bluuebunny/crossref_metadata_2025 huggingface dataset:
1339-P: Hepatic Steatosis and Fibrosis Are Common in Obese Patients with Type 2 Diabetes Mellitus (T2DM)
Authors: VALDEZ SAENZ ENRIQUE , GODINEZ LEIVA EDDISON , LOMONACO ROMINA , KALAVALAPALLI SRILAXMI , MARANGI STEPHEN A. , GONZALEZ MARIA A. , ORTIZ ROCHA ANDREA , CHI XIAOFEI , GURKA MATTHEW J. , BARB DIANA , SHARMA ANU , CUSI KENNETH
Published: June 2023

Diabetes is a strong predictor of worse outcomes in nonalcoholic fatty liver disease (NAFLD), such as cirrhosis, CVD, and overall mortality. However, its true prevalence in clinical practice, and the role of obesity contributing to fibrosis, remain unclear. To this end, we recruited 759 patients without known NAFLD (35% with T2DM; age: 56 ± 11 years; BMI: 30.8 ± 6.5 kg/m2; female 59 %; ethnicity: Caucasian 75%, AA 14%, other 11%) attending outpatient endocrine/primary care clinics. We measured: 1) Routine laboratories; 2) Liver fat (CAP score ≥ 274 dB/m) and fibrosis (liver stiffness measurement or LSM) by elastography. The prevalence of NAFLD in T2DM was 68% vs. 44% in those without T2DM (p<0.05). Comparing patients with vs. without T2DM, the presence of any liver fibrosis (LSM ≥7 kPa or F≥1) was 20% vs. 6%, of clinically significant fibrosis (LSM ≥8 kPa [moderate-to-severe] = F≥2) was 12% vs. 4%, and advanced fibrosis (LSM ≥ 9.7 kPa = F3/F4) was 7% vs. 1%, respectively (all p<0.05). Obesity in T2DM promoted a much higher prevalence of steatosis (80% vs. 47% in T2DM without obesity) and of moderate-to-severe fibrosis (17% vs. 3%, respectively, both p<0.05). In people without T2DM, obesity also played a major role regarding steatosis (obese: 66 % vs. non-obese: 28%) and moderate-to-severe fibrosis (F≥2: 8% vs. 1%, respectively; both p<0.05). Worse glycemic control in people with T2DM (A1c ≥7.0% vs. <7.0%) led to a higher prevalence of steatosis (75% vs. 62%) and of fibrosis (24% vs 18%; both p<0.05). In multiple regression analysis, with a 95% CI, obesity in T2DM was the most significant risk factor for steatosis (OR 2.8, 1.9-4.2) and fibrosis (OR 3.4, 2.1-5.3). Conclusion: People with T2DM are at a very high risk of hepatic steatosis and severe fibrosis. Obesity is a major risk factor for worse disease, even in the absence of diabetes. These findings strongly support recent ADA recommendations to screen people with T2DM and obesity and cardiometabolic risk factors for moderate-to-severe fibrosis.

Disclosure

E.Valdez saenz: None. D.Barb: None. A.Sharma: None. K.Cusi: Consultant; Poxel SA, Altimmune, Arrowhead Pharmaceuticals, Inc., AstraZeneca, 89bio, Inc., Bristol-Myers Squibb Company, Lilly, Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Medscape, Myovant, Novo Nordisk, ProSciento, Quest Diagnostics, Sagimet, Sonic Incytes, Terns, Research Support; Echosens, Inventiva, LabCorp, Zydus. E.Godinez leiva: None. R.Lomonaco: None. S.Kalavalapalli: None. S.A.Marangi: None. M.A.Gonzalez: None. A.Ortiz rocha: None. X.Chi: None. M.J.Gurka: None.

Funding

National Institutes of Health (R01120331-01A1)
1347-P: Utility of Fibrosis-4 (FIB-4) and Nonalcoholic Fatty Liver Disease Fibrosis Scores (NFS) for Liver Fibrosis Screening in Asian-Indians with Type 2 Diabetes—A Cross-Sectional Observational Study
Authors: V RAVI TEJA K. , CHANDEL SHIVANI
Published: June 2023

Background: Fibrosis-4 (FIB-4) and the Nonalcoholic fatty liver disease fibrosis score (NFS) are suggested by American Diabetes Association Standard of Care 2023 for Liver fibrosis screening in type 2 diabetes (T2D).

Aim: Utility of FIB-4 and NFS to detect liver fibrosis in Asian-Indians with T2D.

Methods: This study included a total of 120 patients who underwent NAFLD screening from July 2022 to December 2022, recruited from Liver Clinic of an Endocrine speciality centre. Vibration Controlled Transient Elastography [VCTE (Fibroscan 430 Mini Plus, Echosens, France)] was used. After excluding alcoholics and nondiabetes patients we had total 73 people with T2D and we calculated FIB-4 and NFS for 46 patients. Liver Stiffness measurement (LSM) in KiloPascals (KPa) cut-off values used are - F0 till 7 kPa, F1 is 7 - 10 kPa, F2 is 10 - 13 kPa, F3 is 13 - 16 kPa and F4 is > 16 kPa. FIB-4 and NFS were calculated using https://www.mdcalc.com.

Results: The mean age was 54.6 ± 12.4 years, mean body mass index (BMI) was 27.3 ± 3.7 kg/m2 and 14 (30.4%) were women. Overweight seen in 15.2 % (n=7) and obesity in 69.6 % (n=32). The mean values, Serum Albumin (5.1±2.4 g/dl), SGOT (20.7±8.9 U/L), SGPT (24.0 ±15.1 U/L), Platelet Count (2.7±0.8 x 105) Hba1c % (8.8±2.4) and LSM (6.4 ± 2.6 KPa). NFS grades: F0-F2 in 24 (52.2%), indeterminate in 18 (39%) and F3-F4 in 4 (8.7%). FIB-4 grades: F0-F1 in 40 (86.9%) and F2-F3 in 6 (13.1%). But on VCTE as per LSM it was found F0 in 32 (70%), F1 in 9 (19.6%), F2 in 4 (8.7%) and F4 in 1 (2.2%). We noticed that LSM had significant positive correlation with BMI (p=0.001), SGOT (p=0.04) and SGPT (p=0.011) which are components of FIB-4 and NFS but LSM did not significantly correlate with NFS (p=0.96) and FIB-4 score (p=0.79).

Conclusions: FIB-4 and NFS may be sub-optimal for screening Fibrosis in Asian-Indians with T2D. BMI can be considered as potential first step to identify at risk for liver fibrosis in T2D.

