bluuebunny/crossref_metadata_2025 huggingface dataset:
882-P: QBSAFE: Pilot Study of an Intervention to Shift the Paradigm of Diabetes Care
Authors: CLARK JENNIFER , BOEHMER KASEY , BRESLIN MAGGIE , HAIDER SHANZAY , PASCIAK WERONIKA , GRAVHOLT DEREK , SANCHEZ BRIANNA B.M. , HARTASANCHEZ SANDRA A. , EL KAWKGI OMAR M. , MONTORI VICTOR M. , LIPSKA KASIA J.
Published: June 2021

Background: Diabetes care has traditionally focused on targeting certain levels of glycemic control. This narrow emphasis may impose burdens on patients, including high treatment costs, illness-related work, or medication side effects, while leaving other needs and goals under-addressed.

Methods: In order to shift the focus of care for people with diabetes to Quality of life, Burden of treatment, Safety, and Avoidance of Future Events (QBSAFE), we developed a set of 14 conversation cards that addressed these QBSAFE domains and could be used during routine clinical encounters. We then conducted a single-arm pilot study assessing the feasibility and acceptability of the QBSAFE cards during clinical visits. Visits were video recorded to identify patterns of clinician-patient conversations. Post-visit surveys were sent to patients and clinicians to measure acceptability of the intervention. Qualitative semi-structured interviews for additional feedback and analysis were also performed in a subgroup of patients.

Results: Seven clinicians and 83 patients (54% male, mean age 63 years [SD 15], 80% white) participated in the study. Among patient participants, 63% reported QBSAFE cards were helpful and 76% felt that other patients like them would benefit from their use. In qualitative interviews, patients who responded with ‘neutral’ or ‘disagree’ categories reported feeling they could bring up QBSAFE topics without the cards due to an established, positive relationship with their clinician. Among clinician participants, 90% reported feeling confident addressing issues raised by the cards, 78% would use them again, and 82% would recommend them to their colleagues.

Discussion: With high acceptability among clinicians and patients, the QBSAFE cards have the potential to shift conversations during clinical encounters and address patient needs, symptoms, and capacity. These data suggest that a clinician-level cluster randomized trial to compare the impact of this intervention versus usual care is needed.

Disclosure

J. Clark: None. V. M. Montori: None. K. J. Lipska: None. K. Boehmer: None. M. Breslin: None. S. Haider: None. W. Pasciak: None. D. Gravholt: None. B. B. M. Sanchez: None. S. A. Hartasanchez: None. O. M. El kawkgi: None.

Funding

National Institute on Aging (5R21AG061427-02)
887-P: Moderator Role of Family Protective Factors on the Association between Family Structure Type and Obesity in Children
Authors: SONG MINKYOUNG , HAYMAN LAURA L. , DIECKMANN NATHAN , MUSIL CAROL
Published: June 2021

Purpose: Current literature indicates that childhood obesity is associated with family structure type. For example, children living in grandparent-headed households are more likely to be obese compared to children living in two-parent headed households. However, little is known about the conditions that might interact with family structure to influence children’s obesity. Since family protective factors are known to directly influence childhood obesity, we examined whether two specific family protective factors might moderate the association between family structure type and childhood obesity.

Methods: We utilized data from the 2017-2018 National Survey of Children’s Health (n=24,800). Multivariable logistic regressions were used to assess the moderating effect of “family resilience” and families eating meals (7 vs. < 7 days/week). We controlled for child’s sex, age, race/ethnicity, health insurance, number of adverse childhood experiences, and physical activity level. We tested the moderating effect of family resilience and family meals as dichotomous variables, on the association between family structure type and obesity.

Results: In the fully adjusted models, we observed no significant moderating effect of family resilience on the association between family structure type and childhood obesity. There was a moderating effect of the family meal variable: In grandparent-headed households (compared to two-parent headed households), children were significantly less likely to be obese when families ate meals together 7 days/week (adjusted odds ratio [aOR] =0.95) vs. < 7 days/week (aOR = 2.55). In single-parent headed households, the association did not differ significantly by that variable (aOR =1.02 vs. 1.46).

Conclusion: Our results provide evidence that eating meals together is one family protective factor that could be important considerations when developing family-based obesity interventions for children living with their grandparents.

Disclosure

M. Song: None. L. L. Hayman: None. N. Dieckmann: None. C. Musil: None.
907-P: Diabetes-Inspired Culinary Education (DICE): An Innovative Approach to Type 1 Diabetes Management through Culinary Medicine
Authors: MCMANUS CATHERINE R. , BARKOUKIS HOPE , KIM ROY , NGUYEN JULIA
Published: June 2021

Despite the critical role nutrition plays in T1DM management and growth/development, youth with TIDM consistently have poorer diet qualities compared with their healthy counterparts. While culinary medicine is an area of research that is still in its infancy, initial studies have demonstrated success in improving youth diet quality and dietary and disease management outcomes in individuals with T2DM. Yet despite its great potential to elicit positive behavior change among youth with T1DM, this area of research is under-explored. Therefore, Diabetes Inspired Culinary Education (DICE), a community-based culinary medicine program aiming to improve diet quality and disease management among 6-14 year old youth with T1DM, was developed and assessed for feasibility and potential efficacy in a pilot study. The DICE program included ten, 90-minute lessons delivered weekly at a community teaching kitchen and included: hands-on, age-appropriate culinary education; nutrition and diabetes education delivered through experiential learning; a group family meal prepared by participating youth; and culinary/mealtime goal-setting. Baseline and post-test outcomes were assessed on participating families at the child- (food preparation self-efficacy (SE), involvement, attitude; dietary intake; diabetes management; diabetes quality of life; hgbA1c; BMI), primary caregiver- (dietary intake; diabetes management SE; mealtime SE; BMI) and family-level (family food preparation; mealtime environment). Feasibility was evaluated using participant attendance, retention and a program-specific fidelity tool. Eleven families were recruited and 8 completed (73% retention) the program. On average, 78% of participating families attended weekly lessons. Improvements in primary caregiver SE for healthy mealtime behaviors (p=0.02) and family food preparation (p=0.05) were observed at post-test, inferring potential program efficacy.

