bluuebunny/crossref_metadata_2025 huggingface dataset:
Diabetes Retinopathy (DR) Relates to Complication Risk in Young Persons with T1D
Authors: KATZ MICHELLE , KING GEORGE L. , SUN JENNIFER , LAFFEL LORI M.
Published: June 2018

Young persons who develop DR may represent a high-risk group for early development of other complications. In young persons with youth-onset T1D, we evaluated associations between DR status and markers of other T1D complication risk. Youth (N=127), mean age 21.7 y (range 10.7-31.9), mean T1D onset 6.3 y (range 0.5-17.6) underwent DR assessment (ETDRS-protocol 7 field fundus photos); renal, neuropathic, and CVD risk screenings; and risk screening by blood/urine studies. DR was classified as none (No DR, 37%), mild nonproliferative (Mild DR, 46%), and more than mild NPDR (Advanced DR, 17%). More severe DR was associated with greater age, T1D duration, A1c, and weight status (Table). DR severity was associated with neuropathy, vascular stiffness by pulse wave (aortic AIx), and inflammatory, oxidative stress, and endothelial activation markers (CRP, isoprostane, e-selectin). Paradoxically, greater DR was associated with less PAI-1. After adjustment for age, T1D duration, weight, and A1c by ANCOVA, DR status was associated with differences in cooling threshold (7.6, 8.6, 12.3, p=.0003) and e-selectin (39.8, 34.0, 46.0, p=.02). Young persons with DR have high risk for neuropathic, renal, and CVD complications. While PAI-1 is lower, markers of inflammation and oxidative stress are higher in this group. Optimal glycemic control must be prioritized to prevent or delay DR progression and other complications in young persons with DR.

Unadjusted Associations Between Clinical Factors and DR Status, *indicates ln transformed p valueClinical FactorNo DR (n=47) Mean or Median or %Mild DR (n=59) Mean or Median or %Advanced DR (n=21) Mean or Median or %P value ANOVA or Chi-squareAge (yrs)/T1D Duration (yrs)/A1c (%)18.9/13.2/8.022.6/15.8/8.625.8/19.6/9.1<.0001/<.0001/.03Sex (% male)/Overweight/obese (%)60/3236/6148/57.05/.009Urinary Albumin Excretion* /eGFR per 1.73m27.3/128.26.4/141.29.3/140.6.04/.02Neuropathy (MNSI)/Warm Threshold/Cold Threshold1.3/14.6/7.11.9/15.3/8.63.0/18.2/13.4.004/.005/<.001Mean SBP/Mean DBP/Aortic AIx110/68/2.0112/71/9.0115/74/11.1.2/.008/.003PAI1* (ng/ml)/CRP* (mg/l)/IGF1 (ng/ml)36.8/0.8/207.526.2/2.5/160.614.4/2.7/138.8<.001/.002/.002E-selectin(ng/ml)/Urine isoprostane* (ng/ml)40.8/0.2034.5/0.3441.8/0.40.1/.002

Disclosure

M. Katz: None. G.L. King: Research Support; Self; Sanofi-Aventis. J. Sun: Other Relationship; Self; Novartis Pharmaceuticals Corporation. Research Support; Self; Genentech, Inc., Optovue, Incorporated, Boston Micromachines Corporation, Adaptive Sensory Technology, Kalvista Pharmaceuticals, Inc.. Other Relationship; Self; Novo Nordisk Inc. L.M. Laffel: Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc., Sanofi US, MannKind Corporation, Roche Diagnostics Corporation, Dexcom, Inc., Insulet Corporation, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Johnson & Johnson Diabetes Institute, LLC..
Impact of Target HbA1c Change in Pediatric Participants in the T1D Exchange Clinic Registry
Authors: WOOD JAMIE , BOYLE CLAIRE , QUINN MARYANNE , WONG JENISE C. , HALLER MICHAEL J. , NELSON BRYCE A. , HALLER MICHAEL J. , SCHATZ DESMOND , TAMBORLANE WILLIAM V. , FOX LARRY , PRAHALAD PRIYA , CORATHERS SARAH , MAAHS DAVID M. , ALONSO GUY T. , DESALVO DANIEL J. , PAUL WADWA R. , DIMEGLIO LINDA
Published: June 2018

In 2014, the American Diabetes Association lowered its recommended HbA1c target for children with type 1 diabetes (T1D) from <8.5% for <6 years, <8.0% for 6-<13 years, and <7.5 for 13-<18 years to <7.5% for all ages. To determine if HbA1c changed in response, we compared two cross-sectional cohorts of T1D participants in the United States aged <18 years with T1D duration ≥1 year from the T1D Exchange Clinic Registry. The first cohort (PRE) were participants who enrolled between 2010 and 2012 (n=11,788). The second cohort (POST) were participants with an update between 2016 and 2017 (n=9,234). For each age group, mean HbA1c was compared between the cohorts using a linear regression model adjusted for age, T1D duration, and socioeconomic status (SES). A comparison of the cohorts can be found in Table 1. Demographic and SES characteristics were similar between the cohorts. More participants in the POST cohort were using insulin pumps and CGMs. Mean HbA1c was similar between the two cohorts for those <6 years, though more participants in the POST cohort met the current HbA1c target. For the 6-<13 and 13-<18 age groups, those in the POST cohort had higher mean HbA1c, with fewer meeting the current HbA1c target (p<0.01). Thus, despite the lowering of HbA1c targets, glycemic control remains suboptimal in this population.

Disclosure

J. Wood: None. C. Boyle: None. M. Quinn: None. J.C. Wong: Research Support; Self; Dexcom, Inc.. Other Relationship; Self; Tidepool Project. M.J. Haller: None. B.A. Nelson: Speaker's Bureau; Self; Dexcom, Inc.. M.J. Haller: None. D. Schatz: None. W.V. Tamborlane: Consultant; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Medtronic MiniMed, Inc., Novo Nordisk Inc., Sanofi, Takeda Pharmaceuticals U.S.A., Inc.. L. Fox: None. P. Prahalad: None. S. Corathers: None. D.M. Maahs: Advisory Panel; Self; Insulet Corporation. Consultant; Self; Abbott. Research Support; Self; Medtronic, Bigfoot Biomedical, Dexcom, Inc., Insulet Corporation, Roche Diabetes Care Health and Digital Solutions. G.T. Alonso: None. D.J. DeSalvo: Consultant; Self; Dexcom, Inc.. Speaker's Bureau; Self; Insulet Corporation. R. Wadwa: Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; Dexcom, Inc., Xeris Pharmaceuticals, Inc., Novo Nordisk Inc., MannKind Corporation, Bigfoot Biomedical. L. DiMeglio: Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; Dexcom, Inc., Medtronic, Sanofi, Caladrius Biosciences, Inc., Janssen Research & Development, Xeris Pharmaceuticals, Inc., Sanofi.
Higher Weekly Physical Activity in T1D Pediatric Patients Is Associated with Improved Target Glucose Levels—Findings from Six Months of Fitbit-Monitored Activity
Authors: BARNES TIMOTHY L. , WATSON DAVID A. , GANDRUD LAURA M.
Published: June 2018

Physical activity (PA) in T1D patients has been linked to improved cardiovascular and psychosocial health. Glycemic control has been reported as a benefit of PA, but it remains difficult to assess ’real-life’ PA in T1D pediatric patients.

