bluuebunny/crossref_metadata_2025 huggingface dataset:
1226-P: A Rapid Rate of Kidney Function Decline Is Associated with Increased Risk of Heart Failure in Patients with Type 2 Diabetes—Results from ACCORD Study
Authors: BANO ARJOLA , BUENO CARLOS , TANG YALING , SUN XIUQIN , HALL ELIZABETH , MITRI JOANNA , LUCA MORIERI MARIO , SHAH HETAL , DORIA ALESSANDRO
Published: June 2023

Impaired kidney function and albuminuria are associated with increased risk of heart failure (HF) in patients with type 2 diabetes (T2D). We investigated whether rapid kidney function decline over time is an additional determinant of increased HF risk in patients with T2D. We further assessed whether accounting for the rate of estimated glomerular filtration rate (eGFR) decline over time improved prediction of HF risk as compared to standard clinical predictors. Included in the study were 9,192 participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study with available baseline urinary albumin-to-creatinine ratio (UACR) data and ≥3 eGFR measurements during follow-up. The association between rapid kidney function decline (eGFR loss ≥5 ml/min/1.73 m2/year) and odds of HF hospitalization or HF death during follow-up was estimated by logistic regression. We calculated integrated discrimination improvement (IDI) by adding rapid kidney function decline to HF predictors. Over a median follow-up of 5.0 years (interquartile range 4.1-5.7), 1,432 participants (15.6%) experienced rapid kidney function decline and 355 (3.9%) experienced a HF event. Rapid kidney function decline was associated with a 3.57-fold increase in HF odds (odds ratio [OR] 3.57; 95% confidence interval [CI] 2.86-4.45). This estimate was not attenuated by adjustment for potential confounders, including eGFR and UACR at baseline and censoring (OR 4.47; 95% CI 3.7-6.11). Adding rapid kidney function decline during follow-up to other predictors (WATCH-DM score, eGFR, and UACR) significantly improved HF risk classification (relative IDI=+49%, p<0.0001). In patients with T2D, rapid kidney function decline was associated with a marked increase in HF risk, independent of starting kidney function and/or albuminuria. These findings highlight the importance of serial eGFR measurements over time to improve HF prediction in patients with T2D.

Disclosure

A.Bano: None. C.Bueno junior: None. Y.Tang: None. X.Sun: None. E.Hall: None. J.Mitri: Other Relationship; Novo Nordisk, Research Support; Kowa Company, Ltd. M.Morieri: Advisory Panel; Merck Sharp & Dohme Corp., Amarin Corporation, Servier Laboratories, Speaker's Bureau; Eli Lilly and Company, Novo Nordisk. H.Shah: None. A.Doria: None.

Funding

National Heart, Lung, and Blood Institute (N01HC95178, N01HC95179, N01HC95180, N01HC95181, N01HC95182, N01HC95183, N01HC95184, IAAY1HC-9035, IAAY1HC1010); National Institute of Diabetes and Digestive and Kidney Diseases; National Institute on Aging; National Eye Institute; Centers for Disease Control and Prevention; General Clinical Research Centers
1227-P: Cardiorenal Effectiveness of Empagliflozin vs. GLP-1 Receptor Agonists in Patients with Advanced Chronic Kidney Disease—Results from the EMPRISE Study
Authors: HTOO PHYO T. , PATORNO ELISABETTA , TESFAYE HELEN , WEXLER DEBORAH J. , GLYNN ROBERT , SCHMEDT NIKLAS , KOENEMAN LISETTE , SCHNEEWEISS SEBASTIAN , PAIK JULIE M.
Published: June 2023

Patients with chronic kidney disease (CKD) are at an increased risk of cardiovascular disease, heart failure, and mortality. We reported the final year results of the EMPRISE study program in patients with type 2 diabetes (T2D) and advanced CKD. Using Medicare, Optum, and Marketscan data (2014-19), we identified 10,930 pairs of 1:1 propensity score-matched patients aged >18 years with T2D and CKD stage 3-4 who initiated empagliflozin (EMPA) or a glucagon-like peptide-1 receptor agonist (GLP-1RA). Primary outcomes were hospitalization for heart failure (HHF), a composite of myocardial infarction (MI) or stroke, and end-stage renal disease (ESRD). Secondary outcomes were MI, stroke, and all-cause mortality. We estimated hazard ratios (HR) and rate differences (RD), adjusting for 143 baseline covariates. Compared to GLP-1RA, EMPA was associated with a reduced risk of HHF [HR 0.68 (0.55-0.85); RD -9.44 (-14.78, -4.10)], and ESRD [HR 0.70 (0.56-0.87); RD -9.01 (-14.30, -3.72)], and a trend towards reduced risk for the composite outcome [HR 0.88 (0.72-1.07); RD -3.84 (-9.60, 1.93)]. Estimates for the secondary outcomes were: MI [HR 0.78 (0.61-1.00)], stroke [HR 1.16 (0.83-1.62)], and all-cause mortality [HR 1.08 (0.86-1.36)]. In patients with T2D and advanced CKD in routine care, we observed risk reductions for cardiorenal outcomes with EMPA vs. GLP-1RA.

Disclosure

P.T.Htoo: Employee; Johnson & Johnson. E.Patorno: Research Support; Boehringer Ingelheim Inc., National Institutes of Health, Patient-Centered Outcomes Research Institute, US Food and Drug Administration. H.Tesfaye: None. D.J.Wexler: Other Relationship; Novo Nordisk A/S. R.Glynn: Research Support; Amarin Corporation, AstraZeneca, Kowa Pharmaceuticals America, Inc., Novartis, Pfizer Inc. N.Schmedt: Employee; Boehringer Ingelheim International GmbH. L.Koeneman: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. S.Schneeweiss: Consultant; Aetion, Inc., Research Support; UCB, Inc., Boehringer Ingelheim International GmbH, Stock/Shareholder; Aetion, Inc. J.M.Paik: None.

Funding

Boehringer Ingelheim (116283)
1229-P: DNA Methylation near NFATC2IP and Changes in Clinical Cardiovascular Health—The POUNDs Lost Trial
Authors: LI XIANG , SHAO XIAOJIAN , KOU MINGHAO , XUE QIAOCHU , BRAY GEORGE , SACKS FRANK , QI LU
Published: June 2023

Introduction: A previous epigenome-wide association study causally linked DNA methylation (DNAm) at NFATC2IP gene (cg26663590) on body mass index (BMI). However, whether DNAm at NFATC2IP is associated with cardiovascular health (CVH) is unknown.

