bluuebunny/crossref_metadata_2025 huggingface dataset:
649-P: Making Glucose the Next Vital Sign: An Educational Intervention to Teach Clinicians How to Improve Inpatient Glycemic Control
Authors: SELEY JANE JEFFRIE , MENDELSOHN CURANAJ FELICIA A. , YEH TIFFANY , YEUNG MICHELE , FALCONE JOHN
Published: June 2019

Background: Although the American Diabetes Association recommends avoiding hypoglycemia and hyperglycemia in the inpatient setting, there is a lack of comprehensive education offered to clinicians to learn steps to achieve these goals.

Objectives: 1) Decrease rates of malglycemia while increasing percent of patients in target BG ranges by 3% on medicine units. 2) Increase prescriber test scores post educational intervention.

Methods: We developed interactive role specific educational interventions for physicians, nurse practitioners, physician assistants and registered nurses focusing on strategies to improve glycemic control while preventing adverse events. Education was tailored to each profession with case based face-to-face and on-line educational modules. Glycemic Management pocket cards and dosing guidelines for steroids, enteral feedings and preparation for surgery were distributed as well as "Glucose: The Next Vital Sign" Buttons to create a culture of safety and shared vision.

Conclusion: Results to date indicate an improvement in target BG readings. At the end of February 2019, we will calculate overall rates of hypoglycemia and hyperglycemia as well as in target BGs for the 6 month period and compare to the same months one year earlier. We will analyze prescriber and RN test scores, revise educational intervention and offer the program to other service lines.

Disclosure

J. Seley: Advisory Panel; Self; AstraZeneca, Sanofi US. Consultant; Self; Ascensia Diabetes Care, Johnson & Johnson Diabetes Institute. F.A. Mendelsohn Curanaj: None. T. Yeh: None. M. Yeung: None. J. Falcone: None.

Funding

Weill Cornell Medicine
651-P: Validation of a Clinically Relevant Knowledge Assessment in Pediatric Type 1 Diabetes
Authors: ANASTASIA ALBANESE-O'NEILL , MACINNES JANN W. , THOMAS NICOLE T. , HALLER MICHAEL J. , SCHATZ DESMOND , SILVERSTEIN JANET , ADAMS JANEY , OYETORO REBECCA , KERSHAW BRITTANY A. , ANDERSON KIRA , BERNIER ANGELINA
Published: June 2019

Objective assessment of diabetes knowledge is essential to providing effective diabetes education. There is currently no such resource or instrument designed for pediatric clinical use and validated in the target population. We developed and validated the Knowledge Assessment in T1D (KAT-1) for this purpose. The KAT-1 has a total of 109 multiple choice items divided into 11 subscales designed to be taken individually. Following a pilot study to optimize the KAT-1, a validation study was performed with 200 participants (60% privately insured; 70% female; mean child A1c 8.2%; 10% African American, 11% Hispanic), including 50 parents of children with T1D <10 years; 50 parents of children with T1D ages 11-15 years; 50 adolescents with T1D ages 11-15 years; and fifty 16-21 year olds with T1D. All completed the KAT-1, Diabetes Knowledge Test 2 (DKT2), and a demographic survey. SPSS was used to evaluate the results. The complete KAT-1 scale demonstrated strong internal consistency (Cronbach’s α = 0.92, mean score 84.6, SD = 16.1). Nine of the 11 topical subscales demonstrated strong internal consistency and each took <5 minutes to complete: Supplies/Insurance (α = 0.82, mean time = 2.3 minutes, 9 questions), Hypoglycemia (α = 0.57, time = 3.1 minutes, 8Q), Sick Days/Ketones (α = 0.73, time = 3.2 minutes, 11Q), Basic Management (α = 0.63, time = 3.7 minutes, 13Q), Insulin (α = 0.67, time = 1.7 minutes, 12Q), Pathophysiology (α = 0.66, time = 4.1 minutes, 10Q), Technology/Devices (α = 0.86, time = 2.1 minutes, 15Q), Nutrition (α = 0.51, time = 2 minutes, 7Q), and Diabetes at School (α = 0.52, time = 4.3 minutes, 9Q). Subscale scores were positively correlated with one another. Total scores were positively correlated with the DKT2 and negatively correlated with the child’s reported A1c. All correlations were significant. The validated KAT-1 facilitates objective and expedient assessment of T1D knowledge. Its subscales will be integrated into the EHR as patient-facing surveys to quickly identify individual learning needs and allow for targeted T1D education.

Disclosure

A. Albanese-O'Neill: None. J.W. MacInnes: None. N.T. Thomas: None. M.J. Haller: Advisory Panel; Self; Pancreum, SAB Biotherapeutics. D. Schatz: None. J. Silverstein: None. J. Adams: None. R. Oyetoro: None. B.A. Kershaw: None. K. Anderson: None. A. Bernier: None.
662-P: Facilitators and Barriers to Healthy Eating among American Indian/Alaska Native Adults with Type 2 Diabetes: Stakeholder Perspectives
Authors: MOORE KELLY R. , STOTZ SARAH A. , BREGA ANGELA G. , GONZALES KELLY L.
Published: June 2019

American Indian and Alaska Native (AIAN) adults have a higher rate of type 2 diabetes (T2D) and related complications than non-AIAN adults. Nutrition is the cornerstone of diabetes self-management and nutrition education is a key component of diabetes self-management education. The purpose of this research was to understand stakeholder perspectives on how to adapt the American Diabetes Association (ADA) newly developed nutrition education program entitled “What Can I Eat? Choices for People with T2D and their Families” (WCIE) for AIAN adults. Using focus group and individual interview methods, we interviewed experts in AIAN diabetes nutrition education (n=9); AIAN educators, Native elders, and tribal leaders (n=11); and AIAN adults with T2D (n=29) and their family members (n=22) at 4 geographically distinct urban and reservation sites nationwide. Focus groups and interviews were recorded and transcribed verbatim. We employed the constant comparison method for data analysis and used Atlas.ti (Mac version 8.0) to digitalize the analytical process. Qualitative analysis identified specific facilitators and barriers to healthy eating in Native communities. Facilitators included: strong community and family support systems, traditional values of balance and gratitude, Native pride, and community-based wellness goals. Barriers included: food insecurity, challenges to preparation of home-cooked meals, high consumption of fast food and sugar-sweetened beverages, and loss of access to traditional foods and food-acquisition practices. Findings will be used to culturally adapt the existing ADA WCIE diabetes nutrition education program for AIAN adults with T2D.