In a novel study, we examined the relationship between weekly Fitbit-measured PA and blood glucose (BG) in 1patients over 6 months. BG was measured via home meters. Using generalized linear mixed effects regression we examined the association between weekly PA measures—steps and hours of moderate to vigorous PA (MVPA)—and weekly summaries of BG levels in, below, and above target range (70-140 mg/dL).

On average, patients took 56K steps/week and had a weekly BG measurement of 221 mg/dL. In regression models, as PA increased, patients tended to have significantly lower mean BG levels and more BG measurements in target range. Thus, an increase in 10K steps was associated with a 3.1 mg/dL drop in BG levels and a 6% increase in the odds of a target range BG (see Table). An additional hour of MVPA was associated with a 2.3 mg/dL drop in BG levels and a 4% increase in the odds of a target BG measurement. PA was also associated with being below the target range.Generalized linear mixed effects regression models examining relationship between weekly PA and BG levels1 (n=105)Average BG measurement% BG measurement between 70-140 mg/dL% BG measurement below 70 mg/dL% BG measurement above 140 mg/dLβ (95% CI)2OR (95% CI)3OR (95% CI)3OR (95% CI)3Steps (per 10K)-3.1 (-4.4, -1.8)1.06 (1.05, 1.07)1.06 (1.03, 1.08)0.94 (0.93, 0.95)Hours of MVPA-2.3 (-3.6, -1.0)1.04 (1.03, 1.05)1.03 (1.01, 1.05)0.96 (0.95, 0.97)1 Adjusted for baseline HbA1c, baseline BMI (z-score), age group, sex, treatment group.2 Beta is the fixed effects linear regression coefficient for the specified PA measurement.3 OR is the odds ratio of the indicated event for each unit increase of PA.

This study provides evidence for the positive effects of PA on BG among pediatric T1D patients, providing a further impetus for promoting PA among this population.

Disclosure

T.L. Barnes: None. D.A. Watson: None. L.M. Gandrud: Consultant; Self; UnitedHealth Group.
Clinical Islet Transplantation Outcomes Are Comparable in Obese Type 1 Diabetes Recipients
Authors: LAM ANNA , POTTER KATHRYN J. , FORBES SHAREEN , IMES SHARLEEN , MALCOLM ANDREW J. , HAQQ ANDREA , SHAPIRO A.M. JAMES , SENIOR PETER A.
Published: June 2018

Many clinical islet transplant programs have body mass index (BMI) and/or weight based thresholds for eligibility. Large subjects may require higher islet mass to reliably achieve insulin independence. However, for long term graft function and protection from hypoglycemia, data supporting a BMI based exclusion is lacking.

Methods: Subjects undergoing islet transplantation at a single center, between 1999 and 2017 were included. Graft survival as measured by C-peptide positivity from last CIT was compared between recipients with BMI<30 kg/m2 (n=237, 24.8±2.8 kg/m2) and BMI >30 kg/m2 (n=24, mean±SD 31.9±2.1 kg/m2) pre-transplant.

Results: Apart from BMI and weight (BMI<30 vs. BMI>30, 70.9±11.3 kg vs. 82.8±9.5 kg; P<0.05) there were no difference between groups in terms of baseline recipient characteristics, including in daily insulin dose (0.58±0.16 U/kg vs. 0.59±0.18 U/kg; P=0.34). Both groups received similar total number of islet infusions (2.4±0.9 and 2.3±0.6, p=0.6), total islet equivalents (1 053 022±471 532 vs. 1 182 498±366 368, P=0.19) and total islet equivalents per recipient body weight (15 208±6 373 IE/kg vs. 14 120±5 041 IE/kg, P=0.42). Long term C-peptide survival was not different between groups (P=0.18).

Conclusion: T1D patients with BMI>30 appear to have similar islet mass requirements and graft survival compared to those with BMI<30. This likely reflects careful selection of smaller (weight <90 kg), insulin sensitive (<0.6 U/kg) subjects with only class I obesity. Given the prevalence of obesity in T1D, future studies should evaluate the roles of obesity, weight and insulin sensitivity to ensure rational and equitable access to transplantation.

Disclosure

A. Lam: None. K.J. Potter: None. S. Forbes: None. S. Imes: None. A.J. Malcolm: None. A. Haqq: None. A. Shapiro: Consultant; Self; Viacyte, Inc., Protokinetix. P.A. Senior: Consultant; Self; Abbott, AstraZeneca. Research Support; Self; AstraZeneca, Prometic Life Sciences Inc., Novo Nordisk Inc., Sanofi. Consultant; Self; Eli Lilly and Company. Speaker's Bureau; Self; Eli Lilly and Company, Novo Nordisk Inc.. Consultant; Self; Novo Nordisk Inc., Janssen Pharmaceuticals, Inc.. Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc.. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Speaker's Bureau; Self; AstraZeneca, Merck & Co., Inc., Abbott. Research Support; Self; Viacyte, Inc..
Parental Hypoglycemia Fear and Adoption of Pump Therapy in Youth with New-Onset Type 1 Diabetes (T1D)
Authors: YOUNGKIN ERIN M. , MAJIDI SHIDEH , NOSER AMY , STANEK KELLY R. , FINCH JONATHAN H. , CLEMENTS MARK A. , PATTON SUSANA R.
Published: June 2018

Objective: Hypoglycemia Fear (FH) is common in parents of young children with T1D and related to poor child glycemic control. We explored if T1D device adoption near onset relates to parental FH.

