bluuebunny/crossref_metadata_2025 huggingface dataset:
Diabetogenic Potential of Dexamethasone and Effect of Annona Muricata Methanolic Bark Extract as Post-exposure Therapy in Albino Rats
Authors: OLADIPO TUNBOSUN A. , ADEOYE YEMISI D. , OLADIPO OLUWAMAYOWA O. , OLUKUNLE JOHNNY O.
Published: June 2018

Background: Diabetes mellitus has been identified as the leading cause of death from non-infectious diseases. The use of dexamethasone is on the increase due to wide array of its therapeutic effects. Therefore, the potential of dexamethasone to induce DM and ability of Annona muricata methanolic bark extract (AMMBE) to treat DM were studied.

Methods: The research was carried in Federal College of Animal Health and Production Technology, Ibadan and lasted for twenty eight (28) days. Rats were allotted into four groups. Group B, C and D were induced with Dexamethasone (2mgkg-1) daily for 7 days i.p, while A was positive control group. B was induced without AMMBE administered, C was induced and treated with AMMBE at 400mgkg-1 and D induced and treated with glibenclamide (2.5mgkg-1b/w) for 14 days. Liver, kidney and pancreas were collected for histopathology.

Results: Dexamethasone induced diabetes after 7 days. Average blood sugar in induced groups (B, C and D) were 132.0±4.05a,129.0±1.41aand130.0±2.93a respectively. After administration of AMMBE, average blood sugar for C and D were 91.0±1.72b and 87.0±2.97c respectively. Clinical signs of alopecia, dehydration, paw-licking etc was seen. Massive loss of pancreatic cell mass after induction was seen. Liver lesions ranges from no visible lesion, accentuation and marked vacuolar degeneration of hepatocytes in periportal areas. Kidney degeneration and multifocal coagulation necrosis of tubular epithelium were observed. Blood sugar post exposure to AMMBE and Glibenclamide were drastically reduced.

Conclusions: It could be concluded that prolonged use of dexamethasone has potential of inducing diabetes and AMMBE has antidiabetic effect which could be fully explored.

Disclosure

T.A. Oladipo: None. Y.D. Adeoye: None. O.O. Oladipo: None. J.O. Olukunle: None.
Managing Diabetic Patients with Hypertension Comorbidity by Retail Pharmacists Using a Digital Solution in China
Authors: WANG WEI , LI YINGJIE , WANG ZHEN , LI DONGXING , ZHANG HONGGUANG , LIU KAI , CAO JIUMEI
Published: June 2018

Objective: To identify the effects of implementing a digital approach at pharmacies to manage the healthcare outcomes of comorbidities of diabetes and hypertension.

Methods: A digital solution that includes a set of blood glucose (BG) and blood pressure (BP) tele-monitors, an App, and a cloud engine with decision support algorithms was implemented in 941 drug stores in 91 cities in China. During Jun 8th 2015 to Dec 26th 2017, a total of 3,468 patients of both uncontrolled BG and BP were recruited to receive the monthly in-store healthcare services of: 1) BG and BP testing with the results synchronized to the cloud, 2) App-assisted lifestyle modification for meal planning, coaching and exercise, and 3) App-guided medication consultation.

Results: The study population had an average age of 65.3 ± 10.1, BMI of 24.6 ± 3.3, and male of 47.2%. Their fasting blood glucose (FBG) and random blood glucose (RBG) were reduced by 0.8 mM (baseline: 9.1 ± 2.2 mM, last time: 8.3 ± 2.3 mM, P<0.001) and 3.1 mM (baseline: 14.4 ± 3.2 mM, last time: 11.3 ± 4.0 mM, P<0.001), respectively. Systolic and diastolic BPs were reduced by 9.1 mm Hg (baseline: 154.3 ± 14.7 mm Hg, last time: 145.2 ± 18.7 mm Hg, P< 0.001) and 4.4 mm Hg (baseline: 86.5 ± 11.1 mm Hg, last time: 82.1 ± 11.8 mm Hg, P<0.001), respectively. The proportion of controlled diabetic and hypertensive patients was 30.0% (n=1,040, P<0.001) and 36.1% (n=1,251, P<0.001) by the time of this analysis. Patients were satisfied with the intervention due to the convenient access to the digital database and the services available. The health outcomes were not associated with geographic differences or economic status of the site.

Conclusion: Mobilizing community pharmacists with new digital technologies presents an effective approach to provide patient-centered care for diabetic patients with comorbidities such as hypertension.

Disclosure

W. Wang: None. Y. Li: None. Z. Wang: None. D. Li: None. H. Zhang: None. K. Liu: None. J. Cao: None.
Comparison of Adult and Pediatric Resources for Type 1 Diabetes Care among T1D Exchange Centers
Authors: AGARWAL SHIVANI , HIRSCHFELD EMILY , GARRITY ASHLEY , SHAH AVNI , CORATHERS SARAH , WEINSTOCK RUTH S. , LAMBERT KATHRYN L. , BOBIK CRAIG , CABRERA ALYSSA B. , RIOLES NICOLE , LEE JOYCE
Published: June 2018

Background: The American Diabetes Association recommends that patients with type 1 diabetes (T1D) receive care from a multidisciplinary team. We are unaware of studies that have compared staffing resources in pediatric and adult diabetes centers across the United States (U.S.).

Methods: In 2015, we performed an environmental scan of staffing resources for centers in the T1D Exchange. Total number of T1D patients and staff full-time equivalent (FTE) for T1D patients were enumerated. Mean staff FTE-patient ratios were calculated and compared within and between pediatric and adult clinics.

Results: We collected data on 57 diabetes clinics (38 pediatric, 19 adult) of 77 centers, which collectively cared for 45,873 pediatric and 34,287 adult T1D patients. Staffing ratios did not vary significantly within pediatric or adult clinics. However, upon comparison, adult clinics had approximately half as many staff resources as pediatric clinics, despite having similar volumes of patients (Table 1). Psychologists and social workers were available at 42% of adult vs. 87% of pediatric clinics (p<0.001).