Methods: We included 408 participants from the POUNDs Lost trial. DNAm was profiled by sequencing method at baseline. Regional DNAm at NFATC2IP was defined as the average methylation level over ± 250 bp of cg26663590. We calculated the clinical CVH score at baseline, 6 months, and 2 years, combining BMI, blood pressure, total cholesterol, and fasting glucose. A higher score indicates better CVH.

Results: Regional DNAm at NFATC2IP was significantly associated with improvement in clinical CVH across 2 years (Figure). Participants within the highest tertile of regional DNAm at NFATC2IP had a greater improvement in clinical CVH score, compared to those within the lowest tertile (β [SE]: 0.68 [0.11] vs. 0.49 [0.10], p=0.028) at 6 months. Such association remained significant at 2 years (T3 vs. T1: 0.55 [0.13] vs. 0.23 [0.12], p=0.03). Moreover, higher regional DNAm at NFATC2IP was associated with greater reductions in total cholesterol (β [SE] per SD: -3.94 [1.34], p=0.004) and low-density lipoprotein cholesterol (β [SE] per SD: -3.26 [1.20], p=0.007) at 6 months.

Conclusion: Individuals with a higher regional DNAm level at NFATC2IP benefit more in the improvement of CVH.

Disclosure

X.Li: None. X.Shao: None. M.Kou: None. Q.Xue: None. G.Bray: Advisory Panel; Medifast, Inc., Herbalife International of America, Inc. F.Sacks: None. L.Qi: None.

Funding

National Heart, Lung, and Blood Institute (HL071981, HL034594, HL126024); National Institute of Diabetes and Digestive and Kidney Diseases (DK115679, DK091718, DK100383); Fogarty International Center (TW010790)
123-OR: SGLT2 Inhibitors Are Associated with Kidney Benefits at All Degrees of Proteinuria—A Cohort Study
Authors: FUJITA KADEN K. , YE FENG , COLLISTER DAVID , KLARENBACH SCOTT , CAMPBELL DAVID J.T. , CHEW DEREK , QUINN AMITY E. , RONKSLEY PAUL E. , LAU DARREN
Published: June 2023

Background: The kidney benefits of sodium-glucose lowering co-transporter 2 inhibitors (SGLT2i) in adults with non-severe albuminuria, under-represented in SGLT2i trials, are not well established.

Objective: We performed a retrospective cohort study to examine the effectiveness of SGLT2i compared to dipeptidyl peptidase-4 inhibitors (DPP4i), in Alberta, Canada.

Methods: Using administrative data, we derived a cohort of SGLT2i new-users (2014-2018) with diabetes and eGFR ≥ 30 mL/min/1.73 m2. New SGLT2i users were matched 1:2 to DPP4i users by CKD stage, albuminuria, and diabetes therapy, and by time-conditional propensity-score (age, sex, A1c, etc.). Non-severe albuminuria was defined as a urine albumin to creatinine ratio ≤ 30 mg/mmol. Linear and Poisson regression models were used to determine the association of SGLT2i use with each outcome: eGFR decline (acute [≤ 60 days] and total), adverse kidney events, and all-cause mortality. An adverse kidney event was defined as sustained 40% loss of eGFR, initiation of kidney replacement therapy, or death from kidney causes.

Results: SGLT2i users (n=19,238) had a mean age of 57.9 years (male 59.1%) and non-severe albuminuria in 94.4%. Mean eGFR was 91.7 mL/min/1.73m2, and 62.0% were dispensed ACE inhibitor or ARB. Median follow-up was 1.58 years (IQR 0.91-2.49). The acute change in eGFR was -2.79 (SGLT2i) vs -1.43 (DPP4i), for a difference of -1.36 (95% CI -1.74-[-0.98], p < 0.001). After day 60, SGLT2i use was associated with 0.83 (0.66-1.01, p < 0.001) less annual eGFR loss than in DPP4i users. SGLT2i use was associated with fewer adverse kidney events (IRR 0.58 [0.47-0.71], p < 0.001), driven mostly by less sustained loss of eGFR, but was not associated with all-cause mortality (IR 0.82 [0.66-1.01], p = 0.06). Similar findings were observed in those with non-severe albuminuria.

Interpretation: SGLT2i may prevent eGFR decline and reduce the risk of adverse kidney events in adults with diabetes, regardless of baseline albuminuria status.

Disclosure

K.K.Fujita: None. F.Ye: None. D.Collister: None. S.Klarenbach: Research Support; Bayer Inc., Allergan, GlaxoSmithKline plc., CSL Behring, Lundbeck, University Hospital Foundation (University of Alberta), Purdue Canada. D.J.T.Campbell: None. D.Chew: None. A.E.Quinn: None. P.E.Ronksley: None. D.Lau: None.
1237-P: Proteomic Indicators of Metabolic Health in Diabetes and Social Vulnerability
Authors: SIMPSON MISSY , OSTROFF RACHEL , WILLIAMS STEPHEN A. , SATTAR NAVEED
Published: June 2023

Introduction: Understanding the health impacts of socioeconomic deprivation (SED) and its interaction with type 2 diabetes is important for patient care and effective public health initiatives. Large-scale proteomic profiling using aptamer-based technology to measure 7,000 proteins has facilitated the development of blood-based proteomic signatures for 10 cardiometabolic SomaSignal Tests (SST), including a test that predicts the 4-year risk of a cardiovascular event (CV risk).

Methods: The cross-sectional PsoBid study recruited participants from socioeconomically deprived and affluent areas of Glasgow, Scotland with similar age ranges and equal proportions of male and female, to identify relevant health disparities. We used regression analyses to estimate the association between SSTs and socioeconomic status (affluent (n = 257, 50.7%), deprived (n = 250, 49.3%)) and prevalent diabetes (n = 27 (5.3%), 7 (2.7%) affluent, 20 (8.0%) SV).