Methods: In a prospective study of 5-9 year-olds with new onset T1D (mean age 7.4±1.3 years, mean T1D duration 4.6±3.3 months), parents completed the FH Survey at baseline (T1) and 6 (T3) and 12 (T5) months post-baseline. We recorded pump start dates for youth during the same 12 months.

Results: Between T1 and T3, 44 youth (45%) initiated pump therapy. Between T3 and T5, 12 (13%) started a pump. Forty-one youth never started a pump (42%). Despite pump status, parents reported moderate FH Worry at T1 (32.2±11.2), which increased between T1 and T3 (38.0±11.3, p=0.052) and plateaued between T3 and T5 (38.4±12.3, p=0.45). There was no difference in T1 FH Worry among the 44 parents of youth who started a pump between T1 and T3 and those not on a pump. At T3, FH Worry trended higher in the 12 parents whose child started a pump between T3 and T5 than the 85 parents of youth either already on a pump or not on one (p=0.059). At T5, the 12 parents whose child started a pump between T3 and T5 reported significantly higher FH Worry than the other parents (p=0.048).

Conclusions: Parents of 5-9 year-olds with new onset T1D report moderate FH in the first year of T1D. Our results suggest that initiating pump therapy may not reduce parental FH.

Table.Longitudinal measures of hypoglycemia fear and relation to initiation of insulin pump therapyNT1 (Baseline)T3 (6 months)T5 (12 months)Average Age (years)977.5 ± 1.4Gender (%F)10056 (56.0%)Pump Start (%)1000 (0%)44 (44.0%)12 (12.0%)FH Worry (total)8532.7 ± 11.738.0 ± 11.338.2 ± 12.1FH Worry (pump start T1-T3)4433.1 ± 11.135.9 ± 10.738.0 ± 12.3FH Worry (pump start T3-T5)1233.3 ± 12.743.7 ± 11.644.6 ± 7.98**p value <0.

Disclosure

E.M. Youngkin: None. S. Majidi: None. A. Noser: None. K.R. Stanek: None. J.H. Finch: None. M.A. Clements: Speaker's Bureau; Self; Medtronic. Advisory Panel; Self; Glooko, Inc.. S.R. Patton: None.
Establishing a Clinically Meaningful Cut-Point for the PAID-PR (Problem Areas in Diabetes-Parent Revised) Survey
Authors: TINSLEY LIANE J. , COMMISSARIAT PERSIS V. , VOLKENING LISA , ANDERSON BARBARA , KATZ MICHELLE , LAFFEL LORI M.
Published: June 2018

Managing type 1 diabetes (T1D) in youth can create substantial family distress and affect diabetes care efforts. The current study aimed to establish a cut-point on the PAID-PR, a previously validated measure of diabetes distress in parents of youth with T1D.

The 18-item PAID-PR has shown construct validity with BGM frequency, A1c, and measures of diabetes-specific family conflict (DSFC) and general quality of life (QoL). Higher PAID-PR scores (range 0-100) indicate more diabetes distress. We applied a standard approach to identify a meaningful cut-point: scores ≥75th percentile of the distribution of PAID-PR scores obtained from 2 large clinic samples. Cutoff score was confirmed by convergent validity, including demographics, diabetes data from youth, and parent reported psychosocial measures (DSFC and QoL).

The sample included 527 parents of youth with T1D. Youth (50% male, 84% white) were aged (M±SD) 14.0±2.5 years with T1D duration 6.3±3.6 years; 86% were from 2-parent families. Youth checked BG 5.3±2.5 x/day; A1c was 8.4±1.1% and 69% were pump-treated. PAID-PR score was 43.3±18.5 (range 0-92, IQR 31-56). Analyses determined a cut-point of 56. Youth whose parents scored in the upper quartile vs. lower 3 quartiles were similar with respect to sex and racial distributions, age, percent 2-parent families, T1D duration, and BG checks/day. There were significant differences in A1c (8.6±1.2 vs. 8.3±1.1%) and pump use (60 vs. 71%) (p<.01 for both) between youth whose parents were in the upper vs. lower 3 quartiles of the PAID-PR. Parents in the upper quartile vs. lower 3 quartiles reported more DSFC and poorer youth QoL (p<.001 for both).

As youth-onset T1D may engender diabetes distress in families, pediatric diabetes teams recognize the need to identify parents experiencing extreme symptoms. A cut-point of 56 on the PAID-PR appears to identify families in need of additional medical and psychological support in order to improve biomedical and psychosocial outcomes.

Disclosure

L.J. Tinsley: None. P.V. Commissariat: None. L. Volkening: None. B. Anderson: Advisory Panel; Self; Sanofi-Aventis. M. Katz: None. L.M. Laffel: Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc., Sanofi US, MannKind Corporation, Roche Diagnostics Corporation, Dexcom, Inc., Insulet Corporation, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Johnson & Johnson Diabetes Institute, LLC..
Effects of Modified Lipoproteins on Human Trophoblast Cells-A Role in Preeclampsia in Pregnancies Complicated by Diabetes
Authors: MCLEESE REBECCA H. , ZHAO JIAWU , YU JEREMY , BRAZIL DEREK , LYONS TIMOTHY
Published: June 2018

Preeclampsia (PE) complicates 2-8% of pregnancies worldwide. In women with diabetes, the risk for PE is substantially increased by approximately 4 fold. Evidence indicates that an increased release of two anti-angiogenic factors, soluble fms-like tyrosine kinase (sFlt-1) and soluble endoglin (sEng) from placental trophoblasts into the maternal circulation promotes endothelial dysfunction associated with PE. In this study, we investigated sFlt-1 and sEng release from the human placental trophoblast cell line, HTR8/SVneo, in response to modified lipoproteins and/or elevated glucose. HTR8/SVneo cells were exposed to native low-density lipoprotein (N-LDL) vs. ’highly-oxidized glycated’ LDL (HOG-LDL) (50 µg protein/ml) for 24h, with and without pre-treatment with 30mM glucose for 72h. The mRNA expressions of sFlt-1 isoforms (sFlt-1-i13, sFlt-1-e15a), endoglin and MMP-14 were measured by RT-PCR, and levels of sFlt-1 and sEng in cell supernatant were determined by ELISA. Compared with N-LDL, HOG-LDL increased the mRNA expression of sFlt-1-i13 (2.0 fold, p<0.05), sFlt-1-e15a (1.9 fold, p<0.01), endoglin (1.5 fold, p<0.05) and MMP-14 (1.8 fold, p<0.05). HOG-LDL increased the levels of sFlt-1 and sEng proteins in the supernatant (2.9 fold, p<0.and 3.6 fold, p<0.01, respectively). High glucose alone had no significant effect on sFlt-1 and sEng expressions; however, pre-treatment of high glucose potentiated the effects of HOG-LDL: the supernatant levels of sFlt-1 and sEng were increased by 1.5 fold and 1.8 fold, respectively, compared to HOG-LDL treatment alone (p<0.for both). Exposure of trophoblasts to modified lipoproteins (which accumulate in the tissues of patients with diabetes due to vascular leakage) may contribute to the development of PE in diabetes, which is amplified by the presence of high glucose. These findings may explain, in part, the high risk of PE in women with diabetes.