Disclosure

K.R. Moore: None. S.A. Stotz: None. A.G. Brega: None. K.L. Gonzales: None.

Funding

American Diabetes Association (4-18-SMSC-01 to K.R.M.)
691-P: Validation of the Diabetes Knowledge Test and the Diabetes Attitude Scale 3, in a Diabetic Population in Venezuela
Authors: MARCANO YAMILETH , VELÁSQUEZ ENMANUEL J.
Published: June 2019

Objective: To characterize the elements that demonstrate the validity of the Spanish versions of Diabetes Knowledge Test and the Diabetes Attitude Scale 3 in Venezuela.

Design and Methods: descriptive, observational, transversal, and psychometric field study. Sample included 100 participants with DM type 1 and 2, 12 to 70 years old, assisting to the Endocrinology service of three Venezuelan centers. Content was validated based in theoretical fundamentals. Semantic adaptation of the questionnaires was performed. Corrections were made according to validation of content. The Spanish versions includes 33 questions and 5 sub-scales where the answers were measured with a point scale from 1 to 5, were 5 was “totally agree” and 1 was “totally disagree” for the Diabetes Attitude Scale 3; and 38 questions with 5 areas of knowledge for the Diabetes Knowledge Test. Data was analyzed by the Cronbach’s alpha coefficient for the reliability and by the factor analysis with varimax rotation for the validity of the construct. Data was tabulated with SPSS 11.0.

Results: Diabetes Attitude Scale 3: Cronbach’s Alpha for the global internal consistency was 0,628 guaranteeing the reliability of the scale. New sub-scales were obtained from factor analysis, 6 total. The Cronbach’s Alpha was superior to 0,700 for most of the sub-scales, meaning a good reliability, the exception was the sub-scale “Perception of the gravity of the Disease” with a null reliability. Diabetes Knowledge Test: the global test indicates an excellent internal consistency with a Cronbach’s Alpha of 0,800. New areas were obtained from factor analysis, 4 total. The Cronbach’s Alpha for each of the areas of knowledge was higher of 0,900, indicating an excellent reliability.

Conclusion: our questionnaires have been proven to be reliable, valid, being suitable for its application in future research in the described population.

Disclosure

Y. Marcano: None. E.J. Velásquez: None.
695-P: The Network of 37 Community-Based Education Centers for Diabetes Self-Management in Gyeonggi Province, Korea
Authors: KIM EUNJI
Published: June 2019

Background and Objectives: Diabetes is complex, chronic illness requiring comprehensive risk-reduction strategy including community efforts. While Korea society is getting older and prevalence of diabetes is getting high, control rate of diabetes among treated patients is still low in Korea. Gyeonggi province, the largest province in Korea, developed the network of 37 community-based education centers for diabetes self-management (NCECD). NCECD incorporated community public health centers, diabetes education centers and primary medical clinics to improve knowledge, self-efficacy and self-management among diabetes patients in Gyeonggi province, Korea.

Methods: Standardized education and counseling program has been implemented to about 2,000 diabetes patients during 4 weeks period in 37 cities, Gyeonggi province in 2018. Standardized questionnaire was distributed to participants before and after programs to find out changes of` diabetes knowledge, self-efficacy and self-management of diabetes.

Results: 1,794 people were answered before and after programs and significant changes were seen for diabetes knowledge, self-efficacy and self-management. An average correct answer rate of diabetes knowledge was increased from 76.0% to 88.6%. Mean of diabetes knowledge increased from 7.9 to 8.7 (p=0.000) and the overall assessment of participants’ self-efficacy was increased in mean score from 16.1 to 17.4(p=0.000). Their ability to perform diabetes self-management increased in mean score from 3.4 to 3.7 (p=0.000).

Conclusions: These findings demonstrate that the network of thirty-seven community-based education centers for diabetes self-management can be successful in Gyeonggi province, Korea and important insight is provided for ways that network can be tailored to meet the needs of their populations.

Disclosure

E. Kim: None.
699-P: Assessment and Management of Falling in Type 2 Diabetic Patients with Diabetic Kidney Disease
Authors: IKEJIMA SHIN , TAKAHASHI TOMOMI , KONDO SEIYA , UMEZU JUNKO , UEMA MIKA , HIRAI AIZAN
Published: June 2019

Background: Older type 2 diabetic patients are at an increased risk of falling. On the other hand, the risk of sarcopenia increases in patients with chronic renal disease. In the present study, we reported about the risk of falling in type 2 diabetic patients with diabetic kidney disease (DKD).

Methods: Participants were 111 outpatients with type 2 diabetes at our hospital (66.1±8.8 years old). We measured one-leg standing (OLS) time with eyes open and analyzed the date according to renal function. Participants were defined as patients with a high risk of falling, if their OLS time was less than 20s. In order to examine the cause of short OLS time, we measured the ten times sit to stand test (TTSTS) and toe grip strength test (TGST). Furthermore, we measured hand grip strength, the timed up and go test (TUG), skeletal muscle mass (Inbody S10, Biospace, Tokyo, Japan), and evaluated diabetic peripheral neuropathy (DPN) by DPN Check (HDN-1000, Omron, Tokyo, Japan). At last, we planned original physical therapy for patients.

