therapy with dipeptidyl peptidase-4 inhibitors (DPP4) vs. sulfonylureas (SU), a relevant choice in many settings. We used an instrumental variable as a ‘natural randomizer’.

Methods: We used anonymized data from the UK Clinical Practice Research Datalink (2011 to 2015) to identify people with T2D on metformin monotherapy prescribed <60 days before starting 2nd-line DPP4 or SU. We recreated the inclusion criteria of a ‘real’ RCT (Nauck et al. 2007) that tested non-inferiority of sitagliptin vs. glipizide on HbA1c at 1 year. We then broadened the eligibility to include people over age 78 years or with HbA1c >10% (85.8 mmol/mol), which we analyzed separately. We used an instrumental variable (IV), a GPs’ preference for prescribing either DDP4 or SU, to test the effect of treatment on HbA1c at 1 year, and to minimize confounding. Our study did not estimate complications or adverse effects.

Results: We identified 13,240 people for the target trial: 6,497 met and 6,743 would not have met the criteria for the real RCT (1172). The mean baseline HbA1c by subgroup was 68.2 (s.d. 8.3) and 79.4 (22.3) mmol/mol. The difference in HbA1c at 1 year for DPP4 vs. SU (negative reflects lower values for DPP4) for people in the target trial who met the real RCT criteria was -0.3 (-2.3, 1.6) compared with 0.2 (-0.9, 1.3) for the actual trial. For those in the target trial who would have been excluded from the real RCT, the difference was -3.4 (-6.6, -0.1).

Conclusion: Emulating a target trial provides evidence when none exists. If IV assumptions hold, then DPP4 appear more effective than SU in the subgroup of patients excluded from a key trial.

Disclosure

A.I. Adler: None. D.G. Lugo-Palacios: None. P. Bidulka: None. O. Carroll: None. A. Basu: None. S. O'Neill: None. R. Grieve: None.

Funding

UK NIHR
1401-P: Long-Term Impact of Diabetes Prevention Program (DPP) Interventions on Walking Endurance
Authors: MUNSHI MEDHA , VENDITTI ELIZABETH M. , TJADEN ASHLEY H. , KNOWLER WILLIAM C. , BOYKO EDWARD J. , MIDDELBEEK ROELAND J.W. , LUCHSINGER JOSE A. , LEE CHRISTINE , HAZUDA HELEN P. , SALIVE MARCEL E. , EDELSTEIN SHARON , STORER THOMAS W. , RESEARCH GROUP DPP
Published: June 2024

Introduction & Objective: Type 2 diabetes (T2D) and prediabetes are associated with poor walking endurance, a marker of physical function. Our main aim was to examine the long-term effects of metformin or intensive lifestyle intervention (ILS) in adults at high risk of T2D on their 6-minute walk test (6MWT) performance.

Methods: Participants at high risk of T2D were randomized in the 3y DPP to ILS (physical activity [PA] and weight loss goals), metformin 850 mg bid, or placebo, and subsequently followed in the DPP Outcomes Study with brief lifestyle classes offered to all and metformin continued open label. A 6MWT was conducted 15y after DPP ended (mean 20y after randomization, 64% had developed T2D). The associations between DPP interventions and 6MWT completion (defined as achieving a distance ≥200 meters with or without a walking aid) were assessed using logistic regression. Among test completers, differences in distance walked in 6 min (6MWD) by DPP interventions were evaluated using multivariable linear regression. Additional variables of interest included concomitant measures of BMI and grip strength along with mean measures of HbA1c and self-reported PA over ~20y.

Results: Data on 1830 participants (mean baseline age 50y) were analyzed. The DPP interventions were neither associated with test completion, nor 6MWD among test completers (362, 364 and 360 m in the lifestyle, metformin, and placebo groups respectively, p=0.8). Age, education, grip strength, and PA were each significantly associated with the 6MWT completion and 6MWD after adjustment. Grip strength, PA, and education were positively associated with 6MWD, while age, BMI and HbA1c were negatively associated with 6MWD.