Disclosure

C. R. Mcmanus: None. H. Barkoukis: None. R. Kim: None. J. Nguyen: None.
909-P: Telemedicine Visits Attendance and Perception among Pediatric Patients with Type 1 Diabetes
Authors: DEMETERCO-BERGGREN CARLA , GOTTSCHALK MICHAEL
Published: June 2021

COVID-19 pandemic has triggered the widespread adoption of Telemedicine (TM). As physical distancing measures were established, we rapidly shifted our outpatient appointments to TM. Here we show findings regarding patient TM perception and attendance. Patient demographics and attendance to in person and TM outpatient encounters from January to July 2020 were reviewed. A survey evaluating TM perceptions was distributed to patients and their families following an encounter between March and July 2020. Our diabetes clinic currently cares for 1504 unique patients with type 1 diabetes (T1D) with 46% being publicly insured. A total of 1,653 encounters including in person and TM were included in the analysis. TM visits became available in March 2020, with a total of 571 encounters by July 2020. There was a significantly lower number of completed TM encounters by publicly insured patients when compared with privately insured (p value=0.03523) and a threefold increase in no-shows and same day cancelations by the publicly insured group. Perception of TM was addressed with a survey completed by 40 patients. TM perception was positive with 86% of patients being very satisfied with the visit. TM encounter was thought to be the same as in person encounter by 60% and better than in person visit by 37% of patients. Reported benefits associated with TM included: overall time saved, no missed school day for the patient or workday for the parent, decreased childcare and transportation costs.

In conclusion, although TM is perceived as positive by patients with T1D, low-income families showed lower TM visit attendance rate when compared to privately insured families. The COVID-19 pandemic has highlighted disparities related to access to and use of technology to improve diabetes care. More research is needed to identify the specific causes for the disparities. Patient centered approach to increase education and help navigate the processes required for utilizing TM technology may help decrease the health equity gaps.

Disclosure

C. Demeterco-berggren: None. M. Gottschalk: None.
93-OR: Muller Glial-Derived Zfp36 Expression Protects the Retina from Diabetes-Induced Damages in the Early Stage of Diabetic Retinopathy
Authors: WANG SUI
Published: June 2021

Diabetic retinopathy (DR), one of the most common complications of diabetes, is the leading cause of blindness among working-age populations in the US. The molecular mechanisms responsible for the initiation and early progression of DR have not been fully elucidated. This represents a significant barrier to the development of effective therapies to prevent or slow down the initiation of DR. Retinal Müller glial cells have been shown to play important roles in the initiation and early progression of DR. However, the underlying molecular mechanisms remain unclear. To address this question, we profiled the transcriptomic alterations induced by diabetes specifically in Müller glial cells by RNA-seq in the early stage of DR using diabetic rat models. Zinc finger protein 36 homolog (Zfp36), which is a RNA binding protein and functions via destabilizing the mRNAs of pro-inflammatory genes, was found to be upregulated in Müller glia by diabetes at one and two months after the induction of diabetes. As the disease progresses, the level of Zfp36 decreased to below its normal level starting from three months after diabetes. In addition, depleting Zfp36 enhanced gliosis, retinal ganglion cell degeneration, and vascular lesions in diabetic rats. Over-expression of Zfp36 slowed down the occurrence of DR-related retinopathy phenotypes. More importantly, Zfp36 can modulate inflammatory responses induced by diabetes in Müller glial cells. Based on these results, we concluded that Müller glial cells can exert protective roles via Zfp36, and failure of maintaining Zfp36 levels contributes the development of DR.

Disclosure

S. Wang: None.

Funding

American Diabetes Association/Pathway to Stop Diabetes (1-16-INI-16)
942-P: The Choline Metabolite TMAO Inhibits NETosis and Promotes Placental Development in GDM of Humans and Mice
Authors: LIN XIAOJING , ZHANG YUNQI , HE XIAOLING , CHEN NAN , WANG MIAORAN , CHEN YAN , XIAO XIAOQIU
Published: June 2021

Objective: Trimethylamine N-oxide (TMAO) is a choline metabolite and has been reported as a risk factor of gestational diabetes mellitus (GDM). Diabetes primes neutrophils to produce neutrophil extracellular traps (NETosis). We investigated the effect of TMAO and NETs on the placenta and revealed the role of TMAO and NETs in GDM.

Methods: Peripheral plasma, cord plasma and placenta from normal pregnant and GDM women were collected. Plasma concentrations of TMAO, ds-DNA and myeloperoxidase (MPO) were compared and association analysis was performed. HTR-8/Svneo cells and GDM models of wild-type and PAD4-/- mice were used to observe the effect of TMAO and NETs on the placenta.

Results: The peripheral and cord plasma TMAO levels of GDM women were significantly higher than those of control. BMI and glucose levels were positively correlated with the concentration of blood TMAO, especially the newborn weight and placental thickness were positively correlated with TMAO levels in cord blood. TMAO could promote proliferation, migration, invasion and angiogenesis of HTR-8/Svneo cells, and TMAO-treated neutrophils could resist NETosis stimulated by PMA or LPS. Plasma concentrations of ds-DNA and MPO in peripheral and cord blood were significantly higher in GDM women, and BMI and blood glucose levels were positively correlated with ds-DNA and MPO levels. MPO levels from GDM placenta were also higher than those in the control group. NETs inhibit the proliferation, migration, invasion and angiogenesis of HTR-8/Svneo cells. The placenta weight of PAD4-/- mice was significantly higher than that of wild-type mice. TMAO feeding also significantly increased the weight of the placenta and fetuses, and this increase did not affect the normal structure of the placenta.

Conclusion: Higher TMAO levels and abnormal NETosis were associated with GDM. TMAO could not only promote the development of the placenta and fetus, but also inhibit NETosis to protect the placenta.

