bluuebunny/crossref_metadata_2025 huggingface dataset:
1513-P: The Severe Insulin-Resistant Diabetes Cluster Features Higher Liver Fat Content, but Also an Accelerated Risk of Liver Fibrosis over Five Years after Diagnosis
Authors: ZAHARIA OANA P. , STRASSBURGER KLAUS , KUPRIYANOVA YULIYA , KARUSHEVA YANISLAVA , ANTONIOU SOFIA , BODIS KALMAN , ASPLUND OLOF , BURKART VOLKER , MUESSIG KARSTEN , HWANG JONG-HEE , KUSS OLIVER , GROOP LEIF , AHLQVIST EMMA , SZENDROEDI JULIA , RODEN MICHAEL
Published: June 2019

Cluster analysis using age, BMI, glycemia and homeostasis model estimates (HOMA-IR, -B) revealed distinct risk profiles for progression of diabetic nephropathy in large cohorts, but its relevance for other diabetes-related comorbidities remains unclear. We aimed to (i) examine whether intensified phenotyping would confirm the results of this cluster analysis and (ii) test the hypothesis that liver fat content (HCL), as marker of nonalcoholic fatty liver disease (NAFLD), differs among clusters at diabetes diagnosis and during follow-up. Thus, this cluster analysis was applied to recent-onset patients with non-autoimmune diabetes of the German Diabetes Study. This identified 286 mild age-related (MARD, 44%), 268 mild obesity-related (MOD, 42%), 66 severe insulin-resistant (SIRD, 10%) and 27 severe insulin-deficient (SIDD, 4%) diabetes patients. Furthermore, whole-body insulin sensitivity was assessed by hyperinsulinemic-euglycemic clamps, HCL by magnetic resonance spectroscopy and hepatic fibrosis by a noninvasive score (NAFLD-FS). Congruently, whole-body insulin sensitivity was lowest in SIRD compared to MOD, SIDD and MARD (4.3±2.0 vs. 5.6±2.4, 6.5±2.6, 7.6±2.8 mg*kg-¹*min-¹, all p<0.05). In SIRD, HCL (14±4%) was higher than in SIDD (5±2%), MOD (9±1%) and MARD (7±1%) (all p<0.05). In SIRD, HCL negatively correlated with whole-body insulin sensitivity (r=-0.27, p<0.05). NAFLD-FS was highest in SIRD (0.4) compared to SIDD (-2.9), MOD (-0.8) and MARD (-0.8) (all p<0.05). At the 5-year follow-up (n=159), whole-body insulin sensitivity remained lowest in SIRD (p<0.05 vs. all clusters) with no difference in changes between clusters. Also, significant fibrosis (NAFLD-FS >0.6) was highest in SIRD (21%) compared to SIDD (0%), MOD (16%) and MARD (11%).

In conclusion, patients of the SIRD cluster exhibit higher prevalence of steatosis at diagnosis and increased risk of NAFLD progression over 5 years.

Disclosure

O.P. Zaharia: None. K. Strassburger: None. Y. Kupriyanova: None. Y. Karusheva: None. S. Antoniou: None. K. Bodis: None. O. Asplund: Research Support; Self; Eli Lilly and Company. V. Burkart: None. K. Muessig: None. J. Hwang: None. O. Kuss: None. L. Groop: None. E. Ahlqvist: None. J. Szendroedi: None. M. Roden: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Poxel SA, Servier. Board Member; Self; Eli Lilly and Company. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi. Speaker's Bureau; Self; Novo Nordisk Inc.

Funding

German Ministry of Culture and Science of the State of North Rhine-Westphalia; German Federal Ministry of Health; German Federal Ministry of Education and Research
1514-P: Serum Amylase (AMY) Level and Its Chronological Change as a Predictor of Incident Type 2 Diabetes Mellitus (T2DM)
Authors: ISHII DAI , FUJIHARA KAZUYA , NEDACHI RINA , HARADA MAYUKO , MATSUBAYASHI YASUHIRO , SAITO KAZUMI , KODAMA SATORU , YAMAMOTO-HONDA RITSUKO , ARASE YASUSHI , SONE HIROHITO
Published: June 2019

Low serum AMY is commonly observed in people with a history of pancreatitis, which is a well-known predictor of T2DM. However, few longitudinal studies investigated whether low AMY could be predictive of T2DM, especially considering the effects of baseline HbA1c. Also, it is unclear if a change in AMY is predictive of incident T2DM. Thus, we investigated the impact of AMY and its chronological change on the risk of T2DM considering baseline HbA1c. Analyzed were 5306 individuals who had health examinations yearly for 7 y. We monitored the change in AMY values between baseline 1 (first visit) and baseline 2 (2 y later) and ratio of baseline 2 to baseline 1. During the 5-y follow-up, T2DM occurred in 716 patients. Multivariate Cox analysis showed that both a lower AMY at baseline 2 (HR of Quintile 1, 1.44[1.11-1.88] vs. Q5 as ref.) and a larger AMY decline from baseline 1 (HR of <85%, 1.37[1.01-1.87] vs. ≥115% as a ref.) were independent and significant predictors for incident T2DM. In a stratified analysis of 15 groups divided according to the combination of AMY at baseline 2 and chronological change, those with the lowest AMY at baseline 2 and the largest decline in AMY had a significantly increased risk for incident T2DM (Fig. 1 HR of Quintile 1, < 89.9%, 1.57[1.11, 2.23] vs. Q3/≥100% as ref.). These findings imply the clinical relevance of using the AMY level and its chronological changes to assess risk of incident T2DM.

Disclosure

D. Ishii: None. K. Fujihara: None. R. Nedachi: None. M. Harada: None. Y. Matsubayashi: None. K. Saito: None. S. Kodama: None. R. Yamamoto-Honda: None. Y. Arase: None. 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.
1519-P: A Study on Epidemiological Barriers in Usage of Insulin among Rural South Indians
Authors: MANDAVA PATALI , MUNGANDA HARIHARAN R.S. , UNDAVALLI VAMSI KRISHNA , CHOWDARY PONNAGANTI SATYANARAYANA , AMLE DNYANESH
Published: June 2019

Introduction: Diabetes mellitus (DM) remains the iceberg disease in rural areas with large number of subjects remaining undiagnosed. India is the diabetes capital with home to 72.9 million diabetic people.