Disclosure

K. Ravi Teja: None. S. Chandel: None.
1348-P: Glycemic Control Is Associated with the Histological Severity of Nonalcoholic Fatty Liver Disease
Authors: MIYAKE TERUKI , FURUKAWA SHINYA , MATSUURA BUNZO , YOSHIDA OSAMU , MIYAZAKI MASUMI , SHIOMI AKIHITO , KANZAKI SAYAKA , NAKAGUCHI HIRONOBU , ABE MASANORI , HIASA YOICHI
Published: June 2023

Background: Diabetes mellitus (DM) is a major risk for progression of nonalcoholic steatohepatitis (NASH) from nonalcoholic fatty liver (NAFL). Although DM influences on the pathophysiology of NASH, the impact of glycemic control status on the histological severity of NASH is unclear.

Methods: We conducted an observational study of 331 patients (140 men and 191 women) diagnosed with nonalcoholic fatty liver disease (NAFLD) by liver biopsy. Impact of glycemic control status on histological severity of NAFLD was evaluated by comparison of the four divided groups, based on the hemoglobin A1c (HbA1c) levels: HbA1c ≤5.4%; 5.5-6.4%; 6.5-7.4%; and ≥7.5%, at the time of liver biopsy. The histological severity of NAFLD was determined by fibrosis staging; stage 0-4, and NAS score; 0-8 points. The advanced liver fibrosis and the high NAS score were defined as stage 3-4 and 5-8 points, respectively.

Results: Higher HbA1c groups (5.5-6.4%; 6.5-7.4%; and ≥7.5%) were associated with advanced fibrosis compared to the lowest HbA1c group. In the multivariate analysis, the HbA1c 6.5-7.4% group was significantly associated with advanced fibrosis compared to the lowest HbA1c group after adjusting for age, sex, hemoglobin, alanine aminotransferase, and creatinine levels. When further controlling for body mass index, as well as uric acid, total cholesterol, and triglyceride levels, HbA1c 5.5-6.4%, 6.5-7.4%, ≥7.5% groups were significantly associated with advanced fibrosis compared to the lowest HbA1c group. These HbA1c groups (5.5-6.4%; 6.5-7.4%; and ≥7.5%) were also associated with higher NAFLD activity scores, these associations remained significant in the multivariate analysis.

Conclusions: The glycemic control status is strongly associated with the histological severity of NAFLD, even with mild deterioration in glycemic control. Therefore, adequate glycemic control in NAFLD patients might be important in improving NAFLD activity and preventing progression to NASH.

Disclosure

T.Miyake: None. Y.Hiasa: None. S.Furukawa: Speaker's Bureau; Kowa Company, Ltd., Ono Pharmaceutical Co., Ltd., Sanofi, Novo Nordisk, Eli Lilly Japan K.K. B.Matsuura: None. O.Yoshida: None. M.Miyazaki: None. A.Shiomi: None. S.Kanzaki: None. H.Nakaguchi: None. M.Abe: None.
135-OR: Mapping Cis-Regulatory Programs Affecting Diabetes Risk in Pancreatic Islet Cell Types Using Single-Cell Multimodal Profiling
Authors: MUMMEY HANNAH , ELISON WESTON , KORGAONKAR KATHA , LEE YUN S. , NEWSOME ASHMUS JACKLYN M. , BENAGLIO PAOLA , MILLER MICHAEL T. , MANNING FOX JOCELYN E. , GLOYN ANNA L. , MACDONALD PATRICK , PREISSL SEBASTIAN , GAULTON KYLE J.
Published: June 2023

Genetic variants influencing type 1 diabetes (T1D) risk identified by genome-wide association studies (GWAS) are primarily non-coding and affect cis-regulatory element (cRE) activity in specific cell types. A more detailed understanding of cell type-specific cis-regulatory programs in the pancreas is therefore crucial for deciphering the functional impact of T1D risk. Recently developed assays that generate multimodal single nucleus RNA-seq (snRNA-seq) and ATAC-seq (snATAC-seq) profiles from the same cell enable high-resolution mapping of cis-regulatory programs in specific cell types. We generated deeply sequenced data from 28 nondiabetic pancreatic islet samples from the Alberta Diabetes Institute IsletCore using 10x multiome assays. After extensive quality control and filtering, we clustered multimodal profiles from 174,819 cells and identified ten major cell types. For several cell types we identified evidence of heterogeneous sub-populations; for example, in beta cells there were six sub-populations corresponding to cellular states associated with insulin secretion, stress response, and others. We identified 263,223 cREs across all cell types and developed a novel method to predict target genes of cREs based on the correlation of multimodal profiles across single cells. In beta cells, there were 122,352 cRE-target gene links involving 16,907 unique genes. We mapped chromatin accessibility quantitative trait loci (caQTLs) for cREs in each cell type and identified a total of 14,535 caQTLs at FDR<.10. Finally, we annotated T1D risk variants from high-resolution fine-mapping of 136 T1D signals with cRE-target gene links and caQTLs. At 27 T1D signals including at the INS, MAPT, and DLK1 loci, variants affecting chromatin accessibility were linked to putative target genes in beta cells suggesting mechanisms of action at these loci. Experimental follow up of variant activity at these loci using genome editing in beta cell lines is ongoing.

Disclosure

H. Mummey: None. W. Elison: None. K. Korgaonkar: None. Y.S. Lee: None. J.M. Newsome Ashmus: None. P. Benaglio: Employee; Shoreline Biosciences. M.T. Miller: None. J.E. Manning Fox: None. A.L. Gloyn: Other Relationship; Genentech, Inc., Roche Pharmaceuticals. P. MacDonald: None. S. Preissl: None. K.J. Gaulton: Stock/Shareholder; Neurocrine Biosciences, Inc. Consultant; Genentech, Inc. Stock/Shareholder; Vertex Pharmaceuticals Incorporated.