Conclusion: Although we did not observe a sustained effect of the original randomized interventions, we confirmed that the 6MWT is related to other measures of physical ability such as PA and grip strength in persons at-risk for and with T2D, suggesting potential long-term benefits of maintaining a healthy lifestyle.

Disclosure

M. Munshi: Consultant; Sanofi. E.M. Venditti: None. A.H. Tjaden: None. W.C. Knowler: None. E.J. Boyko: None. R.J.W. Middelbeek: Research Support; Novo Nordisk. J.A. Luchsinger: Consultant; Merck KGaA. Other Relationship; EMD Serono, Wolters Kluwer Health. C. Lee: Employee; Pfizer Inc. H.P. Hazuda: None. M.E. Salive: None. S. Edelstein: None. T.W. Storer: None. D. Research Group: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (UDK048489, UDK048339, UDK048377, UDK048349, UDK048381, UDK048468, UDK048434, UDK048485, UDK048375, UDK048514, UDK048437, UDK048413, UDK048411, UDK048406, UDK048380, UDK048397, UDK048412, UDK048404, UDK048387, UDK048407, UDK048443, UDK048400)
1403-P: Prescribing Trends of Glucose-Lowering Medications among Adult Kidney Transplant Recipients with Type 2 Diabetes—A U.S. Population-Based Cohort Study
Authors: HANSRIVIJIT PANUPONG , PATORNO ELISABETTA , WEXLER DEBORAH J. , ABDI REZA , PAIK JULIE M.
Published: June 2024

Introduction: Type 2 diabetes (T2D) is a common comorbidity among kidney transplant recipients (KTR) in the U.S. To date, there are no recent studies describing the use of glucose-lowering medications (GLM) in KTR. Thus, we investigated the prescribing trends of GLM among adult KTR with T2D in the U.S.

Methods: Prevalence of GLM prescriptions in adult KTR with T2D from 2014-2023 are reported from two large U.S. insurance claims databases (Optum Clinformatics and MarketScan).

Results: We identified 64,611 adult KTR with T2D. The mean age was 60.2±12.1 years, and 61.2% were male. The mean number of GLM used was 2.8±4.2 per patient. Insulin was the most prescribed GLM, but the trend declined from 59.5% in 2014 to 48.9% in 2023. Similarly, sulfonylureas (SU) showed a decreasing trend over time, from 16.7% in 2014 to 9.7% in 2023. In contrast, newer GLM such as sodium glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1RA), steeply increased throughout our study period. SGLT2i use increased from 2.9% in 2020 to 11.2% in 2023 while that of GLP1RA increased from 2.3% in 2014 to 9.4% in 2021.

Conclusion: Insulin was the most prescribed GLM to KTR with T2D. However, the decline in insulin and SU was proportional to the rise in GLP1RA and off-label SGLT2i use. This trend follows with the timeline of clinical trials on SGLT2i and GLP1RA.

Disclosure

P. Hansrivijit: None. E. Patorno: Research Support; Boehringer-Ingelheim, Food and Drug Administration (FDA), National Institutes of Health, Patient-Centered Outcomes Research Institute. D.J. Wexler: Other Relationship; Novo Nordisk. R. Abdi: None. J.M. Paik: None.
1404-P: U.S. Rural–Urban Disparities in Obesity Mortality, 2000–2019
Authors: VARGHESE BEN T. , MIELKE MICHELLE , VELLA ADRIAN , BAILEY KENT R. , DUGANI SAGAR B.
Published: June 2024

Introduction: Obesity prevalence is higher in US rural vs nonrural counties. The objective was to evaluate trends in obesity-related mortality by rurality.

Method: We used CDC WONDER data, 2000−2019, on obesity as a multiple cause of death (ie, top 20 contributor) among US residents aged ≥25 years. County rurality was based on 6 levels: large central metro (urban) to noncore (rural). We obtained annual rates of obesity mortality/100 000 persons (AOM) and reported AOM fold change (2018-2019 vs 2000-2001) and annual percent change (APC) based on linear regression of log(rates).