Methodology: Our cross-sectional observational and analytical survey studied 516 subjects with uncontrolled type 2 DM (HbA1c >9%) in the 9 villages (having 35,000 population) at Rural health centre, Veleru of Dr. PSIMS and RF, Krishna district, Andhra Pradesh, South India which is a predominantly rice eating population and analyzed the socio-demographic factors influencing insulin administration. Participants were assessed through a pre-tested structured questionnaire to elicit awareness regarding insulin usage.

Results: Though 40.3% were prescribed insulin at some point of time, only 10.1% subjects were taking it. Awareness of diabetes was lacking in 67.8% and that of insulin in 54.1%. Commonest reason for avoiding insulin was fear of injections (31.8%), unawareness of insulin technique in 25.8%, lack of facilities to store insulin in 19.8% subjects, lack of access to pharmacy in 9.3%, unsure about correct timing in 20.2%, concerned about proper dosage measurements in 1.9%, but only 3.9% were concerned about cost.

Conclusion: Proper awareness programs can significantly increase effective and regular use of insulin in diabetes subjects.

Disclosure

P. Mandava: None. H.R.S. Munganda: None. V. Undavalli: None. P. Satyanarayana Chowdary: None. D. Amle: None.
152-OR: Changes in Consumption of Sugary Beverages and Artificially Sweetened Beverages and Risk of Type 2 Diabetes among U.S. Women and Men
Authors: DROUIN-CHARTIER JEAN-PHILIPPE , ZHENG YAN , LI YANPING , MALIK VASANTI , PAN AN , MANSON JOANN E. , WILLETT WALTER C. , HU FRANK
Published: June 2019

Background: Whether changes in consumption of sugary beverages or artificially sweetened beverages (ASBs) are associated with type 2 diabetes (T2D) risk has never been evaluated.

Objective: We evaluated the association of changes in sugary beverage and ASB consumption over a 4-year period with subsequent 4-year risk of T2D among U.S. women and men.

Methods: We followed-up 78,357 women in the Nurses’ Health Study (1986-2012), 82,937 women in the Nurses’ Health Study II (1991-2013) and 35,148 men in the Health Professionals Follow-up Study (1986-2012). Beverage intakes were assessed using validated food frequency questionnaires every 4 years. Cox proportional regression models were used to calculate hazard ratios (HRs) for T2D regarding 4-year changes in beverage consumption, adjusted for initial beverage intake and BMI. Results of the 3 cohorts were pooled using an inverse variance-weighted, fixed-effect meta-analysis.

Results: During 2,849,389 person-years of follow-up, we documented 12,007 incident cases of T2D. Increasing sugary beverage intake by >0.5 serving/day over a 4-year period was associated with a 14% (95% CI: 7%, 21%) higher T2D risk compared with maintaining a stable consumption. Both beverages with added sugars (e.g., soft drinks) and 100% fruit juices were associated with higher T2D risk. Increasing ASB consumption by >0.5 serving/day was associated with a 19% (95% CI: 12%, 27%) higher T2D risk. Substituting ASB for sugary beverages was not associated with subsequent T2D risk (HR: 0.99, 95% CI: 0.96, 1.02). However, decreasing sugary beverage consumption and increasing water, coffee or tea intake by 1 serving/day was associated with a 3% to 11% lower risk of T2D.

Conclusion: Increasing consumption of sugary beverages or ASBs was associated with a higher risk of T2D compared with maintaining a stable consumption of these beverages. Substituting water, coffee or tea but not ASB for sugary beverages was associated with lower T2D risk.

Disclosure

J. Drouin-Chartier: Other Relationship; Self; Dairy Farmers of Canada. Y. Zheng: None. Y. Li: None. V. Malik: None. A. Pan: None. J.E. Manson: None. W.C. Willett: None. F. Hu: None.

Funding

National Institutes of Health (UM1CA186107, UM1CA176726, UM1CA167552, DK112940, HL60712, HL118264); Canadian Institutes of Health Research (BPF-156628)
1532-P: Greater Type 2 Diabetes Risk among College Students in Egypt Is Alarming
Authors: EID ELSAYED MOHAMED , TOMAH SHAHEEN , ELDIB AHMED H. , ABOUELMAGD MEGAHED MOH , FAHMY EMAN M. , ELBADAWY AYMAN MOHAMAD , GHAZI HOSSAM ARAFA , HAMDY OSAMA
Published: June 2019

Egypt, a country with a population of 100 million (60% of them younger than age 30 years old), is among the top 10 nations in number of patients with diabetes according to the International Diabetes Federation. Type 2 diabetes (T2D) risk among young adults in Egypt is unknown. We evaluated T2D risk among 377 college students with age ranging between 19-21 years using the Finish Diabetes Score (FDS); Female 61%, body weight 71.6±14.4 kg, BMI 25±4.5 kg/m2. The overall FDS of the entire cohort was 6 (range: 0-16). Low-risk group (LR) with FDS <7 was observed in 52% of the sample (BMI 23±0.2 kg/m2, Female 54%) compared to 48% in the greater risk group (GR) with FDS ≥7 (BMI 27.6±0.3 kg/m2, Female 68%, p<0.001, p<0.01 respectively). Among GR group, there were variable T2D risk levels; slightly elevated in 36.3%, moderately elevated in 9.8%, and highly elevated risk in 1.9%. GR group had significantly higher total cholesterol versus LR group (189±2.4 vs. 179±2.3 mg/dL, p<0.01) and higher LDL-cholesterol (115±2.2 vs. 107±2.2 mg/dL, p<0.05), while HDL-C, VLDL-C, triglycerides, fasting serum insulin, fasting plasma glucose, and HOMA-IR were not different between the 2 groups. Higher proportion of subjects in the GR group reported frequent consumption of fast food (57% vs. 45%, p<0.05). Among parameters not included in the FDS model was social stress, which was significantly higher in GR (45% vs. 35%, p<0.05), and was an independent predictor of worsening FDS (β=-1.04, P<0.01) in the total cohort. We conclude that increased T2D risk is notable among Egyptian college students, especially among females and those who are overweight. Having 48% of college students at greater T2D risk is alarming. This warrants urgent need for earlier-age screening and implementing diabetes prevention programs with specific aims of reducing body weight, improving lipid profile and reducing consumption of fast food. Social stress should be considered as an important risk factor in any future development of T2D risk model in Egypt.

