bluuebunny/crossref_metadata_2025 huggingface dataset:
737-P: Physical Activity Levels among Latino Adults with Type 2 Diabetes
Authors: BEVIER WENDY C. , GLANTZ NAMINO M. , HOPPE CHARIS B. , MORALES JESSIKAH , LAREZ ARIANNA J. , CONNEELY MARY M. , CHEN KONG Y. , KERR DAVID
Published: June 2019

Physical activity (PA) is a cornerstone of type 2 diabetes (T2D) treatment. In the U.S, Latinos bear a disproportionate cardio-metabolic disease burden from T2D. The aim of this study was to determine levels and patterns of PA among free-living Latino adults with T2D comparing a ubiquitous consumer device with an established accelerometry method.

Participants (57 women and 31 men, BMI (kg/m2) 32.2±7.9 and 29.9±4.5, waist circumference (WC cm) 97.1±30.1 and 93.7±33.0, and HbA1C% 8.0±2.0 and 8.1±1.8, respectively) wore a research device (Actigraph, wGT3X-BT, AG) on the dominant hip and a consumer device (Fitbit Charge 2™, FB) on the non-dominant wrist to monitor daily activity for one week [outcome measures estimated by steps and energy expenditure (EE)].

AG median steps/weekday (M-F) was 6990 (range 1091-25884) compared to 9329 (288-31669) using the FB data (p≤0.01). Both devices recorded higher number of steps on weekdays compared to weekends [AG 5608 (1066-19892) and FB 7577 (1023-23603), both p≤0.05]. This corresponded to activity-related energy-expenditure of 442 (63-1821) kcals/weekday and 361 (58-1396) kcals/weekend using AG and 2344 (1135-5802) kcals/weekday and 2178 (1378-4930) kcals/weekend by FB (including resting metabolic rate). AG and FB data were highly correlated to each other for daily steps (r’s>0.7, p’s<0.01) but not for estimated EE. Men were more active than women on average and maintained their PA throughout the week. However, women decreased their PA on weekends (by around 1700 steps or 130 kcals/day by AG) while their weekday PA was negatively correlated with BMI and WC (p<0.05). Using AG, only 2 participants reached 6,000 steps in an hour at least twice during the week and 58% never reached 3,000 steps in 30 minutes on any day of the week (a common moderate to vigorous intensity PA goal).

In conclusion, to incentivize PA in Latino adults with T2D, considerations need to be made of the timing of measurements (weekdays versus weekends), gender and technologies used.

Disclosure

W.C. Bevier: Research Support; Self; Eli Lilly and Company. N.M. Glantz: Research Support; Self; Eli Lilly and Company. C.B. Hoppe: Research Support; Self; Eli Lilly and Company. J. Morales: Research Support; Self; Eli Lilly and Company. A.J. Larez: Research Support; Self; Eli Lilly and Company. M.M. Conneely: Research Support; Self; Eli Lilly and Company. K.Y. Chen: None. D. Kerr: Advisory Panel; Self; Ascensia Diabetes Care, Novo Nordisk A/S, Sanofi. Research Support; Self; Lilly Diabetes. Stock/Shareholder; Self; Glooko, Inc.

Funding

Eli Lilly and Company
738-P: Meta’omic Analysis of Elite Athletes Identifies a Performance-Enhancing Microbe that Functions via Lactate Metabolism
Authors: KOSTIC ALEKSANDAR
Published: June 2019

The human gut microbiome encodes a vast metabolic repertoire with direct impacts on many aspects of host physiology, yet it is unknown whether it has any bearing on physical performance or exercise. To begin to address this question, we performed a longitudinal metagenomic analysis on runners in the 2015 Boston Marathon to identify microbiome features associated with intense physical activity. The strongest microbiome feature enriched post-marathon was an increase in the abundance of the bacterial genus Veillonella. We isolated Veillonella atypica directly from the marathon runners, and found that upon inoculation in laboratory mice in an AB/BA crossover study testing treadmill runtime to exhaustion, runtime was increased 13% in a V. atypica-dependent manner. V. atypica has a preference for lactate as its primary carbon source, and we find using shotgun metagenomic analysis in a cohort of elite athletes that every differentially expressed gene family in the pathway metabolizing lactate to the short-chain fatty acid propionate is at higher relative abundance post-exercise. Using 13C3-labeled lactate in mice we demonstrate that serum lactate crosses the epithelial barrier into the lumen of the gut. We also show that intrarectal instillation of propionate is sufficient to reproduce the increased treadmill runtime performance observed with V. atypica gavage. Taken together, these studies reveal that V. atypica improves runtime via its metabolic conversion of exercise-induced lactate into propionate, thereby identifying a natural, microbiome-encoded enzymatic process that enhances athletic performance.