Conclusions: Among specialized T1D centers in the U.S., there are stark disparities in staffing in adult vs. pediatric clinics. The relationship of these resources to outcomes is unknown. Benchmarking may be needed to optimize T1D care for pediatric and adult populations with T1D.Table 1. T1D staff FTE to patient ratios of pediatric vs. adult diabetes clinics in the T1D ExchangeStaffPediatricAdultp-valuesMean RatioSDMean RatioSDPhysician1:1711:931:2181:1160.63Nurse Practitioner1:3471:931:6471:192<0.001Certified Diabetes Educator1:581:191:1611:57<0.001Registered Dietician1:3791:1771:7971:133<0.001

Disclosure

S. Agarwal: None. E. Hirschfeld: None. A. Garrity: None. A. Shah: None. S. Corathers: None. R.S. Weinstock: Research Support; Self; Medtronic MiniMed, Inc., Mylan, Kowa Pharmaceuticals America, Inc., Diasome Pharmaceuticals, Inc., Calibra Medical, Dexcom, Inc., Ultradian Diagnostics LLC., JAEB Center For Health Research, JDRF, National Institute of Diabetes and Digestive and Kidney Diseases. K.L. Lambert: None. C. Bobik: None. A.B. Cabrera: None. N. Rioles: None. J. Lee: Consultant; Self; Unitio.
Probabilistic Prognosis of Different Treatment for the Diabetic Kidney Disease Course in Overweight and Obese T2DM Patients with Microalbuminuria
Authors: VELICKIENE DZILDA , MALECKAS ALMANTAS , IESMANTAS TOMAS , ALZBUTAS ROBERTAS
Published: June 2018

Introduction: Diabetic kidney disease (DKD) is one of the most enabling microvascular complications. Comparison of different treatment is problematic, as there are no clinical trials comparing different managements and patients’ characteristics vary between the studies.

Aim: to create probabilistic model, which allows predict DKD course according to the different treatment.

Methods: A systematic literature review was performed, which allowed to estimate transition probabilities between the states of DKD - normoalbuminuria (NA), microalbuminuria (MA), diabetic nephropathy (NP), end stage renal disease. Due to the high complexity of dependence between transition rates and probabilities, Markov Chain Monte Carlo scheme was applied.

Results: Of 1,812 articles identified after initial search, 95 publications had relevant data to estimate transition probabilities between DKD states. The lowest transition probabilities from MA to NP and the highest probability of remission from MA to NA was found in surgery group, followed by ACEI and ARB medications group (Fig.1).

Conclusions: according to the model data bariatric surgery presents the highest probability of regression to NA state and the lowest probability of progression to NP state among the overweight and obese patients with type 2 diabetes mellitus and MA.

Disclosure

D. Velickiene: None. A. Maleckas: None. T. Iesmantas: None. R. Alzbutas: None.
Implementation Strategy for a Digital Health Tool Influences User Engagement
Authors: SHOMALI MANSUR , PEEPLES MALINDA
Published: June 2018

Background and Aims: Digital health tools not only should be effective in clinical trials, but should be implemented into the healthcare ecosystem without adding undue burden for patient and the care team. We hypothesized that different modes of implementation may be associated with differences in engagement.

Method: In the first model, users received a prescription for a FDA-cleared digital tool from their healthcare providers. In the second model, certified diabetes educators provided the digital tool to their patients. In the third model, the digital tool was distributed via a direct-to-patient email from a large, national health plan for Medicare enrollees. The user data was collected electronically and de-identified according to data policies.

Results: 3,141 users were identified as part of the provider prescription model. Of note, 30.7% of users did not enter their diabetes medications into the system. 136 users were identified in the educator-driven model. Again, a significant minority (25.3%) did not enter their diabetes medications. In the health plan model, of the 11,000 enrollees who were invited to participate by email, 161 individuals activated accounts. Interestingly 67% of these users engaged with the digital tool via the web, not on mobile devices.

Conclusions: In the provider prescription and the educator models, individuals were provided the digital tool during a face-to-face visits. Though overall engagement with the system was good, a significant minority of users still did not enter their medications into the system. In the health plan driven model, only a small proportion of recipients of the emails activated their accounts. Surprisingly, those users were more likely to use the web portal vs. the mobile app. These insights can be used to guide the effective integration of digital tools into clinical practice.

Disclosure

M. Shomali: Consultant; Self; WellDoc, Inc. M. Peeples: Employee; Self; WellDoc, Inc..
Development of a Clinical Screening Tool for Undiagnosed Diabetes in a Hospital Observation Unit
Authors: NOONAN REBECCA M. , CASTILLO WILFRIDO J. , SAFFRAN GABRIEL M. , MONTGOMERY COLLIN B. , PHAYAL GANESH , SEEMANGAL RONALD H. , KOHN NINA , TIBERIO ALLISON , WOLFF ELISSA , SCHULMAN RIFKA , SILVERMAN ROBERT
Published: June 2018

Background: While diabetes mellitus (DM) is typically diagnosed in the outpatient setting, 30% of patients in the U.S.A remain undiagnosed, prompting novel approaches to screening. There are 2 million Observation Unit (OU) stays annually in the U.S.A. The OU allows prolonged care for Emergency Department (ED) patients who are not sick enough to be hospitalized. A previous study found 9% of OU patients have undiagnosed DM and therefore our OU practice is to obtain HbA1c on patients without a history of DM. A typical OU stay is 24 hours, allowing adequate time for screening, education and initiation of treatment if warranted. To conserve resources, we developed a screening tool to allow selective HbA1c testing in the OU.

Methods: We reviewed OU admissions at a tertiary hospital and included patients with no known history of DM and who had HbA1c assessed during their OU stay. Those with HbA1c ≥ 6.5 were categorized as newly diagnosed DM. Previously validated clinical variables were tested in the model; also included were clinical variables readily available in the OU. A model was developed on 2/3 of the cohort and validated on the remaining 1/3.

Results: A total of 2425 patients met inclusion criteria. The final model included: BMI, race, family history of DM, age, serum sodium and potassium, glucose on ED arrival and initial systolic blood pressure. Predictive assessment of the model was strong with a C-statistic of 0.823. The model was validated and findings remained strong with a C-statistic of 0.788. Performance at the optimal cut-point yielded a sensitivity of 0.750 and specificity of 0.771.