Disclosure

E.M. Eid: None. S. Tomah: Stock/Shareholder; Self; Amarin Corporation. A.H. Eldib: None. M.M. Abouelmagd: None. E.M. Fahmy: None. A.M. Elbadawy: None. H.A. Ghazi: None. O. Hamdy: Advisory Panel; Self; AstraZeneca, Sanofi-Aventis. Consultant; Self; Abbott, Merck & Co., Inc. Research Support; Self; National Dairy Council. Stock/Shareholder; Self; Healthimation, LLC.
1535-P: An Insulin Resistance Genetic Risk Score (IR_GRS) Is Associated with Mortality in Type 1 Diabetes (T1D)
Authors: MILLER RACHEL G. , COSTACOU TINA , ONENGUT-GUMUSCU SUNA , CHEN WEI-MIN , RICH STEPHEN S. , ORCHARD TREVOR J.
Published: June 2019

Many SNPs in multiple loci are associated with IR in the general population. IR itself is associated with increased complication and mortality risk in T1D. We thus assessed whether a genetic risk score derived from IR SNPs (IR_GRS) is associated with mortality in the T1D prospective Pittsburgh Epidemiology of Diabetes Complications (EDC) Study. In 422 participants of European ancestry, with available DNA, a weighted IR_GRS based on 16 published IR-associated SNPs was calculated. First, for each SNP, the effect size of the association between each SNP and estimated glucose disposal rate (eGDR, an inverse measure of insulin resistance) was estimated using a general additive linear model. This effect size was then multiplied by the risk allele count to obtain the IR-weighted count. The IR_GRS was calculated as the sum of the 16 weighted counts. All deaths were classified by a physician committee yielding underlying and contributing causes. IR_GRS was related to 25-year total, any mention of cardiovascular disease (CVD), and any end-stage renal disease (ESRD) mortality in Cox models adjusted for sex, principal components for ancestry, and T1D duration and baseline (1986-88) clinical risk factors, including HbA1c, lipids, blood pressure, albumin excretion rate (AER), estimated glomerular filtration rate, and white blood cell count. IR_GRS was associated with increased risk of mortality outcomes: total (99 deaths, p=0.003), any CVD (71 deaths, p=0.01), and any ESRD (49 deaths, p=0.01). Adjustment for clinical risk factors attenuated these associations: total mortality (p=0.04), CVD mortality (p=0.17), ESRD mortality (p=0.10), largely as a result of adjustment for log-transformed AER, which was significantly associated with the IR_GRS (p=0.0003). These results, while needing validation in other cohorts, suggest that an IR_GRS may help to identify individuals with T1D who are at increased risk of mortality and vascular damage (i.e., AER) due to IR.

Disclosure

R.G. Miller: None. T. Costacou: None. S. Onengut-Gumuscu: None. W. Chen: None. S.S. Rich: None. T.J. Orchard: Consultant; Self; Boehringer Ingelheim International GmbH.

Funding

National Institutes of Health; Rossi Memorial Fund; JDRF
1539-P: Assessing the Risk of Amputation with Canagliflozin in Middle-Aged Adults and Adults over 65 Years of Age: An Observational Study Using Three Nationwide Databases
Authors: FRALICK MICHAEL , KIM SEOYOUNG C. , SCHNEEWEISS SEBASTIAN , EVERETT BRENDAN M. , GLYNN ROBERT J. , PATORNO ELISABETTA
Published: June 2019

Canagliflozin was associated with an increased risk of lower-limb amputation in the CANVAS trial. Prior trials of younger adults did not detect an increased risk of amputation, which raises the question of whether this was a chance finding or specific to older adults.

We conducted a new-user cohort study from March 29th, 2013 to September 30th, 2017 in three U.S. healthcare databases. Patients with diabetes mellitus type 2 newly prescribed canagliflozin were 1:1 propensity score-matched to patients newly prescribed a glucagon-like peptide-1 (GLP-1) receptor agonist. The primary outcome was lower-limb amputation requiring surgery. Hazard ratios (HR) and 95% confidence intervals (CI) were computed for the risk of subsequent amputation among patients <65 and ≥65 years old.

We identified 464,827 patients who were newly prescribed canagliflozin or a GLP-1 agonist. Adults over age 65 prescribed canagliflozin had a 66% higher rate of amputation compared to adults prescribed a GLP-1 agonist (HR=1.66, 95% CI 1.33-2.07, I2=0%). For adults under 65 years of age, the rate of amputation was similar for canagliflozin compared to GLP-1 agonists (HR=1.09, 95% CI 0.89-1.34, I2=0%).

Canagliflozin may be associated with an increased rate of amputation compared to GLP-1 agonists among adults over the age of 65 years, but not among adults under 65 years of age.

Disclosure

M. Fralick: None. S.C. Kim: Research Support; Self; Bristol-Myers Squibb Company, Genentech, Inc., Pfizer Inc. S. Schneeweiss: Consultant; Self; Aetion, WHISCON, LLC. B.M. Everett: Advisory Panel; Self; American College of Cardiology. Consultant; Self; Abbott Laboratories, Amgen Inc., National Institute of Diabetes and Digestive and Kidney Diseases, Novartis Pharmaceuticals Corporation, Roche Diagnostic USA. Research Support; Self; Novartis Pharmaceuticals Corporation. Other Relationship; Spouse/Partner; Merck & Co., Inc. Other Relationship; Self; UpToDate. Other Relationship; Spouse/Partner; UpToDate. R.J. Glynn: Research Support; Self; AstraZeneca, Kowa Pharmaceutical Europe Co. Ltd., Novartis Pharmaceuticals Corporation, Pfizer Inc. E. Patorno: Research Support; Self; National Institute on Aging. Other Relationship; Self; Boehringer Ingelheim International GmbH.
155-LB: The Increase in Endogenous Glucose Production with SGLT2 Inhibition Is Unchanged by Renal Denervation but Highly Correlates to Urinary Glucose Excretion
Authors: SOLIS-HERRERA CAROLINA , ALATRACH MARIAM , AGYIN CHRISTINA , HONKA HENRI , PATEL RUPAL , TRIPLITT CURTIS L. , ADAMS JOHN M. , GASTALDELLI AMALIA , ABDUL-GHANI MUHAMMAD , CERSOSIMO EUGENIO , DEFRONZO RALPH A.
Published: June 2019

Background: SGLT2 inhibition causes a “paradoxical” increase in EGP, indicating the presence of a “reno-hepatic axis.”