Disclosure

A. Kostic: Stock/Shareholder; Self; DeepBiome Therapeutics, Inc., FitBiomics, Inc.

Funding

American Diabetes Association/Pathway to Stop Diabetes (1-17-INI-13)
75-LB: Glucose Excursions over 140 mg/dL May Impact Quality of Life in Patients with Well-Managed Type 1 Diabetes
Authors: GAREY COLLEEN , HUGHES ALLYSON , BISPHAM JEOFFREY , LIU JINGWEN , FULLER LILY , NYKAZA EDWARD T. , MENO JASON A. , MCAULIFFE-FOGARTY ALICIA
Published: June 2019

Introduction: In people with well-managed type 1 diabetes (T1D), increased glycemic variability is related to poorer quality of life (QoL). However, less is known about hyperglycemia and QoL in the same population. Clinically, mild hyperglycemia (level 1) is defined as glucose >180 mg/dL and moderate (level 2) >250 mg/dL; however, this does not take into account diabetes management behaviors. This analysis aimed to assess the impact of high blood glucose (HBG) on QoL in well-managed individuals using survey and CGM data.

Methods: Adults with T1D (N = 71), 68.6% female, 93.2% white, aged 44.1 years, with diabetes for 26.7 years, completed an online survey through T1D Exchange Glu and uploaded CGM data via Tidepool.

Results: In this population, the average A1c was 6.5%, with 74% of participants ≤7.0%, suggesting that, overall, they are very well-managed. On average, this cohort reported that they consider HBG to be above 189 mg/dL, but 65% consider HBG to be a value below 180 mg/dL (range 100-175 mg/dl). Because the majority of participants considered HBG to be a value below the clinically recognized cut-off, this analysis explored events >140 mg/dL as a potentially meaningful cut point for HBG. Results indicated that that more events >140 mg/dL in the past 7 days were associated with poorer QoL. Participants with ≥24 events above 140 mg/dL in the past 7 days had an 83% increased risk for poor QoL as defined by the WHO-5.

Conclusions: Clinically relevant cutoffs of >180 mg/dL and >250 mg/dL are currently used to define mild (level 1) and moderate (level 2) hyperglycemia. This data suggests that in a very well-managed population, excursions >140 mg/dL have an impact on a persons’ well-being and healthcare providers need to consider how tightly managed an individual is when assessing psychosocial impacts of the disease. Limitations include small sample size and convenience sampling. Future research should further investigate the relationships of these factors in a larger sample.

Disclosure

C. Garey: None. A. Hughes: None. J. Bispham: None. J. Liu: None. L. Fuller: None. E.T. Nykaza: None. J.A. Meno: None. A. McAuliffe-Fogarty: None.
761-P: Correlation of Periodontal Inflamed Surface Area with Glycemic Status in Patients with Controlled Type 2 Diabetes Mellitus and Uncontrolled Type 2 DM With and Without Microvascular Complications
Authors: RADHAKRISHNAN CHANDNI , VADAKKEKUTTICAL ROSAMMA JOSEPH , ANIL KRISHNA , PARAMBATH FAIROZ CHERIYALINGAL
Published: June 2019