Result: A total of 101 cases (60 males; 51 females) were included in this study. The prevalence of patients with a high risk of falling was 60.0%. In patients without renal failure (eGFR ≥ 60 ml/min/1.73 m2), with mild renal failure (30 ≤ eGFR < 60), and with sever renal failure (eGFR < 30), the prevalence of patients with a high risk of falling was 48.1%, 67.9%, and 81.8 % respectively. Patients with a short OLS time tended to perform the TTSTS more slowly than patients with a normal OLS time. Short OLS time is also associated with TGST. Patients with DPN did badly on the TGST. Based on this result, we provided patients with a physical therapy program and diet therapy.

Conclusion: These findings showed that the OLS time was significantly shorter in type 2 diabetic patients, especially those with advanced DKD. Therefore, exercise therapy, diet therapy including a good quality protein intake and management of complication including diabetic DPN are important for type 2 diabetic patients with DKD.

Disclosure

S. Ikejima: None. T. Takahashi: None. S. Kondo: None. J. Umezu: None. M. Uema: None. A. Hirai: None.
703-P: A Model Project of Structured Group Education Demonstrated Significant and Reproducible Effect on Good Metabolic Control
Authors: JIRKOVSKA JARMILA
Published: June 2019

Background: A number of diabetics do not meet targets for metabolic control, with high morbidity, mortality, and costs. Prevention is of fundamental importance to reduce the burden. Various approaches are used including patient self-management education program. Aim was to assess reproducibility and homogeneity of significant effect on metabolic control improvement in pilot high-quality standardized structured group education program implemented in education centers countrywide within 2 subsequent years.

Methods: An out-patient program including 4x2 hours of structured education lessons (self-monitoring; diet; exercise; foot care) was realized in 9 centers in 2016 and 10 centers in 2017. Overall 62 type 2 diabetics on insulin in 2016 and 58 in 2017 were included (comparable in age, gender, BMI). Metabolic parameters were measured at baseline and 6 months later. Reproducibility of group education effect on diabetes control between 2016 and 2017 as well as homogeneity of outcomes among centers were assessed by standardized statistical analysis.

Results: Proportion of individuals with comparably well controlled diabetes (HbA1c<60 mmol/mol) 6 months after the program increased significantly both in 2016 (26 to 45%, p=0.007) and 2017 (36 to 67%, p=0.001) in comparison with baseline. Mean HbA1c declined from 70.0±16.2 at baseline to 63.1±12.6 mmol/mol at 6 months (p=0.001) in 2016 and from 65.0±15.8 to 58.3±13.0 mmol/mol (p=0.001) in 2017. Likewise, for both years we observed significant decline in fasting plasma glucose, body weight reduction and decrease in systolic blood pressure as well as assessed homogeneity in diabetes improvement among centers.

Conclusion: Project demonstrated good reproducibility of significantly improved metabolic control and homogeneity among centers in 2 consecutive years. The model is helpful in discussion with health insurance companies on adequate reimbursement.

Disclosure

J. Jirkovska: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Research Support; Self; Sanofi. Speaker's Bureau; Self; Ascensia Diabetes Care, Lilly Diabetes, Novo Nordisk Inc.

Funding

Czech Diabetes Society
718-P: Post-exercise Enhancement of Insulin-Stimulated Glucose Uptake in Insulin-Resistant Rat Skeletal Muscle Concomitant with Greater γ3-AMPK Activity and Insulin-Stimulated AS160 Phosphorylation on Key Regulatory Phosphosites
Authors: PATAKY MARK W. , ARIAS EDWARD B. , ZHENG XIAOHUA , WANG HAIYAN , CARTEE GREGORY D.
Published: June 2019

One exercise session can increase subsequent insulin-stimulated glucose uptake (ISGU) by healthy skeletal muscle, and recently published research linked this outcome to exercise-induced elevation in γ3-AMPK activity which leads to greater phosphorylation of Akt substrate of 160 kDa (pAS160) on an AMPK-phosphomotif (Ser704), which in turn favors greater insulin-stimulated pAS160 on a key Akt-phosphomotif (Thr642) that regulates ISGU. Studying healthy muscle is important, but a more urgent need is to understand the mechanisms for enhanced ISGU in insulin resistant muscle. Our primary goal was to determine if exercise, which increases ISGU, also increases γ3-AMPK activity and pAS160 on key regulatory sites at 3-hours post-exercise (3hPEX) in insulin resistant muscle. Rats fed a high fat diet (HFD; 2 week) known to cause muscle insulin resistance performed acute swim exercise (2 h) or remained sedentary (SED). Other chow-fed (low fat diet, LFD; 2 week) SED rats served as healthy controls. Isolated epitrochlearis muscles from 3hPEX rats (and SED controls) were used for ISGU, pAS160 and γ1- and γ3-AMPK isoform-specific activity. ISGU was lower in HFD SED muscles compared to LFD SED, but this decrement was eliminated in the HFD 3hPEX group. The γ3-AMPK activity, but not γ1-AMPK activity, was elevated in HFD 3hPEX muscles versus both SED controls. In addition, insulin-stimulated pAS160 on Thr642 and Ser704 in HFD 3hPEX muscles was elevated above HFD SED controls and equal to values in LFD SED muscles. These novel results demonstrated, for the first time in an insulin-resistant model, that the post-exercise increase in ISGU was accompanied by enhanced pAS160Ser704 and γ3-AMPK activation. Our working hypothesis is that these key signaling events are necessary for acute exercise to restore the ISGU of insulin resistant muscles to values equal to normal LFD SED controls.