Funding

National Institutes of Health (HG012059, DK105554, DK122607, DK114650)
1353-P: Glycemic Control and Longitudinal Brain MRI in Children Diagnosed with Diabetes before 3 Years of Age (CLARiFY Study)
Authors: MORAN CHRIS , GBADEYAN OYETUNDE , BROWN AMY , SAKOWSKI STACEY A. , SRIKANTH VELANDAI , CAMERON FERGUS , NORTHAM ELISABETH A. , FELDMAN EVA L. , BEARE RICHARD
Published: June 2023

Though early childhood onset of type 1 diabetes (T1D) is associated with brain development alterations, the affected brain regions and role of glycemic control are unknown. We aimed to examine associations between of HbA1c mean and variability and brain structure in a cohort of children diagnosed with T1D before 3 years of age. We recruited children presenting to a tertiary hospital in Australia from 1990-1992 in the Cognition and Longitudinal Assessment of Risk Factors over 30 Years (CLARiFY) Study. HbA1c was serially measured over 30 years after T1D diagnosis. Brain MRI was performed at ~12- and 30-years post diagnosis. We used linear mixed effects modelling to examine associations between mean HbA1c and HbA1c coefficient of variation and brain MRI structural measures. Data were available for 10 subjects (6 female). The mean age of diabetes diagnosis was 1.9 years. The mean HbA1c at 12- and 30-years post diagnosis was 8.5%. We did not find an association between mean HbA1c and any of the brain structures. Greater HbA1c coefficient of variation was associated with less sub-cortical gray matter volume (β=-41537, p=0.006) and greater cortical thickness (β=0.47, p=0.02) but not other brain structure measures (Table 1). In these preliminary analyses, we found HbA1c variability associated with measures of gray matter. Work is ongoing to confirm and understand the implications of these results.

Disclosure

C.Moran: None. O.Gbadeyan: None. A.Brown: None. S.A.Sakowski: None. V.Srikanth: None. F.Cameron: None. E.A.Northam: None. E.L.Feldman: None. R.Beare: None.

Funding

National Institutes of Health (R01DK129320)
1356-P: Association of HbA1c with Diabetes Outcomes across Health Status Categories in Older Adults
Authors: LIPSKA KASIA J. , HUANG ELBERT , LIU JENNIFER , PARKER MELISSA M. , MOFFET HOWARD H. , GRANT RICHARD W. , LAITEERAPONG NEDA , KARTER ANDREW J.
Published: June 2023

For older adults with type 2 diabetes (T2D) on insulin/sulfonylureas, Endocrine Society recommends HbA1c between 7-<7.5% for those in good health, 7.5-<8% for those in intermediate health, and 8-<8.5% for those in poor health.

We evaluated associations between HbA1c levels and complications in adults age ≥65 yrs with T2D on insulin/sulfonylureas from an integrated healthcare delivery system. Complications included any microvascular or macrovascular events, severe hypoglycemia, or mortality during calendar year 2019. We categorized HbA1c (last result prior to 1/1/2019) as being below (overtreated), within (reference), or above (undertreated) recommended target range. Health status was adapted from the ADA Standards of Care. Cox proportional hazards models of complications were adjusted for sociodemographic and clinical variables.

Among 63429 eligible patients (mean age 74.2 yrs, 46.8% women), 8773 (13.8%) experienced a complication. Complication risk was significantly elevated for patients in good health who were overtreated or undertreated (Table). Among those with intermediate health, complication risk was elevated only for those who were undertreated. Among those with poor health, complication risk did not differ significantly by level of attained HbA1c.

Factors other than HbA1c level are likely to be more important predictors and/or drivers of complications in patients with T2D and poor health.

Disclosure

K.J.Lipska: Other Relationship; UpToDate. E.Huang: Advisory Panel; Twin Health, Stock/Shareholder; AbbVie Inc., Cardinal Health, Amgen Inc. J.Liu: None. M.M.Parker: Research Support; Dexcom, Inc. H.H.Moffet: Research Support; Dexcom, Inc. R.W.Grant: None. N.Laiteerapong: None. A.J.Karter: None.

Funding

National Institute on Aging (R01AG063391, R56AG074986); National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092924, P30DK092949)
1359-P: Gaps in the Use of Evidence-Based Diabetes Medications for NASH
Authors: ALEXOPOULOS ANASTASIA-STEFANIA , PARISH ALICE , OLSEN MAREN , BATCH BRYAN , MOYLAN CYNTHIA A. , CROWLEY MATTHEW J.
Published: June 2023

Patients with type 2 diabetes (T2D) and nonalcoholic steatohepatitis (NASH) are at exceedingly high risk of NASH progression to cirrhosis and end-stage liver disease. T2D medications shown to improve histologic features of NASH, such as GLP-1 receptor agonists and pioglitazone, should be considered for use in all patients with T2D and NASH, unless contraindications exist. However, utilization of T2D medications that benefit NASH are poorly understood. Our objective was to address this gap by examining their use in patients with T2D and NASH engaged with Primary and/or Endocrinology care in the Duke University Healthcare System between 1/1/2019 and 1/1/2021. T2D and NASH were defined by ICD-10 codes, E11.xx and K75.81, respectively and 848 patients were included in the analyses. Mean age of our cohort was 60 (SD 12) years, 62% were female (n=525), 13% (n=110) were Black race and 4.7% (n=40) were Hispanic ethnicity. The mean HbA1c was 7.5% (SD 1.5), and the majority followed with Endocrinology (58.5%, n=496) and used insulin (62.4%, n=529). Only 26.3% (n=223) had an appointment with Duke Hepatology during the study period (either new consultation or follow-up visit). The use of evidence-based T2D medications for NASH was low (34.8%, n=295), with only 31.3% (n=265) and 6.5% (n=55) of patients having been prescribed a GLP-1 receptor agonist or pioglitazone during the study period, respectively. Prescriptions of these medications did not significantly vary by race (Black vs. White unadjusted OR 1.08, 95% CI 0.71, 1.64) or Hispanic ethnicity (unadjusted OR, 1.46, 95% CI 0.77, 2.79).

In summary, we observed a large gap between recommended and current use of evidence-based medications for NASH in patients with T2D. Use of pioglitazone was particularly low, despite its low cost and longstanding evidence for use in NASH. Future studies should explore reasons for underuse of these evidence-based T2D medications in NASH, and whether this is changing over time with growing evidence supporting their use in NASH.

Disclosure

A. Alexopoulos: None. A. Parish: None. M. Olsen: None. B. Batch: Advisory Panel; LLENA (AI). C.A. Moylan: Advisory Panel; Boehringer Ingelheim Inc. Research Support; GlaxoSmithKline plc. M.J. Crowley: None.