Conclusions: This screening tool identifies 75% of previously undiagnosed DM patients, while excluding 77% of nondiabetic patients from testing. The model can be used at the bedside or embedded in the electronic medical record to selectively screen for DM. There is potential to identify large numbers of previously undiagnosed DM in the OU and the typical 24-hour stay allows time for education and treatment to be initiated.

Disclosure

R.M. Noonan: None. W.J. Castillo: None. G.M. Saffran: None. C.B. Montgomery: None. G. Phayal: None. R.H. Seemangal: None. N. Kohn: None. A. Tiberio: None. E. Wolff: None. R. Schulman: None. R. Silverman: None.
Complement and Cardiometabolic Risk in Adolescents
Authors: HOFFMAN ROBERT P. , COPENHAVER MELANIE M. , YU CHACK-YUNG
Published: June 2018

Background: Adipocytes produce complement C3 and respond to activation products of the complement cascade. Increased complement levels in adults predict future cardiometabolic disease such as type 2 diabetes and myocardial infarction. Since these diseases have their origins in childhood we studied the relationships of complement components, C3 and C4, to cardiometabolic risk factors in healthy, nonHispanic white adolescents.

Methods: C3 and C4 levels, endothelial function (reactive hyperemia (RH), venous occlusion plethysmography), arterial stiffness (augmentation index (AI), arterial tonometry), lipids, interleukin-6 (IL-6), c-reactive protein, plasminogen activator inhibitor 1 (PAI1) insulin sensitivity and secretion (oral glucose tolerance test) were measured in 59 subjects (29 female, age=15.3±1.7 years, BMI=22.4.1±5.9 kg/m2, mean±SD). BMI percentile, waist circumference and percent body fat (air displacement) were measured to assess adiposity.

Results: C3 correlated with multiple cardiometabolic risk factors including reactive hyperemia (r=0.41, p=0.002), LDL (r=0.34 p=0.012), triglycerides (r=0.56, p<0.001), PAI1 (r=0.30, p=0.023) insulin sensitivity (r=-0.31, p=0.024). C3 tended to correlated with AIX (r=0.25, p=0.074) and insulin secretion (r=0.24, p=0.079). C4 levels correlated with RH (r=0.28, p=0.043), AI (r=0.26, p=0.074) and IL-6 (r=0.41, p=0.003). Stepwise regression found that C3 levels predicted LDL independent of measures of adiposity and triglycerides in conjunction with waist circumference while C4 levels in conjunction with BMI%tile predicted AI, and IL-6 in conjunction with waist circumference. Adiposity measures alone predicted RH, HDL, PAI1 and insulin secretion and sensitivity.

Conclusions: These results indicate that obesity induced increases in C3 are likely to play a significant role in the development of adverse lipids with increased plasma triglyceride and LDL levels while C4 plays a role in the development of increased arterial stiffness and inflammation.

Disclosure

R.P. Hoffman: None. M.M. Copenhaver: None. C. Yu: None.
Effectiveness and Applicability of Self-Management Peer Coaching in the Continuity of Diabetes Care
Authors: MCGOWAN PATRICK
Published: June 2018

The goal of this 2-year research project was to investigate the feasibility and effectiveness of telephone peer coaching for persons with type 2 diabetes. It involved a partnership between a university and 11 diabetes centers. One hundred nine persons with type 2 diabetes or who were familiar with type 2 diabetes (e.g., family members) were trained as coaches and learned how to use self-management behavioral change strategies and to navigate the healthcare system. Diabetes educators recruited 115 adults with type 2 diabetes who were experiencing difficulty managing.

Coaches and subjects were paired, and over a 6-month period, coaches telephoned subjects once each week and engaged in a 30 minute conversation focusing on managing their condition, their medications and on their family and work life. Both coaches and subjects completed questionnaires at baseline, and at 6 and 12 months. A one-way repeated-measures analysis of variance was used to investigate change with 14 measures. To investigate the peer coaching process, a grounded theory qualitative analysis was conducted to obtain information on the coaching process.

The analysis showed statistically significant improvements between baseline and 12 months, namely: A1c (-9%), patient activation (+15%), depression (-24%), self-efficacy (+23%), communication with health care professionals (+23%), and diabetes empowerment (+10%). Further analysis found that these results were not influenced by covariates of age, gender, number of chronic health conditions and education level. The main themes found in the qualitative study which contributed to participant improvements were: learning self-management skills, personal accountability, encouragement, finding resources, and the boundary between the coach and participant.

This pilot “pragmatic” study demonstrated that peer coaches are acceptable to clinicians and clients and have an important role in the continuity of care for persons experiencing diabetes.

Disclosure

P. McGowan: None.
Effect of Liraglutide, Metformin, and Gliclazide on Body Composition in Type 2 Diabetic Patients with Nonalcoholic Fatty Liver Disease—A Randomised Trial
Authors: FENG WENHUAN , BI YAN , LI PING , YIN TINGTING , GAO CAIXIA , SHEN SHANMEI , GAO LIJUN , JIANG CAN , ZHU DALONG
Published: June 2018

Objective: To compare the effects of gliclazide, liraglutide, and metformin on body composition in type 2 diabetes mellitus (T2DM) patients with nonalcoholic fatty liver disease (NAFLD).

Methods: Eighty-five subjects were randomly allocated and received gliclazide (n=27), liraglutide (n=29), or metformin (n=29) monotherapy for 24 weeks. Body composition was measured using dual-energy x-ray absorptiometry.

Results: Liraglutide and metformin reduced weight and total, trunk, limb, android, and gynoid fat mass. However, no significant changes in weight or fat mass occurred with gliclazide. In the liraglutide and metformin arms, weight loss was mainly due to reductions in total, trunk, limb, android, and gynoid fat mass. The stable weight obtained with gliclazide resulted from identical reductions in fat mass and increases in lean tissue mass. Blood glucose concentrations and glycated haemoglobin A1c (HbA1c) levels improved in all treatment arms, but lower HbA1c levels were found with liraglutide and metformin. Serum alanine aminotransferase (ALT) concentrations decreased in all treatment arms, whereas serum aspartate aminotransferase (AST) concentrations reduced with liraglutide and metformin only. For all subjects, weight loss and total, trunk, limb, and android fat mass reductions were positively correlated with reductions in serum ALT and AST concentrations, and reductions in waist circumference were positively correlated with reductions in serum ALT concentrations.