Disclosure

X. Lin: None. Y. Zhang: None. X. He: None. N. Chen: None. M. Wang: None. Y. Chen: None. X. Xiao: None.

Funding

National Natural Science Foundation of China (82071734, 81871222)
946-P: Unchanged Prevalence of Preeclampsia after Implementation of Prophylactic Aspirin to All Pregnant Women with Preexisting Diabetes: A Prospective Cohort Study
Authors: DO NICOLINE C. , VESTGAARD MARIANNE , ÁSBJÖRNSDÓTTIR BJÖRG , NOERGAARD SIDSE K. , RINGHOLM LENE , ANDERSEN LISE LOTTE TORVIN , JENSEN DORTE M. , DAMM PETER , MATHIESEN ELISABETH R.
Published: June 2021

Aim: To evaluate the prevalence of preeclampsia before and after implementing a change from a risk-based aspirin prophylaxis to prophylactic aspirin to all pregnant women with pre-existing diabetes.

Methods: A prospective cohort study of 410 consecutive pregnant women with pre-existing diabetes (257 with type 1 and 153 with type 2 diabetes); 203 women (selected-cohort) prior to February 2018 where aspirin was prescribed to selected women at risk of preeclampsia followed by 207 women (all-cohort) who all were prescribed aspirin according to the new aspirin prophylaxis strategy. The primary outcome was preeclampsia.

Results: Documented prescription of aspirin at approximately 10 weeks increased from 25% (selected-cohort) to 88% (all-cohort). In the all-cohort vs. selected-cohort HbA1c (median 46 mmol/mol (interquartile range 42-53) vs. 47 (43-53), p=0.18), parity, chronic hypertension, home blood pressure, microalbuminuria/diabetic nephropathy and smoking were similar in early pregnancy. In the all-cohort fewer women had type 2 diabetes (32% vs. 42%, p=0.04) and BMI tended to be lower (p=0.05). The prevalence of preeclampsia was unchanged (12% vs.11%, p=0.69) in the all- vs. selected-cohort and similar results were seen when stratifying for diabetes type. Preterm delivery <37 weeks (23% vs. 27%, p=0.30), preterm delivery with preeclampsia (7% vs. 7%, p=0.96), and large and small for gestational age infants (40% vs. 32% (p=0.07) and 7% vs. 6% (p=0.88), respectively) were similar in the two cohorts.

Conclusion: Implementation of prophylactic aspirin to all pregnant women with pre-existing diabetes was not followed by a decline in the prevalence of preeclampsia. The possible effect of aspirin prophylaxis in women with diabetes needs to be further evaluated in randomized controlled trials.

Disclosure

N. C. Do: None. M. Vestgaard: None. B. Ásbjörnsdóttir: Employee; Self; Novo Nordisk A/S. S. K. Noergaard: Research Support; Self; Novo Nordisk. L. Ringholm: Research Support; Self; Novo Nordisk. L. Andersen: None. D. M. Jensen: None. P. Damm: Advisory Panel; Self; Novo Nordisk A/S, Other Relationship; Self; Novo Nordisk A/S. E. R. Mathiesen: Advisory Panel; Self; Novo Nordisk, Research Support; Self; Novo Nordisk, Speaker’s Bureau; Self; Novo Nordisk, Sanofi-Aventis.
952-P: Deranged Liver Enzyme Levels and Indices of Hepatic Steatosis and Fibrosis on the Development of Gestational Diabetes
Authors: CHAI THORA Y.L. , PASUPATHY DHARMINTRA , GEORGE JACOB , CHEUNG N. WAH
Published: June 2021

Objective: Nonalcoholic fatty liver disease has been associated with the development of gestational diabetes (GDM). We sought to determine whether abnormal liver enzyme levels and indices of hepatic steatosis and fibrosis in an entire pregnant population are associated with GDM development.

Methods: A retrospective cohort study was conducted on adult women (≥18 years) who delivered at 2 teaching hospitals in Sydney Australia from January 2016 to December 2017. Liver enzymes (aspartate aminotransaminase (AST), alanine aminotransaminase (ALT), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), albumin (ALB) and bilirubin (BIL)) obtained 12 months pre-gravid, or during pregnancy but prior to GDM screening, were extracted from the hospital pathology database and linked with oral glucose tolerance test results. The Fibrosis-4 (FIB-4) and Hepatic Steatosis Index (HSI) were calculated. Univariate analysis was undertaken to determine the association between deranged liver enzymes, FIB-4, HSI and GDM. Multiple logistic regression, with adjustment for age, ethnicity, pre-gravid body mass index (BMI), parity, prior GDM and family history of diabetes, was conducted to determine if any of these were independent predictors of GDM.

Results: Over 2 years, 1429 women had liver enzymes collected. As per IADPSG (2010) criteria, 255 had diagnosed GDM, of which 82 (32.2%) were obese (BMI >30kg/m2), 243 (82.4%) were multiparous, and 223 (87.5%) had prior GDM. Elevated GGT (>35IU/L, p=0.006) and HSI (p=0.005) were associated with development of GDM, whilst low ALB (<35g/L) and elevated ALP (>110IU/L), ALT (>35IU/L), AST (>35IU/L), BIL (>19umol/L) and FIB-4 were not. On adjustment for confounders, elevated GGT (AOR 1.1, 95% CI 0.32-3.8, p=0.88) and HSI (AOR 0.6, 95% CI 0.26-1.3, p=0.21) were not independent predictors of GDM.

Conclusions: Our results indicate deranged liver enzymes or clinical indices of hepatic steatosis and fibrosis were not associated with GDM.

Disclosure

T. Y. L. Chai: None. D. Pasupathy: None. J. George: None. N. Cheung: None.
955-P: Postpartum Carbohydrate Intake Is Not Associated with Oral Glucose Tolerance Test Results
Authors: ROSENBERG EMILY A. , SEELY ELLEN W. , JAMES KAITLYN , CALLAHAN MICHAEL J. , NELSON STACEY , POWE CAMILLE E.
Published: June 2021

Background: In pregnant and postpartum (PP) women, an oral glucose tolerance test (OGTT) is the diagnostic test of choice for glucose intolerance. Consistent with classic studies outside of pregnancy, we recently found that lower carbohydrate intake on the day before an OGTT in pregnancy was associated with higher post-load OGTT glucose. Here, we test for a relationship between carbohydrate intake and OGTT glucose in PP women.