Funding

National Institutes of Health (KL2TR002554)
136-LB: The Implication of Glycemic Risk Index Varies with Different Levels of Glycosylation A1c (HbA1c) in Type 1 Diabetes
Authors: HE BINBIN , XIE YUTING , LI XIA , ZHOU ZHIGUANG
Published: June 2023

Objective: Type 1 diabetes (T1D) is characterized by significant fluctuations in blood glucose, necessitating comprehensive assessment of glycemic control. The Glucose Risk Index (GRI) is a new glucose assessment metric derived from continuous glucose monitoring (CGM) that can simultaneously indicate hyperglycemic and hypoglycemic risks. This study explored the implications of GRI for T1D with different HbA1c levels.

Methods: We obtained 507 CGM and clinical data points from 281 patients with T1D, some of whom had follow-up data with intervals of over 3 months. The included patients aged 4-72 years with duration greater than 3 months and wore a CGM for at least 14 days. The hypoglycemic index and hyperglycemic index were calculated by time below range (TBR) <54 mg/dL + 0.8 × TBR <70-54 mg/dL and time above range (TAR) >250 mg/dL) + 0.5 × TAR >180-250 mg/dL, respectively. GRI is the sum of 3 times hypoglycemic index and 1.6 times hyperglycemic index. Relationships between GRI and HbA1c, each CGM metrics were explored and compared in patients with HbA1c <7% and ≥7%.

Results: The mean GRI and HbA1c were 57.6 ± 20.6 and 7.3 ± 1.1%, respectively, and HbA1c of 7% approximately corresponded to GRI of 55. GRI was correlated with HbA1c (R = 0.536), hypoglycemic index (R = 0.466) and hyperglycemic index (R = 0.654), but the correlation between GRI and HbA1c disappeared in subgroup with HbA1c <7%. Compared with the HbA1c ≥7% group, GRI in the HbA1c <7% group had a stronger correlation with hypoglycemic index and a weaker correlation with hyperglycemic index. Further analysis showed the combination of dichotomous HbA1c (<7% or ≥7%) and GRI (<55 or ≥55) conferred best evaluation of glycemic control.

Conclusions: The implication of GRI varies with different levels of HbA1c in T1D, with GRI mainly representing hypoglycemic risk when HbA1c <7%, and hyperglycemic risk when HbA1c ≥7%. A more comprehensive assessment of glycemic control in T1D should be the combination of dichotomous HbA1c and GRI.

Disclosure

B. He: None. Y. Xie: None. X. Li: None. Z. Zhou: None.

Funding

National Natural Science Foundation of China (81600649)
1360-P: Health Disparities in Clinical Research among Those Living with Diabetes-Related Retinopathy
Authors: COOPER LILLIAN H. , AINLEY LEXIE , STEVENS HENRY , QUINN KEVIN , COOPER BLAKE A.
Published: June 2023

Background: Despite the higher rates of diabetes among the Black, Indigenous, and People of Color (BIPOC) population, there is a significant underrepresentation of this population in diabetes-related clinical trials which compromises the generalizability of results and further exacerbates health disparities.

Objective: To identify barriers and solutions to BIPOC enrollment in diabetes-related clinical trials.

Methods: We reviewed 18 diabetes-related clinical trials at Retina Associates LLC in Kansas City and interviewed recruiting physicians from practices across the US. Results: Fewer BIPOC population (15.6%) and women (40%) were enrolled in the analyzed trials. Men were 1.6 times more likely to be screened despite having a 20% higher screen fail rate than women. The fail rate was lower among Caucasian participants than among Hispanic participants (29.6% vs 37.5%). Based on zip codes, the fail rate was 1.25 times higher for those with an estimated average household income below $70,000 compared to those with an income above $100,000. The interviewed physicians valued a potential clinical trial patient’s ability to understand, commitment to health, reliability, and overall interest. They stressed the immense difficulty of time and travel commitments that clinical trials can pose for patients and agreed that increasing diversity in the staff could prove to be beneficial, especially regarding the language barrier many patients face.

Conclusions: Several recommendations from the reviewed trials and interviews to improve BIPOC enrollment. Clinical trial sponsors should provide Informed Consent Forms (ICFs) in multiple languages. There needs to be a level of diversity when hiring healthcare providers and study coordinators. Clinical trials should be designed to be less burdensome and include geographic locations with a higher population percentage of minorities, as well as locations within the neighborhoods where these populations receive their healthcare care.

Disclosure

L.H.Cooper: None. L.Ainley: None. H.Stevens: None. K.Quinn: None. B.A.Cooper: Advisory Panel; Genentech, Inc., Speaker's Bureau; Regeneron, Optomed.
1363-P: Clinical Profile and Outcome of Diabetic Ketoacidosis in an Emergency Department Non-COVID ICU
Authors: R CHANDNI , JAMI BIPENTHUNG N. , SURESH ANJANA , MANGALY AUSTIN J.
Published: June 2023

The clinical profile of DKA in a 4-bedded ED ICU of a single tertiary care centre from 12 April 2022 to 4 January 2023 is presented. A total of 11 DKA events were managed, with a mean age of 45.5 ± 19.2 y with M: F ratio of 1:2.7. Type 1 in 36%, type 2 in 45% and 18% were unclassified. 55% had no comorbidities, and 45% had Hypertension, CAD, CKD, and hypothyroidism. Presented with nausea & vomiting in 6 (55 %), shortness of breath in 5 (45%), dysuria in 4 (36 %), fever & fatiguability in 3 (27%), abdominal pain, chest pain, loose stools in 2 (18%), cough, haematemesis and loss of consciousness in 1 (9%). Of the total patients, 36 % were only on OADs, 18 % on Insulin and OADs and 18 % on Insulin alone. Duration of diabetes ranged from 2 to 13 years, and 2 were first diagnosed. Reasons for DKA were Non-adherence to medication (18%), the first presentation of DM (18%), Infections (73%), CAD-ACS (18%) and Pancreatitis (9%). One patient was on Dapagliflozin 10 mg daily with blood glucose 240 mg/dL at presentation. Lab parameters are shown in Table 1. Course in ICU: All patients received the standard treatment of DKA. 27 % had AKI and 27% had Acute on CKD. ICU mortality was 36 % with definite alternative causes identified for death. Conclusions: Infections are the most important cause of precipitating events for DKA. Co-morbidities and Complications decide the outcome and early recognition and standard treatment and ICU care are important in critically ill.

Disclosure

C.R: None. B.N.Jami: None. A.Suresh: None. A.J.Mangaly: None.
1364-P: Cinicoradiological and Microbial Spectrum of Skull Base Osteomyelitis and Its relation to Diabetes Mellitus
Authors: RADHAKRISHNAN SUMA , C DINSHA , DAHIYA VIJEYTA , R CHANDNI
Published: June 2023

Skull base osteomyelitis (SBO) is a rare life-threatening disease, which is on the increase specifically the incidence of fungal skull base osteomyelitis.