Results: Diabetes was associated with SST predicted increased visceral fat, lean body mass, liver fat, body fat percentage, resting energy rate, and CV risk score, and worse proteomic predictors of cardiorespiratory fitness, glucose tolerance, alcohol impact, and kidney health (p<0.05). SED was associated with SST predicted increased visceral adiposity and CV risk score, and decreased cardiorespiratory fitness, glucose tolerance, and kidney health (p<0.05). The association between diabetes and CV risk score was highest among socioeconomically deprived participants (interaction p-value: 0.01).

Conclusion: These results demonstrate that participants with diabetes and SED have proteomic phenotypes consistent with decreased cardiometabolic health compared to participants without diabetes or SV and SED is associated with worse predicted cardiovascular risk in patients with diabetes. Proteomics may be useful in identifying and monitoring the health effects of diabetes and SED or the impact of relevant interventions.

Disclosure

M.Simpson: Employee; SomaLogic Operating CO., Inc. R.Ostroff: Employee; SomaLogic. S.A.Williams: Employee; SomaLogic. N.Sattar: Advisory Panel; Amgen Inc., Boehringer Ingelheim and Eli Lilly Alliance, Novartis, Roche Diagnostics, Consultant; Afimmune Limited, Hanmi Pharm. Co., Ltd., Pfizer Inc., Other Relationship; Abbott, AstraZeneca, Boehringer Ingelheim Pharma GmbH&Co.KG, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Novo Nordisk, Sanofi, Research Support; AstraZeneca, Boehringer Ingelheim Pharma GmbH&Co.KG, Novartis, Roche Diagnostics.
124-OR: Effects of Dapagliflozin Therapy on Renal Hemodynamics in Type 2 Diabetes Patients
Authors: QIN YUEJUAN , BASKOY GOZDE , TRIPLITT CURTIS L. , SOLIS-HERRERA CAROLINA , ADAMS__III JOHN M. , DEFRONZO RALPH A. , CERSOSIMO EUGENIO
Published: June 2023

Aim: To investigate the renal hemodynamic effects of SGLT-2i therapy in patients with type 2 diabetes [T2D].

Design & Methods: We recruited 24 drug naïve T2D, not receiving ACEi/ARBs. GFR [>100ml/min/1.73m2] was measured with Iohexol clearance and renal plasma (blood) flow [RP(B)F] with PAH clearance divided by (1-Hct). Mean arterial pressure [MAP] and renal vascular resistance [RVR] were determined before and 4 months after dapagliflozin 10mg/day (DAPA, n=12); results were compared to T2D receiving metformin±glipizide to achieve similar glycemic reduction (CONTROL, n=12).

Results: HbA1c decreased equally in DAPA (8.2±0.2 to 7.1±0.2%) and CONTROL (8.4±0.3 to 7.2±0.1%); body weight decreased in DAPA (89.9±4.0 to 86.2±4.2 kg) and rose in CONTROL (86.5±6.2 to 88.9±5.5 kg). GFR [ml/min/1.73m2] declined in DAPA (118±5 to 103±5) but not in CONTROL (113±6 vs. 114±7) (p<0.01). RPF [ml/min] did not change in DAPA (668±65 vs. 676±70) and CONTROL (630±40 vs. 629±39), while filtration fraction [FF] decreased in DAPA (18±1 vs. 15±1%) but not in CONTROL (18±2 vs. 18±2%) (p<0.05). MAP [mmHg] declined in DAPA (95.4±2.6 vs. 89.9±2.5) but not in CONTROL (90.3±4.1 vs. 90.7±2.1) (p<0.05). Thus, calculated RVR [mmHg/L/min] in DAPA decreased (87.0±4.2 to 77.6±2.9), whereas it did not change (86.2±3.8 to 86.4±4.2) in CONTROL after 4 months of therapy (p<0.05).

Conclusion: Despite equal glycemic control, treatment with dapagliflozin, but not with metformin+glipizide, reduced glomerular filtration fraction and renal vascular resistance. Thus, unlike studies in T1D, our data suggest that in T2D post-glomerular vasodilatation is the predominant reno-protective mechanism of SGLT-2 inhibitors. Concomitant pre-glomerular vasoconstriction, however, cannot be excluded.

Disclosure

Y.Qin: None. G.Baskoy: None. C.L.Triplitt: Speaker's Bureau; Novo Nordisk. C.Solis-herrera: None. J.M.Adams: None. R.A.Defronzo: Advisory Panel; AstraZeneca, Bayer Inc., Boehringer-Ingelheim, Novo Nordisk, Research Support; AstraZeneca, Boehringer-Ingelheim, Merck & Co., Inc., Speaker's Bureau; AstraZeneca. E.Cersosimo: None.

Funding

AstraZeneca; Texas Diabetes Institute
125-LB: Risk of Hypoglycemia as Measured by Continuous Glucose Monitoring in the Hospital Setting—An Observational Study
Authors: O'CONNOR MOLLIE , SABEAN AMY , STEINER BARBARA , ZHENG HUI , YAN JOYCE , ASHLEY ANNABELLE , ANANDAKUGAN NILLANI , CALVERLEY MELISSA M. , BARTHOLOMEW RACHEL , GREAUX EVELYN , RUSSELL STEVEN J. , PUTMAN MELISSA S.
Published: June 2023

Background: Prospective studies investigating the occurrence of and risk factors for continuous glucose monitoring (CGM) detected hypoglycemia in the inpatient setting are limited.

Methods: In this prospective observational study, patients hospitalized on medical and surgical floors and undergoing fingerstick glucose monitoring wore blinded Dexcom G6Pro sensors. Participants with sensor readings <54mg/dL were identified after excluding erroneous readings from compression via manual review. Data from participant survey and chart review were analyzed chi square tests for categorical variables, and t test and Kruskal-Wallis test for continuous variables to identify predictors of hypoglycemia.

Results: CGM data were collected from 268 participants. At least one episode of CGM glucose <54 mg/dL occurred in 30 (11%). Participants with at least one episode of glucose <54mg/dL had longer hospital stay, lower A1c (but also lower hemoglobin level), and were more likely to have type 1 diabetes compared to those without hypoglycemia (Table 1). Forty-six (17%) had what appeared to be a false reading <70 mg/dL due to compression or artifact at least once.

Conclusion: CGM may be helpful in identifying hypoglycemia in hospitalized patients. Further research is needed to identify patient populations who may benefit from inpatient CGM monitoring for prevention of hypoglycemia.