Conclusions: As compared with gliclazide monotherapy, liraglutide and metformin monotherapies resulted in greater weight loss, reductions in body fat mass, and improvements in liver function and blood glucose control among patients with T2DM and NAFLD.

Disclosure

W. Feng: None. Y. Bi: None. P. Li: None. T. Yin: None. C. Gao: None. S. Shen: None. L. Gao: None. C. Jiang: None. D. Zhu: None.
Longitudinal Predictors of Insulin Sensitivity and Secretion during Puberty
Authors: KELSEY MEGAN M. , PYLE LAURA , HILKIN ALLISON M. , JOHNSON AIMEE , NADEAU KRISTEN J. , ZEITLER PHIL
Published: June 2018

All youth experience a transient reduction in Si during puberty, but little is known about the associated physiology. We previously demonstrated cross-sectionally that insulin-like growth factor 1 (IGF-1) and leptin are associated with Si early in puberty. We now aim to evaluate longitudinal predictors of Si and acute insulin response to glucose (AIRg) during puberty.

Methods: Forty-five (47% female) normal-weight (mean BMI %ile 44±22%) ethnically mixed youth entered the study in early puberty (Tanner [T] 2-3). Study visits, including an IV glucose tolerance test (IVGTT), fasting laboratory studies, and DXA, were performed at T2-3, T4, and T5, based on breast development and testicular volume. Physical activity (PA) was assessed by the 3DPAR (3-Day PA Recall). Repeated measures models were used to test if changes over time in potential predictors (IGF-1, leptin, estradiol, total testosterone, dehydroepiandrosterone-sulfate, PA, and urinary gonadotropins) were associated with changes over time in the outcomes, with and without adjustment for sex and % body fat.

Results: Si (p=0.04) decreased and AIRg increased (p=0.12) from T2/3-T5. IGF-1 and leptin were the only significant predictors of change in Si and AIRg over time. IGF-1 was associated with both Si (β=-0.016, p=0.0004) and AIRg (β=1.40, p=0.002), and remained so after adjusting for sex and % fat (p=0.0007 and 0.004, respectively). Leptin was associated with Si in univariate analysis (p=0.003) and with both Si (β=-0.238, p=0.003) and AIRg (β=38.4, p=0.043) after adjustment for sex and % fat.

Conclusions: This is the first study to show a longitudinal relationship between leptin and Si and AIRg during puberty independent of sex and body fat, and confirms previous reports of associations between IGF-1 and Si and AIRg. These results suggest that leptin and IGF-1 may be driving factors for changes in Si and AIRg during puberty. Knowledge of normal pubertal metabolism may contribute to understanding of diseases of pubertal onset, such as type 2 diabetes.

Disclosure

M.M. Kelsey: Other Relationship; Self; Daiichi Sankyo Company, Limited, Merck Sharp & Dohme Corp.. L. Pyle: None. A.M. Hilkin: None. A. Johnson: None. K.J. Nadeau: None. P. Zeitler: Consultant; Self; Daiichi Sankyo Company, Limited, Merck & Co., Inc., Eli Lilly and Company, Takeda Development Center Americas, Inc., Boehringer Ingelheim GmbH.
Increased Glucagon, but Reduced GIP Secretion, in Adolescents with Obesity and T2DM
Authors: KRISTINSSON HJALTI , MANELL HANNES , VILHELMSSON MONICA , PRESTO JENNY , GÄREDAL CAROLINA , RITZÉN HANNA , FORSLUND ANDERS H. , BERGSTEN PETER
Published: June 2018

We have previously reported that insulin and glucagon levels at fasting and during OGTT are increased in obese adolescents as glucose intolerance develops. In adults incretin hormone GIP has been coupled with enhanced glucagon secretion. We hypothesized that the observed elevated glucagon levels in obese adolescents were associated with increased levels of GIP. Total GIP in plasma samples from obese (NGT=7, IGT=9, T2DM=4) and lean (n=8) adolescents was measured at fasting and during OGTT with a newly developed ELISA (Mercodia AB, Uppsala, Sweden). Newly secreted GIP and glucagon were defined as GIP and glucagon area under curve AUC during the first 30 min, AUC30. Ethical approval was obtained from the Uppsala Ethical Review Board. Fasting GIP levels ± SEM were 4.7 ± 2.8, 3.6 ± 2.0, 2.9 ± 1.7 and 2.2 ± 0.9 pM in lean, obese NGT, obese IGT and obese T2DM adolescents, respectively. During OGTT GIP concentrations peaked at 30 min for all groups (Figure). Highest concentrations were observed throughput the OGTT in lean, followed by obese NGT, obese IGT and obese T2DM adolescents. GIP AUC30 ± SEM was 1181 ± 197, 920 ± 22, 707 ± 146 and 699 ± 211 pmol/L *min in lean, obese NGT, obese IGT and obese T2DM, respectively. For the same groups glucagon AUC30 ± SEM was -73 ± 21, -39 ± 43, -3 ± 30 and 91 ± 80 pmol/L *min. Hyperglucagonemia in adolescents developing T2DM does not seem to be driven by enhanced GIP secretion.