Objectives: To describe the demographic, and clinicoradiological profile, and to assess the outcome of skull base osteomyelitis.

Methodology: A prospective study from a tertiary care centre, in Kerala from 1st February 2018 to 31st August 2019 with a minimum follow-up of 6 months. All patients diagnosed with skull base osteomyelitis were included. The demographic profile and relevant investigations, radiological correlations and treatment outcomes were analysed.

Results and Discussions: 30 patients (23 males and 7 females) were studied. Incidence was found to be high in the age group 51-60 years. The mean (SD) of Age (Years) was 62.02 (14.21), ranging from 1.5-78 years. The most common presentation was a nocturnal earache (86.7%).13.3% of patients presented with headache alone, these cases were diagnosed to be central skull base osteomyelitis and had a significant association with clival erosion. All the patients were having diabetes mellitus except 1.5 yrs old who had congenital cyclic neutropenia. We could see an association between uncontrolled blood glucose and the severity of the disease (P value <0.001). 63.3% of the participants had Cranial Nerve Palsy at the presentation. The culture yielded Pseudomonas followed by staphylococcus aureus, MRSA & Aspergillus. The ESR and CRP levels were reliable for the detection, progression and resolution of disease status in SBO. All patients were treated with third-generation cephalosporins and fluoroquinolones for a minimum of 6 weeks and of which, 12 patients with fungal SBO were given antifungals also.

Conclusions: Skull base osteomyelitis is an entity that requires a lifelong commitment. A high index of suspicion, early diagnosis, and prompt and aggressive management are critical for a positive outcome. Uncontrolled diabetes mellitus was the risk factor recognised.

Disclosure

S.Radhakrishnan: None. D.C: None. V.Dahiya: None. C.R: None.
1365-P: Recurrent Diabetic Ketoacidosis—Patient Characteristics and Clinical Outcomes in Qatar
Authors: ELEDRISI MOHSEN , ALABDULRAZZAK IMAD , ALKABBANI HAIFAA M. , ABOAWON MALK K. , ALI AYA A. , ELHAJ MAAB F. , AHMED ASHRAF O.E. , ALQAHWACHI HAZIM , MALIK RAYAZ A.
Published: June 2023

Background: Recurrent diabetic ketoacidosis (DKA) is associated with poor clinical outcomes.

Objective: We aimed to examine patients’ characteristics and clinical outcomes for patients hospitalized with recurrent DKA in Qatar.

Methods: The hospital database was interrogated for patients admitted with DKA to government hospitals in Qatar between 2015 to 2020. Precipitating cause, clinical characteristics, laboratory data, severity of DKA, complications, need for admission to the intensive care unit, length of hospital stay, time to resolution of DKA, and mortality rates were evaluated in patients with recurrent (>1 admission) compared to a single admission.

Results: A total of 1612 episodes of DKA, of which 434 patients (26.9%) had recurrent DKA, were evaluated. Compared to patients who had a single admission for DKA, those with recurrent DKA were younger [35.0 (24.0-53.0) vs 39.0 (28.0-54.0) years, p<0.001], more likely to be females (50.6% vs 37.1%, p<0.001), more likely to have type 1 diabetes (47.9% vs. 33.4%, p<0.001), a longer duration of diabetes [12.0 (5.0-19.0 vs 5.0 (0.0-13.0) years, p<0.001], more likely to have severe DKA (48.6% vs 38%, p<0.001), with a shorter time to resolution of DKA [12.5 (9.0-24.0) vs 23.0 (10.0-33.0) hours, p<0.001]. There was no difference in the precipitating cause of DKA, need for admission to the intensive care unit, hospital stay or inpatient mortality. On multivariable logistic regression analysis, significant predictors of occurrence of recurrent DKA were younger age (OR, 0.96; 95% CI, 0.95-0.98; p= 0.0001), female gender (OR, 0.63; 95% CI, 0.46-0.85; p= 0.003) and longer duration of diabetes (OR, 1.07; 95% CI, 1.04-1.09, p= 0.0001).

Conclusion: In this cohort study, recurrent DKA was associated with younger age, female predominance and longer duration of diabetes. However, hospital course and inpatient mortality rates did not differ from those with a single admission for DKA.

Disclosure

M.Eledrisi: None. I.Alabdulrazzak: None. H.M.Alkabbani: None. M.K.Aboawon: None. A.A.Ali: None. M.F.Elhaj: None. A.O.E.Ahmed: None. H.Alqahwachi: None. R.A.Malik: None.
1366-P: Nonalcoholic Fatty Liver Disease in Young-Onset Type 2 Diabetes Mellitus—A New Epidemic?
Authors: SHARMA ANU , GODINEZ LEIVA EDDISON , LOMONACO ROMINA , VALDEZ SAENZ ENRIQUE , ORTIZ ROCHA ANDREA , MARANGI STEPHEN A. , GONZALEZ MARIA A. , SHRESTHA SULAV , SHETTY SHWETHA S. , BUDD JEFFREY T. , BARB DIANA , KALAVALAPALLI SRILAXMI , CUSI KENNETH
Published: June 2023

The prevalence of young-onset type 2 diabetes mellitus (YOT2DM), defined as T2DM diagnosed in adults <45 years old, is steadily increasing. Nonalcoholic fatty liver disease (NAFLD) is common in people with T2DM but its prevalence in YOT2DM is unknown. We therefore hypothesized that NAFLD is an emerging health concern in this population. A total of 161 adults aged 35-44 years with and without T2DM, underwent screening for NAFLD with laboratory tests and imaging by elastography (steatosis by controlled attenuation parameter [CAP]; fibrosis by liver stiffness measurement [LSM]). Of these, 25 (16%) had YOT2DM and 136 (84%) did not have diabetes mellitus (noDM). While obesity was very prevalent in the cohort (53%), those with YOT2DM had a higher BMI (35±7 vs. 31±7 kg/m2, p<0.01), and reported comorbidities more frequently: hypertension (48% vs. 24%, p=0.02) and atherogenic dyslipidemia (76% vs. 54%, p=0.04). Hepatic (HOMA-IR 4.6±2.8 vs 2.6±1.9, P<0.01) and adipose tissue (6.5±5.1 vs 3.9±3.5, p=0.01) insulin resistance were worse in people with YOT2DM. Adiponectin, a reflection of proper adipose tissue function, was lower in YOT2DM (4.2±2.3 vs 6.2±3.5 μg/mL, p=0.02). Hepatic steatosis (CAP ≥274 dB/m) was prevalent in both groups but higher in people with YOT2DM (64% vs. 47%), but much lower in people without obesity or diabetes (27%; p<0.01). Male sex was associated with a significantly higher risk of hepatic steatosis (OR 3.7, 95% CI 1.5-9.2). The frequency of any fibrosis as measured by LSM (≥7.0 kPa) was 3-fold higher in YOT2DM compared to people without diabetes (12% vs. 4%, p=0.08). Every 1 unit increase in BMI elevated the risk of both steatosis and fibrosis by 20% (OR 1.2, 95% CI 1.03-1.3).