Disclosure

R.H. McLeese: None. J. Zhao: None. J. Yu: None. D. Brazil: None. T. Lyons: None.
Enrichment of miR-126 Boosts the Therapeutic Effects of Endothelial Progenitor Cells Derived Exosomes on Ischemic Stroke in Diabetic Mice
Authors: WANG JINJU , PAN QUNWEN , LIU HUA , ZHAO BIN , YANG YI , MA XIAOTANG , BIHL JI
Published: June 2018

We have demonstrated that endothelial progenitor cell (EPCs) have therapeutic effects on ischemic stroke in diabetic mice and that microRNA (miR)-126 modulates the function of EPC through vascular endothelial growth factor receptor 2 (VEGFR2) pathway in cell culture studies. Here, we determined the effects of EPC-released exosomes (EPC-EXs) on ischemic stroke in diabetic mice and tested whether miR-126 enriched EPC-EXs (EPC-EXsmiR126) could have enhanced efficacy. Type 2 diabetic mice subjected to filament-induced focal ischemic stroke were intravenously administrated with vehicle, or PKH26 labelled EPC-EXs or EPC-EXsmiR-126. The neurological deficit score (NDS), cerebral blood flow (CBF), infarct volume, cerebral microvascular density (MVD), cell death, angiogenesis and neurogenesis, and levels of miR-126, VEGFR2 and cleaved caspase-3 were measured. We found: 1) Injected EPC-EXs merged with brain endothelial cells, neurons and astrocytes dominantly in the peri-infarct area; 2) EPC-EXsmiR126 were more effective than EPC-EXs in decreasing NDS, ischemic damage and cell death, and increasing CBF and MVD on both day 2 and 14, and in promoting angiogenesis and neurogenesis on day 14; 3) These effects were accompanied with down-regulated cleaved caspase-3 on day 2 and prolonged VEGFR2 up-regulation till day 14. The data suggest that transfusion of EPC-EXsmiR126 has enhanced therapeutic efficacy on ischemic stroke in diabetic mice by attenuating acute injury and promoting neurological function recovery.

Disclosure

J. Wang: None. Q. Pan: None. H. Liu: None. B. Zhao: None. Y. Yang: None. X. Ma: None. J. Bihl: None.
Long-Term Function of Islet Allografts Transplanted on the Omentum Using a Biological Scaffold
Authors: BAIDAL DAVID , RICORDI CAMILLO , BERMAN DORA M. , PILEGGI ANTONELLO , ALVAREZ GIL ANA M. , PADILLA NATHALIA , CIANCIO GAETANO , LINETSKY ELINA , ALEJANDRO RODOLFO
Published: June 2018

The liver is the preferred site for islet transplantation (ITx) but not ideal due to limitations affecting engraftment.

We evaluated the safety and efficacy of ITx in the omentum using a resorbable biological scaffold in 3 subjects with type 1 diabetes and negative C-peptide. Islets were combined with autologous plasma and thrombin to generate a biologic scaffold and layered laparoscopically on the omentum. Induction was with anti-thymocyte globulin and etanercept. Maintenance was with mycophenolate sodium and tacrolimus. Demographics, islet dose and metabolic data are shown in the Table.Subject #Age (years)Duration T1DM (years)BMI (Kg/m2)IEQ†/KgMMTT‡ Stimulated Glucose (mg/dl)/C-peptide (ng/ml)Insulin dose U/Kg/day (Units/day)HbA1c%6 months12 months24 monthsPre-ITxLatestPre-ITxLatest1432621.511,386181/3.32277/1.79317/0.490.62 (33)0.14 (7)6.85.32321625.39,635372/0.88374/0.65332/0.52*0.45 (31)0.45 (30)5.75.6346422412,648277/2.47--0.45 (20)0.2 (11)6.36.3* 18 months Post-ITx † IEQ= islet equivalents ‡ MMTT = mixed meal tolerance test

Subject 1 was insulin independent for 15 months and maintains stable glycemic control. Subject 2 had marginal graft function with persistence of severe hypoglycemia (SH) and then underwent intrahepatic ITx resulting in insulin independence. Subject 3 had a 55% reduction in insulin dose and maintains excellent glycemic control.

Our initial experience demonstrates feasibility and safety of ITx on the omentum. Graft function persisted throughout follow-up (6-24 months) resulting in improved glycemic control and absence of SH (subjects 1 and 3).

Results suggest a significant loss of islets early post-ITx followed by gradual functional decline similar to intrahepatic ITx. Strategies to improve oxygen delivery and neo-vascularization and minimize immunosuppression are needed to improve long-term outcomes at this site.

Disclosure

D. Baidal: None. C. Ricordi: None. D.M. Berman: Stock/Shareholder; Self; Pfizer Inc. A. Pileggi: Stock/Shareholder; Self; Converge Biotech, Inc.. Stock/Shareholder; Spouse/Partner; Converge Biotech, Inc. A.M. Alvarez Gil: None. N. Padilla: None. G. Ciancio: None. E. Linetsky: None. R. Alejandro: None.
Family History of Diabetes Delays Fetal Brain Activity
Authors: SCHLEGER FRANZISKA , WALTER LAURA , HENI MARTIN , BRUCKER SARA Y. , HAERING HANS-ULRICH , FRITSCHE ANDREAS , PREISSL HUBERT
Published: June 2018

Introduction: We have previously shown that fetuses of mothers with gestational diabetes mellitus (GDM) and insulin resistance exhibit a prolongation of fetal auditory evoked brain responses (fAER) compared to fetuses of normal glucose tolerant (NGT) women during an oral glucose tolerance test (OGTT). This implies that maternal metabolism may program the fetal brain. We asked whether a positive family history of type 2 diabetes (FHD) without metabolic programing also impacts fetal brain activity. We therefore investigated brain activity in fetuses of NGT mothers with positive FHD.