Disclosure

M. O'connor: None. E. Greaux: None. S. J. Russell: Consultant; Beta Bionics, Inc., Senseonics, ConvaTec Inc., Employee; Beta Bionics, Inc., Stock/Shareholder; Beta Bionics, Inc. M. S. Putman: Consultant; Synspira Therapeutics, Other Relationship; Vertex Pharmaceuticals Incorporated, Research Support; Dexcom, Inc. A. Sabean: None. B. Steiner: Stock/Shareholder; Bristol-Myers Squibb Company. H. Zheng: None. J. Yan: None. A. Ashley: None. N. Anandakugan: None. M. M. Calverley: None. R. Bartholomew: None.

Funding

National Institutes of Health (R01DK119699-02S1, T32DK007028); Dexcom, Inc. (to M.O.)
1250-P: Clinical and Demographic Characteristics of Patients with Coexistent Type 2 Diabetes, Hypertension, and Dyslipidemia—Results from the Largest Retrospective EMR Study from India
Authors: NATARAJAN VIDHYA , CHAWLA RAJEEV , DALAL JAMSHED , CHANDRA PRAVEEN , KUMAR VIVEKA , AYYAR VAGEESH , BADANI RAJESH S. , HUSSAIN NAQVI SYED MUJTABA , GAURAV KUMAR , DHANAKI GAURI D. , RATHOD RAHUL T. , KOTAK BHAVESH P.
Published: June 2023

Introduction: Common manifestations of end-organ damage due to diabetes, dyslipidemia and hypertension, predispose patients to develop cardiovascular diseases (CVD). The data on triple disease in India is scarce. In patients with triple disease, CVD risk is amplified, necessitating better understanding of their current clinical characteristics and care gaps.

Aims and Methods: This was an EMR based, retrospective, multicenter, cross sectional, database study to evaluate the demographic and clinical profile of adult patients with age more than 18 years having coexistent type 2 DM, dyslipidemia, and hypertension in India. Data of patients with type 1 DM, FH and pregnancy were excluded.

Results: Data of 6722173 patients with age ≥18 years registered in EMR from Jan ‘21 to Dec ‘21 was extracted from the EMR database. Out of these patients, 427835 (6.36%) were found to have coexistent hypertension, type 2 DM and dyslipidemia. Mean age was 59.92 years and 57% were males. The mean BMI was 28.07 kg/m2, and 73% had an above normal BMI (>24.99). The mean SBP and DBP in mmHg were noted to be 138.81 and 82.17, respectively. Only 10% and 28% of patients had a normal SBP and normal DBP, respectively. The mean HbA1c was 8.35% with only 27% having HbA1C <7%. The mean (% optimal control) LDL, total cholesterol, triglycerides in mg/dl (%) was 98.38 (44), 174.75 (28), and 181.42 (56), respectively. ARBs (25%) and combination of anti-hypertensive with diuretics (14%) were most used for hypertension treatment. Statin alone was used in 38% of patients while statin in combination with other drugs was used in 56%. Biguanides alone and its combination with sulphonylureas were used in 74.6% and 41% of patients with diabetes, respectively.

Conclusion: The findings suggests that control of triple disease in India is inadequate despite therapy. There is need to optimize management of triple disease.

Disclosure

V.Natarajan: Employee; Dr. Reddy’s Laboratories Ltd. G.D.Dhanaki: None. R.T.Rathod: None. B.P.Kotak: Employee; Dr. Reddy’s Laboratories Ltd. R.Chawla: None. J.Dalal: None. P.Chandra: None. V.Kumar: None. V.Ayyar: None. R.S.Badani: None. M.Syed: None. K.Gaurav: None.
1252-P: Differences in Cardiometabolic and Immune Biomarkers between Novel Subphenotypes of Individuals at Elevated Risk for Type 2 Diabetes
Authors: SZCZERBINSKI LUKASZ , JANUCIK ADRIAN , KWEDLO WOJCIECH , KONOPKA PAULINA , CITKO ANNA , PASZKO ADAM , TAYLOR MARK , CZAJKOWSKI MARCIN , KONDRACIUK MARCIN , SOWA PAWEL , KOWALSKA IRINA , KAMINSKI KAROL A. , FLOREZ JOSE C. , KRETOWSKI ADAM J.
Published: June 2023

Recent efforts to address heterogeneity among individuals at elevated risk for type 2 diabetes (T2D) have focused on metrics derived from oral glucose tolerance tests, body fat distribution, and hepatic fat content to subphenotype and stratify patients. A novel classification scheme identified six subphenotypes with significantly distinct risks of developing T2D, complications of insulin resistance, and mortality. The aim of our study was to evaluate differences in cardiometabolic and immune biomarkers among these clusters. Fasting serum levels of 5 Olink targeted protein panels (Cardiovascular III, Cardiometabolic, Immune response, Inflammation, Metabolism) comprising 460 oligo-species were measured in 1,597 individuals without diabetes from the Bialystok PLUS study and the Polish Registry of Diabetes. Pairwise differences between subgroups for biomarkers were assessed with generalized linear mixed models, with and without adjustment for the clustering variables. In the unadjusted model, 164 biomarkers showed significantly different levels among clusters (q-value < 0.05), whereas the adjusted model identified 166 significantly different biomarkers. Generally, cluster 2 (lowest T2D and mortality risk) had a more favorable profile of cardiometabolic and immune biomarkers, with clusters 5 and 6 (high-risk) showing more unfavorable profiles. Among significant biomarkers, the greatest differences were observed for tissue-type plasminogen activator and fatty acid binding protein 4, with lowest levels in cluster 2 and highest levels in clusters 5 and 6. Insulin-Like Growth Factor Binding Protein 1 and Paraoxonase 3 showed the greatest differences in the opposite direction. Our study shows that clusters of individuals at elevated risk for T2D stratify across orthogonal axes of cardiometabolic and immune biomarkers, underlining a prominent independent role of these pathways in the pathophysiology of novel subtypes.