Disclosure

M.W. Pataky: None. E.B. Arias: None. X. Zheng: None. H. Wang: None. G.D. Cartee: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases
721-P: Exercise Training Alters Subcutaneous Adipose Tissue Morphology in Obese Adults Even without Weight Loss
Authors: AHN CHIWOON , RYAN BENJAMIN J. , GILLEN JENNA B. , LUDZKI ALISON , SCHLEH MICHAEL W. , REINHEIMER BENJAMIN A. , HOROWITZ JEFFREY F.
Published: June 2019

Many metabolic health complications in obese adults are linked to abnormalities within their enlarged adipose tissue mass, which include hypertrophic adipocytes, a fibrotic extracellular matrix (ECM), and suppressed capillary density. Exercise training is a first-line treatment for obesity-related diseases, but the direct effects of exercise on adipose tissue structure and metabolic function remain unclear. The purpose of this study was to determine the effects of moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) on subcutaneous adipose tissue morphology. 17 obese adults were randomly assigned to 12 weeks (4 days/week) of MICT (45 minutes at 70% HRmax, n=9) or HIIT (10 X 1 minutes at 90% HRmax, 1 minute recovery, n=8) and were required to maintain their body weight throughout. Abdominal subcutaneous adipose tissue biopsy samples were collected before and after training for histological and immunoblot measures to assess adipocyte cell size, markers of ECM remodeling and capillarization. Aerobic fitness (VO2peak) improved ∼10% in both MICT and HIIT (P<0.001), while body weight and fat mass remained unchanged, as designed. However, even in the absence of weight loss, adipocyte size decreased slightly (∼10%), yet significantly after training (P=0.04). The reduction in adipocyte cell size in HIIT was accompanied by a significant increase in the protein abundance of a key adipogenic regulator, CEBPα (P=0.03). Exercise training also induced a strong trend for a reduction in the abundance of collagen 6a (P=0.07). We also found a strong trend for HIIT to increase the protein abundance of the angiogenic regulator VEGFα (P=0.06), although this did not translate to a measurable increase in capillarization.

In summary, exercise training, perhaps especially HIIT, may increase adipogenic and angiogenic capacity in adipose tissue, as well as trigger adipose ECM remodeling.

Disclosure

C. Ahn: None. B.J. Ryan: None. J.B. Gillen: None. A. Ludzki: None. M.W. Schleh: None. B.A. Reinheimer: None. J.F. Horowitz: Research Support; Self; American Diabetes Association.

Funding

National Institutes of Health (R01DK077966, P30DK089503, T32DK007245); Canadian Institutes of Health Research (DFS146190)
723-P: A Single Session of Exercise Increases Resident Macrophages in Subcutaneous Adipose Tissue from Healthy Human Subjects
Authors: LUDZKI ALISON , KRUEGER EMILY M. , BALDWIN TOREE C. , TAYLOR NATALIE M. , MUIR LINDSEY A. , LUMENG CAREY , HOROWITZ JEFFREY F.
Published: June 2019

Infiltration of pro-inflammatory adipose tissue macrophages (ATMs) is implicated in systemic low-grade inflammation that underlies metabolic health complications in obesity. Exercise training has been linked to reduced adipose tissue and systemic inflammation, but these observations are often confounded by concomitant weight loss. Many metabolic benefits of exercise are a cumulative effect of each bout of exercise, thus the aim of this study was to determine changes in ATMs (using flow cytometry) in response to a single exercise session. We collected subcutaneous abdominal adipose tissue samples from 10 obese (BMI: 33±3kg/m2; fat mass: 41±20kg) and 14 lean (BMI: 23±13kg/m2; fat mass: 16±5kg) adults, 12 hours after exercising for 60 minutes at 70% VO2max (EX); and again 3 days after their most recent exercise session (No-EX). To characterize the cellular response to exercise without the confounding influence of exercise novelty, all subjects were habitual exercisers. The exercise session did not alter total immune cell number (OBESE: 30±7 vs. 31±7; LEAN: 27±9 vs. 28±8% live cells) or total ATM number (OBESE: 3.9±1.7 vs. 4.0±1.6; LEAN: 3.5±1.5 vs. 4.3±1.9% live cells; for No-EX and EX, respectively). However, there was a main effect for exercise to increase the number of CD11c- ATMs (OBESE: 1.3±1.4 vs. 1.5±1.5; LEAN: 1.0±0.6 vs. 2.0±1.6% live cells; P=0.03), indicating the abundance of resident ATMs increased after exercise. Surprisingly, the response to exercise was not different in lean vs. obese subjects. Although the change in resident ATM content after exercise was rather subtle in this cohort of healthy regular exercisers, these are the first single cell data to suggest each session of exercise may induce a phenotypic shift in subcutaneous ATMs. This could be a mechanism contributing to the anti-inflammatory health benefits of exercise.

Disclosure

A. Ludzki: None. E.M. Krueger: None. T.C. Baldwin: None. N.M. Taylor: None. L.A. Muir: None. C. Lumeng: None. J.F. Horowitz: Research Support; Self; American Diabetes Association.

Funding

National Institutes of Health (R01DK077966) Canadian Institutes of Health Research (DFS146190)
724-P: Timing of Basal Insulin Reduction to Prevent Hypoglycemia during Exercise in Adults and Adolescents with Type 1 Diabetes Using Insulin Pump Therapy: Preliminary Results
Authors: TAGOUGUI SEMAH , TALEB NADINE , HEYMAN ELSA , MESSIER VIRGINIE , SUPPERE CORINNE , BERTHOIN SERGE , RABASA-LHORET RÉMI
Published: June 2019

Background We have shown that the reduction of basal insulin (-80%) 40-min before exercise is insufficient to reduce the time spent on hypoglycemia (Roy-Fleming et al., 2018. Diabetes and Metabolism). These results suggest that earlier basal insulin reductions need to be tested. We compared the efficacy of two timings to decrease basal insulin infusion rate to reduce exercise-induced hypoglycemia in patients with T1D using insulin pump therapy. Furthermore, we explored if decreased muscle vasoreactivity (secondary to decreased insulin levels) is associated with a reduced time spent in hypoglycemia.