Aim: We measured EGP after SGLT2 inhibition in renal transplant subjects with and without type 2 diabetes to evaluate the role of renal nerves and SNS in mediating this “reno-hepatic axis.” Six T2D (A1c = 7.2±0.1) and 8 non-T2D (A1c = 5.6±0.1) with normal renal function and no history of rejection (prednisone ≤ 5mg/day) received two 6-hr measurements of EGP preceded by dapagliflozin or placebo.

Results: Following DAPA in T2D, FPG (143±15 to 112±9 mg/dl, p=0.01) and FPI (14±3 to 11±2, p=0.02) decreased while glucagon increased (45±13 to 54±14 pg/mL, p=0.09) (all p<0.05 vs. placebo); plasma epinephrine and norepi did not change from baseline. Following placebo, EGP decreased (p<0.01) in both T2D and non-DM. In contrast, after DAPA EGP increased (p<0.01) in both T2D (by 0.4±0.1 mg/kg.min) and in non-T2D (by 0.1±0.1 mg/kg.min) compared to placebo. The DAPA-induced increment in EGP production was highly correlated (r = 0.824, p<0.001) with the increment in urinary glucose excretion in all subjects (Figure).

Conclusions: (1) Renal denervation in renal transplant patients failed to block the DAPA-mediated stimulation of EGP; (2) DAPA-stimulated rise in EGP is strongly related to the increase in urinary glucose excretion blunting the decline in FPG.

Disclosure

C. Solis-Herrera: Advisory Panel; Self; Sanofi. M. Alatrach: None. C. Agyin: None. H. Honka: None. R. Patel: None. C.L. Triplitt: Consultant; Self; Abbott. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc. J.M. Adams: None. A. Gastaldelli: Consultant; Self; A. Menarini Diagnostics, Eli Lilly and Company, Genentech, Inc., Gilead Sciences, Inc., Inventiva Pharma. M. Abdul-Ghani: None. E. Cersosimo: None. R.A. DeFronzo: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Elcelyx Therapeutics, Inc., Intarcia Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk Inc. Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Merck & Co., Inc. Speaker’s Bureau; Self; AstraZeneca, Novo Nordisk Inc.
1552-P: Relationship between Diabetes Status and Chronic Kidney Disease in New York City Chinese and Non-Chinese Populations
Authors: CHANG TA-MIN , LIU GEORGE , GEORGE JOHN D. , SHARP JAMES W. , HU ANTHONY
Published: June 2019

Diabetes mellitus (DM) and prediabetes incidence have increased in the U.S. in recent years. In our center we have observed higher prevalence of diabetes/prediabetes in NYC Chinese-Americans than the general population. Diabetes patients are often associated with cardiovascular disease and chronic kidney disease (CKD).

Aim: To determine the relationship between diabetes status and CKD status in NYC Chinese population compared to the general population so that proper medical management can be achieved.

Method: Using A1C test to determine the diabetes status, with A1C value of <5.7 classified as nondiabetics, 5.7-6.4 as prediabetics and >6.5 as diabetics. Estimated glomerular filtration rate (eGFR) were determined and values <60 mL/min/1.73 m2 were regarded as having CKD. The data of 274,784 NYC Chinese and 1,271,642 non-Chinese were reviewed and compared in 18-64 years and ≥65 years groups.

Results: In both populations the A1C levels tended to increase with increasing age, whereas their mean eGFR tended to decrease with age. The CKD prevalence was 8.9% in Chinese and 9.5% in non-Chinese. In 18-64 years groups CKD was 2.4% in Chinese and 2.7% in non-Chinese, whereas in ≥65 years group they were 29% in Chinese and 25.6% in non-Chinese. When A1C and eGFR were reviewed together, CKD prevalence was 3.1% of nondiabetics, 10.3% of prediabetics, 22.6% of A1C 6.5-6.9 DM, 24.1% of A1C 7.0-8.0 DM, 29.6% of A1C 8.1-8.9 DM and 27.6% of A1C >9.0 in Chinese population. In non-Chinese population, the CKD prevalence was 5.3%, 13.2%, 21.1%, 23.5%, 23.8%, and 18.6%, respectively for the corresponding nondiabetics, prediabetics and various DM subgroups.

Conclusion: Significant prevalence of CKD were found in prediabetics of NYC Chinese and general populations. There is a high prevalence of CKD associated with diabetes mellitus in both populations. Prevalence of CKD in NYC Chinese is higher than the general population, particularly in the ≥65 years group and those having severer DM with A1C >8.0.

Disclosure

T. Chang: None. G. Liu: None. J.D. George: None. J.W. Sharp: None. A. Hu: None.
1554-P: Real-Word Use of Insulin and Oral Antidiabetes Drugs in the Hospital
Authors: PASQUEL FRANCISCO J. , MAGEE MICHELLE F. , HOCHBERG IRIT , HAWTHORNE ROBERT B. , PENG LIMIN , UMPIERREZ GUILLERMO E.
Published: June 2019

Insulin therapy is the preferred treatment for glycemic control in the hospital. Oral antidiabetes drugs (OAD) are commonly used despite the lack of safety and efficacy data. We analyzed individual patient-data of non-critically ill patients with T2D admitted to a teaching medical institution between 2008 - 2018 to determine the relative efficacy and safety of OAD. We did logistic regression analysis adjusting for relevant covariates. A total of 10,205 patients were included in the analysis, 970 patients (9.5%) were treated with OAD, 691 (6.8%) with OAD plus basal insulin, and 8,544 (83.7%) with basal insulin. Patients treated with OAD had lower admission BG and HbA1c and had less comorbidities compared to those receiving basal insulin. Hypoglycemia was less common with metformin (2.4%) and DPP-4i (0.0%) compared to sulfonylureas (13%) or insulin therapy (13%). After adjusting for age, gender, BMI, race, hospital setting, Charlson score, and admission creatinine, treatment with OADs was associated with better BG control and lower odds of complications compared to insulin use (Figure).