Result: The AOM increased across all rurality levels (Figure). The AOM fold change (APC) ranged from 2.4 (4.9%) in large central metro to 2.9 (6.0%) in noncore, with 22% higher APC in noncore vs large central metro counties. Furthermore, in noncore vs large central metro counties, the APC was 13.8% higher in men and 33.6% higher in women. In noncore vs large central metro counties, the APC was 40.8% higher in the 25-54 age group, 24.6% higher in the 55-74 age group, but 4.8% lower in the ≥75 age group. In noncore vs large central metro counties by region, the APC was 41.9% higher (West), 15.8% higher (South), 9.4% higher (Midwest), and 1.4% lower (Northeast).

Conclusion: In US adults, obesity-related mortality increased 2-3 fold with higher rates in noncore counties, with additional disparity by gender, age, and region. The increasing mortality and persistent disparities require evaluation.

Disclosure

B.T. Varghese: None. M. Mielke: Consultant; Biogen. Advisory Panel; Eisai Inc., Merck & Co., Inc. Consultant; Eli Lilly and Company. Advisory Panel; Roche Diagnostics. A. Vella: Research Support; Novo Nordisk. Consultant; Hanmi Pharm. Co., Ltd., Crinetics Pharmaceuticals, Inc. Advisory Panel; Rezolute, Inc. K.R. Bailey: None. S.B. Dugani: None.

Funding

National Institutes of Health (K23 MD106230)
1407-P: Gaps in the Initiation of Diabetes Drugs with Cardiovascular and Kidney Benefits by Medical Specialists
Authors: MCCOY ROZALINA G. , VANDERGRIFT JONATHAN L. , GRAY BRADLEY M.
Published: June 2024

Introduction: Endocrinologists, cardiologists, and nephrologists commonly care for people with diabetes and coexisting cardiovascular disease (CVD), heart failure (HF), and chronic kidney disease (CKD). Guidelines recommend that GLP-1 receptor agonists (GLP-1RA) and SGLT2 inhibitors (SGLT2i) be prescribed in this context, but they remain broadly underutilized particularly among older adults.

Methods: In this retrospective cohort study using 100% sample of 2019 Medicare fee-for-service claims linked to American Board of Internal Medicine data files, we calculated the proportions of pharmacologically treated patients ≥66 years with diabetes and CVD, HF, or CKD treated by endocrinologist, nephrologist, or cardiologist and subsequently filled GLP-1RA or SGLT2i prescribed by one of these specialists. We used logistic regression to quantify associations with GLP-1RA/SGLT2i prescribing and both patient and physician characteristics.

Results: We identified 402,922/ 330,003/ 638,408 pharmacologically treated patients seen by 5,338/ 8,059/ 10,761 endocrinologists/ nephrologists/ cardiologists, respectively. Most endocrinologists prescribed diabetes drugs to their patients (73.7%) while nephrologists and cardiologists rarely did (6.3% and 4.0% respectively). Among patients they prescribed to, just 12.2% of nephrologist-, 13.9% of cardiologist-, and 26.6% of endocrinologist-treated patients filled a GLP-1RA or SGLT2i prescription prescribed by that specialist. Across specialties, GLP-1RA or SGLT2i use were lowest for older patients (10-25 percentage points less for ≥85 vs 66-69 year olds). Differences were also observed by race, dual Medicare/Medicaid eligibility, and physician age.

Conclusion: Nephrologists and cardiologists caring for people with diabetes rarely prescribed GLP-1RA and SGTL2i to patients who would benefit from them and may benefit from additional training and support to prescribe them, particularly to older adults.