Disclosure

L.Szczerbinski: None. P.Sowa: None. I.Kowalska: None. K.A.Kaminski: Other Relationship; AstraZeneca, Boehringer Ingelheim Inc. J.C.Florez: Consultant; AstraZeneca, Novo Nordisk, Other Relationship; AstraZeneca, Merck & Co., Inc. A.J.Kretowski: None. A.Janucik: None. W.Kwedlo: None. P.Konopka: None. A.Citko: None. A.Paszko: None. M.Taylor: None. M.Czajkowski: None. M.Kondraciuk: None.
1256-P: Should Clinical Guidelines for Diabetes Screening Use Waist Circumference Instead of Body Mass Index?
Authors: AGGARWAL RAHUL , CHIU NICHOLAS , BHATT DEEPAK L.
Published: June 2023

Introduction: Diabetes is increasing in the US. The USPSTF and ADA recommend screening based on body mass index (BMI). We evaluated if waist circumference was a better predictor of diabetes than BMI.

Methods: We used NHANES (2015-2018). We identified nonpregnant adults ages ≥20 years (N=10,614). A mediation analysis was performed, assessing if the association of BMI (kg/m2) with diabetes prevalence was mediated by waist circumference (cm), using survey weighted logistic regression. Estimates were US representative. Results: We identified 233,874,251 weighted adults. A one-point BMI increase was associated with a 0.95% (95% CI: 0.84%, 1.07%, P<0.001) increase in diabetes prevalence. Similarly, a one-centimeter increase in waist circumference was associated with a 0.51% (95% CI: 0.46%, 0.55%, P<0.001) increase in diabetes prevalence. After adjusting for waist circumference, BMI was not associated with diabetes prevalence (P<0.001) (Figure), while waist circumference continued to predict diabetes prevalence by 0.87% (95% CI: 0.73%, 1.01%, P<0.001) per one-centimeter increase. The association of BMI for diabetes prevalence was fully mediated by waist circumference (indirect effect ≥ total effect).

Conclusion: The predictive ability of BMI for diabetes is fully mediated by waist circumference. Clinical guidelines could consider waist circumference to replace BMI in screening guidelines.

Disclosure

R.Aggarwal: None. N.Chiu: None. D.L.Bhatt: Board Member; Bristol-Myers Squibb Company, Research Support; Lexicon Pharmaceuticals, Inc., Sanofi, Lilly, Boehringer Ingelheim Inc., AstraZeneca, Novo Nordisk.
1259-P: Resting Heart Rate and Sleep Disorders in Maturity-Onset Diabetes of the Young
Authors: AROSEMENA MARILYN A. , WROBLEWSKI KRISTEN , TASALI ESRA , PHILIPSON LOUIS H.
Published: June 2023

Background: Sleep disturbances have been linked to higher resting heart rate (RHR), a marker of cardiovascular risk. Obstructive sleep apnea (OSA) and insomnia are common in other types of diabetes, but they have not been studied in Maturity Onset Diabetes of the Young (MODY), a unique subtype characterized by patients being lean and not using insulin.

Objective: To evaluate sleep disorders and RHR in MODY.

Methods: Participants were recruited from the Monogenic Diabetes Registry at the University of Chicago. The presence and severity of OSA was objectively assessed by a validated home screening device. Insomnia was assessed by a validated survey (Insomnia Severity Index). Resting (sleeping) heart rate was assessed by Fitbit activity tracker for 2 weeks.

Results: Considering all patients (n=51; Table 1), OSA was found in 37% (31% mild, 2% moderate, 4% severe). Insomnia was found in 47% of patients (10% clinical insomnia and 37% subthreshold insomnia). Overall, the mean RHR was 66±9 bpm, with transcription factor (TF) related MODY (HNF1A, HNF4A, HNF1B) having significantly higher RHR compared to GCK-MODY (70±10 bpm vs. 63±8.7 bpm; p=0.01).

Conclusion: OSA and insomnia are common in patients with MODY despite their lack of traditional risk factors for sleep disorders. TF-related MODY has a higher RHR compared to GCK-MODY. Future research should investigate the pathophysiology of sleep-diabetes relationship in MODY.

Disclosure

M.A.Arosemena: None. K.Wroblewski: None. E.Tasali: None. L.H.Philipson: Advisory Panel; Nevro Corp., Research Support; Novo Nordisk, Dompé, Provention Bio, Inc., Imcyse, Novo Nordisk Foundation.
1260-P: Verifying the Use of FIB4 and BARD Scores to Predict Advanced Fibrosis Using Transient Elastography in People with Type 2 Diabetes in a Tertiary Care Center in India
Authors: TEWARI AJOY , TEWARI JAY , MAHESHWARI ANUJ , TEWARI VINEETA , TEWARI BHAGWAT
Published: June 2023

Background: There is a high prevalence of nonalcoholic fatty liver disease in people with type 2 diabetes. Liver biopsy is the gold standard for diagnosing advanced fibrosis but is usually not feasible in routine clinical practice. Transient elastography is accepted as a viable non-invasive alternative but is not universally available due to high cost. FIB4 and BARD scores are easy to perform in routine clinical practice and can guide for referral for transient elastography or liver biopsy. The aim of this study was to assess the utility of these simple scores (FIB4 and BARD) to exclude advanced fibrosis in people with type 2 diabetes.

Material and Methods: A total of 133 consenting people were subjected to fibro scan. Serum markers (AST, ALT, Platelet count) were measured, and FIB 4 and BARD scores were calculated using standard equations. LSM (liver stiffness measurement) cut-off value of 11.4 was used to exclude advanced fibrosis.

Results: Out of 133 people with diabetes in the study, 51.1% males and 48.9% were females, with a mean age of 50years, BMI 26.6, hba1c 8.7%, duration of diabetes 7.6yrs. The average LSM was 9.1, mean AST was 36 U/ml and ALT 38.5U/ml, platelet count was 208cubic mm. Mean FIB4 score was1.7 and BARD score was 3. 82.7% had a LSM value of <11.5 and 17.3% had a LSM value of>11.5%, neither BARD score nor FIB4 had significant correlation with liver stiffness measurement. Fib4 had a (Negative predictive value) NPV of 83.6% and BARD score had a NPV of 85.7% to exclude advanced fibrosis (>11.4)

Conclusion: A FIB 4 score of less than 2.6 and BARD score of less than 2 have a high negative predictive value to exclude advanced fibrosis. Due to the high incidence of NAFLD in people with diabetes, these should be routinely used to exclude advanced fibrosis and the decision to referral for fibro scans and liver biopsy.