Methods: PP women (N=84, median [IQR] = 9 [8-14] weeks PP) completed a 75 g OGTT and a validated self-administered 24-hr dietary recall. We tested for an association between carbohydrate intake in the day before the OGTT and 1-hr OGTT glucose using linear regression, with adjustment for age, race, BMI, time postpartum, and caloric intake. We also tested for associations with 30 minute and 2-hr OGTT glucose and glucose area under the curve (AUC). A subset of women (N=72) had completed the same protocol during pregnancy (median=26 weeks gestation).

Results: PP women with lower carbohydrate intake (<median=230 g/day) had similar age, BMI, race, education, GDM status, time postpartum, and time fasting before OGTT to women with higher intake. We found a trend toward higher fasting glucose in those with lower carbohydrate intake (median=87 vs. 81 mg/dl, P=0.09), but no association between carbohydrate intake and post-load OGTT glucose (1-hr: β=1.2 mg/dl, P=0.74, 30 min: β=-2.0 mg/dl, P=0.39, 2-hr: β=1.0 mg/dl, P=0.74, AUC: β=66, P=0.83). Post-load results did not change with fasting glucose adjustment. In women with data available in pregnancy, we found similar results to those previously reported: at ~26 weeks gestation, lower carbohydrate intake was associated with higher OGTT glucose.

Conclusion: While carbohydrate intake in the day prior to an OGTT may alter gestational diabetes diagnosis, we found no relationship between carbohydrate intake and OGTT glucose among PP women. Metabolic factors that differentiate the pregnant and postpartum state may account for our findings.

Disclosure

E. A. Rosenberg: None. E. W. Seely: None. K. James: None. M. J. Callahan: None. S. Nelson: None. C. E. Powe: None.

Funding

National Institutes of Health (K23DK113218); Robert Wood Johnson Foundation (T32DK007028); Massachusetts General Hospital
961-P: Management of Gestational Diabetes (GDM): Are New Glycemic Targets Needed?
Authors: FESTA CAMILLA , VIOLATI MATTEO , AMOROSI FRANCESCA ROMANA , BITTERMAN OLIMPIA , CONVERTINO ALESSIO , GIULIANI CHIARA , MARAVALLE MAURIZIO , NAPOLI ANGELA
Published: June 2021

Background and Aim: There is no consensus on glycemic targets for the management of GDM. Since women with GDM managed with current glycemic targets show still worse pregnancy outcomes than women without it, we aim to identify which glycemic levels are associated to normal pregnancy outcomes with particular reference to Large for Gestational Age (LGA) rate.

Methods: This is an observational study, involving women with GDM (IADPSG criteria) from 2016 to 2019. Glycemic values <90 mg/dl at fasting and <130 mg /dl 1h after a meal were "in target." Blood Glucose (BG) levels and clinical factors were related to LGA/GDM adverse outcomes through Data Analysis, Multiple Correspondence Analysis and conceptual maps. The RECPAM (RECursive Partitioning and Amalgamation) analysis was used to identify homogeneous and distinct groups of patients at risk for LGA/adverse outcome and to set the glycemic value cut-off discriminating for LGA/adverse outcome.

Results: We analyzed 386 women and 40844 glycemic values. We found 4 natural categories for fasting BG (<78.2; ≥78.2 and <84; 84-89; ≥90 mg/dl) and 5 for post-prandial BG. Women exceeding the cut-off of 84 mg/dl at fasting > 2 times in the week, showed a high rate of LGA than those who did not (p 0.02), were more often overweight and needed insulin, enrolled earlier, had higher HbA1c values and an inadequate weight gain (p .001). The conceptual maps identified 3 clusters of women grouped homogeneously and distinctly according to BG and outcomes: women with fasting and postprandial BG included in the first two natural categories showed better outcomes than those with higher values, with a linear trend. BG> 84 mg/dL in more than 2/7 measurements, BMI> 25 kg/m2, and inadequate weight gain were predictive factors of LGA risk (OR 0.9 CI95% 1.2-5, p .012; OR 0.713 CI95% 1-3.8, p .029 OR 0.792 CI95% 1-4.8, p .04). Finally, RECPAM identified women with BMI> 25 kg/m2 and/or with fasting blood glucose> 97 mg/dl as a higher LGA risk subgroup.

Conclusions: Tighter glycemic targets for GDM management are needed.

Disclosure

C. Festa: None. M. Violati: None. F. Amorosi: None. O. Bitterman: None. A. Convertino: None. C. Giuliani: None. M. Maravalle: None. A. Napoli: None.
972-P: Trends in Rehospitalisation Rates for Myocardial Infarction, Heart Failure, and Stroke in People with and without Diabetes in Australia from 2012-2018
Authors: MORTON JEDIDIAH I. , ILOMAKI JENNI , WOOD STEPHEN J. , MAGLIANO DIANNA J. , SHAW JONATHAN E.
Published: June 2021