Methods: 13 adults and adolescents (10 adults; 5 adolescents; mean A1C: 8,2±1,0%) practiced 60-min exercise sessions (ergocyle) at 60% VO2peak, 240 minutes after a standardized lunch. In randomized order, we compared an 80% reduction of basal insulin applied 40-min (T-40) and 90-min (T-90) before exercise onset. Near-infrared spectroscopy (NIRS) was used to investigate muscle hemodynamic at vastus lateralis. Venous blood samples for glycemia measurement were drawn every 10 min during exercise.

Results: T-90 strategy could reduce hypoglycemia risk during exercise: glycemic drop during exercise tend to be more important during T-40 vs. T-90 strategy (-41.44 ± 57.65 mg/dl vs. -14.05 ± 34.23 mg/dl respectively; p=0.09). This trend is confirmed by the repeated measures ANOVA test, which shows a significant interaction effects (blood glucose level during exercise × strategy “T90 vs. T-40”) (p = 0.01). However, contrary to our hypothesis, the estimation of local muscle perfusion measured by NIRS shows comparable results between 2-strategies.

Conclusion: Our preliminary results in 15 DT1 patients (planned 20) show that decreasing basal insulin infusion rate by 80% up to 90 minutes before exercise onset tend to reduce exercise-induced hypoglycemia. This drop does not seem to be related to a decrease in local muscle perfusion.

Disclosure

S. Tagougui: None. N. Taleb: None. E. Heyman: None. V. Messier: Other Relationship; Self; Eli Lilly and Company. C. Suppere: None. S. Berthoin: None. R. Rabasa-Lhoret: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Merck & Co., Inc., Novo Nordisk A/S, Sanofi. Research Support; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Novo Nordisk A/S.
726-P: Impaired Glucose Tolerance Blunts Exercise-Training Induced Improvements in Aerobic Exercise Capacity
Authors: MACDONALD TARA , PATHAK PRERANA , LESSARD SARAH
Published: June 2019

Background: Low aerobic exercise capacity independently and strongly predicts metabolic disease and mortality. While aerobic exercise training can increase exercise capacity and reduce health risks, people with impaired glucose tolerance (IGT; i.e., prediabetes, T1D and T2D) have lower exercise capacity than glucose-tolerant subjects, even when exercise training “dose” is matched. We tested the hypothesis that low exercise capacity in IGT is caused by blunted exercise training-induced improvements in exercise capacity.

Methods: IGT was induced in CD-1 mice by a) diet-induced insulin resistance (Western Diet, WD; 40% kcal from fat), or b) streptozotocin injection (STZ; 2x 40 mg/kg) to reduce circulating insulin. Control and STZ mice consumed standard chow (10% fat). Eight weeks following treatment, mice were partitioned into sedentary or exercise-trained (voluntary wheel running) groups. Exercise capacity (meters, m) was measured before and after a 3-week training intervention, and the change (Δ) in exercise capacity was calculated. Body composition was measured (DEXA) and tissues were harvested to measure metabolic health outcomes.

Results: Baseline exercise capacity and total running distance were similar among Control, WD and STZ groups. Mice from all treatment groups displayed metabolic benefits from training, including increased muscle GLUT4 and mitochondrial content, and reduced adiposity. In contrast, exercise capacity only improved with training in Control mice (Δ124.82±40.25 m), whereas WD-trained (Δ29.69±24.11 m) and STZ-trained (Δ37.10±25.76 m) animals had no significant increase in exercise capacity. These data demonstrate that IGT can prevent improvements in exercise capacity with exercise training, despite the induction of other beneficial metabolic health outcomes.

Conclusions: Our data identify IGT as a negative regulator of improved exercise capacity with training and a novel mechanism underlying low exercise capacity in diabetes.

Disclosure

T. MacDonald: None. P. Pathak: None. S. Lessard: None.

Funding

American Heart Association (1-19-PDF-168)
731-P: Exercise Training Does Not Alter Resting Fatty Acid Mobilization from Adipose Tissue
Authors: SCHLEH MICHAEL W. , RYAN BENJAMIN J. , GILLEN JENNA B. , VARSHNEY PALLAVI , FOUG KATIE , LUDZKI ALISON , HOROWITZ JEFFREY F.
Published: June 2019

Excessive fatty acid (FA) mobilization from subcutaneous adipose tissue into systemic circulation underlies many metabolic health complications associated with obesity, such as insulin resistance. Exercise is often used to help treat and/or prevent insulin resistance, but the direct effects of exercise training (without weight loss) on systemic FA mobilization are unclear. The aim of this study was to determine the effect of both high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on FA rate of appearance (FA Ra) into systemic circulation and factors regulating FA mobilization from subcutaneous adipose tissue. 18 obese adults (33±3 kg•m-2) were randomized to 12 weeks (4 d/week) of either HIIT (10 x 1 min at 90% HRmax with 1 min recovery; n=8) or MICT (45 min at 70% HRmax; n=10), and were required to maintain bodyweight throughout. Resting FA Ra (13C palmitate dilution) and abdominal subcutaneous adipose tissue samples were collected in the overnight fasted state before and after training (72h following their final exercise session). The abundance of key lipolytic and lipid storage proteins in adipose tissue were measured via immunoblot. Aerobic fitness (VO2peak) increased ∼10% after training (P = 0.002), with no difference between HIIT and MICT. Body weight remained unchanged after training (HIIT: 98±12 vs. 98±13 kg, MICT: 101±12 vs. 100±13), as did fat mass (HIIT: 40±5 vs. 39±5 kg, MICT: 42±8 vs. 41±9). Training did not affect resting FA Ra in either HIIT (16.5±3.2 vs. 15.3±1.8 μmol•kg FM-1•min-1) or MICT (16.5±2.6 vs. 15.8±1.4 μmol•kg FM-1•min-1). In line with this finding, neither HIIT nor MICT altered adipose tissue abundance or phosphorylation-state of the lipolytic enzymes ATGL and HSL, or other factors involved in FA mobilization and storage in adipose tissue (e.g., GPAT, DGAT, CGI-58, G0S2, CD36).