Disclosure

A. Tewari: None. J. Tewari: None. A. Maheshwari: None. V. Tewari: None. B. Tewari: None.
1261-P: Prevalence of Nonalcoholic Fatty Liver Disease and Liver Fibrosis in Patients with Type 1 Diabetes
Authors: SALAH TAREQ , TOMAH SHAHEEN , AL-BADRI MARWA , KIBAA KARIM , DHAVER SHILTON E. , CURRY MICHAEL P. , LAI MICHELLE , JIANG ZHENGHUI , KHATER ABDELRAHMAN , MCCARRAGHER RYAN , DEMATTOS LILY , TRAN MINH , HAMDY OSAMA
Published: June 2023

Nonalcoholic fatty liver disease (NAFLD) is a common comorbid condition in patients with type 2 diabetes. However, little is known about its prevalence among patients with type 1 diabetes (T1D). We used transient elastography to measure controlled attenuation parameter (CAP) as steatosis indicator and liver stiffness measurement (LSM) as fibrosis indicator. We evaluated 537 patients with T1D: age 49±16 years; 55% females; 81% non-Hispanic whites; BMI 27.6±5.5 kg/m2; diabetes duration 29±15.6 years; A1C 7.1±1.0%; total daily insulin (TDI) 49±28 U/day; ALT 19±10 IU/L; AST 22±8 IU/L. The prevalence of NAFLD (CAP≥274 dB/m) was 28.5% (95% CI 24.6-32.6) and fibrosis (LSM≥7 kPa) 8.4% (95% CI 6-11). Moreover, 4.1% (95%CI 2.6-6.2) of NAFLD had ≥F2 fibrosis (LSM ≥ 8.2 kPa) suggesting nonalcoholic steatohepatitis (NASH). Higher CAP positively correlated with higher BMI (p<0.001); diabetes duration (p<0.01); and TDI (p<0.001). It was common in males (OR 2.1, 95%CI 1.3-3.5, p<0.01). Among those with NAFLD, mean ALT was 21±11 IU/L (p=0.02), AST 22±7 IU/L, BMI 32.7±5.8 kg/m2, and waist circumference (WC) 103±15 cm. Among those with fibrosis, mean ALT was 23±10 IU/L (p=0.01), AST 24±7 IU/L (p=0.03), BMI 31.7±6.4 kg/m2 and WC 104±15 cm. Obesity (BMI >30 kg/m2) and larger WC (>102 cm in men, >88 cm in women) were associated with increased risk for hepatic steatosis (OR 3.1, 95% CI 1.6-6.0, p=0.001; OR 4.0, 95% CI 2.2-7.5, p<0.001, respectively). In conclusion, prevalence of NAFLD and liver fibrosis is considerable among patients with T1D, while liver enzymes are within normal range. Obesity and large waist circumference are associated with increased risk of hepatic steatosis. Independent predictors of NAFLD include: higher BMI, longer diabetes duration, higher TDI and male gender. Screening for NAFLD and liver fibrosis is advisable for patients with T1D irrespective of their liver enzymes, particularly in patients with higher BMI, longer diabetes duration or among those treated with larger insulin dose.

Disclosure

T.Salah: None. R.Mccarragher: None. L.Demattos: None. M.Tran: None. O.Hamdy: Advisory Panel; Abbott Nutrition, Nemaura Medical, L-Nutra Inc., Twin Health, Consultant; Sanofi, Research Support; Novo Nordisk, Eli Lilly and Company, Gilead Sciences, Inc., Stock/Shareholder; Healthimation. S.Tomah: Employee; Altimmune. M.Al-badri: None. K.Kibaa: None. S.E.Dhaver: None. M.P.Curry: Advisory Panel; Mallinckrodt PLC, Alexion Pharmaceuticals, Inc., Albireo. M.Lai: None. Z.Jiang: Advisory Panel; Olix Pharmaceutical, Research Support; Pfizer Inc., Gilead Sciences, Inc. A.Khater: None.
1265-P: Insights and Implications—Creating and Executing the First National-Scale Home Sample Collected Autoantibody Screening Service for Type 1 Diabetes (T1D) Risk Assessment for JDRF’s T1Detect
Authors: SEFTEL DAVID
Published: June 2023

On December 12, 2020, a unique home-collected sample T1D autoantibody detection program was launched online. Serving 48 states, the JDRF T1Detect autoantibody screening program features a pioneering 3-year collaboration between the JDRF and a clinical reference laboratory spun out of the University of California at Berkeley and Stanford University. Using a completely novel, and now patented, way of detecting antibodies - using unique DNA barcodes that bind to antibodies and are thus readable by standard PCR machines - the T1Detect program was able to offer gold-standard-matching accuracy using easily-collectable dried blood spot samples. The approach, called Antibody Detection by Agglutination PCR (ADAP) was co-invented by 2022 Nobel Laureate in Chemistry, Stanford Prof. Carolyn Bertozzi. ADAP was validated over 6 years via multiple studies with the NIDDK, TrialNet, the National Science Foundation, the JDRF, the Joslin Diabetes Center, Mayo Clinic and Stanford Pediatric Endocrinology. The presentation covers these aspects: Econometric, individual and public health benefits of T1D risk screening, including selecting patients for closer glycemic monitoring and consideration for therapeutic intervention. Summary of both pediatric and adult T1D incidence studies underlying the emerging consensus around longitudinal general population screening. How the joint program with JDRF was conceived and executed - from ideation to realization. Key T1Detect screening program data findings and outcomes to date. How clinicians can best collaborate with screening programs to enhance the care of first-degree relatives of T1D patients and their general patient population. In summary, the developmental journey of this T1D testing initiative with JDRF and the resulting insights are distinctively first-in-class and can be uniquely instructive and helpful to clinicians and researchers alike.

Disclosure

D.Seftel: Employee; Enable Biosciences, Inc.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (5R44DK111005-03); The Leona M. and Harry B. Helmsley Charitable Trust; Sweden National Science Foundation (1758698); JDRF (2-SRA-2018-535-S-B)
1273-P: Guidance to Persons Who Screen Positive for Islet Autoantibodies and Their Health Care Providers—Ask the Experts
Authors: SIMMONS KIMBER M. , BAUTISTA KIMBERLY A. , GENO RASMUSSEN CRISTY , KARBAN RACHEL , O'DONNELL HOLLY K. , FROHNERT BRIGITTE I. , STECK ANDREA , REWERS MARIAN
Published: June 2023

Objective: Detecting early-stage type 1 diabetes (T1D) by screening for islet autoantibodies (IA) can prevent serious morbidity at clinical onset and allow for a trial prevention, e.g., FDA-approved teplizumab therapy. The Ask the Experts program provides confirmation of positive screening results, monitoring, and education for individuals who screen positive for IA as well as their families and health care providers (HCPs).