Disclosure

R.G. McCoy: Research Support; American Diabetes Association. Other Relationship; American Diabetes Association. Consultant; Wolters Kluwer Health. Research Support; National Institutes of Health, Patient-Centered Outcomes Research Institute. Consultant; Yale New Haven Health System. J.L. Vandergrift: Employee; American Board of Internal Medicine. B.M. Gray: None.
1408-P: Biobank Scale Identification of Exposome Risk Factors in Cardiometabolic Disease and Their Mediators
Authors: PATEL CHIRAG , TANGIRALA SIVATEJA
Published: June 2024

Cardiovascular disease and diabetes are influenced by potentially many exposures; however, traditional epidemiological studies examine but a few candidate factors at a time. Here, we demonstrate a pipeline for identifying exposures, made efficient by integrating genetic data at biobank scale. First, we conducted an Exposure-Wide Association Study (ExWAS) to systematically identify observational associations across 362 exposures in type 2 diabetes [T2D] and coronary artery disease [CAD] in participants of the UK Biobank. Causality estimates between exposure-disease phenotype pairs using bi-directional Two-Sample Mendelian Randomization [MR] across two large biobanks, UK Biobank and FinnGen, were computed. For CAD, we identified 172 (47.5%) FDR-significant exposure factors and for type 2 diabetes we identified 224 (61.9%) factors, finding 157 in both. We were able to deduce genetic-based causality between 14 (out of 172 ExWAS-identified) in CAD and 16 (out of 224) in T2D. Among the MR-validated associations for CAD, we report the interquartile range (IQR) of ExWAS and MR-derived odds ratios to be [0.742, 0.892] and [0.389, 0.711], respectively. For T2D, we report the IQR to be [0.658, 0.897] and [0.277, 0.669] for ExWAS and MR-derived odds ratios (OR), respectively. For example, we found having a college or university degree is causally inversely associated with CAD (MR beta estimate = -0.569, MR p-value = 3.51x10-5). However, we found low specificity (37.3 % for CAD and 26.3% for T2D) suggesting that most ExWAS-identified (or observational) associations are confounded. We find three MR-validated associations for T2D and one MR-validated association for CAD to be strongly mediated by causal risk factors (e.g., Body Mass Index[BMI]). Biobank samples, replete with clinical, exposure and genetic information enhance identification of exposures for metabolic disease and their mediators.

Disclosure

C. Patel: None. S. Tangirala: None.

Funding

National Institutes of Health (R01ES032470)
1429-P: Multimorbidity among Adults with Diabetes in India
Authors: MOHAN SAILESH , JARHYAN PRASHANT , DUBEY MANISHA , SRINIVASAPURA VENKATESHMURTHY NIKHIL , PRABHAKARAN DORAIRAJ
Published: June 2024

Introduction: Limited information is available on the burden of multimorbidity among diabetics in India.

Methods: We conducted a cross-sectional study among 12284 adults aged ≥ 30 years, using multistage cluster random sampling, from rural and urban areas of North and South India. Trained interviewers administered a questionnaire to collect data on socio-demographics, lifestyle characteristics and collected blood samples. We defined diabetes, hypertension, and their control as per standard definitions; dyslipidemia as per ATP IV or on treatment; CKD as those on treatment or with urine albumin-creatinine ≥30 mg/g or eGFR <60 ml/min/1.73 m2; central obesity as waist circumference ≥ 90 cm (men) and ≥ 80 cm (women); heart disease and stroke per self-reported physician diagnosis or treatment. Multivariable logistic regression was conducted to determine factors independently associated with multimorbidity.

Results: The age-adjusted prevalence of diabetes was [17.5%, 95% CI (16.9-18.2)], 56.1% (54.5-57.6) were aware and 86.8% (85.3-88.2) were taking antidiabetic treatment. The prevalence of multimorbidity was higher among diabetics [hypertension: 55.1% (53.1-57.2), central obesity: 72.9% (71.0-74.8), dyslipidemia: 74.4% (72.5-76.2), CKD: 8.8% (8.7-8.9), heart disease: 5.5% (4.6-6.5), stroke: 2.0% (1.5-2.9)] compared to nondiabetics [hypertension: 31.1% (30.1-34.7), central obesity: 53.2% (52.5-53.8), dyslipidemia: 51.2% (50.6-51.6), CKD: 5.9% (5.6-6.2), heart disease: 2.2% (2.0-2.4), stroke: 1.1% (1.0-1.2)]. Increasing age, poor education [adjusted odds ratio (aOR): 1.7 (1.1-2.6)], richest [aOR: 2.1 (1.2-3.5)] and urban residents [aOR: 1.5 (1.1-2.0)] were more likely to have at least one multimorbidity. Those taking anti-diabetic treatment were less likely to have multimorbidity [aOR: 0.7 (0.5-0.9)].