Disclosure

H. Kristinsson: None. H. Manell: None. M. Vilhelmsson: Employee; Self; Mercodia AB. J. Presto: Employee; Self; Mercodia AB. C. Gäredal: None. H. Ritzén: None. A.H. Forslund: None. P. Bergsten: None.
Perceptions of Physical Activity in American-Indian Youth at Risk for Diabetes
Authors: KIMBLEY HEATHER , CHADWICK JENNIFER , COLEMAN CHARLOTTE L. , TULLIER MARY A. , WOLBERT LISA D. , COPELAND KENNETH C. , SHORT KEVIN R.
Published: June 2018

American Indians (AI) have high prevalence of diabetes, which might be reduced through targeted lifestyle changes. We conducted an exercise program for AI adolescents at risk for diabetes. We tested whether the participants’ perceptions of physical activity were related to their physical characteristics or exercise participation. Overweight (OW) AI youth (n = 75), 11-20 years old, with low physical activity, were instructed to exercise 3d/week for 16 weeks at tribal centers. Another 39 normal weight (NW) peers from the same communities served as a reference group but did not enter the exercise program. Perceived comfort and enjoyment of physical activity was measured on a 15-item, 5-point scale. Clinical tests included body composition, aerobic fitness (VO2pk), and physical activity (daily steps). Mean perception score was higher (more positive outlook) for NW than OW/Ob (4.1 ± 0.5 vs. 3.5 ± 0.6, p < 0.001) and for boys than girls (3.9 ± 0.5 vs. 3.5 ± 0.6, p < 0.02). Perception was negatively correlated with body mass index (r = -0.52), percent body fat and total fat free mass (r = -0.54 and -0.23, respectively), and positively correlated with VO2pk and daily steps (r = 0.53 and 0.38). OW participants completed 27 ± 15 exercise sessions, lasting 34 ± 7 minutes per session. Participants who completed at least 24 sessions had higher perception scores than those with less than 24 sessions (3.6 ± 0.6 vs. 3.3 ± 0.6, p=0.04). More OW participants reported perceived limitations to exercise (64%) and life stressors (85%) than the NW group (51% and 74%, respectively), but these barriers did not explain variance in exercise compliance. In AI adolescents, perception of physical activity varies with body weight, physical activity, and aerobic fitness, and may contribute to rates of participation in a wellness-center based exercise program. Thus, physical activity programs to reduce diabetes risk in this population must be tailored to address additional barriers related to one’s perceptions in order to to optimize participation.

Disclosure

H. Kimbley: None. J. Chadwick: None. C.L. Coleman: None. M.A. Tullier: None. L.D. Wolbert: None. K.C. Copeland: Other Relationship; Self; Novo Nordisk Inc.. K.R. Short: None.
Complement C3 and C4 Genetics and Cardiometabolic Risk in Adolescents
Authors: HOFFMAN ROBERT P. , COPENHAVER MELANIE M. , YU CHACK-YUNG
Published: June 2018

Background: Although not usually manifest until adulthood, evidence indicates that cardiometabolic disease has its origins in pediatrics. If we are truly to decrease cardiometabolic disease we must understand the pathophysiology of cardiometabolic risk in childhood. Individuals with the F polymorphism of the complement C3 gene have increased rates of myocardial infarction and athereosclerosis. Individuals with increased gene copy number of the complement C4 long and A genes have decreased longevity.

Methods: C3 F vs. S genotype and C4A, C4B, C4L and C4s gene copy number were measured in 59 non-Hispanic white subjects (29 female, age=15.3±1.7 years, BMI=22.4.1±5.9 kg/m2,, mean±SD). Endothelial function (reactive hyperemia (RH), venous occlusion plethysmography), arterial stiffness (augmentation index (AI), arterial tonometry), lipids, interleukin-6 (IL-6), c-reactive protein, plasminogen activator inhibitor 1 (PAI1) insulin sensitivity and secretion (oral glucose tolerance test) were used to assess cardiometabolic risk. BMI percentile, waist circumference and percent body fat (air displacement) were measured to assess adiposity.

Results: Forty percent of subjects had at least one C3F allele. These subjects were found to have increased waist circumference (78±18 vs. 70±11 cm, p=0.029) and higher HDL levels (55±14 vs. 46±11 mg/dl, p=0.024) compared to those with only the S allele. Increased C4L (r=0.34, p=0.017) and C4A (r=0.33, p=0.019) gene copy number were associated with decreased endothelial function. Multiple linear regression including percent body fat and either C4L or C4A showed that both relationships became more significant.

Conclusions: In adolescent the C3 F polymorphism gene is associated with increased central obesity but surprisingly increased HDL. Increased C4L and C4A gene copy are associated with decreased endothelial function. This could explain their association with deceased longevity.

Disclosure

R.P. Hoffman: None. M.M. Copenhaver: None. C. Yu: None.
Paternal Bisphenol A Exposure Alters Offspring Glucose Tolerance in a Time, Dose, and Sex-Specific Manner
Authors: RASHID CETEWAYO S. , BANSAL AMITA , SIMMONS REBECCA A.
Published: June 2018

As it is becoming increasingly accepted that maternal exposure to the ubiquitous environmental pollutant bisphenol A (BPA) predisposes offspring to metabolic impairments, paternal contribution in this context remains unresolved. To investigate a relationship between paternal BPA exposure and offspring obesity and glucose tolerance, a mouse model was developed using dietary BPA exposure at doses comparable to human exposure levels (7% Corn Oil diet (Control), 10 μg/mg/day (Lower BPA), and 10 mg/kg/day (Upper BPA)). Two exposure windows were investigated: 1) direct exposure of male mice beginning at sexual maturation (5 weeks of age) and continuing for 12 weeks prior to mating, and 2) in utero exposure, in which dams were exposed beginning 2 weeks prior to mating and ending at weaning. F1 males were sired to unexposed females. At 16 weeks of age, offspring from both exposure windows underwent body composition analysis via NMR or DEXA scan as well as glucose tolerance testing. Paternal BPA exposure during adulthood did not affect body weight, adiposity or glucose tolerance in offspring. In utero-exposed sires produced offspring that also had no changes in body weight or adiposity. However, female offspring from the Lower BPA dose were glucose intolerant. Females with glucose intolerance were selected for islet perifusion, and interestingly, those females from Lower BPA dose exhibited enhanced glucose-stimulated insulin secretion compared to controls indicating insulin resistance. These data demonstrate that while paternal BPA exposure after sexual maturity may be metabolically innocuous, paternal BPA exposure during gestation and lactation precipitates sex-specific impairments in glucose tolerance. Further studies are required to describe precisely the glucose homeostatic impairment and elucidate epigenetic changes in sperm associated with phenotypic transmission.