Conclusion: Hepatic steatosis is highly prevalent in young-onset type 2 diabetes (YOT2DM) and is strongly influenced by obesity. Hepatic fibrosis is relatively common and affects 1 in 8 people with YOT2DM. These results warrant the need for larger and longer follow-up studies in this population.

Disclosure

A. Sharma: None. E. Godinez Leiva: None. R. Lomonaco: None. E. Valdez Saenz: None. A. Ortiz Rocha: None. S.A. Marangi: None. M.A. Gonzalez: None. S. Shrestha: None. S.S. Shetty: None. J.T. Budd: None. D. Barb: None. S. Kalavalapalli: None. K. Cusi: Research Support; Echosens, Inventiva. Consultant; Poxel SA. Research Support; LabCorp, Zydus. Consultant; Altimmune, Arrowhead Pharmaceuticals, Inc., AstraZeneca, 89bio, Inc., Bristol-Myers Squibb Company, Lilly, Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Medscape, Myovant, Novo Nordisk, ProSciento, Quest Diagnostics, Sagimet, Sonic Incytes, Terns.
1369-P: The Natural Trends in Incidence of Lower Extremity Amputations in South Korea, 2003–2021
Authors: YOUNG JEON JA , KIM NAYOUNG , HWAN BACK JOUNG , LEE NAMI , JIN HAN SEUNG , JIN KIM HAE , JUNG KIM DAE , HO KIM TAE , AN SOYEON , LEE KWANWOO
Published: June 2023

Introduction: National data in incidence of lower extremity amputations in the population of South Korea is lacking. Diabetes mellitus is a major risk factor for lower extremity amputations. The prevalence of diabetes mellitus is increasing faster than previously estimated in South Korea. Therefore, we investigated the trend of lower extremity amputations not only in people with diabetes, but also in the total (medically documented) population.

Method: We gathered and analyzed the data of the medically documented population, aged 20 years or older, from the Korean Health Insurance Service claims database between 2003 and 2021.

Results: Since 2003, incidence of lower extremity amputations among the total population has steadily increased, more than doubling by 2021 (6.8 to 14.5 amputations per 100,000 of population). The contribution of diabetes mellitus on lower extremity amputation has also elevated from 47% in 2003 to 70% in 2021. During the study period, the incidence of lower extremity amputations was consistently higher by more than three times in men (21.6) than in women (7.3), amputations per 100,000 of population in 2021. When foot amputations were classified by lower extremity parts, the proportion of major amputations (above ankle) has decreased slightly. In the last 10 years, the frequency and proportion of three or more repeated foot amputations has reduced (431 (9.2%) to 207 (4.1%)).

Conclusion: We reported the increasing trend of lower extremity amputation between 2003 and 2021 according to the increase in the prevalence of diabetes mellitus in South Korea. Among all lower extremity amputations, the major amputations and multiple amputations, 3 or more times, are decreasing.

Disclosure

J.Jeon: None. K.Lee: None. N.Kim: None. J.Back: None. N.Lee: None. S.Han: None. H.Kim: None. D.Kim: None. T.Kim: None. S.An: None.
137-LB: Modified Personal Glycemic State Model Predicts the Need for Islet Transplantation in Human
Authors: ORR CHRIS , HACKER-STRATTON JEANNETTE , EL-SHAHAWY MOHAMED , FOROUHAR ELENA , OMORI KEIKO , QI MEIRIGENG , KANDEEL FOUAD R.
Published: June 2023

Continuous glucose monitoring (CGM) has become a valuable tool for assessing glycemic control. The personal glycemic state (PGS)1 is a mathematical model that considers 5 CGM data elements (mean blood glucose, percent time in range, glucose variability percentage, and frequency of moderate and severe hypoglycemia) equally to generate a score representing the degree of metabolic control. Our adapted personal glycemic state for islet transplant (PGSFIT) targets normoglycemia in islet transplantation by limiting the percent time in range to 70-140mg/dl instead of commonly used 70-180mg/dl, and uses weighted components without limiting the influence of any individual component on the total score. This allowed us to account for T1D patients keeping blood glucose high to avoid hypoglycemia or low to avoid long term complications despite increased hypoglycemia. Using PGS and PGSFIT to analyze glycemic control in 16 subjects with T1D post allogenic islet transplantations showed concordance in classifying the glycemic control as acceptable (PGS/PGSFIT <15) or unacceptable (≥15) in 88% of the cases when variability was low (standard deviation of PGS components ≤ 0.1), and both PGSFIT and PGS models had excellent correlation with fasting c-peptide results. In contrast, when variability was high (standard deviation of PGS components > 0.1), 71% of patients deemed clinically suitable for repeat transplant had PGSFIT score ≥15 but only 14% had PGS score ≥15. In patients who had not yet received their final islet infusion, high parameter variability and PGSFIT ≥15 was associated with lower fasting C-peptide compared to patients with high parameter variability and PGSFIT ≤15 who received the maximum therapeutic dose. PGSFIT significantly improved after repeat transplant in patients with high PGSFIT and high component variability. These results suggest PGSFIT may also be used to identify subjects suitable for first islet transplant.

Disclosure

C. Orr: None. J. Hacker-stratton: None. M. El-shahawy: None. E. Forouhar: None. K. Omori: None. M. Qi: None. F. R. Kandeel: None.