Methods: A 75g OGTT was administered to healthy pregnant women. Glucose and insulin levels were measured after 0, 60 and 120 minutes. Each blood extraction was preceded by magnetoencephalographic recordings of fAER. From a group of 151 participants, a sub-sample of 53 women, 38 with a negative and 15 with a positive FHD (at least one first- or second-degree relative) was selected based on the following inclusion criteria: no GDM, BMI 18.5-30 kg/m², no preterm birth, no change in fetal position, at least two fMEG with detectable fetal responses.

Results: There were no significant differences in age, BMI at delivery, weight gain during pregnancy and gestational age between the groups. Maternal glucose levels and insulin sensitivity determined by glucose and insulin measurements during the OGTT were not significantly different. Manova with gestational age as covariate showed a significant interaction between measurement timepoint and FHD on fAER latency (F(2)=4.96, p=0.009). Fetuses of mothers with positive FHD had a prolonged fAER (273±109ms) compared to fetuses of mothers with negative FHD (218±67ms) at 60 minutes during the OGTT (F(1)=5.21, p=0.027).

Discussion: In addition to the previously shown influence of maternal metabolism on fetal brain activity, a positive maternal FHD also appears to delay fetal brain activity. This can be due to the genetic or environmental influence which is linked to a positive FHD.

Disclosure

F. Schleger: None. L. Walter: None. M. Heni: Research Support; Self; Boehringer Ingelheim GmbH. Speaker's Bureau; Self; Boehringer Ingelheim GmbH, Merck Sharp & Dohme Corp., Novo Nordisk Inc.. S.Y. Brucker: None. H. Haering: None. A. Fritsche: Advisory Panel; Self; Sanofi-Aventis Deutschland GmbH, Novo Nordisk A/S, Eli Lilly and Company, Boehringer Ingelheim GmbH. H. Preissl: None.
Haptoglobin Concentration, Pregnancy, and Preeclampsia in Women with Type 1 Diabetes
Authors: KELLY CLARE B. , YU JEREMY , JENKINS ALICIA , NANKERVIS ALISON J. , HANSSEN KRISTIAN F. , GARG SATISH K. , ASTON CHRISTOPHER E. , LYONS TIMOTHY
Published: June 2018

Haptoglobin (Hp) binds the globin portion of free haemoglobin (Hb) thus inhibiting oxidative damage: it also has anti-inflammatory and pro-angiogenic properties. There are two Hp alleles and three phenotypes, Hp 1-1, Hp 2-1, and Hp 2-2; the latter is present in ∼50% of people, and is associated with cardiovascular risk and declining renal function in diabetes patients. Preeclampsia (PE) occurs more frequently in diabetic than nondiabetic women (∼20% vs. ∼5%): reasons are not fully elucidated, but oxidative stress, inflammation, and altered angiogenesis are implicated.

We determined maternal plasma Hp levels (ELISA, R and D Systems) and Hp phenotype (ELISA, Savyon Diagnostics Ltd.) in a prospective study of 23 pregnant women with type 1 diabetes (T1D) who developed PE, 24 who remained normotensive, and 19 pregnant normotensive nondiabetic women. Samples were collected at 3 visits (V1-V3) (12.4 ± 1.8, 21.7 ± 1.4, and 31.3 ± 1.4 weeks gestation (mean ± SD)). All subjects were free of microalbuminuria and hypertension at enrolment, and all visits preceded clinical PE onset.

Results: Longitudinal analyses revealed significant temporal decreases of plasma Hp during pregnancy in T1D women who developed PE (p=0.001) and in nondiabetic normotensive women (p=0.017), but not in T1D who remained normotensive. Among all T1D women, plasma Hp was lower in those with Hp 2-2 vs. ’non-Hp 2-2’ phenotype at V2 (p=0.005) and V3 (p=0.002), independent of PE status. In Hp 2-2 T1D women only, plasma Hp was higher in those who did vs. did not develop PE at V1 (77.0 ± 31.4 vs. 50.7 ± 14.5 (mg/dl)) (p=0.033) and V2 (61.9 ± 19.0 vs. 42.0 ± 21.5) (p=0.046). Plasma Hp correlated positively with CRP at all visits (p<0.01), but not with previously-measured anti-angiogenic/angiogenic factors.

Conclusion: Maternal plasma Hp may serve as an early marker for PE in T1D pregnancy, particularly in women with the Hp 2-2 phenotype.

Disclosure

C.B. Kelly: None. J. Yu: None. A. Jenkins: Research Support; Self; Medtronic, Mylan, Sanofi-Aventis. A.J. Nankervis: None. K.F. Hanssen: None. S.K. Garg: Research Support; Self; Dexcom, Inc., Eli Lilly and Company, Sanofi US. Advisory Panel; Self; Sanofi US. Research Support; Self; MannKind Corporation, Diasome Pharmaceuticals, Inc., Labstyle Innovations, Lexicon Pharmaceuticals, Inc., Medtronic. Advisory Panel; Self; Novo Nordisk A/S. C.E. Aston: None. T. Lyons: None.
IRS1 Is a Target of MicroRNA-126
Authors: TRYGGESTAD JEANIE B. , TEAGUE APRIL M. , CHERNAUSEK STEVEN
Published: June 2018

Exposure to diabetes in utero has been shown to program offspring toward cardiometabolic disease and diabetes (DM). Alteration of fetal microRNA expression is a potential mechanism that mediates the effects of maternal conditions on the fetus. In previous work, we have shown that miRNA-126 expression is increased in umbilical vein endothelial cells (HUVEC) and in cord blood from infants born to mothers with DM. In this study we evaluated the capacity of miRNA-126 to target IRS1 mRNA by binding to a complementary sequence in the 3’UTR. A commercially available plasmid (SwitchGear Genomics) containing the 3’UTR of IRS1 with a luciferase reporter was co-transfected along with miRNA-126 into HEK-293A cells. Luciferase expression was reduced by 1.5-fold with the addition of miR-126 as compared to the controls (Figure 1). As confirmation, the sequence predicted to target miR-126 was cloned from HUVEC into the pmirGLO vector (Promega) also containing luciferase reporter. With the addition of miR-126, luciferase expression was reduced by 2.2-fold. The data suggest that IRS1 is a target for miR-126. As miR-126 is increased in HUVEC of infants born to mothers with DM, we postulate that IRS1 protein will be decreased, potentially impacting downstream signaling within the cell, as well as endothelial function. Future studies are planned to evaluate the impact of miR-126 on endothelial function.