In summary, in the absence of weight loss, 12 weeks HIIT or MICT did not alter the regulation of resting FA mobilization from subcutaneous adipose tissue.

Disclosure

M.W. Schleh: None. B.J. Ryan: None. J.B. Gillen: None. P. Varshney: None. K. Foug: None. A. Ludzki: None. J.F. Horowitz: Research Support; Self; American Diabetes Association.

Funding

National Institutes of Health (R01DK077966, P30DK089503, T32DK007245); Canadian Institutes of Health Research (DFS146190)
735-P: Seasonal Variation in Vascular Function in People with Type 2 Diabetes Who Exercise Regularly
Authors: HONDA HIROTO , IGAKI MAKOTO
Published: June 2019

The purpose of this study was to investigate seasonal variation in vascular function in people with type 2 diabetes (T2D) who exercise regularly. Fourteen Japanese adults with uncomplicated T2D (5 men and 9 women, age: 65.9 ± 0.9 years, HbA1c: 7.1 ± 0.1%, mean ± SE). All patients exercised at our hospital for 5 years (January 2010-December 2014). Moderate intensity aerobic exercise using a treadmill or bicycle ergometer was performed for 40 min/day (frequency: ≥ 2 days/week). Vascular function, including flow-mediated dilation (FMD), cardio-ankle vascular index (CAVI), and ankle-brachial pressure index (ABI) in each season (spring: March-May, summer: June-August, fall: September-November, winter: December-February) were compared. Variation in FMD throughout the year was 1.0%, and the level in winter was significantly worse than in spring and summer (winter vs. spring and summer: 3.5 ± 0.1% vs. 4.4 ± 0.1% and 4.6 ± 0.1%; p < 0.01 and p < 0.01, respectively) (Figure). However, CAVI and ABI showed no significant change throughout the year. These results suggested that FMD rather than CAVI and ABI might show seasonal variation, even in people with T2D who exercise regularly. It is important to consider these characteristics when managing T2D.

Disclosure

H. Honda: None. M. Igaki: None.
739-P: Type 2 Diabetes Is an Independent Predictor of Lowered Peak Aerobic Capacity in Patients with Reduced and Nonreduced Ejection Fraction Heart Failure
Authors: ABE TAKAHIRO , YOKOTA TAKASHI
Published: June 2019

Background: Low aerobic capacity is a strong and independent predictor of all-cause mortality for both diabetic patients and chronic heart failure (CHF) patients. We tested the hypothesis that coexistance of type 2 diabetes lowers peak aerobic capacity in patients with CHF.

Methods: We retrospectively studied 276 CHF patients with or without type 2 diabetes who underwent cardiopulmonary exercise testing (CPET). All CHF patients had a history of hospital admission due to worsening HF with either non-reduced left ventricular ejection fraction (LVEF; ≥40%) or reduced LVEF (<40%).

Results: Peak oxygen uptake (VO2) was significantly decreased in diabetic group compared to nondiabetic group not only in total CHF population (median 13.8 [interquartile range 11.8-16.4] vs. 16.4 [13.2-20.2] mL/kg/min) but also in CHF patients with LVEF ≥40% (14.1 [12.4-16.6] vs. 17.4 [13.9-20.7] mL/kg/min) and in CHF patients with LVEF <40% (13.4 [10.3-16.3] vs. 16.0 [12.5-20.0] mL/kg/min). There was an inverse correlation between peak VO2 and glycosylated hemoglobin in total CHF population (r=-0.16, P=0.017). Multivariate analysis showed that the presence of type 2 diabetes was an independent predictor of the lowered peak VO2 in CHF patients with LVEF ≥40% and <40%, respectively, after adjustment for age, gender, anemia, renal function, LVEF, and B-type natriuretic peptide.

Conclusions: Type 2 diabetes is an independent predictor of the lowered peak VO2 in CHF patients. The presence of type 2 diabetes has a negative impact on peak aerobic capacity in CHF patients with both reduced and non-reduced LVEF.

Disclosure

T. Abe: None. T. Yokota: None.
740-P: Cardiorespiratory Fitness and Heart Failure in Patients with Diabetes
Authors: FASELIS CHARLES , MYERS JONATHAN N. , NARAYAN PUNEET , KARASIK PAMELA , MOORE HANS , AHMED ALI , SHERIFF HELEN M. , NYLEN ERIC , KOKKINOS PETER
Published: June 2019

Introduction: Patients with type 2 diabetes mellitus (T2DM), have significantly higher risk of cardiovascular events, including heart failure (HF). Cardiorespiratory fitness (CRF) has been shown to favorably modify comorbidities of HF and lower the risk of HF. However, the independent effect of CRF on HF incidence in patients with T2DM has not been assessed.

Methods: We identified 6,263 patients (aged 58.1+10.0 years) with T2DM and no HF or evidence of ischemia prior to an exercise treadmill testing (ETT). We established four fitness categories, based on age-stratified quartiles of peak metabolic equivalents (METs) achieved Least-Fit (4.7±1.1 METs; n= 1,547); Low-Fit (6.6±1.2 METs; n=2,104) Moderate-Fit (8.0±1.3 METs; n=1,454) and Fit (10.9±2.3 METs; n=1,160). Cox proportional hazards model was constructed to assess HF incidence risk associated with exercise capacity. The model was adjusted for age, BMI, race, comorbidities, and medications. The Least-Fit category served as the reference group. P-values <0.05 using two sided tests were considered statistically significant for all test.

Results: During a follow-up of 12.9+7.1 years, 1,429 or 21.5% of these patients developed HF accounting for 13.5 events per 1,000 person-years of observation. The CRF-CHF risk association was inverse and graded. Risk decreased by 16% (HR: 0.84; CI: 0.82-0.87; p<0.001) for each 1-MET increase in CRF. When CRF categories were considered, HF risk declined progressively by 38% (HR: 0.62; CI: 0.55-0.71; p<0.001) for those in the Low-Fit; 49% in the Moderate-Fit (HR: 0.51; CI: 0.44-0.59; p<0.001), and 64% (HR: 0.36; CI: 0.30-0.43; p<0.001) for individuals in the Fit category.