Disclosure

C.S. Rashid: None. A. Bansal: None. R.A. Simmons: None.
Utility of Fibroscan in Screening Overweight and Obese Children at Risk for Nonalcoholic Fatty Liver Disease
Authors: DAYTON KRISTIN A. , BRIL FERNANDO , CUSI KENNETH
Published: June 2018

Study Objective: Nonalcoholic fatty liver disease (NAFLD) is associated with elevated risk for metabolic syndrome, type 2 diabetes, cardiovascular disease and cirrhosis. Available diagnostic tools (plasma aminotransferases and liver ultrasound) have low sensitivity. This study screened a broad population of children from an endocrine clinic with a combination of imaging tools and biomarkers previously used only in children with known liver disease. We hypothesized that Fibroscan (an ultrasound based imaging tool for hepatic fibrosis) would correlate well with MR-elastography (MRE) and be a useful adjunct in combination with known biomarkers of fatty liver disease to screen for advanced cases of NAFLD.

Methods: Overweight patients were recruited from pediatric and endocrinology clinics. They underwent liver 1H magnetic resonance spectroscopy, magnetic resonance elastography, liver Fibroscan, and fasting lab studies. Plasma biomarkers analyzed included hemoglobin A1c, lipid panel, AST and ALT levels, cytokeratin 18 and homeostatic model of insulin resistance.

Results: Twenty seven patients were recruited and analyzed. NAFLD was present in 30% of patients based on ≥5.5% intrahepatic triglyceride content (liver fat) on 1H-MRS. Five patients (19%) showed fibrosis based on Fibroscan ≥7%, however, only one case was confirmed to have fibrosis on MRE. Two patients with positive Fibroscan were unable to undergo MRE. Metabolic markers including A1c and HOMA-IR were worse in NAFLD vs. no NAFLD patients, but only triglycerides and ALT reached statistical significance.

Conclusions: Fibroscan is useful to eliminate fibrosis, but a positive fibroscan must be further evaluated as many false positives occurred. In combination with triglycerides and ALT, this tool may be useful to stratify those patients most at risk for severe NAFLD and those patients requiring evaluation by pediatric gastroenterologists, biopsy, and more intensive intervention.

Disclosure

K.A. Dayton: None. F. Bril: None. K. Cusi: Consultant; Self; Janssen Global Services, LLC., Eli Lilly and Company. Research Support; Self; Cirius Therapeutics. Other Relationship; Self; Nordic Bioscience. Research Support; Self; Novartis Pharmaceuticals Corporation, Novo Nordisk Inc.. Other Relationship; Self; Quest Diagnostics. Research Support; Self; Zydus Pharmaceuticals (USA) Inc.. Other Relationship; Self; OWL metabolomics, Echosens. Research Support; Self; Janssen Global Services, LLC.. Consultant; Self; Tobira Therapeutics, Pfizer Inc..
Co-occurrence of 2+ Early Complications in Type 1 Diabetes—SEARCH for Diabetes in Youth
Authors: SAUDER KATHERINE A. , STAFFORD JEANETTE M. , MAYER-DAVIS ELIZABETH J. , JENSEN ELIZABETH T. , SAYDAH SHARON , MOTTL AMY K. , DOLAN LAWRENCE M. , HAMMAN RICHARD F. , LAWRENCE JEAN M. , PIHOKER CATHERINE , MARCOVINA SANTICA M. , DAGOSTINO RALPH , DABELEA DANA ,   SEARCH FOR DIABETES IN YOUTH STUDY GROUP
Published: June 2018

SEARCH reported a high burden of early complications in type 1 diabetes (T1DM). We examined co-occurrence of complications and related risk factors among 1327 SEARCH T1DM participants aged 10-30 years. Risk factors were assessed at baseline (mean diabetes duration and age = 0.8 and 10.9 years, respectively) and follow-up (7.8 and 18.0 years, respectively). Retinopathy (RET), diabetic kidney disease (DKD), peripheral neuropathy, cardiovascular autonomic neuropathy (CAN), and arterial stiffness (AS) were assessed at follow-up. We examined co-occurrence of ≥2 complications overall, by type, and within four demographic/metabolic risk factor clusters identified using cluster analysis. Clusters were characterized by worsening risk profiles (Table). Co-occurrence of ≥2 complications was observed in 5.9% of participants, more frequently than expected by chance (4.4%, p=0.02). Specifically, RET+DKD (0.83% vs. 0.23%), RET+AS (0.98% vs. 0.34%), and AS+CAN (1.81% vs. 1.04%) all co-occurred more frequently (all p<0.05). Prevalence of ≥2 complications increased across risk clusters from 2.3% to 20.8%.

Selected characteristics and prevalence of 2+ complications at follow-up by risk factor clustersCluster 1 (n=261)Cluster 2 (n=509)Cluster 3 (n=348)Cluster 4 (n=24)p-valueNHW (n, %)217 (83.1)395 (77.6)257 (73.9)15 (62.5)0.002Private insurance (n, %)211 (80.8)386 (76.1)222 (64.2)9 (37.5)<0.001A1c (%)8.5 ± 1.59.0 ± 1.79.7 ± 1.911.8 ± 2.0<0.001Non-HDLc (mg/dl)79.0 ± 12.9105.7 ± 12.2147.9 ± 21.5245.5 ± 33.5<0.001Waist to height ratio0.44 ± 0.050.46 ± 0.060.49 ± 0.070.50 ± 0.05<0.001Mean arterial pressure (mmHg)80.0 ± 8.082.6 ± 8.682.4 ± 8.484.4 ± 10.1<0.001≥2 complications (n, %)6 (2.3)32 (6.3)28 (8.0)5 (20.8)<0.001

In conclusion, early T1DM complications co-occur more frequently than expected, at a young age and short diabetes duration. A cluster of risk factors including minority race/ethnicity, lack of private insurance, and poor metabolic profiles identifies groups to target with interventions to reduce complications.

Disclosure

K.A. Sauder: None. J.M. Stafford: None. E.J. Mayer-Davis: None. E.T. Jensen: None. S. Saydah: None. A.K. Mottl: None. L.M. Dolan: None. R.F. Hamman: None. J.M. Lawrence: None. C. Pihoker: None. S.M. Marcovina: None. R. Dagostino: Consultant; Self; Teva Pharmaceutical Industries Ltd., Acelity, RedHill Biopharma, Edwards Lifesciences. D. Dabelea: None.
Grazing in Young Children with Type 1 Diabetes Is Associated with Higher HbA1c
Authors: SECKOLD ROWEN L. , HOWLEY PETER , KING BRUCE R. , BELL KIRSTINE , SMART CARMEL E.
Published: June 2018

Glycemic control in the young child with type 1 diabetes (T1D) has traditionally been challenging. Unpredictability in appetite and dietary intake has made the achievement of glycemic targets difficult. This study aimed to assess the nutritional quality and dietary behaviors of young children with T1D that attend a clinic that meets glycemic targets in this age group.