Conclusions: High levels of multimorbidity in India warrants implementation of effective health system interventions for integrated management of diabetes and multimorbidity to improve outcomes.

Disclosure

S. Mohan: None. P. Jarhyan: None. M. Dubey: None. N. Srinivasapura Venkateshmurthy: None. D. Prabhakaran: None.

Funding

An unrestricted grant under the Lilly NCD Partnership programme.
1430-P: Demographic and Socioeconomic Predictors of Poor Glycemic Control among Rural Americans without a Prior Diagnosis of Diabetes
Authors: YI HAESEUNG , QUINTERO ARIAS CAROLINA , FLORES TAMMY A. , MOTOLA HALEY L. , YI STELLA S. , KOZIATEK CHRISTIAN A. , DORAN KELLY , ANTHOPOLOS REBECCCA , THORPE LORNA , TRASANDE LEONARDO , LEE DAVID C.
Published: June 2024

Introduction & Objective: Rural residents experience higher diabetes rates than their urban counterparts, which may be due to poverty or living in food deserts far from grocery stores. This study sought to identify risk factors for poor glycemic control among rural residents without a prior diagnosis of diabetes using data from a detailed health survey and food frequency questionnaire (FFQ).

Methods: We performed HbA1c testing among residents of Sullivan County, New York, a rural region known to have poor health outcomes and socioeconomic instability. We collected data on demographics, socioeconomic factors (income, education, unemployment, financial, food, and housing insecurity), disability, grocery accessibility (travel time to store), packaged food consumption (frequency of eating canned or plastic wrapped foods), and diet quality (based on healthy eating index scores) as possible predictors of poor glycemic control.

Results: Among 232 rural residents without a prior history of diabetes, 3 (1.3%) were found to have HbA1c ≥ 6.5%, consistent with previously undiagnosed diabetes, and 52 (22.4%) were in a prediabetes range (HbA1c: 5.7% to 6.4%). In the multivariable linear regression, statistically significant predictors of poor glycemic control among these rural residents included age (p<0.01), male sex (p=0.03), Black race (p<0.01), and food insecurity (p<0.01).

Conclusion: In our geographically-focused analysis of risk factors for rural diabetes, we did not find that diet quality or distance to grocery store were significant risk factors for poor glycemic control. Among the socioeconomic indicators tested, food insecurity was the only statistically significant risk factor for diabetes identified. Our results highlight the need to investigate how food insecurity increases diabetes risk among rural Americans especially if not mediated by poor diet quality, but through some other mechanism.

Disclosure

H. Yi: None. C. Quintero Arias: None. T.A. Flores: None. H.L. Motola: None. S.S. Yi: None. C.A. Koziatek: None. K. Doran: None. R. Anthopolos: None. L. Thorpe: None. L. Trasande: None. D.C. Lee: None.

Funding

National Institutes of Diabetes and Digestive and Kidney Diseases (R01DK124400)
1435-P: Heterogeneous Associations of Socioeconomic Status with Metabolic Disease in Racial and Ethnic Subgroups in the United States
Authors: JANE CROMER SARA , BURNETT-BOWIE SHERRI-ANN M. , PATEL CHIRAG
Published: June 2024

Introduction: Unfavorable socioeconomic status (SES) is associated with adverse health outcomes including metabolic disease. However, whether these associations are uniform across US racial and ethnic subpopulations is unknown.