Conclusions: High levels of CRF were protective against HF incidence in Veterans with T2DM. The CRF-HF association was graded and independent of other risk factors.

Disclosure

C. Faselis: None. J.N. Myers: None. P. Narayan: Research Support; Self; AstraZeneca, Eli Lilly and Company. P. Karasik: None. H. Moore: None. A. Ahmed: None. H.M. Sheriff: None. E. Nylen: None. P. Kokkinos: None.
755-P: A Plant-Based Meal Stimulates Incretin and Insulin Secretion More than an Energy- and Macronutrient-Matched Standard Meal in Type 2 Diabetes: A Randomized Crossover Study
Authors: KAHLEOVA HANA , TURA ANDREA , KLEMENTOVA MARTA , BELINOVA LENKA , HALUZIK MARTIN , PAVLOVICOVA RENATA , HILL MARTIN , PELIKANOVA TEREZIE
Published: June 2019

Objective: We tested the effects of two energy- and macronutrient-matched meals: a standard meat (M-meal) and a vegan (V-meal) on postprandial incretin and insulin secretion in participants with type 2 diabetes (T2D).

Research Design and Methods: A randomized crossover design was used in 20 participants with T2D. Plasma concentrations of glucose, insulin, C-peptide, glucagon-like peptide -1 (GLP-1), amylin, and gastric inhibitory peptide (GIP) were determined at 0, 30, 60, 120 and 180 minutes. Beta-cell function was assessed with a mathematical model, using C-peptide deconvolution. Repeated-measures ANOVA was used for statistical analysis.

Results: Postprandial plasma glucose responses were similar after both test meals (p=0.64). An increase in the stimulated secretion of insulin (by 30.5%; 95% CI 21.2 to 40.7%; p<0.001), C-peptide (by 7.1%; 95% CI 4.1 to 9.9%; p<0.001), and amylin (by 15.7%; 95% CI 11.8 to 19.7%; p<0.001) was observed following consumption of the V-meal. An increase in stimulated secretion of GLP-1 (by 19.2%; 95% CI 12.4 to 26.7%; p<0.001) and a decrease in GIP (by -9.4%; 95% CI -17.3 to -0.7%; p=0.02) were observed after the V-meal. Several parameters of beta-cell function increased after the V-meal, particularly insulin secretion at a fixed glucose value 5 mmol/L, rate sensitivity, and the potentiation factor.

Conclusions: Our results indicate an increase in postprandial incretin and insulin secretion, following consumption of a single vegan meal, suggesting a therapeutic potential of plant-based meals for improving beta-cell function in T2D.

Disclosure

H. Kahleova: None. A. Tura: None. M. Klementova: None. L. Belinova: None. M. Haluzik: None. R. Pavlovicova: None. M. Hill: None. T. Pelikanova: None.

Funding

Ministry of Health of the Czech Republic (AZV15-27338A); Institute for Clinical and Experimental Medicine (MZCR00023001)
762-P: Association of Sleep Duration with Metabolic, Anthropometric, and Lifestyle Factors in Type 2 Diabetes: Analysis of Components of the U-shaped Relationship
Authors: NAKAYAMA HITOMI , YAMADA YASUSHI , YAMADA KENTARO , IWATA SHIMPEI , WADA NOBUHIKO , TAJIRI YUJI , NOMURA MASATOSHI
Published: June 2019

Although accumulating evidence has shown that there is a U-shaped association between sleep duration and the risk of metabolic disorders related to obesity, its underlying mechanism is still not fully understood. In this study, we analyzed the association of sleep duration with metabolic, anthropometric, and lifestyle factors in patients with type 2 diabetes. Subjects were 280 patients with type 2 diabetes aged 60±14 years with BMI 25.9±5.1kg/m2, and A1C 9.0±1.8%. Patients with advanced complications were excluded from the study. Diets were evaluated by registered dietitians using software. Body composition was assessed by the multi-frequency bioelectrical impedance method. Habitual physical activity included all of leisure-time, occupational, and household ones. Self-reported nightly sleep duration was 6.4±1.4 h with no gender difference. Sleep duration was inversely correlated with A1C levels, total energy intake, and the intake of three major nutrients. Body fat ratio and skeletal muscle mass, but not body weight or BMI, were correlated positively and negatively, respectively, with sleep duration, even after the adjustment for age. When subjects were divided into three groups based on sleep duration, the intake of fat and carbs was highest in short sleepers (<5.5 h). The percentage of patients who had habitual physical activity was lower in long sleepers (>7 h) than in moderate or short sleepers (25.4%, 31.3%, and 44.0%, respectively). Thus, short sleepers ingested more energy, but %body fat was lower than other groups. This apparent paradox can be explained by the high ratio of habitual physical activity in short sleepers. Long sleep duration is likely a marker of low physical capacity in diabetic subjects. Hence, the U-shaped association may be attributable, at least in part, to excessive eating in short sleepers and a sedentary lifestyle in long sleepers.

Disclosure

H. Nakayama: None. Y. Yamada: None. K. Yamada: None. S. Iwata: None. N. Wada: None. Y. Tajiri: None. M. Nomura: None.
771-P: Protein Intake at Breakfast Contributes to Maintenance of Skeletal Muscle Mass in Japanese Elderly Patients with Type 2 Diabetes
Authors: KUBOTA SODAI , KUWATA HITOSHI , OKAMOTO SAKI , YABE DAISUKE , MUROTANI KENTA , HAMAMOTO YOSHIYUKI , SEINO YUTAKA
Published: June 2019

Aim: The objective of this study is to investigate the relationship between meal habits and skeletal muscle mass (SMM) in elderly Japanese type 2 diabetes (T2D) patients.