Carers of children aged <7 years with type 1 diabetes attending a specialist Pediatric Diabetes Service in Australia completed a 3 day food diary and a survey regarding diabetes management and dietary behaviours.

Twenty one children participated (mean age: 4.7 ±1.3y, 57% male, mean BMI z score: 0.9 ± 0.9, duration since diagnosis 1.6 ±1.1y, 38% insulin pump therapy, mean HbA1c: 6.3 ± 0.7% (45±7mmol/mol)). Offering food ’whenever they are hungry’ was associated with higher HbA1c than routine meals (7.2% vs. 6.1%, p=0.02). HbA1c was not correlated with daily total CHO intake, which ranged from 126g to 236g/day. Almost all carers (95%) gave mealtime insulin before food. Most carers (55%) substituted when 6-10 grams (range 1g to >15g) of CHO less than the predicted quantity was consumed. Children consumed saturated fat in excess of recommendations (15 ± 3% E) with no children meeting recommended serves of vegetables.

Young children with type 1 diabetes can achieve target glycemic control and can safely dose insulin before meals. Continuous eating episodes were positively associated with HbA1c. Dietary quality remains a concern in this age group.

Disclosure

R.L. Seckold: None. P. Howley: None. B.R. King: None. K. Bell: Other Relationship; Self; Novo Nordisk Inc.. C.E. Smart: None.
Family History of Diabetes Is Associated with Increased Risk of Recurrent DKA in Pediatric Patients in Rhode Island
Authors: VAKHARIA JANAKI D. , AGRAWAL SUNGEETA , BACIC JANINE , TOPOR LISA S.
Published: June 2018

Factors related to recurrent DKA in pediatric patients with DM have been studied previously, with family history (FHx) of DM suggested as a protective factor. We sought to determine associations with DKA recurrence in our pediatric population as the first step in developing an intervention to reduce the frequency of DKA recurrence. In a retrospective chart review, we identified 270 patients admitted for DKA at our institution during a 5 year period. We excluded patients with new onset DM or missing data, identifying 255 DKA admissions amongst 131 patients. Patients were divided into a Recurrence group (≥ 2 admissions, n=51 (39%)) and Non-Recurrence group (1 admission). FHx was significantly associated with Recurrence in both univariate (OR 6.96, p-value <0.0001) and multivariate (OR 8.32, p-value < 0.001) logistic regression analyses. Older age was also significantly associated with Recurrence in both analyses. Younger age at diagnosis and public insurance was only significant in the multivariate and univariate analysis, respectively (Table 1). Family history of DM is associated with increased risk of DKA recurrence in our pediatric patients. Larger, multicenter studies are needed to study the relationship between FHx of DM and frequency of DKA admissions. At our center, this data may be used to identify patients at risk, and develop an intervention targeting all household members with DM.

Disclosure

J.D. Vakharia: None. S. Agrawal: None. J. Bacic: None. L.S. Topor: None.
Insulin Treatment and Clinical Outcomes in 67 Participants with Infancy-Onset Diabetes
Authors: LETOURNEAU LISA R. , CARMODY DAVID , DENSON ANNA M. , SANYOURA MAY , NAYLOR ROCHELLE N. , PHILIPSON LOUIS H. , GREELEY SIRI ATMA W.
Published: June 2018

Infancy-onset diabetes occurs within the first year of life and can be monogenic or autoimmune. We investigated insulin regimens and clinical outcomes through the U.S. Monogenic Diabetes Registry. Relevant data was extracted from medical records collected from the time of diagnosis through the first two years of life. Medical records from 67 individuals were obtained. Clinical characteristics are shown in Table 1. Insulin regimens are reported in Table 2. Most participants stayed on an insulin regimen with the same intensity, ranging from staying on a pump (CSII) to staying on 2 shots of insulin per day. While 30% increased in intensity, 14% decreased (Table 2). Many different regimens appeared to be effective in infants, but further research on greater numbers of patients may show additional advantages to more intense regimens such as CSII.

Disclosure

L.R. Letourneau: Other Relationship; Self; Novo Nordisk Inc. D. Carmody: Research Support; Self; Novo Nordisk Inc.. A.M. Denson: None. M. Sanyoura: None. R.N. Naylor: None. L.H. Philipson: Research Support; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Merck & Co., Inc.. Research Support; Self; JAEB Center For Health Research, JDRF, Janssen Pharmaceuticals, Inc., Medtronic MiniMed, Inc. S.W. Greeley: Research Support; Self; Novo Nordisk Inc..
Socioeconomic Disparities in Outpatient Diabetes Care Patterns for Young Adults with Type 1 Diabetes
Authors: AGARWAL SHIVANI , VIROSLAV HANNAH L. , EIEL JACK N. , LONG JUDITH A.
Published: June 2018

Background: Few young adults (YA) with type 1 diabetes (T1D) achieve national glycemic targets, and even fewer of low socioeconomic status (SES) meet these goals. Inconsistent clinic attendance is thought to contribute to this disparity in glycemic control but has not been studied.

Methods: We evaluated clinic attendance in YA with T1D, 18-25 years, seen in a young adult diabetes clinic. We extracted data from medical charts and used insurance status to identify low and higher SES YA, comparing individuals with federal/state-sponsored (public) insurance to commercial (private) insurance. Glycemic control was defined as the difference between the last documented A1c and the baseline first appointment A1c. There were 2 outcomes representing inconsistent attendance: 1) missing ≥1 scheduled quarterly visit per year and 2) gap in care >6 months. We used multilevel mixed effects linear and logistic regression models to examine relationships between insurance status, inconsistent attendance, and glycemic control, adjusting for demographic, clinical, social, and health system factors.