Contemporary estimates of readmission rates and trends over time following cardiovascular events are required to prioritise clinical care. We estimated the incidence of readmission for myocardial infarction (MI) and heart failure (HF) following an MI, and of readmission for stroke following a stroke, stratified by diabetes status. We included everyone who was discharged from a hospital following an MI or stroke between 1 July 2012 and 30 June 2017 in Victoria, Australia (n=102323). Individuals were followed from discharge following an MI until readmission for MI or HF, or followed from discharge after a stroke until readmission for stroke, censoring at death or 1 year of follow-up. The incidence (per 100 person-years) of readmission for MI decreased in both people with and without diabetes (from 28.9 [95% CI: 27.4, 30.5] to 27.0 [25.6, 28.5] and from 18.5 [17.8, 19.3] to 15.2 [14.5, 16.0] from 2012 to 2016 [years beginning 1 July] in people with and without diabetes, respectively), but the incidence of readmission for HF only improved in people without diabetes (from 23.4 [22.0, 24.9] to 22.5 [21.1, 23.9] and 4.5 [4.1, 4.9] to 3.2 [2.9, 3.5]), and the incidence of readmission for stroke did not change (from 11.0 [9.5, 12.9] to 10.6 [9.2, 12.2] and 10.3 [9.3, 11.3] to 11.2 [10.3, 12.2]). However, the incidence rate ratio for people with vs. without diabetes increased for readmission for MI and HF. The excess risk for readmission for MI and HF for people with diabetes persisted after adjustment for age, sex, socioeconomic status, polypharmacy, comorbidity, and the competing risk of death: with subhazard ratios of 1.32 (1.28, 1.37) for MI and 3.77 (3.57, 3.98) for HF. The effect of diabetes on readmission for MI, but not HF or stroke, was stronger for women than men. Thus, improvements in rates of readmission for MI and HF were greater in people without diabetes than people with diabetes, therefore the excess risk for people with diabetes worsened from 2012-2018.

Disclosure

J. I. Morton: None. J. Ilomaki: Consultant; Self; AstraZeneca, Research Support; Self; Amgen Inc., Research Support; Spouse/Partner; GlaxoSmithKline plc. S. J. Wood: None. D. J. Magliano: None. J. E. Shaw: Advisory Panel; Self; Eli Lilly and Company, Merck Sharp & Dohme Corp., Pfizer Inc., Research Support; Self; AstraZeneca, Speaker’s Bureau; Self; AstraZeneca, Eli Lilly and Company, Novo Nordisk.

Funding

Australian Government Research Training Program (to J.I.M.); Monash University (to J.I.M.)
973-P: Unmet Social Needs and Emergency Department Visits and Hospitalization among U.S. Safety-Net Health Center Patients with Both Diabetes and Hypertension
Authors: YAN ALICE , OZIEH MUKOSO N. , SHI ZUMIN
Published: June 2021

Introduction: Diabetes and hypertension coexist in approximately 40 to 60% of patients with type 2 diabetes. This study examined the association between unmet social needs and emergency department (ER) visits and hospitalizations for this high group.

Methods: Cross-sectional data on adults (aged≥18 years) with self-reported diabetes from the 2014 National Health Center Patient Survey (HCPS) was analyzed. The HCPS is a nationally representative survey of patients who receive care at safety-net health centers. Outcomes (binary) were the ER visits or hospitalizations due to diabetes and hypertension (HBP) in prior 12 months. The independent variables were 17 SDOH unmet social factors clustered three domains: (1) basic needs; (2) Health-related social needs (i.e., transportation, medical interpreter) and (3) adverse income or assets factors (food stamps and unstable housing). Responses were coded as binary (unmet or met). Logistic regression models with complex sampling design tested the association between adverse SDOH and the outcome, adjust for sociodemographic covariates.

Results: The prevalence of HBP was 74.7% among diabetic adults. Among 910 participants (61.3% female and 25.6% Blacks) with comorbidities of diabetes and hypertension (16.9% weighted prevalence), 40.0 % were unstably housed and 52.1% were food stamp recipients and their top 3 unmet were home visit, find a job, and basic clothing/shoes. In the fully adjusted model, receiving food stamps and unmet needs in obtaining free medications were positively associated with, and unmet needs in free service outside health center were inversely associated with HBP related ER or hospitalization.

Conclusions: Interventions that address unmet financial needs and help with obtaining free/affordable medications may improve health outcomes for this high-risk group.

Disclosure

A. Yan: None. M. N. Ozieh: None. Z. Shi: None.
978-P: Prevalence of Diabetic Cardiomyopathy in Adults with Diabetes or Prediabetes and Its Association with the Risk of Overt Heart Failure: A Multicohort Analysis
Authors: SEGAR MATTHEW W. , PATEL KERSHAW , KONDAMUDI NITIN , PANDEY AMBARISH
Published: June 2021

Introduction: Diabetic cardiomyopathy (DbCM) is characterized by abnormalities in cardiac structure or function in the absence of cardiovascular (CV) disease. The prevalence of DbCM and its independent contribution to the risk of heart failure (HF) among community-dwelling individuals with prediabetes or diabetes (Pre-DM/DM) is not well known.

Methods: Adults without prevalent CAD or HF were pooled from 3 community-based cohort studies (ARIC, CHS, and CRIC cohorts). Presence of DbCM in patients with Pre-DM/DM was defined by elevated NT-proBNP levels (>125 in normal/overweight or >100 pg/mL in obese) plus either ≥1 or ≥2 echocardiographic abnormalities (left atrial enlargement, left ventricle hypertrophy, diastolic dysfunction). The DbCM definition with ≥2 echo abnormalities was used for the primary analysis and the cohort was stratified into three groups: euglycemia, pre-DM/DM without DbCM, and pre-DM/DM with DbCM. Kaplan-Meier and Cox models adjusted for demographics, CV risk factors, and kidney function were used to evaluate the risk of overt HF across the study groups.

Results: The study included 10,208 individuals, of which 6,852 had pre-DM/DM. The prevalence DbCM in the overall cohort was 6.6% and 19.5% based on the presence of ≥2 or ≥1 echocardiographic abnormalities with elevated NT-proBNP levels. Over 10-year follow up, individuals with pre-DM/DM had a higher risk for overt HF than euglycemic individuals (10.1% vs. 6.4%). Among individuals with pre-DM/DM, presence of DbCM identified a higher risk subset of individuals with significantly greater risk for developing overt HF as compared with pre-DM/DM without DbCM in unadjusted (19.6% vs. 9.1%) as well as adjusted analysis (HR [95% CI] pre-DM/DM without DbCM = 1.32 [1.12-1.55], pre-DM/DM with DbCM = 2.28 [1.81-2.86], ref: euglycemia).

Conclusions: Presence of DbCM in individuals with pre-DM/DM identifies a high-risk subgroup for development of overt HF.