Funding

National Institutes of Health (U24DK098085)
137-OR: Metabolite Ratios and Development of Type 1 Diabetes
Authors: JOHNSON RANDI K. , ROMERO ALEX , WILLEMS EMILEIGH , RICH STEPHEN S. , REWERS MARIAN , FIEHN OLIVER , NORRIS JILL M.
Published: June 2023

Ratios between metabolites more directly reflect flux through chemical reactions than individual metabolites. Variation in metabolites and their ratios are determined, in part, by genetic factors. Thus, genetic loci associated with variation in metabolite ratios may help disentangle genetic from non-genetic processes captured by the metabolome. We integrated metabolite ratios with genetics to predict changes preceding type 1 diabetes (T1D) in The Environmental Determinants of Diabetes in the Young (TEDDY) study. Quantitative trait loci (QTLs) were identified for 132 metabolite ratios previously associated with progression from islet autoimmunity (IA) to T1D. Ratios were calculated from untargeted metabolomics data available at the time of seroconversion to IA for 338 cases and 921 matched controls in TEDDY. Genotyping was performed using a genome-wide array with custom content with imputation to the TOPMed reference panel. Ratio-SNP associations were estimated using Matrix eQTL software, adjusting for case-control status and genetic relatedness. Genome-wide significant association (P < 4.9×10-9) was observed at 202 independent loci, involving 49 metabolite ratios. Twenty-six loci (12.9%) involved ratios between polyunsaturated fatty-acids (PUFAs) and fatty acid esters of hydroxy fatty acids (FAHFAs), a novel class of bioactive lipids with antidiabetic and anti-inflammatory effects. Variation in the metabolite ratio of eicosadienoic acid to FAHFA (18:1/O-15:1) was significantly determined by a site on chromosome 3 (ITPR1); ITPR1 encodes a receptor integral to calcium signaling and glucose-induced insulin secretion. Other genetic loci contributing to variation of PUFA:FAHFA ratios reside in genes controlling inflammatory and innate immune response (e.g., TSPO, TTLL12, NCAM1) and apoptosis (PPM1L). These novel metabolite ratio QTLs, some with known association with T1D risk, expand potential biomarkers of T1D risk, with PUFA:FAHFA ratios representing candidate FAHFA biosynthesis genes.

Disclosure

R.K. Johnson: None. A. Romero: None. E. Willems: Employee; Amgen Inc. S.S. Rich: None. M. Rewers: Research Support; Provention Bio, Juvenile Diabetes Research Foundation (JDRF), Hemsley Charitable Trust, Dexcom, Inc., Janssen Research & Development, LLC. O. Fiehn: None. J.M. Norris: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R03DK127472); National Institute of Allergy and Infectious Diseases; National Institute of Child Health and Human Development; National Institute of Environmental Health Sciences; JDRF; Centers for Disease Control and Prevention
1370-P: Glycemic Control and Intelligence over 30 Years in Children Diagnosed with Diabetes before 3 Years of Age (CLARiFY Study)
Authors: CAMERON FERGUS , MORAN CHRIS , BROWN AMY , BEARE RICHARD , GBADEYAN OYETUNDE , SAKOWSKI STACEY A. , SRIKANTH VELANDAI , FELDMAN EVA L. , NORTHAM ELISABETH A.
Published: June 2023

Early childhood onset of type 1 diabetes (T1D) is associated with poorer cognition. Yet, the contribution of glycemic control to poorer cognition is unclear. We examined the association between glycemic control and full-scale intelligence quotient (FSIQ) in a cohort of children diagnosed with T1D before age 3 followed over 30 years. We recruited children presenting to a tertiary hospital in Australia from 1990-1992 in the prospective Cognition and Longitudinal Assessment of Risk Factors over 30 Years (CLARiFY) cohort study. Those with T1D underwent a cognitive test series at entry and 2, 6, 12 and 30 years post-diagnosis. Linear mixed effects modelling examined associations between HbA1c mean and coefficient of variation and FSIQ over time. Data were available for 12 subjects (6 male). The mean diabetes diagnosis age was 1.9 years. The mean HbA1c at each time of 2, 6, 12 and 30 years was 7.9, 8.3, 8.4 and 8.7%, respectively (Fig.1 shows HbA1c plots across time for each subject). We did not find an association between mean HbA1c (β=-3.2, p=0.09) nor HbA1c coefficient of variability (β=23.2, p=0.34) and FSIQ. Future analyses with more data will further document the impact of lifetime glycemic control on IQ and other cognitive measures in later life. Future work will also examine the impact of diagnosis age and acute dysglycemic events on cognitive outcomes 30 years after diagnosis vs healthy controls.

Disclosure

F.Cameron: None. C.Moran: None. A.Brown: None. R.Beare: None. O.Gbadeyan: None. S.A.Sakowski: None. V.Srikanth: None. E.L.Feldman: None. E.A.Northam: None.

Funding

National Institutes of Health (R01DK129320)
1372-P: Micro and Macro Complications Three-Year Follow-up in LANDMARC—Longitudinal Nationwide Study on Real-World Outcomes of Type 2 Diabetes in India
Authors: RAIS NADEEM , DAS ASHOK K. , JOSHI SHASHANK R. , MITHAL AMBRISH , KALRA SANJAY , GOPALAKRISHNAN UNNIKRISHNAN AMBIKA , THACKER HEMANT , SETHI BIPIN , CHOWDHURY SUBHANKAR , SUGUMARAN AMARNATH , SATPATHY ASHWINI , GADEKAR ARVIND , MENON SHALINI K. , NEOGI RENUKA , CHODANKAR DEEPA , TRIVEDI CHIRAG , KUMAR WANGNOO SUBHASH , ZARGAR ABDUL H. , PRASANNA KUMAR K.M.
Published: June 2023

Microvascular and macrovascular complications were evaluated during the 3 years (yrs) of LANDMARC, a prospective observational study (CTRI/2017/05/008452) that included participants with T2D on ≥2 antihyperglycemic medications. Out of 6222 evaluable participants (mean baseline age: 52.1 yrs, T2D duration: 8.6 yrs and A1C: 8.05%), 5273 participants completed the 3-yr follow-up. The mean A1C decreased by 0.68% (p<0.0001) in 3 yrs. Microvascular complications were noted in 18.02% (1121/6222) of participants, while the incidence of macrovascular complications was 3.29% (205/6222). Neuropathy was the most commonly reported complication (baseline: 11.8% and 3-yrs: 14.8%). The 3-yr results indicate slightly higher complications among those who were overweight, but the difference was non-significant (p=0.8380); and significantly higher complications among those with suboptimal glycemic control (p<0.0001) or having CV risk factors (p<0.0001) (Table). The most common macrovascular complication was MI. A total of 37 CV deaths were reported, with majority being sudden deaths (n=24), followed by fatal myocardial infarction (MI, n=10), coronary artery procedure (n=2), and stroke (n=1). These results offer insights into disease progression and suggest the need for controlling risk factors and timely treatment adjustment in participants with T2D.