Disclosure

J.B. Tryggestad: None. A.M. Teague: None. S. Chernausek: Advisory Panel; Self; Novo Nordisk Inc..
Budget Impact Analysis of Self-Monitoring of Blood Glucose vs. Flash-Continuous Glucose Monitoring in Intensive Insulin Users with Diabetes Type 2 Covered by Medicare and Medicaid
Authors: STUEVE MAGNUS , ZOELLNER YORK F.
Published: June 2018

Introduction: Self-Monitoring of Blood Glucose (SMBG) uses capillary blood glucose to measure glycemia in diabetic patients. Recently FDA-approved Flash Continuous Glucose Monitoring (F-CGM) reveals glucose levels when scanned by the reading device. The Centers for Medicare and Medicaid Services (CMS) have announced to reimburse F-CGM at the same level as CGM devices.

Aim: This analysis’ objective was to quantify the CMS budget impact (BI) of F-CGM reimbursement in patients with type 2 diabetes (T2DM) on intensified insulin therapy (IIT), and compare it to the BI of conventional SMBG via cost-related break-even metrics. These were chosen because - in the absence of RCT-based, primary endpoint-driven clinical superiority evidence of F-CGM over SMBG for this population (REPLACE study) - they are well-suited to inform budget allocation decisions.

Methods: An economic model was developed in Excel. CMS reimbursement/patient co-insurance levels for SMBG and F-CGM were used; data on morbidity, treatment and usage patterns were sourced from the literature and official websites. Different scenarios were simulated to elicit break-even points between F-CGM and SMBG.

Results: The annual cost of SMBG with 3.7 tests per day (see REPLACE) is $180 per patient, compared to $2,156 incurred per F-CGM patient, representing a cost difference of $1,976/year or $5.41/day. This implies a budget break-even ratio of 1:12 patients (F-CGM:SMBG). Both technologies would break even at a consumption of 44 test strips per day. A year’s SMBG budget would last only 30 days if spent on F-CGM.

Conclusion: With diabetes budgets under pressure, thoughtful spending policies are needed. It is recommended to analyze in detail which T2DM subgroups will benefit most from F-CGM, focusing reimbursement to the latter. SMBG, being an established technology, represents - at current reimbursement levels - an attractive spending option to budget holders.

Disclosure

M. Stueve: Employee; Self; JnJ GmbH Life Scan. Y.F. Zoellner: Research Support; Self; J&J Medical GmbH, LifeScan.
Persistence of Allosensitization after Islet Allograft Failure
Authors: RIOS PAOLA , BAIDAL DAVID , PADILLA NATHALIA , ALVAREZ GIL ANA M. , MADIRAJU SRIGITA , AMBUT JONATHAN , MANTERO ALEJANDRO M. , RICORDI CAMILLO , ALEJANDRO RODOLFO
Published: June 2018

Allosensitization (PRA+) has been reported after discontinuation of immunosuppression (IS) following graft failure (GF) in islet transplant (ITx) recipients. Persistence of PRA+ after GF is unknown.

Thirteen ITx alone (IA) and 5 ITx subjects who also received donor CD34+ hematopoietic stem cells (IBM) and developed GF enrolled in the study “Allosensitization After Islet Transplantation.” Panel reactive antibodies (PRA) were measured yearly while having graft function, within 1 year post-GF and yearly after study enrollment. Two subjects who developed GF but remained on mycophenolate mofetil (MMF) for 2 years and 18 subjects with persistent graft function (15 IA and 3 islet after kidney [IAK]) were also evaluated.

80% IBM subjects developed high PRA+ (>89%) (Figure 1a) while 70% IA subjects were PRA+ at enrollment (0.8-6 years post-GF) and 42%-55% were PRA+ throughout follow-up. PRA results were variable (Figure 1b). The 2 subjects taking MMF post-GF and 1 subject who required IVIG pre-GF (for parvovirus infection) were not PRA+. Four subjects with persistent graft function by 10 years became PRA+ (2 IA and 2 IAK; Figure 1c).

After stopping IS, 70% IA subjects became PRA+ with persistence of PRA (although variable) for at least 10 years post-GF. PRA+ was higher in IBM compared to IA subjects. While receiving IS, PRA+ was minimal. Persistence of PRA+ remains a concern due to potentially prolonged wait list time for subsequent organ transplantation if needed.

Disclosure

P. Rios: None. D. Baidal: None. N. Padilla: None. A.M. Alvarez Gil: None. S. Madiraju: None. J. Ambut: None. A.M. Mantero: None. S. Messinger Cayetano: None. C. Ricordi: None. R. Alejandro: None.
The Skin Autofluorescence of Pregnant Women with Diabetes Predicts Macrosomia in Their Newborns
Authors: FOUSSARD NINON , HELMER CATHERINE , GONZALEZ CONCEPCION , BLANCO LAURENCE , MOHAMMEDI KAMEL , RIGALLEAU VINCENT
Published: June 2018

Advanced Glycation End-products accumulated during long-term hyperglycaemia can be detected by measuring the Skin Autofluorescence (SAF). As pregestational and early gestational diabetes especially predispose to macrosomia, we sought whether the SAF of pregnant women with diabetes predicted macrosomia in their newborns. During years 2013-2015, we measured SAF (AGE-Reader, Diagnoptics, Groningen) at 25±7 weeks of amenorrhea in women with singleton pregnancies and diabetes. The birth weights and centiles according to gestational ages were recorded. Macrosomia was defined by birth weight ≥ 4000g and/or Large for Gestational Age ≥ 90 centile. The relation between SAF and macrosomia was tested by binary logistic regression analysis, adjusted for the other risk factors for macrosomia: maternal age and BMI, parity, and the type of diabetes (pregestational, early and late gestational diabetes mellitus). Two hundred and twelve women participated to the study: 16 pregestational, 75 early and 121 late gestational diabetes. They were 33±5 years old, their pregestational BMI were 27.2±6.9 kg/m2, and 1were nulliparous. The birth weights were 3160±550 g, and 23 newborns were macrosomic (10.8%). Mothers of macrosomic newborn had higher SAF: 2.04±0.31 AU vs. 1.83±0.34 for other mothers (p<0.005). By binary logistic regression, the relation between SAF and macrosomia was significant (OR: 3.47; 95% CI: 1.01-11.86) after adjusting for maternal age (OR:1.13; 95% CI: 1.02-1.26) and for the type of diabetes (pregestational: OR: 5.97; 95% CI:1.51-23.54). This relation kept significant (OR: 4.21; 95% CI:1.13-15.67) after introducing the HbA1C in the model, available for 163 women. The skin autofluorescence, a marker of glycaemic memory, is higher in pregnant women with diabetes who will deliver a macrosomic newborn.