Disclosure

M. W. Segar: None. K. Patel: None. N. Kondamudi: None. A. Pandey: None.

Funding

Applied Therapeutics
980-P: Existing Microvascular Complications and Risk of Subsequent Heart Failure (HF) in Type 1 Diabetes (T1D)
Authors: GUO JINGCHUAN , COSTACOU TINA , MILLER RACHEL G. , ORCHARD TREVOR J.
Published: June 2021

We aimed to quantify the association between existing microvascular diseases and risk of subsequent HF in adults with T1D. Participants from Pittsburgh Epidemiology of Diabetes Complication (EDC) Study without known baseline HF (n=655) were classified into 4 groups based on the number (n=0-3) of existing microvascular diseases, i.e., overt nephropathy, proliferative retinopathy, and confirmed distal symmetric polyneuropathy (CDSP). Overt nephropathy was defined as an AER >300mg/24h in ≥ 2 of three validated timed biennial urine collections. Proliferative retinopathy was based on stereoscopic fundus photographs or a history of receiving laser therapy for proliferative diabetes retinopathy. CDSP was identified by following the Michigan Neuropathy Screening Instrument and the Michigan Diabetes Neuropathy Score. HF was determined by hospitalization, cause-of-death records, clinic exams, and/or self-reports of physician diagnosis. We applied Cox PH models to quantify the association between the number of existing microvascular diseases and risk of subsequent HF over 25 years follow-up controlling for diabetes duration (or age), sex, HbA1c, and CAD comorbidity. Mean baseline age and T1D duration were 27 years and 19 years. The 25-year cumulative incidence of HF was 6.6% (43/655). Over half didn’t have any microvascular disease at baseline; 19.7%, 16.7% and 10.8% had 1, 2 and 3 microvascular diseases, respectively. In participants with 1, 2, and 3 microvascular diseases, the adjusted HR (95%CI) of any clinically defined HF was 3.1 (1.3, 7.6), 2.5 (0.9, 6.9), and 4.0 (1.3, 11.9), compared with those without any microvascular disease. The HR (95%CI) of hospitalization or death for HF was 2.0 (0.6, 7.3), 2.2 (0.6, 8.7), and 4.1 (1.0, 16.4). As microvascular disease burden increases so does the risk of HF, independently of diabetes duration, sex, HbA1c, and CAD among adults with long-duration childhood-onset T1D.

Disclosure

J. Guo: None. T. Costacou: None. R. G. Miller: None. T. J. Orchard: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK034818)
985-P: Black New Yorkers with Type 2 Diabetes: Afro-Caribbean Immigrants Have Better Cardiometabolic Health than African Americans
Authors: FARAG MARIA , KHOSLA LAKSHAY , BHAT SONALI , MONTIEL ISHINO FRANCISCO A. , WILLIAMS FAUSTINE , HORLYCK-ROMANOVSKY MARGRETHE F.
Published: June 2021

Using the 2013/14 New York City Health and Nutrition Examination Survey population sample, this study compared Afro Caribbean immigrants and US-born African American New Yorkers to determine a) whether prevalence and odds of type 2 diabetes (T2DM) differed between ethnic groups; and b) whether cardiometabolic health profiles differed among those with T2DM. T2DM was defined by prior diagnosis, HbA1c≥6.5%, or fasting glucose ≥126mg/dL. Weighted logistic regression estimated odds of T2DM adjusting for BMI, waist circumference, age, sex, education, income, marital status and physical activity. T2DM prevalence in Afro Caribbeans (n=81, age (Mean±SE) 49±2y, BMI 29.2 ±0.7kg/m2) was 31%, and 21% in African Americans (n=118, age 46±2years, BMI 30.3±0.9kg/m2). Afro Caribbeans had more than three times greater odds of T2DM than African Americans [aOR=3.32 (95%CI 1.11-9.88), P=0.0313]. Compared to African Americans with T2DM (n=21, Age 60.3±3.3y, BMI 34.6±1.7kg/m2), Afro Caribbeans with T2DM (n=23, Age 57.9±2.5y, BMI 29.9±0.8kg/m2) were less likely to have obesity (33.2% vs. 74.7%) and had lower waist circumference (102±2cm vs. 114±3cm, P=0.002). Although fewer Afro Caribbeans with T2DM met HP2010 physical activity goals (42.9% vs. 75.5%, P=0.0335), their mean HDL levels tended to be higher than those of African Americans with T2DM (50.6±2.5 mg/dL vs. 42.5±3.2mg/dL, P=0.0519). Afro Caribbean immigrants in New York City have higher odds of T2DM than African Americans. Nevertheless, Afro Caribbeans with T2DM have better cardiometabolic health than African Americans with T2DM. Differences in anthropometrics, blood lipids and health behaviors illustrate important intraethnic variations which affect future risk of T2DM complications among populations of African descent.

Disclosure

M. Farag: None. L. Khosla: None. S. Bhat: None. F. A. Montiel ishino: None. F. Williams: None. M. F. Horlyck-romanovsky: None.
986-P: Evaluation of Cardiovascular Risk and All-Cause Mortality in Type 1 Diabetes: Comparison of Risk Engines in a 10-Year Follow-up
Authors: GAROFOLO MONIA , GUALDANI ELISA , LUCCHESI DANIELA , FALCETTA PIERPAOLO , FRANCESCONI PAOLO , DEL PRATO STEFANO , PENNO GIUSEPPE
Published: June 2021