Results: 312 YA were seen in the clinic (mean age 23.5 years) totaling 2376 care visits. Forty-six percent (n=147) had public insurance. Publicly insured YA were more frequently black (42% vs. 11%, p<0.001) and in worse glycemic control (mean baseline A1c 9.9% vs. 8.1%, p<0.001). In multivariate analyses, compared to privately insured YA, publicly insured were 50% more likely to miss a quarterly appointment (OR=1.56, p=0.005) and 96% more likely to have a gap in care >6 months (OR 1.96, p=0.008). In addition, missed appointments worsened glycemic control from baseline (A1c +0.57%, p<0.001).

Conclusions: Low SES YA with T1D are a particularly high-risk subset who are more likely to miss appointments and have gaps in care, which is associated with worse glycemic control. Our results highlight the need to refocus on improving follow-up rates in vulnerable populations to address disparities in glycemic outcomes.

Disclosure

S. Agarwal: None. H.L. Viroslav: None. J.N. Eiel: None. J.A. Long: None.
Effect of Significant Family Life Events in the First Year of Type 1 Diabetes (T1D)
Authors: STANEK KELLY R. , MAJIDI SHIDEH , YOUNGKIN ERIN M. , NOSER AMY , CLEMENTS MARK A. , PATTON SUSANA R.
Published: June 2018

Objective: Examine the impact of stressful life events on families in the first year after diagnosis of T1D in a young child using a mixed methods design.

Methods: In a prospective study of 5-9 year-olds new to T1D (mean age 7.4±1.3 years, T1D duration 4.7±3.3 months), we measured A1c, changes in family health, marital status, coping, and income every 3 months up to 12 months post-baseline using surveys.

Results: Of 135 families, 40 reported job/income changes (11 promoted, 20 changed job, 7 quit job, 2 lost job), 4 marital changes (2 divorces, 1 separation, 1 spouse death), and 42 health changes (78.6% family member health, 21.4% child). Of those, 4 family members were also diagnosed with T1D and 3 youth were diagnosed with an additional autoimmune disorder in the 12 month follow-up. Income decrease at any time point in first 12 months correlated with health change (r=0.142, p=0.048) and marital status change (r=0.169, p=0.049) at any time point in the first 12 months, while baseline Active Avoidance Coping correlated with future income decrease (r=0.169, p=0.03). There was a cross-sectional association between A1c and income decrease at time point 4, corresponding to ∼1 year post-T1D diagnosis (Table).

Longitudinal HbA1c, incidence of life events, and correlation of income decrease and HbA1c in youth.Baseline3 Months6 Months9 Months12 MonthsMean HbA1c, % (SD)7.66 (±1.3)7.72 (±1.2)8.(±1.2)8.20 (±1.2)8.25 (±1.2)Health Change, n (%)14 (12.1%)11 (10.1%)8 (8.3%)9 (9.8%)Marital Status Change, n (%)75.7% married3 (2.6%)001 (1.1%)Income Decrease, n (%)5 (4.3%)9 (8.3%)4 (4.2%)5 (5.4%)Cross-sectional Correlation HbA1c To Income Decrease0.077-0.1080.260**0.083Sig. (1-tailed)0.2070.1310.0050.216N1351161099692

Conclusions: Families can experience significant concurrent life stressors during the first year of T1D. Future research should explore if these events have a direct effect on T1D management and long-term glycemic control.

Disclosure

K.R. Stanek: None. S. Majidi: None. E.M. Youngkin: None. A. Noser: None. M.A. Clements: Speaker's Bureau; Self; Medtronic. Advisory Panel; Self; Glooko, Inc.. S.R. Patton: None.
Five-Year Experience with Telemedicine Clinics for Youth with Type 1 Diabetes (T1D)
Authors: WADWA R. PAUL , STACY JOHN , REZNICK-LIPINA TYLER , SLOVER ROBERT H. , THOMAS JOHN F.
Published: June 2018

Poor access to specialty care is a problem for youth with T1D in rural America, where 79% of children live over 20 miles from a pediatric endocrinologist. Rural families are less likely to have adequate T1D follow-up per ADA guidelines. Telemedicine may mitigate such issues. Since 2012, the Barbara Davis Center for Diabetes telemedicine program has provided care for over 290 pediatric T1D patients in rural Wyoming and Colorado via real-time, encrypted videoconferencing. This study sought to determine how increased access to specialty care via telemedicine affects glycemic control over a 3 to 5 year follow-up period. Glycemic control was analyzed for 21 patients with at least 3 years follow-up since initial use of telemedicine. Data were analyzed by age group (< 12 years (pre-pubertal, n=13) vs. ≥12 years (post-pubertal, n=8)) and treatment method at baseline (insulin pump, n=8 vs. multiple daily injections (MDI), n=13). Mean T1D duration at baseline was 4.1 ± 3.5 years and mean follow-up time was 4.1 ± 0.6 years. Mean change in A1c was 0.0 ± 2.0% (p=0.96 for baseline vs. follow-up A1c). Median (interquartile range (IQR)) A1c at baseline and at follow-up were 9.2 (8.2, 10.0)% and 9.0 (8.5, 10.1)% respectively. One third of patients had a clinically significant increase in A1c of more than 0.5%, a third had a decrease of more than 0.5% and a third had a change in A1c of less than 0.5%. The post-pubertal group showed worse change in glycemic control compared to the pre-pubertal group (mean A1c change 0.2 ± 3.0 vs. -0.1 ± 1.3% respectively (p=0.78)). Patients on MDI at baseline showed mean A1c change of -0.5 ± 1.4% compared to a mean A1c change for patients on insulin pumps of 0.9 ± 2.7% (p=0.21). Of 13 MDI patients, 7 transitioned to insulin pump use during follow-up. Overall, glycemic control was no worse and pump use increased with 5 years of telemedicine clinics for T1D youth. While further work is needed to improve overall glycemic control, use of telemedicine reduces barriers and improves access to T1D specialty care for rural families.

Disclosure

R. Wadwa: Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; MannKind Corporation, Dexcom, Inc., Xeris Pharmaceuticals, Inc., Bigfoot Biomedical. J. Stacy: None. T. Reznick-Lipina: None. R.H. Slover: None. J.F. Thomas: None.