Conclusion: The use of OAD in the hospital appears to be safe and effective and is not associated with higher odds of complications, with the exception of sulfonylurea use that is associated with a high rate of hypoglycemia. Residual confounding due to selection assignment to basal insulin therapy to sicker patients is probable.

Disclosure

F.J. Pasquel: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck & Co., Inc. M.F. Magee: Consultant; Self; Mytonomy. Research Support; Self; Lilly Diabetes, Mytonomy, Sanofi. Speaker's Bureau; Self; PRIMED. I. Hochberg: None. R.B. Hawthorne: None. L. Peng: None. G.E. Umpierrez: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc. Research Support; Self; AstraZeneca, Merck & Co., Inc., Novo Nordisk Inc., Sanofi US.
1555-P: Differences in Oral Microbiota as Risk Factors for Periodontal Disease in Diabetic Subjects
Authors: MIZUSHIRI SATORU , DAIMON MAKOTO , MURAKAMI HIROSHI , MURABAYASHI MASAYA , MATSUHASHI YUKI , KAMBA AYA
Published: June 2019

Objective: Periodontal disease, caused by infection with gram-negative anaerobic bacteria, is the biggest risk factor for losing teeth in most westernized countries. Recently, periodontal disease has been regarded as complication of diabetes, since it develops frequently and progress rapidly in diabetic subject. However, although association between diabetes and minimal chronic inflammation induced by periodontal disease has been reported, association between differences in microbiota and periodontal diseases in diabetic subject have not been well examined.

Research Design and Methods: Among participants of the population-based Iwaki study of Japanese held in 2016, those with information of oral cavity environment evaluated by the salivary multi-test, and microbiota of saliva samples evaluated using 16S rRNA sequencing were included in the study (n=1078). Diabetes: HbA1c levels ≧6.5% or FBG ≧126 mg/dl; normal glucose tolerance (NGT): HbA1c levels <6.0% or FBG <100 mg/dl.

Results: The number of dental caries-causing bacterium was significantly higher (3.15±1.61 vs. 2.61±1.61, p <0.01), and the saliva buffer capacity was significantly lower (71.9±10.8 vs. 77.8±10.4, p <0.01) in diabetic subjects compared to those with NGT. Further, proportion of the phylum Firmicutes was higher (41.3±12.4% vs. 37.2±11.6%, p <0.01), and the phylum Bacteroidetes was significantly lower (18.9±8.5% vs. 20.9±8.3%, p=0.01) in diabetic subjects compared to those with NGT.

Conclusions: Abnormal glucose tolerance may change oral microbiota, induce dental caries, and be a risk factor for periodontal disease. We will further examine association between microbiota and diabetes in taxonomic category below phylum, and, also, in consideration with nutrients consumed.

Disclosure

S. Mizushiri: None. M. Daimon: None. H. Murakami: None. M. Murabayashi: None. Y. Matsuhashi: None. A. Kamba: None.
156-OR: Risk-Benefit of SGLT2 Inhibitors (SGLT2i) vs. GLP-1 Receptor Agonists (GLP-1RA) in Routine Care of Older Adults
Authors: PATORNO ELISABETTA , KIM DAE H. , PAWAR AJINKYA , SCHNEEWEISS SEBASTIAN , GLYNN ROBERT J. , MUNSHI MEDHA , BESSETTE LILY G. , KIM SEOYOUNG C.
Published: June 2019

Both SGLT2i and GLP-1 RA have shown cardiovascular (CV) benefits in RCTs among diabetic patients generally younger than 65 years with CV disease. Whether these agents are associated with differential effectiveness and safety in routine care of older adults remains unexplored. Using claims data from Medicare (4/2013-12/2016), we identified 44,179 pairs of 1:1 propensity score-matched (PSM) patients ≥65 years with type 2 diabetes initiating a SGLT2i or a GLP-1 RA. We assessed a composite CV outcome (MI, stroke, or all-cause mortality), and hospitalization for heart failure (HHF). Safety outcomes of interest were severe hypoglycemia, bone fractures, lower-limb amputations (LLA), and diabetic ketoacidosis (DKA). We estimated HRs and 95% CIs in the PSM population well-balanced across >140 baseline covariates. Compared to GLP-1 RA, SGLT2i were associated with a similar risk of the composite CV outcome [HR (95% CI) = 1.04 (0.93-1.15)], and its components, but with decreased risk of HHF [0.68 (0.56-0.83)], over a mean 8.4-month follow-up (Table). Results were consistent in patients with and without CV disease. SGLT2i initiators had similar risk of severe hypoglycemia and fractures, but increased risk of LLA [1.47 (1.07-2.04)] and DKA [1.63 (1.16-2.28)]. Overall in 1,000 person-years, SGLT2i initiation vs. GLP-1 RA was associated with about 2.2 fewer HHF events, but 0.9 more LLA and 1.0 more DKA events.

Disclosure

E. Patorno: Research Support; Self; National Institute on Aging. Other Relationship; Self; Boehringer Ingelheim International GmbH. D.H. Kim: None. A. Pawar: None. S. Schneeweiss: Consultant; Self; Aetion, WHISCON, LLC. R.J. Glynn: Research Support; Self; AstraZeneca, Kowa Pharmaceutical Europe Co. Ltd., Novartis Pharmaceuticals Corporation, Pfizer Inc. M. Munshi: Consultant; Self; Lilly Diabetes, Sanofi. L.G. Bessette: None. S.C. Kim: Research Support; Self; Bristol-Myers Squibb Company, Genentech, Inc., Pfizer Inc.
1562-P: Diabetes as Leading Cause of Permanent Occupational Disability due to Ocular Diseases in the Mexican Institute of Social Security
Authors: JESUS ASCENCIO-MONTIEL IVAN DE , JESÚS ZITLE-GARCÍA EDGAR , ALBERTO REYES-MARTÍNEZ CARLOS , ALTAGRACIA GARCÍA-LOPEZ MÓNICA
Published: June 2019