Type 1 diabetes (T1D) has higher risk of death and CVD compared with general population. Effective risk stratification is essential to implement preventive strategies. We compare the performance of Steno Type 1 Risk Engine (ST1RE) and EURODIAB PCS Risk Engine (EURO-RE) in 733 T1D (M 52%; age 39.3±11.1; DD 18.5±11.6; A1c 7.8±1.2%) with no prior CVD over a 11-yr follow-up (IQR: 9.9-13.0). Both models include age, A1c and albuminuria; ST1RE includes 7 more variables (sex, DD, SBP, LDL-C, eGFR, smoking and exercise), EURO-RE only 2 more variables (WHR, HDL-C). By ST1RE, 453 T1D (61.8%) had low- (<10%), 179 (24.4%) moderate- (10-20%) and 101 (13.8%) high-risk (≥20%); for EURO-RE, estimates were 496 (67.7%), 161 (22.0%) and 76 (10.4%). Regression between 10-yr risks was 0.921 (p<0.0001); concordance of risk strata attribution was 82.5% (n = 605); 98 (13.4%); 30 (4.1%) T1D had higher and, respectively, lower risk by ST1RE vs. EURO-RE. C-statistic for all-cause death (n = 46) was 0.810 (95% CI 0.738-0.882) for ST1RE and 0.802 (0.729-0.875) for EURO-RE. Incidence of CVD was available for 697 T1D (95%). C-statistics for all CVD (n = 32) were 0.770 (0.699-0.841) and 0.777 (0.706-0.849) for ST1RE and EURO-RE, respectively; for coronary events (n = 23) 0.739 (0.650-0.828) and 0.765 (0.683-0.847); for coronary revascularization (n = 14) 0.802 (0.707-0.897) and 0.824 (0.742-0.905). With the limitation of low number of events, C-statistics for stroke (n = 8) were 0.764 (0.596-0.931) and 0.805 (0.654-0.955) for ST1RE and EURO-RE; for peripheral disease (n = 5) 0.794 (0.658-0.931) and 0.733 (0.518-0.948); for ESRD (n = 8) 0.719 (0.544-0.893) and 0.723 (0.529-0.917). Cox regression with backward variable processing selects EURO-RE as covariate for CVD and all other vascular events including ESRD, with ST1RE selected as the strongest covariate for all-cause death. Both ST1RE and the less-demanding EURO-RE are validated and widely available tools to identify high risk T1D individuals.

Disclosure

M. Garofolo: Consultant; Self; Eli Lilly and Company. E. Gualdani: None. D. Lucchesi: None. P. Falcetta: None. P. Francesconi: None. S. Del prato: Advisory Panel; Self; Eli Lilly and Company, Novo Nordisk, Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Speaker’s Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis Pharmaceuticals Corporation, Sanofi. G. Penno: Advisory Panel; Self; Eli Lilly and Company.
992-P: Early Menopause and Cardiovascular Disease Risk in Women with and without Diabetes
Authors: YOSHIDA YILIN , CHEN ZHIPENG , BAUDIER ROBIN L. , KROUSEL-WOOD MARIE , ANDERSON AMANDA H. , FONSECA VIVIAN , MAUVAIS-JARVIS FRANCK
Published: June 2021

Background: Early menopause may be associated with higher cardiovascular disease (CVD) risk due to the early cessation of estrogens protection. The presence of diabetes (DM) coupled with early menopause may result in even greater CVD risk in postmenopausal women. We compared CVD risk in women with early vs. normal age menopause with and without DM.

Methods: We pooled data from the Atherosclerosis Risk in Communities Study, the Multi-Ethnic Study of Atherosclerosis, and the Jackson Heart Study. Women with data on menopausal status, age at menopause and DM (yes/no) were included. We excluded pre- or peri-menopausal women, those with hysterectomy/oophorectomy or prevalent CVD. Outcomes were incident coronary heart disease (CHD), ischemic or hemorrhagic stroke, heart failure (HF), and a composite CVD outcome (CHD, stroke or HF). Cox models examined the risk associated with early (<45 yrs) vs. normal age (≥45 yrs) menopause. Covariates included baseline age, race, education, BMI, blood pressure, cholesterol, smoking, alcohol consumption, and hormone therapy use.

Results: During a median follow-up of 15 yrs for 5964 postmenopausal women, 684 CHD, 434 stroke, 962 HF and 1535 CVD events occurred. In adjusted models, women with early menopause had elevated risk of CHD (Hazard ratio 1.12, 95% CI 1.03-1.22), stroke (1.09, 1.01-1.18) and HF (1.09, 1.00-1.19) compared to those with normal age menopause. DM was a significant effect modifier to the relationship between early menopause and CHD, stroke or CVD (P for interaction ≤0.05). HRs for early menopause and the outcomes were greater in diabetic than nondiabetic women (CHD 1.34, 1.02-1.78 vs. 1.10, 1.00-1.20; stroke 1.26, 0.98-1.61 vs. 1.07, 0.98-1.16; CVD 1.41, 1.01-1.95 vs. 1.04, 0.94-1.14).

Conclusion: Early menopause increases risk for CVD in postmenopausal women; DM places this group at even higher CVD risk. Attention to CVD risk monitoring and management in women with early menopause, with and without diabetes, should be considered.

Disclosure

Y. Yoshida: None. Z. Chen: None. R. L. Baudier: None. M. Krousel-wood: None. A. H. Anderson: None. V. Fonseca: Consultant; Self; Abbott Diabetes, Asahi Kasei Corporation, Bayer Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Intarcia Therapeutics, Inc., Novo Nordisk, Pfizer Inc., Sanofi-Aventis, Stock/Shareholder; Self; Amgen Inc., Bravo4health, Mellitus Health. F. Mauvais-jarvis: None.

Funding

National Institutes of Health (K12HD043451)
997-P: Thyroid Safety in T2DM Patients Treated with Long-Term Administration of Liraglutide
Authors: ZHANG MENGYU , WANG YANRU , YIN JIAJING , ZHA XIAOJUAN , SHENG CHUNJUN , YANG PENG , LI HONG , QU SHEN
Published: June 2021

Objective: It has prompted concerns about the risk of thyroid nodules and thyroid tumors with liraglutide treatment. Our study intends to provide clinical observations on thyroid nodules in T2DM patients treated with liraglutide.

Methods: We collected T2DM patients treated with or without liraglutide from January 2015 to September 2020 in Shanghai Tenth People’s Hospital. Thyroid ultrasonography was available, including the size of thyroid nodule and TI-RADS classification.