Disclosure

N. Foussard: None. C. Helmer: None. C. Gonzalez: None. L. Blanco: None. K. Mohammedi: Speaker's Bureau; Self; Novo Nordisk Inc.. Other Relationship; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Sanofi. Other Relationship; Self; Sanofi, Takeda Development Centre Europe Ltd., Boehringer Ingelheim Pharmaceuticals, Inc.. V. Rigalleau: None.
Glycemic Control in Patients with Diabetes across Primary and Tertiary Government Health Sectors in the Emirate of Dubai, United Arab Emirates—A Five-Year Pattern
Authors: ALAWADI FATHEYA , ABDELGADIR ELAMIN I.E. , BASHIER ALAAELDIN , HASSANEIN MOHAMED , RASHID FAUZIA , ALSAEED MARYAM , HAFIDH KHADIJA , ELSAYED MOHAMED , ABUELKHEIR SONA , FAROOQI MOHAMMED
Published: June 2018

Background: In the United Arab Emirates (UAE) the comparative prevalence of diabetes is reported as 18.98%, but there are very few studies evaluating glycemic control.

Aims: Our primary aim was to assess the level of glycemic control across Dubai Health Authority (DHA) points of care over the past five years (2012-2016).

Methods: This audit is a retrospective analysis of the electronic medical records of all patients who attended the Dubai Health authority between 2012-2016.

Results and Discussion: A total of 26447 patients were included in the study making it the largest cohort of patients to be evaluated for diabetes control in the UAE. Out of those patients, UAE nationals were 73.8% (n=19508), while the other nationalities accounted for 26.2% (n=6939). The overall mean HbA1c from 2012 to 2016 was 7.76%. Patients attending primary care clinics had a mean HbA1c of 7.64%, compared to 7.68% for the tertiary care cohort. Out of the total population, 37.7% of them achieved HbA1c <7%, while the majority (42.0%) had HbA1c of 7-9%, and only 20.3% of the total patient had an HbA1c >9%. Upon comparing primary vs. tertiary patients who had HbA1c <7, there were 40.79% and 34.87%, respectively. Moreover, the total percentage of patients with HbA1c <9% were 80.53% and 79.24% in primary and tertiary setup, respectively.

Disclosure

F. Alawadi: None. E.I.E. Abdelgadir: None. A. Bashier: None. M. Hassanein: None. F. Rashid: None. M. Alsaeed: None. K. Hafidh: None. M. Elsayed: None. S. Abuelkheir: None. M. Farooqi: None.
In Early Pregnancy, a High Proportion of Women with Type 2 Diabetes Have Lower Daily Carbohydrate Consumption than Recommended by the Institute of Medicine
Authors: ÁSBJÖRNSDÓTTIR BJÖRG , RONNEBY HELLE , VESTGAARD MARIANNE , RINGHOLM LENE , JENSEN DORTE M. , RABEN ANNE , DAMM PETER , MATHIESEN ELISABETH R.
Published: June 2018

Aim: Maternal glucose is the primary metabolic substrate for fetal growth and a diet low in carbohydrates is common among young women in the Western world. To secure sufficient carbohydrate consumption in pregnancy, the Institute of Medicine (IOM) recommends a minimum daily consumption of 175 grams of carbohydrates, corresponding to approximately 150 grams from the major carbohydrate sources. We aimed to explore the carbohydrate consumption in early pregnancy among women with type 2 diabetes and, for comparison, in women with type 1 diabetes.

Methods: As part of routine care, all pregnant women with type 2 and type 1 diabetes have since 2013 been asked to hand in a 3-day dietary record focusing on carbohydrates at their first antenatal visit. In the present study, total daily self-reported carbohydrate consumption from major carbohydrate sources, presence of ketonuria, HbA1c, weight and daily physical activity were evaluated.

Results: Dietary records were available from 96 women with type 2 diabetes vs. 1women with type 1 diabetes at median 71 (range 60-87) vs. 63 (56-76) gestational days (p=0.003) where HbA1c was 6.6 ±1.2% (49 ±13 mmol/mol) vs. 6.5 ±0.8% (48 ±8 mmol/mol) (P=0.8), respectively. Body weight was 90.8 (±22) vs. 75.5 (±15) kg (P<0.001), but average daily carbohydrate consumption was similar in the two groups (159 ±56 vs. 167 ±48 g, P=0.3), as was the level of physical activity (246 ±104 vs. 233 ±96 metabolic equivalent of task (MET)-hour/week, P=0.5). A high proportion of the women consumed fewer carbohydrates than recommended by the IOM (52% vs. 40%, P=0.08). There was a low prevalence of ketonuria (>4 mmol/L, equivalent to blood ketones of approx. 0.2 mmol/L) (2% vs. 1%, P=0.6).

Conclusion: In early pregnancy, women with type 2 diabetes had similar carbohydrate consumption to women with type 1 diabetes, despite higher body weight. Lower carbohydrate consumption than recommended by the IOM was prevalent, and ketonuria was rare.

Disclosure

B. ásbjörnsdóttir: None. H. Ronneby: None. M. Vestgaard: None. L. Ringholm: None. D.M. Jensen: None. A. Raben: None. P. Damm: Advisory Panel; Self; Novo Nordisk A/S. Other Relationship; Self; Novo Nordisk A/S. E.R. Mathiesen: Speaker's Bureau; Self; Novo Nordisk A/S. Other Relationship; Self; Novo Nordisk A/S, Novo Nordisk Foundation, Novo Nordisk A/S.
Gestational Diabetes and Diabetes and Prediabetes Risks Postpartum—A Large Observational Study
Authors: SHEN YUN , WANG PENG , WANG LEISHEN , ZHANG SHUANG , LIU HUIKUN , LI WEIQIN , LI NAN , LI WEI , LENG JUNHONG , WANG JING , TIAN HUIGUANG , ZHANG CUILIN , YANG XILIN , YU ZHIJIE M. , HU GANG
Published: June 2018