Eye diseases are an important cause of disability and economic burden on society, affecting economically active population. We described the rates of permanent occupational disability due ocular diseases and specifically due diabetic retinopathy in workers affiliated to the Mexican Institute of Social Security (IMSS), during the 2000-2016 period. A cross-sectional analysis was conducted with data from the IMSS permanent occupational disability database. Subjects with ocular diseases were classified using the International Classification of Diseases, 10th revision (ICD-10) in the following groups: diabetic retinopathy (ICD-10: E103, E113, E123, E133, E143, H280, H360), glaucoma (ICD-10: H40), age-related macular degeneration (ICD-10: H353), cataract (ICD-10: H25-H28), hypertensive retinopathy (ICD-10: H350), trachoma (ICD-10: B940) and blindness (ICD-10: H54). Data for each worker including sex, age at time of permanent occupational disability and ocular diseases were acquired. Permanent occupational disability rates were expressed x100,000 total worker affiliate population. There were 31,221 workers with permanent occupational disability due ocular diseases, 79.3% were male and mean age was 50.8 years old. Diabetic retinopathy was the most frequent cause of ocular permanent occupational disability with 21,161 workers (67.8%). Ocular disease rate increase from 10.52 to 13.78 x 100,000 affiliated workers during 2000 and 2016 respectively (percentage increase 30.9%), and diabetic retinopathy rate also showed an incremented in the same period (from 6.48 to 11.38 x 100,000 affiliated workers, percentage increase 75.7%).The increase in the number of workers with permanent occupational disability due to diabetic retinopathy, reflects an important diabetes complications incidence among the more than 19 million working people affiliated to the IMSS, the largest social security institution in Latin America.

Disclosure

I. Ascencio-Montiel: None. E. Zitle-García: None. C. Reyes-Martínez: None. M. García-Lopez: None.

Funding

Consejo Nacional de Ciencia y Tecnología (72694 to I.D.A-M.)
1567-P: Diabetes Subtypes and Risk for Complications
Authors: BANCKS MICHAEL , CARNETHON MERCEDES R. , CHEN HAIYING , COTCH MARY FRANCES , KLEIN BARBARA E.K. , KLEIN RONALD , SZKLO MOYSES , BERTONI ALAIN
Published: June 2019

Background: Recent reconsideration of the classification of diabetes identified novel unique diabetes phenotypes using data on traditional diabetes characteristics. Our objective was to assess whether unique diabetes phenotypes are present in a multi-ethnic U.S. sample and, if so, are differentially associated with incident complications.

Methods: We included 1201 MESA participants who were identified as having diabetes at exams 1 (2000-02) or 2 (2002-04) via any of the following: self-report of previous diabetes diagnosis, diabetes medication use, fasting glucose ≥126 mg/dL, random glucose ≥200 mg/dL, and glycated hemoglobin (HbA1c) ≥6.5%. We used an iterative data-driven method (k-means clustering) to partition the sex-stratified sample into unique groups based on data for each of the following: age at diabetes diagnosis, body mass index, waist circumference, HbA1c, and years of insulin use. We estimated the association between diabetes subtype with risk for CVD, death, chronic kidney disease, and retinopathy from 2002 through 2015.

Results: We identified four unique subtypes of diabetes related to aging (AR; 52% of sample), insulin use (IU; 3%), severe obesity (SO; 32%), and severe hyperglycemia (SH; 14%). Compared to the AR group, risk for death was higher for the SH and IU groups and risk for retinopathy was higher for SH (Table).

Conclusions: Our work supports consideration of unique diabetes subtypes that have differential risk for complications.

Disclosure

M. Bancks: None. M.R. Carnethon: None. H. Chen: None. M. Cotch: None. B.E.K. Klein: None. R. Klein: None. M. Szklo: None. A. Bertoni: Consultant; Self; Merck & Co., Inc.

Funding

National Heart, Lung, and Blood Institute (HHSN268201500003I)
1572-P: Association of Genetic Variants Related to Hyperinsulinemia with Dietary Intake
Authors: MERINO JORDI , COLE JOANNE B. , LIM ELISE , YATES KAYLA , LIU CHING-TI , FLOREZ JOSE C.
Published: June 2019

Background: The carbohydrate-insulin model of obesity postulates that hyperinsulinemia induces weight gain through increased hunger and lower energy expenditure. We investigated the extent to which genetic risk for hyperinsulinemia associates with energy intake and dietary composition.

Methods: We conducted a population-based study of 148,494 unrelated individuals from the UK Biobank with available genetic and dietary data. Insulin resistance (IR) and secretion (IS) were captured by a 10 and 19-variant genetic risk score (GRS) respectively. Dietary intake was evaluated using a web-based 24-hour diet recall. Linear regression models were used to examine the associations of IR-GRS and IS-GRS with total energy intake and dietary composition after adjusting for confounders. We tested for effect modification by age, sex, and body mass index. In sensitivity analyses we excluded individuals with diabetes.

Findings: The IR-GRS was associated with higher energy (β=131 kcal/day [95% CI 73 to 189] P=0.02) and polyunsaturated fat intake (β=0.52% of energy [95% CI 0.27 to 0.77] P=0.03). We noted interactions between the IR-GRS and age on carbohydrate (Pint=0.03) and sugar intake (Pint=0.02), showing that age magnified the effect of the IR-GRS on carbohydrate (top decile of age compared to the bottom decile: β=2.62% of energy[95% CI -0.02 to 5.26] vsβ=-4.24% of energy [95% CI -7.24 to -1.24]) and sugar intake (β=2.45% of energy[95% CI 0.18 to 5.12] vs. β=-3.12% of energy[95% CI -5.60 to -0.64]). These findings were consistent in individuals free of diabetes (n=140,969). There were no significant findings for the IS-GRS.

Interpretation: These data suggest that genetically driven hyperinsulinemia is associated with dietary intake, and that age could modify the association between genetic risk and carbohydrate intake. Our findings underline the importance of hyperinsulinemia on eating behavior and may serve as preliminary evidence to inform novel strategies for the prevention of common complex metabolic diseases.