Results: A total of 268 T2DM patients were included in liraglutide group (L) and 328 T2DM in control group(C). Before liraglutide injection, 97 patients diagnosed of thyroid nodules in L group with an average size of 16.37±7.28mm, including 7 in TI-RADS 1, 15 in TI-RADS 2, and 75 in TI-RADS 3. There were 108 patients diagnosed of thyroid nodules in C group with an average size of 17.65±9.27mm, including 6 in TI-RADS 1, 22 in TI-RADS 2, and 80 in TI-RADS 3. After treating with liraglutide of 1.18±0.26mg/ day for 24.1±2.8 months, the average size of nodules in L group was 17.54±7.89mm, with 5 patients in TI-RADS 1, 13 in TI-RADS 2 and 79 in TI-RADS 3. The average size of nodules in C group was 18.19±8.52mm, with 5 patients in TI-RADS 1, 20 in TI-RADS 2, and 81 in TI-RADS 3. There was one patient with hyperthyroidism and one papillary thyroid carcinoma(PTC)in L group, and 2 PTC in C group. The nodules size was not significantly increased (P < 0.01).

Conclusion: There was no significant changes of thyroid nodules size during the continuous administration of liraglutide in T2DM patients, and liraglutide was not considered associated with risk of thyroid tumor. However, the effect of liraglutide on thyroid function still needs further investigation.

Disclosure

M. Zhang: None. Y. Wang: None. J. Yin: None. X. Zha: None. C. Sheng: None. P. Yang: None. H. Li: None. S. Qu: None.

Funding

National Key Research and Development Project of China (2018YFC1314101); Shanghai Committee of Science and Technology (19DZ1910200, 18411951803, 17DZ1910603)
Økonomiens primat – den utslagsgivende årsak til norsk forsvarsomstilling etter den kalde krigen
Authors: Diesen Sverre
Published: June 2021

Denne artikkelens hovedargument er at det i overveldende grad er økonomien som har vært den drivende faktor bak Forsvarets omstilling etter den kalde krigen, inkludert da invasjonsforsvar ble forlatt som forsvarskonsept i 2001. De sikkerhetspolitiske endringene har først og fremst vært utnyttet retorisk for å begrunne nedbygging av forsvarsstrukturen, når den økonomiske nødvendigheten ikke lenger lot seg skjule. Kostnader forbundet med økt deltagelse i internasjonale operasjoner har kun i svært beskjeden grad bidratt til reduksjonen i forsvarsstrukturen – kostnadene var her alt for lave til å kunne gi noen troverdig årsaksforklaring alene. Årsaken er i stedet at forsvarsbudsjettene etter den kalde krigen ikke kompenserte for den reelle kostnadsutviklingen i sektoren. Det resulterte i et kjøpekrafttap som gradvis tæret på Forsvaret.
Abstract in English:Economy – the Driving Force behind Norwegian Defence Transformation after the Cold WarThe main conclusion of this article is that to an overwhelming degree, economic factors have been the driving force behind the transformation of the Norwegian Armed Forces following the end of the Cold War, including the discontinuation of anti-invasion defence as a level of ambition in 2001. The changes in international affairs have been used rhetorically to justify the downsizing of the force structure, when the financial necessity could no longer be concealed or ignored. Additional costs caused by participation in international operations overseas have only to a very limited extent contributed to the sweeping reduction of the armed forces, since these costs were far too small to explain the cutbacks. The actual financial reason is that the defence budgets throughout the 1990s and 2000s did not compensate for the growth in real term costs in the defence sector, particularly those pertaining to the acquisition and operation of modern weapon platforms and systems. This resulted in a loss of purchasing power which gradually wore down the force structure.
Transition from Korean to English Language of South Korean Journals Both Dedicated to the Oral and Maxillofacial Surgery (OMS): The Transitions` Impact on OMS Residency Programs
Authors: Tymofieiev Oleksii , Fesenko Oksana , Fesenko Ievgen
Published: June 2021

In South Korea, two peer-reviewed journals related to the field of oral and maxillofacial surgery (OMS) [1-3]: 1) Journal of the Korean Association of Oral and Maxillofacial Surgeons for 43 years; 2) Maxillofacial Plastic and Reconstructive Surgery are already existing for 40 years. Both have a long time traditions of publishing and editorial process of peer-review articles. And both journals have undergone the process of changing the language of publications – transition from the official state language to English. The purpose of that analytic paper is to highlight that transition, as each of the journals has a different type of language transition. The transitions` impact on OMS residency programs is also discussed.
Sosyal Medya Verileri Kullanılarak Milli Park Ziyaretlerinin Mekânsal ve Zamansal Değişiminin Modellenmesi: Beydağları Sahil Milli Parkı Örneği
Authors: USLU Ahmet
Published: June 2021

Günümüzde milli parklar, ziyaretçi kullanımının artmasıyla birlikte doğa temelli turizm ve rekreasyon faaliyetleri açısından popüler turizm destinasyonları haline gelmiştir. Doğa temelli turizm araştırmaları ve milli parkların yönetimi için ziyaretçilerin davranışları ve tercihleri hakkında gerçek zamanlı verilere ihtiyaç duyulmaktadır. Ziyaretçi verilerini anketler yoluyla elde etmek çok pahalı ve zaman alıcıdır. Bu bağlamda coğrafi etiketli sosyal medya verileri ziyaretçi verilerini toplamak, korunan alanlardaki ziyaret modellerine ilişkin güçlü içgörüler elde etmek için potansiyel bir veri kaynağı olabilir. Bu çalışmada, Beydağları Sahil Milli Parkı’na gelen ziyaretçilerin zamansal ve mekânsal davranış modellerini analiz etmek amacıyla coğrafi etiketli fotoğrafların kullanım potansiyeli araştırılmıştır. Çalışmanın sonuçları, Flickr verilerinin milli parkların özelliklerini değerlendirmek, zamansal ve mekânsal yönlerini analiz etmek için yararlı bir kaynak oluşturduğunu ve gelecekteki araştırmalar için yeni fırsatlar sunduğunu ortaya koymuştur.