Methods: We examined the race-stratified association of two SES indicators (educational attainment and income-to-poverty ratio) with type 2 diabetes (T2D) and obesity prevalence among adult participants in the National Health and Nutrition Examination Survey 1999-2018. We tested for multiplicative interactions between race or ethnicity and SES on disease prevalence, estimated the heterogeneity of odds ratios (I2 statistic), and tested whether the association between SES and T2D was mediated by BMI in racial and ethnic subgroups.

Results: Age-adjusted prevalence of T2D and obesity was higher among non-Hispanic Black, Mexican American, Other Hispanic, and Other/Multi-Racial participants and in those with lower SES. Higher educational attainment and income were independently associated with lower prevalence of T2D and obesity among non-Hispanic White and Asian participants, with smaller or even opposite associations observed among other racial and ethnic groups (e.g., higher income was associated with higher obesity prevalence for non-Hispanic Black participants). The association between SES and T2D was mediated through BMI in non-Hispanic White participants but not non-Hispanic Black, Mexican American, and Other Hispanic participants (29-53% v. 0-9% mediation).

Conclusion: The associations between SES and pathways to metabolic disease are heterogeneous or point in opposite directions depending on racial or ethnic group. To prevent biased estimates, research on socioeconomic health disparities should examine for heterogeneity between groups, particularly racial and ethnic groups, and examine mediation in a longitudinal setting.

Disclosure

S. Cromer: Other Relationship; Johnson & Johnson Medical Devices Companies. Advisory Panel; Alexion Pharmaceuticals, Inc. Other Relationship; Wolters Kluwer Health. S.M. Burnett-Bowie: Advisory Panel; Upliv Health. C. Patel: None.

Funding

American Diabetes Association (7-21-JDFM-005); NIEHS (R01ES032470)
1436-P: High Prevalence of Exocrine Pancreatic Dysfunction in Pediatric Subjects with Diabetes Mellitus
Authors: TATUM JONATHAN D. , HORNUNG LINDSEY , ELDER DEBORAH A. , SHAH AMY S. , ABU-EL-HAIJA MAISAM
Published: June 2024

Introduction & Objective: This study aimed to describe the frequency of exocrine pancreatic disease in youth with diabetes mellitus (DM) to better understand the connection between diseases of the endocrine and exocrine pancreas.

Methods: Data was obtained from a single center database of DM patients excluding pre-DM and neonatal DM diagnosis. Patients were categorized as having “Other” DM if they had CFRD, MODY, or drug/chemical induced DM. All patients were then evaluated for exocrine pancreas disease, inclusive of pancreatitis or pancreatic insufficiency.

Results: Nine hundred ninety-one patients with DM diagnosis were included and 37/991 (4%) were diagnosed with pancreatic exocrine disease. 11/991 had pancreatitis before DM while 9/991 developed pancreatitis post DM. There were no differences in age, race/ethnicity and sex between DM youth with and without exocrine disease or between those with vs without pancreatitis. Patients with exocrine disease were more likely to have “Other” DM and a lower median hemoglobin A1c at DM diagnosis (6.8% IQR 5.6-9.2% vs 11.2%, 8.9-13.8%; p<0.0001). Excluding those with T1D, those with exocrine disease were more likely to have received insulin therapy (8/37, 22% vs 11/954, 1.2%; p<0.0001) than youth with DM and no exocrine problem. Patients with pancreatitis at any time relative to DM diagnosis were more likely to have “Other” DM and less likely to have T1D (p<0.001), had a lower median A1c (8%, IQR 5.8-9.4% vs 11.2.%, IQR 8.9-13.8%; p=0.0004), and more likely to have received insulin therapy but not have T1D (6/20, 30% vs 11/954, 1.2%; p<0.001).

Conclusions: The co-existence of exocrine and endocrine pancreatic disease occurred in 4% of DM patients. Pancreatitis occurred at a rate of 1% in patients with DM, rates higher than the general population (0.01%). Future studies are needed to determine the specific mechanisms involved in the connection between the endocrine and exocrine pancreas in children.

Disclosure

J.D. Tatum: None. L. Hornung: None. D.A. Elder: Research Support; Dexcom, Inc. A.S. Shah: None. M. Abu-El-Haija: None.