Disclosure

J. Merino: None. J.B. Cole: None. E. Lim: None. K. Yates: None. C. Liu: None. J.C. Florez: None.

Funding

European Commission
1575-P: Influence of Adolescent and Maternal Coffee Consumption on Risk of Obesity and Type 2 Diabetes Mellitus in Middle-Aged Women and Their Offspring: Results from Two Prospective Cohort Studies in the United States
Authors: ALPERET DERRICK , DHANA KLODIAN , CHAVARRO JORGE E. , SUN QI
Published: June 2019

In a double-blind randomized trial, coffee intake was shown to decrease fat mass in healthy overweight adults, suggesting that coffee could be modulating lower type 2 diabetes mellitus (T2DM) risk (as ascertained in observational studies) among adults through pathways involving adiposity. However, it is not known if earlier-life (e.g., in-utero, adolescence) exposure to coffee intake could modulate risk of developing childhood obesity and, ultimately, T2DM later in life. In individuals free of diabetes, cancer or cardiovascular disease at baseline, we examined the relationship between: 1) adolescent caffeinated coffee intake (assessed using a validated high-school FFQ in 1998) and later-life (mean ages 43 to 57 years) T2DM risk [self-reported physician-diagnosed cases during follow-up (1998-2011) confirmed by a validated supplementary questionnaire] among 47,355 middle-aged women in the Nurses’ Health Study II (NHSII) using Cox proportional hazards regression; and, 2) prenatal/perinatal coffee intake [ascertained using validated FFQs adjacent to pregnancy (1989-1995)] among 7,629 mothers in NHSII and risk of obesity [defined according to age- and sex- specific BMI thresholds during follow-up (2004-2013)] among 10,657 male and female offspring in the Growing Up Today Study II using log-binomial regression. Adolescent caffeinated coffee intake was associated with 17% lower T2DM risk [≥1 cup/day vs. never/rarely: HR 0.83 (95% CI 0.71-0.98); P-trend=0.03] in later-life. Moderate to large increase (median: +17.5 cups/week) in caffeinated coffee intake from adolescence to adulthood was associated with 20% lower T2DM risk [>1 cup/day increase vs. no change: HR 0.80 (95% CI 0.72-0.89); P-trend<0.0001] in later-life. Total caffeinated or decaffeinated coffee intake during peri-pregnancy was not significantly associated with childhood obesity risk.

Disclosure

D. Alperet: None. K. Dhana: None. J.E. Chavarro: None. Q. Sun: Consultant; Self; Emavant Solutions GmbH.

Funding

National Institutes of Health (UM1CA176726, UM1CA176726, P30DK046200, U54CA155626, T32DK007703-16, HD066963, HL096905, DK084001, OH009803, MH087786)
1576-P: Metabolomic Profiling of the Dietary Approaches to Stop Hypertension (DASH) Diet: Novel Insights for the Nutritional Epidemiology of Type 2 Diabetes Mellitus (T2DM)
Authors: YASHPAL SHAHEN , LIESE ANGELA D. , WAGENKNECHT LYNNE E. , HAFFNER STEVEN M. , JOHNSTON LUKE W. , BOUCHER BEATRICE , BAZINET RICHARD P. , REWERS MARIAN , ROTTER JEROME I. , WATKINS STEVE M. , HANLEY ANTHONY
Published: June 2019

Background: The DASH diet is inversely associated with T2DM risk. Metabolic changes due to DASH adherence and their potential relationship with incident T2DM have not been described.

Objective: To determine metabolite clusters associated with adherence to a DASH-type diet in the Insulin Resistance Atherosclerosis Study (IRAS) cohort and explore if they predict 5-year T2DM incidence.

Methods: DASH adherence for 570 nondiabetic multi-ethnic participants aged 40-69 years was determined using a 10-point scale for 8 DASH food groups. Data for 88 metabolites (acylcarnitines, amino acids, bile acids, sterols, and fatty acids) were obtained at baseline. Metabolite clusters associated with a DASH-type diet were determined using partial least squares analysis (PLS). Multivariable-adjusted logistic regression was used to explore the associations between metabolite clusters and incident T2DM.

Results: A group of acylcarnitines loaded strongly on two components retained under PLS (Figure). Component 2 was inversely associated with incident T2DM (OR: 0.86; 95% CI 0.79-0.95) after adjustment for demographic and metabolic covariates. Component 1 was not associated with T2DM risk (OR: 0.97; 95% CI 0.87-1.10).

Conclusion: Adherence to a DASH-type diet may contribute to reduced T2DM risk in part through modulations in acylcarnitine physiology.

Disclosure

S. Yashpal: None. A.D. Liese: None. L.E. Wagenknecht: None. S.M. Haffner: None. L.W. Johnston: None. B. Boucher: None. R.P. Bazinet: None. M. Rewers: None. J.I. Rotter: None. S.M. Watkins: Stock/Shareholder; Self; Verso Biosciences, Inc. A. Hanley: None.

Funding

National Institutes of Health
1578-P: Meal Consumption Patterns and Contributions of Meals and Snacks to Total Nutrient Intakes by Diabetes Status
Authors: KELLY OWEN , FANELLI STEPHANIE M. , KROK-SCHOEN JESSICA L. , TAYLOR CHRISTOPHER A.
Published: June 2019

Glycemic control greatly relies on total dietary and carbohydrate intakes, but more importantly the distribution of these intakes throughout the day. The purpose of this study was to understand meal and snack patterns and their contribution to the day’s intakes in people with and without diabetes. Meal and snack intakes were assessed for adults over 30 years of age (n=23708) using dietary and hemoglobin A1c data from the 2005-2016 National Health and Nutrition Examination Survey (NHANES). Dietary intakes were assessed from a 24-hour dietary recall. Participants self-reported meals and snacks. Intakes were aggregated to obtain nutrients consumed at meals and snacks and were used to compute the percent of the total day’s intakes contributed by each meal or snack. Participants were stratified into diabetes status using A1c values: <5.7% (nondiabetes, n=14841); 5.7-6.4% (prediabetes, n=5923); 6.5-6.9% (controlled diabetes, n=923); and >7% (poorly controlled diabetes, n=2021). Data were weighted to create a nationally representative sample. Significantly less adults with controlled and poorly controlled diabetes consumed all three meals per day (60-62%, P<0.001). Lunch was the most skipped meal (19.8-25.8%) across all groups, with nondiabetes having the highest percent (P<0.001). Snacks contributed more energy, carbohydrates, and added sugars than breakfast in all groups. Dinner contributed nearly 40% of protein, sodium, and saturated fat intakes as well as more than one-third of total energy. Breakfast accounted for nearly half the day’s whole grain intake, yet mean daily intakes were below 0.5 ounces. Distributing food intake, especially carbohydrates, throughout the day is an effective strategy to promote optimal glycemic control. Meal skipping, particularly lunch more than breakfast, was more common in adults with diabetes, with considerable intakes of energy and carbohydrates obtained during dinner and snacks, suggesting uneven meal distribution is prevalent.