Methods: Individuals and HCPs concerned for T1D (e.g., screen positive for IA) can enroll in Ask the Experts via phone, e-mail or website. We recommend and facilitate screening or confirmation of IA status and collect demographic and clinical data. When IA positivity is confirmed, we partner with HCPs to provide early T1D training and collaborative follow-up, customized to HCP interest and clinical capacity.

Results: We have enrolled 71 participants to date, mostly youth (83%), aged 1 to 62 years (61% female; 79% non-Hispanic white). Most referrals were for confirmation of IA results (52%) or HCP concern for early T1D based on dysglycemic HbA1c or glucose (30%). IA were measured at 6 commercial laboratories, including the Barbara Davis Center Autoantibody Laboratory with 53% screening positive for a single IA and 47% for multiple IA. The most common IA detected was insulinoma antigen-2 IA (48%) with glutamic decarboxylase 65 and insulin IAs both present in 41% of those who screened positive. Of those who presented with one or more IA on screening, 66% were negative for all four major IA on confirmation testing completed at the Barbara Davis Center Autoantibody Laboratory. 80% of individuals confirmed IA positive have engaged in remote monitoring while 20% have been followed by their local HCP with our training and support.

Conclusion: Persons who screen positive for IA should have confirmation testing completed given the discordance between screening and confirmation results. HCPs require support for following screening detected individuals.

Disclosure

K.M.Simmons: Advisory Panel; Provention Bio, Inc., Consultant; Dexcom, Inc., Provention Bio, Inc., Research Support; Novartis. K.A.Bautista: None. C.Geno rasmussen: None. R.Karban: None. H.K.O'donnell: None. B.I.Frohnert: Advisory Panel; Provention Bio, Inc. A.Steck: None. M.Rewers: Research Support; Provention Bio, Juvenile Diabetes Research Foundation (JDRF), Hemsley Charitable Trust, Dexcom, Inc., Janssen Research & Development, LLC.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
1277-P: Prediction of HbA1c Test Eligibility in Emergency Department
Authors: SMART MARY , LIN JANET , LEE TODD , LAYDEN BRIAN T. , EISENBERG YUVAL , DANIELSON KIRSTIE K. , KONG ANGELA
Published: June 2023

Introduction: Diabetes screening using best practice advisory (BPA) alerts integrated into the emergency department (ED) workflow may efficiently identify at-risk patients disproportionally affected by diabetes. The objectives of this study were to 1) validate a BPA algorithm informed by the American Diabetes Association (ADA) screening criteria using elements from the electronic medical record (EMR) to identify eligible patients for hemoglobin A1c (HbA1c) testing, and 2) compare the characteristics of the ADA-based algorithm with one informed by the United States Preventative Services Task Force (USPSTF) recommendations.

Methods: This cross-sectional study involved adults admitted to the University of Illinois Health ED in May 2021 with labs ordered (n=2963). Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) estimated the BPA algorithm’s ability to correctly identify patients eligible for diabetes screening using manual EMR chart review as the reference standard. Receiver operator characteristic (ROC) curves and area under the curve (AUC) were calculated to compare ADA and USPSTF-informed algorithms.

Results: The sensitivity, specificity, PPV, and NPV of the ADA model were 0.70 (95% CI: 0.66-0.75), 0.91 (0.90-0.92), 0.76 (0.73-0.79), and 0.88 (0.86-0.89), respectively. Compared to the ADA model, the USPSTF model’s sensitivity was worse (0.25 (0.22-0.27)) and specificity was slightly higher (0.94 (0.93-0.95)), though PPV remained similar (0.75 (0.71-0.79)) and NPV was lower (0.64 (0.62-0.66)). The ROC AUC for the ADA and USPSTF-based models were 0.91 (0.89-0.93) and 0.86 (0.84-0.89), respectively.

Conclusion: Despite moderate to low sensitivity, the PPVs and large AUCs are acceptable due to the high prevalence of at-risk populations presenting to the ED. Findings suggest that a BPA algorithm informed by the ADA guideline is an adequate tool to identify eligible patients for diabetes screening in the ED, especially given its ease of workflow integration.

Disclosure

M.Smart: None. J.Lin: Research Support; Novo Nordisk, Xeris Pharmaceuticals, Inc. T.Lee: None. B.T.Layden: Consultant; Bayer Inc. Y.Eisenberg: None. K.K.Danielson: None. A.Kong: None.

Funding

Novo Nordisk (G2111)
1278-P: Prevalence of Untreated Prediabetes and Alterations of Glucose Metabolism in Mexico—A Nationally Representative Analysis Spanning 2016–2021
Authors: FERMÍN-MARTÍNEZ CARLOS A. , PAZ CABRERA CÉSAR D. , PEREZALONSO ESPINOSA JERONIMO , EDUARDO ANTONIO VILLA NEFTALI , RAMÍREZ-GARCÍA DANIEL , VARGAS-VÁZQUEZ ARSENIO , FERNÁNDEZ CHIRINO LUISA , SEIGLIE JACQUELINE A. , YAXMEHEN BELLO-CHAVOLLA OMAR
Published: June 2023

Background: Identifying phenotypes at risk of diabetes may be useful in guiding prevention efforts. Here, we estimated the prevalence of glucose metabolism disturbances in Mexico and the association of different prediabetes criteria with cardiometabolic conditions.

Methods: We conducted a serial cross-sectional analysis of National Health and Nutrition Surveys in Mexico (2016-2021), excluding individuals with diagnosed or undiagnosed diabetes. Prediabetes was defined using ADA (FPG 100-125 mg/dL and/or HbA1c 5.7-6.4%), WHO (FPG 110-125 mg/dL), and IEC criteria (HbA1c 6.0-6.4%).

Results: We analyzed a total of 21,440 participants. Prediabetes prevalence in Mexico rose between 2020 (19.2% [95% CI: 17.1-21.4]) and 2021 (27.3% [24.4-30.2]) (Fig1A), with the increase largely driven by higher HbA1c (Fig1B). Prediabetes prevalence was highest in older adults (≥60 years), individuals with obesity (BMI ≥30 kg/m2), and those with high social disadvantage. Prevalence of prediabetes defined by concordant ADA, WHO and IEC criteria were low; however, these definitions better identified cardiometabolic alterations (Fig1C).