The objective of this study was to compare risks of postpartum type 2 diabetes (T2D) and prediabetes in Chinese women with and without gestational diabetes (GDM) during pregnancy. Tianjin GDM observational study included 1263 women with a history of GDM and 7women without GDM who participated in the whole population’s GDM universal screening survey by using World Health Organization (WHO)’s criteria. Postpartum T2D and prediabetes were defined according to the American Diabetes Association (ADA) criteria after a standard oral glucose tolerance test. Cox proportional hazards regression was used to assess risks of postpartum T2D and prediabetes between women with and without GDM. During a mean follow-up of 3.53 years postpartum, 90 T2D and 599 prediabetes were identified. Multivariable-adjusted hazard ratios (HR) associated with GDM were 76.1 (95% CI 23.6-246) for T2D, and 25.4 (95% CI 18.2-35.3) for prediabetes. When a mean of follow-up extended to 4.40 years, 121 T2D and 616 prediabetes were identified. Women with prior GDM had a 13.0-fold increased risk (adjusted HR: 95% CI 5.54-30.6) for diabetes and 2.15-fold risk (95% CI 1.76-2.62) for prediabetes than women without GDM. The positive associations between GDM and the risks of postpartum T2D and prediabetes were significant and persistent across stratum by age at delivery (i.e., < 30 years vs. >= 30 years) and overall body adiposity status (i.e., normal vs. overweight). The present study among Chinese women indicated that women with prior GDM had a significantly increased risk for early postpartum T2D and prediabetes, with the risk being highest at the first 3 years postpartum, compared with those without GDM.

Disclosure

Y. Shen: None. P. Wang: None. L. Wang: None. S. Zhang: Employee; Self; American Diabetes Association. Advisory Panel; Self; Company/ABC. H. Liu: None. W. Li: None. N. Li: None. W. Li: None. J. Leng: None. J. Wang: None. H. Tian: None. C. Zhang: None. X. Yang: None. Z.M. Yu: None. G. Hu: None.
Vitamin D Status during Pregnancy and the Risk of Gestational Diabetes Mellitus—A Longitudinal Study in a Multiracial Cohort
Authors: XIA JIN , SONG YIQING , RAWAL SHRISTI , WU JING , HINKLE STEFANIE , TSAI MICHAEL Y. , ZHANG CUILIN
Published: June 2018

Background: Emerging evidence suggests that vitamin D status in pregnancy may be associated with the development of gestational diabetes (GDM). However, the temporal relationship remains unclear due to the lack of prospective data with serial measurements of maternal vitamin D levels. We prospectively examined longitudinal changes in vitamin D biomarkers in relation to subsequent GDM risk.

Methods: A nested case-control study of 107 GDM cases and 214 controls (matched on age, race/ethnicity, and gestational week (GW) at blood draw) was conducted within the NICHD Fetal Growth Studies-Singleton Cohort (2009-2013). Plasma concentrations of D2 and D3 25-hydroxyvitamin D (25(OH)D) and vitamin D binding protein were measured at GWs 10-14, 15-26, 23-31, and 33-39; we further calculated total, free, and bioavailable 25(OH)D. Linear mixed-effects models and conditional logistic regression models were used adjusting for confounders.

Results: Compared with controls, women who developed GDM appeared to have lower concentrations of total 25(OH)D as early as GWs 10-14 (median: 25.59 vs. 27.46 ng/mL) and had a greater longitudinal increase in total 25(OH)D levels from GWs 10-14 to 15-26 (LS mean difference in log-scale: 0.10 vs. 0.04, p=0.046). We found no linear associations between vitamin D biomarkers at GWs 10-14 or GWs 15-26 and GDM risk. However, vitamin D deficiency (<20 ng/mL) at GWs 10-14 was associated with a 2.82-fold increased GDM risk (adjusted OR=2.82, 95% CI: 1.15-6.93). Furthermore, women with persistent vitamin D deficiency at both weeks 10-14 and weeks 15-26 had more than 4-fold elevated risk for GDM compared to those persistently non-deficient (adjusted OR=4.46, 95% CI: 1.15-17.3).

Conclusions: Our findings suggest that maternal vitamin D deficiency in the first trimester of pregnancy may be implicated in the development of GDM. Assessment of vitamin D status in early pregnancy may be clinically important and valuable for the primary prevention of GDM.

Disclosure

J. Xia: None. Y. Song: None. S. Rawal: None. J. Wu: None. S. Hinkle: None. M.Y. Tsai: None. C. Zhang: None.
Postpartum Relapse in Diet Quality among Women Diagnosed with Gestational Diabetes
Authors: CHAKKALAKAL ROSETTE J. , HACKSTADT AMBER J. , SILVER HEIDI J. , ELASY TOM
Published: June 2018

Background: Women with gestational diabetes (GDM) often improve their dietary intake during pregnancy to control hyperglycemia. Maintaining improved diet quality after delivery could reduce women’s risk of type 2 diabetes (T2DM) later in life.

Methods: We compared the diet quality of English and Spanish-speaking women diagnosed with GDM during vs. after pregnancy in this prospective cohort study. Study participants were contacted by telephone to complete two 24-hour diet recalls during pregnancy and 2 recalls after delivery. The alternative healthy eating index (AHEI) score was calculated from recall data to assess diet quality; higher scores indicate better diet quality. We compared the mean pregnancy AHEI score to the mean postpartum AHEI score for the sample. We then calculated the difference in mean pregnancy and postpartum AHEI scores for each participant, reported the mean difference in AHEI scores for the sample, and tested for significant differences using paired t-tests.

Results: Of the 38 participants who completed at least 1 pregnancy recall, 27 also completed at least 1 postpartum recall. Mean age of participants was 32.76+/-4.42 and mean BMI was 32.17+/-8.55. Half of the participants spoke Spanish. Medicaid and/or CHIP provided insurance coverage for 73.7% of participants. Medication was necessary to control hyperglycemia in 42.1% of participants. The mean pregnancy AHEI score was higher than the mean postpartum AHEI score (66.8+/- 11.2 vs. 60.3+/-12.9, respectively) for the sample. The mean difference in AHEI scores from pregnancy to postpartum was -6.96 (p=0.013). In a sensitivity analysis of participants completing all 4 recalls, the mean difference in AHEI scores was -7.03; the difference remained statistically significant (p=0.05).

Conclusions: GDM-affected women report significantly better diet quality during vs. after pregnancy. Efforts to prevent this postpartum relapse in diet quality could reduce rates of T2DM in this high-risk population.

Disclosure

R.J. Chakkalakal: None. A.J. Hackstadt: None. H.J. Silver: None. T. Elasy: None.