Disclosure

O. Kelly: Employee; Self; Abbott. Employee; Spouse/Partner; Abbott. S.M. Fanelli: None. J.L. Krok-Schoen: None. C.A. Taylor: Consultant; Self; Abbott Laboratories. Research Support; Self; Abbott Laboratories. Other Relationship; Self; Elsevier.

Funding

Abbott Nutrition
1579-P: Higher Calcium Intake Is Associated with Lower Incidence of Diabetic Nephropathy in Japanese Patients with Type 2 Diabetes
Authors: HORIKAWA CHIKA , AIDA REI , TANAKA SHIRO , TANAKA SACHIKO , KAMADA CHIEMI , YOSHIMURA YUKIO , ARAKI ATSUSHI , MORIYA TATSUMI , KATAYAMA SHIGEHIRO , AKANUMA YASUO , SONE HIROHITO
Published: June 2019

Evidence for optimal dietary intake of calcium for prevention of diabetic complications is sparse although population-based cohort studies showed that calcium intake reduces the risk of type 2 diabetes (T2D). We aimed to investigate the relationship between calcium intake and the incidence of diabetes complications in Japanese patients with T2D aged 40-70 years with HbA1c ≥6.5%. This analysis was conducted as a multicenter prospective study of the incidence of and risk factors for macro- and microvascular complications among 2205 Japanese patients with T2D from outpatient clinics in 59 university and general hospitals in Japan. Analyzed were 1588 responders to a baseline dietary survey assessed by the Food Frequency Questionnaire based on food groups or a dietary record. Primary outcome was the 8-year risk of nephropathy, retinopathy, and cardiovascular disease (CVD). Cox regression analyses estimated hazard ratios (HRs) for dietary intake adjusted for age, gender, BMI, HbA1c, smoking, energy intake, and other confounders. Mean calcium intake in quartiles ranged from 487.5 to 751 mg/day, and more than half of participants had calcium intake below the recommended daily dietary allowance in Japan (men 700 mg/d; women 650 mg/d). After adjusting for confounders, HRs of diabetic nephropathy in the 2nd, 3rd, and 4th quartiles for calcium intake compared with the 1st quartile were 1.20 (95% confidence interval 0.67-2.18, p=0.540), 0.60 (0.28-1.28, p=0.185), and 0.42 (0.18-0.97, p=0.024), respectively. There were no significant associations of calcium intake with retinopathy and CVD in the 2nd to 4th quartiles relative to the 1st quartile (retinopathy: 1.15 (0.81-1.64, p=0.441), 1.14 (0.78-1.68, p=0.491), and 0.93 (0.59-1.46, p=0.809); CVD: 0.86 (0.51-1.44, p=0.558), 0.92 (0.53-1.61, p=0.763), and 0.81 (0.42-1.53, p=0.508). Findings suggested an association of high calcium intake with a lower incidence of diabetes nephropathy in Japanese patients with T2D.

Disclosure

C. Horikawa: None. R. Aida: None. S. Tanaka: None. S. Tanaka: None. C. Kamada: None. Y. Yoshimura: None. A. Araki: Speaker's Bureau; Self; Dainippon Sumitomo Parma Co. Ltd., Merck & Co., Inc., Tanabe Mitsubishi Pharma Corporation. T. Moriya: None. S. Katayama: None. Y. Akanuma: None. 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.

Funding

Japan Society for the Promotion of Science; Japan Ministry of Health, Labour and Welfare
1580-P: Dietary Index of Insulin Resistance and Insulin Secretion Predicts Diabetes Risk in Asian Indians
Authors: FORD CHRISTOPHER N. , STAIMEZ LISA R. , SHAIKH NIDA I. , TANDON NIKHIL , PRABHAKARAN DORAIRAJ , NARAYAN VENKAT K.M. , GARG VANDANA
Published: June 2019

Background: The diets of Asian Indians (AIs) may place them at greater risk of diabetes Caucasian populations. The objective of this study was to develop a dietary index of diabetes risk in adult AIs.

Methods: Data were included from a representative sample of adults from Delhi, India in 2014 - 2015 (n = 2,660). Insulinogenic Index (IGI), Disposition Index (DI), Matsuda’s index (MI), HOMA-IR and HOMA-B were calculated from fasting, 30-min and 2-hour insulin and plasma glucose from an OGTT. Intakes of 25 food groups were estimated using a 28-item food frequency questionnaire, the Indian Food Composition Table and Nutritionist Pro. Reduced rank regression (RRR) was used to estimate the relationship between dietary variables and standardized natural logs of IGI, DI, MI, HOMA-IR and HOMA-B (response variables). The first RRR pattern was extracted, RRR pattern score was computed, and respondents were split into quartiles according to RRR pattern score. Logistic regression was used to estimate the relationship between quartile of RRR pattern score and diabetes, adjusting for age and gender.

Results: There were 2,572 (96.7%) respondents with complete data for diet and response variables. The first RRR pattern explained 3.1% of the variation in response variables, 7.1% of the variance in diet variables, and was moderately correlated with MI (-0.24), HOMA-IR (0.19) and HOMA-B (0.17) (all p <0.05). Intakes of pickles (0.52), milk-based products (0.32), milk (0.27), uncooked vegetables (0.27) low-sugar fruits (0.24), rice (-0.52), fish (-0.35), and organ meats (-0.33) were significantly correlated with the first RRR pattern. Those in Q4 of the first RRR pattern were 1.63 (95% CI: 1.31, 2.02) as likely as those in Q1 to have diabetes. The relationship was attenuated with adjustment for age and gender (OR: 1.29; 95% CI: 1.03, 1.61).

Conclusion: A diet pattern high in intakes of pickles, milk and milk-based products, and low in intakes of rice, fish and organ meats may increase diabetes risk in adult AIs.

Disclosure

C.N. Ford: None. L.R. Staimez: None. N.I. Shaikh: None. N. Tandon: None. D. Prabhakaran: None. K. Narayan: None. V. Garg: None.

Funding

National Heart, Lung, and Blood Institute; Department of Health and Human Services (HHSN268200900026C); United Health Group, Minneapolis, MN