Subjects and Methods: This is a retrospective study of the medical records of 68 elderly(≧65 years old) T2D patients who were admitted to hospital for diabetes conditions and received dietary instructions from January 2014 to September 2017. Upon release, we ascertained nutrition intake by self-administered 3-day food records calculated by Healthy Maker Pro 501. Baseline and post-12 month body composition was measured by BIA device (Inbody S10 or S20).

Result: The 68 patients were divided into 2 groups by variation of SMM after 12 months: Group A (n=45; ΔSMM <0kg) and group B (n=23; ΔSMM≧0kg). There were no differences in age, baseline body weight, or T2D duration between the groups; baseline HbA1c and insulin use (%) were significantly higher in Group B (Table 1). Regarding meal habits, protein intake for breakfast and fat intake for lunch were significantly higher in Group B, suggesting an association with maintaining SMM (Table 2). Logistic regression analysis indicated that the variation of SMM was associated with protein intake for breakfast (OR 1.99 (95% CI; 1.21-1.90) (per 0.1g/kgBW)).

Conclusion: Protein intake for breakfast could be the key to maintain SMM in Japanese elderly T2D.

Disclosure

S. Kubota: None. H. Kuwata: Research Support; Self; Eli Lilly and Company. S. Okamoto: None. D. Yabe: Advisory Panel; Self; Abbott. Research Support; Self; Astellas Pharma Inc. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi K.K., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. K. Murotani: None. Y. Hamamoto: Speaker's Bureau; Self; Novo Nordisk A/S. Y. Seino: Research Support; Self; Arkray, Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Terumo Medical Corporation.
775-P: Significant Association of Food Group Intake with Obesity among Patients with Type 2 Diabetes Mellitus in Japan
Authors: HATTA MARIKO , FUJIHARA KAZUYA , TAKEDA YASUNAGA , NEDACHI RINA , ISHII DAI , MORIKAWA SAKIKO Y. , HORIKAWA CHIKA , KATO MITSUTOSHI , MAEGAWA HIROSHI , SONE HIROHITO ,   JDDM STUDY GROUP
Published: June 2019

Although obesity is closely associated with development and progression of type 2 diabetes mellitus (T2DM) and its complications, food group intake associated with obesity in diabetic patients has been very poorly investigated to date largely due to lack of large-scale databases with details on dietary intake. Thus, we aimed to determine intake of food groups by utilizing our nationwide database for people with diabetes with adjustment for confounders including energy intake. Analyzed were 1891 Japanese patients with T2DM (mean age, 62 y; men, 62%) who completed the Food Frequency Questionnaire. Obesity was defined by BMI>25. The associations between obesity and food groups were determined by multivariate quartile analysis. Among 15 food groups, both green and yellow and light-colored vegetables had significant negative associations with the presence of obesity among both men and women (Table). In addition, fruit and beans in men and fish in women were also negatively associated with obesity. Conversely, confectionery had positive associations with obesity in both men and women. Other food groups such as rice, meat or eggs did not show significant trends toward the presence of obesity. These results identified favorable dietary patterns for people with T2DM, which could be used for effective nutritional education to prevent obesity.

Disclosure

M. Hatta: None. K. Fujihara: None. Y. Takeda: None. R. Nedachi: None. D. Ishii: None. S.Y. Morikawa: None. C. Horikawa: None. M. Kato: None. H. Maegawa: Research Support; Self; Antares Pharma, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.
776-P: Low AMY1 Copy Number Variations Are Associated with Cardiometabolic Risk Factors in Overweight or Obese Adults
Authors: MARQUINA CLARA , MOUSA AYA , NADERPOOR NEGAR , BARBORA DE COURTEN
Published: June 2019

Background: Low serum amylase has been implicated in the pathogenesis of obesity and insulin resistance. Copy number variations (CNVs) in the salivary amylase gene (AMY1) correlate with serum amylase, and CNVs <4 have been associated with a higher risk of obesity and insulin resistance. However, the relationship between AMY1 and cardiometabolic risk has not been fully elucidated.

Objective: To examine whether AMY1 CNVs are associated with cardiometabolic risk factors.

Methods: In overweight or obese (BMI >25kg/m2), otherwise healthy adults, we measured AMY1 copy numbers (qPCR); serum amylase (commercial assay); anthropometry (BMI; body composition by dual-energy X-ray absorptiometry); cardiovascular parameters (blood pressure, plasma lipids by ELISA); fasting and 2-h glucose levels post-75g oral glucose tolerance test (glucose oxidase method), insulin sensitivity (hyperinsulinemic-euglycemic clamp), insulin secretion (intravenous glucose tolerance test), and serum inflammation markers (LEGENDplex™, Biolegend).

Results: Fifty-nine adults (58% males) aged 31.27 ± 8.61 were included in the study. Based on previous studies and median values, participants were divided into low CNV and high CNV carrier groups for individuals with ≤4 and >4 AMY1 CNVs, respectively. Low AMY1 CNV carriers (n=29) had a higher BMI (32.65 ± 5.37 vs. 30.28 ± 3.51 kg/m2, p = 0.04), % fat mass (40.76 ± 12.22 vs. 33.13 ± 8.60%, p = 0.008), and LDL-c (3.25 ± 0.80 vs. 2.87 ± 0.63 mmol/L, p = 0.04) compared with the high AMY1 CNV group (n=30), as well as higher levels of interleukins [IL]-6, -1β, -10, and tumor necrosis factor-alpha (all p<0.05). Results remained significant after adjustment for age and sex. There were no differences between AMY1 CNV groups in glycaemic outcomes including insulin sensitivity or secretion as well as fasting and 2-hour glucose post-OGTT (p>0.1).

Conclusions: Our results suggest that low AMY1 CNVs are associated with increased obesity, cardiovascular risk, and inflammation.

Disclosure

C. Marquina: None. A. Mousa: None. N. Naderpoor: None. B. de Courten: None.