Disclosure

N.Rais: Advisory Panel; Bayer Consumer Care AG, Board Member; Abbott, Biocon. A.Sugumaran: Employee; Sanofi. A.Satpathy: Employee; Sanofi. A.Gadekar: Employee; Sanofi. S.K.Menon: Employee; Sanofi. R.Neogi: Employee; Sanofi. D.Chodankar: Employee; Sanofi. C.Trivedi: None. S.Wangnoo: None. A.H.Zargar: None. K.Kumar: None. A.K.Das: n/a. S.R.Joshi: Advisory Panel; Biocon, Zydus Cadila, Torrent Pharmaceuticals Ltd, Franco India, Consultant; Glenmark Pharmaceuticals, Twin Health, Speaker's Bureau; Abbott Nutrition, Sanofi, Abbott, Novo Nordisk, Lupin Pharmaceuticals, Inc. A.Mithal: Advisory Panel; Eris Lifesciences Ltd., Consultant; Glenmark Pharmaceuticals, Lupin Pharmaceuticals, Inc., USV Private Limited, Research Support; Sanofi, Speaker's Bureau; Novo Nordisk, Boehringer-Ingelheim, AstraZeneca, Sun Pharmaceutical Industries Ltd., Novartis. S.Kalra: Speaker's Bureau; Abbott, Bayer Inc., Novo Nordisk, Sanofi. A.Unnikrishnan: Speaker's Bureau; Sanofi, AstraZeneca, Boehringer-Ingelheim, Intas Pharmaceuticals Ltd. H.Thacker: None. B.Sethi: None. S.Chowdhury: None.

Funding

Sanofi India
1374-P: Ultra-processed Food Consumption and Cardiometabolic Risk in Individuals With and Without Type 1 Diabetes Mellitus
Authors: PANG TIANTIAN , ALMAN AMY C. , GRAY HEEWON L. , DAGNE GETACHEW , BASU ARPITA , BURO ACADIA W. , SNELL-BERGEON JANET K.
Published: June 2023

Background: Ultra-processed foods (UPFs) contribute to almost 60% of energy intake in the American diet. The longitudinal association between UPF consumption and cardiometabolic risk is less known, especially in people with type 1 diabetes mellites (T1DM) who are at a higher risk of developing cardiometabolic diseases than people without diabetes (non-DM).

Methods: We performed a longitudinal analysis of data from the Coronary Artery Calcification in Type 1 Diabetes study (T1DM: n=652; non-DM: n=764) collected at baseline and years 3, 6, and 14. Baseline age was 37.8±9.3 years. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire, and cardiometabolic biomarkers (BMI, waist circumference, triglycerides, HDL-C, LDL-C, and systolic and diastolic blood pressure) were measured at all four time points. NOVA food classification was used to compute UPF consumption (servings/d). Linear mixed-effects models were used to estimate longitudinal associations of UPF consumption with cardiometabolic risk, adjusting for potential confounders (race, age, sex, education, physical activity, smoking, energy intake, antihypertensive and lipid-lowering drugs, and diabetes duration for T1DM).

Results: People with T1DM consumed more UPFs, including processed meat, soft drinks, salty snacks, and margarine, than non-DM at baseline (8.7±7.8 vs. 7.3±6.7 servings/d, P<0.01). Higher UPF consumption was associated with higher anthropometric measures (BMI: β=0.01±0.01, waist circumference: β=0.03±0.01), worse lipid levels (triglycerides: β=0.21±0.09, HDL-C: β=-0.04±0.02), and higher systolic blood pressure (β=0.05±0.02) when adjusted for diabetes status and other covariates (all P<0.05).

Conclusion: UPF consumption significantly worsened the cardiometabolic profile over time in people with and without T1DM. Decreasing UPF intake may reduce the risk of developing cardiometabolic diseases across the lifespan.

Disclosure

T.Pang: None. A.C.Alman: None. H.L.Gray: None. G.Dagne: None. A.Basu: None. A.W.Buro: None. J.K.Snell-bergeon: None.

Funding

American Diabetes Association (7-13-CD-10 to J.K.S-B.), (7-13-CE-02 to A.C.A.); National Heart, Lung, and Blood Institute (R01HL079611, R01HL113029); Diabetes Endocrinology Research Center (P30DK57516, P30DK1116073)
1376-P: Dietary Sodium Intake and Risk of Incident Type 2 Diabetes
Authors: WANG XUAN , MA HAO , TANG RUI , XUE QIAOCHU , LI XIANG , HEIANZA YORIKO , QI LU
Published: June 2023

Background: Type 2 Diabetes (T2D) and hypertension often coexist and share many common risk factors. High dietary sodium intake is a well-established risk factor for hypertension, whereas few studies have assessed the relation between dietary sodium intake and type 2 diabetes (T2D). In this study, we aimed to evaluate the association between the frequency of adding salt to foods, a surrogate marker for evaluating the long-term sodium intake, and incident T2D risk.

Methods: A total of 402,982 participants from UK biobank, who were free of diabetes, chronic kidney disease, cancer, or cardiovascular disease at baseline, and had completed information on adding salt were analyzed in this study. Cox proportional hazards models were used to estimate the association between the frequency of adding salt to foods and incident T2D.

Results: During a median of 11.8 years of follow-up, 13,120 incident T2D were documented. Compared with participants who Never/Rarely added salt to foods, the adjusted Hazard Ratios (95% confidence interval) were 1.13 (1.08, 1.17), 1.20 (1.14, 1.26), and 1.39 (1.30, 1.49) across the groups of Sometimes, Usually, and Always, respectively (P-trend<0.001). We did not find significant interactions between the frequency of adding salt to foods and baseline hypertension status and other covariates on the risk of incident T2D. The observed positive association was partly mediated by body mass index (BMI), waist to hip ratio, and C-reactive protein, with a significant mediation effect of 32.9%, 36.6% and 7.0%, respectively. The significant mediation effect of BMI was largely driven by the body fat mass rather than the body fat-free mass.

Conclusions: Our findings for the first time indicate that higher frequency of adding salt to foods, a surrogate marker for a person’s long-term salt taste preference and intake, is associated with a higher T2D risk.

Disclosure

X.Wang: None. H.Ma: None. R.Tang: None. Q.Xue: None. X.Li: None. Y.Heianza: None. L.Qi: None.