Conclusion: The burden of prediabetes is rising in Mexico and in high-risk populations. Use of concordant ADA criteria and higher diagnostic thresholds may help identify subjects at increased risk of cardiometabolic comorbidities.

Disclosure

C.Fermín-martínez: None. C.D.Paz cabrera: None. J.Perezalonso espinosa: None. N.Antonio villa: None. D.Ramírez-garcía: None. A.Vargas-vázquez: None. L.Fernández chirino: None. J.A.Seiglie: Consultant; BDMT Global, Techspert Expert Network. O.Bello-chavolla: None.
1284-P: Prediabetes with Obesity Is a Major Risk Factor for NAFLD and Liver Fibrosis
Authors: GODINEZ LEIVA EDDISON , LOMONACO ROMINA , SHRESTHA SULAV , MARANGI STEPHEN A. , CHI XIAOFEI , KALAVALAPALLI SRILAXMI , SHETTY SHWETHA S. , ORTIZ ROCHA ANDREA , VALDEZ SAENZ ENRIQUE , GONZALEZ MARIA A. , MANSOUR LYDIA , CALVET MARIANNA M. , BARB DIANA , MATHEWS APRIL , SHARMA ANU , CUSI KENNETH
Published: June 2023

Clinical practice guidelines suggest that patients with prediabetes (preDM) are at a higher risk of NAFLD and liver fibrosis, among other high-risk groups. However, there is limited data available. The aim of this study was to examine the prevalence of liver steatosis and fibrosis in preDM in unselected patients attending their regular outpatient visits, unaware of having NAFLD. To this end, we recruited 711 middle-aged patients in whom elastography was performed to screen for liver fibrosis (liver stiffness measurement or LSM, 1º outcome) and for steatosis (CAP: ≥274 dB/m, 2º outcome). Among them, 127 had preDM, 254 T2DM and 330 were healthy controls (CON). The 3 groups were matched for age, gender and BMI. The prevalence of NAFLD (by CAP) was higher in T2DM (67%) and preDM (54%) vs. CON: 40% (both p<0.01 vs. CON). Overall, the OR 95% CI for steatosis in preDM vs. CON was 1.64, 1.05-2.58 (p<0.01). Steatosis also increased in preDM independent of obesity (non-obese [OB] CON: 26% vs. non-OB preDM: 38% vs. non-OB T2DM: 47%; p <0.05 vs. CON). The prevalence of any liver fibrosis (LSM ≥7.0 = ≥F1) was 3-fold higher among preDM vs. CON (6% and 2%, p=0.015), but significantly lower than in T2DM (17%; p<0.001). Moderate-to-severe fibrosis (≥F2) also happened more often in preDM 5% vs. CON 1% (in T2DM = 9%; both vs. CON p<0.01). Obesity led to a higher prevalence of NAFLD in T2DM (78%) and in preDM (71% vs. 26% in non-OB CON; p<0.01). Obesity increased the prevalence of liver fibrosis in preDM and T2DM (increasing from 1% [non-OB] to 13% [OB] and from 4% to 23%, respectively; both p <0.05) with the majority having F≥2 (10% and 13%, respectively). Prediabetes with obesity vs. CON with obesity had a 3-fold rate of liver fibrosis (3.35, 1.04-10.82; p<0.001). Conclusion: Prediabetes is associated with a high prevalence rate of NAFLD and liver fibrosis, both increasing significantly in the presence of obesity. Prediabetes deserves screening and fibrosis risk stratification to prevent cirrhosis, in particular, in the presence of obesity.

Disclosure

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

Funding

National Institutes of Health (R01120331-01A1)
1286-P: Hyperinsulinemia Is Common in Individuals with Normoglycemia in a Nationwide Working-Age Population
Authors: LOUIE JUDY Z. , SHIFFMAN DOV , MEIGS JAMES B. , MCPHAUL MICHAEL J.
Published: June 2023

Introduction: Hyperinsulinemia is associated with future diabetes and cardiovascular disease. However, fasting insulin (FI) levels are rarely assessed in individuals with normoglycemia. To investigate the potential magnitude of undiagnosed hyperinsulinemia (FI >16 uIU/mL), we assessed the prevalence of hyperinsulinemia in individuals with normoglycemia (fasting glucose [FG] 70 to <100 mg/dL) in a nation-wide study of working-age individuals without diabetes.

Methods: The study included employees and spouses who participated in an annual health assessment program at Quest Diagnostics (October 2020 to February 2021). Those with diabetes, with FG <70 or ≥100 mg/dL, or with missing data were excluded. FI was measured by a mass-spectrometry assay standardized for the peptide content of WHO reference materials.

Results: Participants included 23,339 individuals (68% women) with normoglycemia (FG ≥70 or <100 mg/dL) and median age of 43 years (IQR 34 to 53). Hyperinsulinemia was observed in 7% (n =1,546) of participants. Of these, 1,064 individuals also participated in the health assessment program in a subsequent year and 46% (n =490) of them had persistent hyperinsulinemia. Obesity (BMI ≥30 kg/m2) was more common (83% vs. 71%) in those with persistent hyperinsulinemia than in those without (P <0.001) and they had lower HDL-C levels (45 vs 47 mg/dL, P <0.001) Age, sex, and triglyceride levels did not differ between those with and without persistent hyperinsulinemia (all P >0.05). Of the 490 individuals with persistent hyperinsulinemia, 76% (n =373) had persistent normoglycemia.

Conclusion: In a large population of working-age individuals, hyperinsulinemia was found in about 1 in 15 individuals with normoglycemia. Those with persistent hyperinsulinemia in a subsequent year were more likely to have obesity and lower HDL-C levels, and about 1 in 5 were no longer normoglycemic. Measurement of FI levels may have value in even apparently metabolically normal individuals.

Disclosure

J.Z.Louie: Employee; Quest Diagnostics. D.Shiffman: Consultant; Quest Diagnostics, Employee; Quest Diagnostics. J.B.Meigs: Consultant; Quest Diagnostics. M.J.Mcphaul: Employee; Quest Diagnostics.