The bidirectional relationship between periodontitis and diabetes mellitus has been well documented. Periodontitis causes systemic inflammatory burden through inflammatory mediators. The currently used tools such as Clinical Attachment Loss (CAL) and Probing Pocket Depth (PPD) to assess periodontitis are linear measurements, that do not exactly quantify the inflammatory burden of periodontitis. Periodontal Inflamed Surface Area (PISA) reflects the surface area of bleeding pocket epithelium and estimate the inflammatory burden. This study was undertaken to assess the proportion of periodontitis and correlation of PISA with glycemic status in controlled, uncontrolled type 2 diabetes mellitus (T2D) with and without micro-vascular complications. The study comprised of 180 T2D patients who were divided into three groups based on their Glycosylated Hb levels (HbA1c) (i) well controlled T2D group: (HbA1c ≤ 7%) (ii) Uncontrolled T2D group: (HbA1c > 7%) without complications, and (iii) Uncontrolled T2D group: (HbA1c >7%) with microvascular complications. All subjects were assessed for the periodontal parameters (Bleeding on Probing (BOP), PPD, CAL and PISA) and systemic parameters (HbA1c, FPG, and PPPG). The proportion of periodontitis among Uncontrolled T2D group without complication and Uncontrolled T2D group with micro-vascular complications was (93.4% and 96.6%) very high as compared to Well controlled T2D group (75%) (p <0.001). Extent and severity of periodontitis were high in uncontrolled T2D group. Uncontrolled T2D with micro-vascular complications group attained the highest mean score for PPD, CAL, BOP and PISA. Positive correlation was found between PISA and HbA1c among the groups (r = 0.079, 0.109, 0.248 respectively). A statistically significant positive correlation has been found between PISA and HbA1c among all study subjects (r= 0.393, p < 0.001).

Disclosure

C. Radhakrishnan: None. R.J. Vadakkekuttical: None. K. Anil: None. F.C. Parambath: None.
766-P: Development and Validation of a Smartphone-Based Short Food Frequency Questionnaire for Chinese Population
Authors: YANG DAIZHI , WANG CHAOFAN , LUO SIHUI , ZHENG XUEYING , LIN QIONGYAN , WEI XUEYING , YAN JINHUA , WENG JIANPING
Published: June 2019

Objective: To develop and evaluate a smartphone-based short food frequency questionnaire.

Methods: We developed a digitalized short food frequency questionnaire adapted to the diet habit of the Chinese people. Seventy participants were recruited by quota sampling. Participants completed an FFQ face to face (1st FFQ) and a 3-day dietary record (DR) at the baseline for validation. A second FFQ (2nd FFQ) was completed 3 weeks later for reproducibility study, either face to face or on the phone.

Results: Sixty-seven participants completed the study per protocol and rendered eligible FFQs and 3-day DR. Twenty-one people were interviewed on the phone for 2nd FFQ and correlation coefficients of energy and nutrient intakes with 1st FFQ were 0.848∼0.959(all P<0.01). Difference between 2nd FFQ and DR was not significant either and correlation coefficients were 0.504∼0.878(all P<0.01). Correlation coefficients of energy and nutrient intakes between two FFQs ranged from 0.912 to 0.959(all P<0.001). Correlation coefficients of energy and nutrient intakes between 2nd FFQ and DR ranged from 0.584 to 0.861 (all P<0.01). The agreement rates of two FFQs for classifying food and nutrient intakes into same and adjacent quartiles were 65.67%∼74.63% and 25.37%∼31.34%, respectively; and between 2nd FFQ and DR, the corresponding agreement rates 38.81%-59.70% and 29.85%∼40.30%, respectively. Results of subgroup correlation analysis showed that reproducibility and validity coefficients were higher in females, well-educated group, and lower income group. We also carried out correlation analysis in diabetic patients. Correlation coefficients between two FFQs were 0.893∼0.947(P<0.01), between 2nd FFQ and DR were 0.661∼0.833(all P<0.01).

Conclusion: Our FFQ had satisfying reproducibility and validity in general and diabetic population and was ready to apply to remote surveys.

Disclosure

D. Yang: None. C. Wang: None. S. Luo: None. X. Zheng: None. Q. Lin: None. X. Wei: None. J. Yan: None. J. Weng: None.
769-P: Short-Term Dietary Reduction of Branched-Chain Amino Acids Reduces Meal-Induced Insulin Secretion and Modifies Microbiome Composition in Overweight Patients with Type 2 Diabetes
Authors: KARUSHEVA YANISLAVA , GEMERT THERESA VAN , STRASSBURGER KLAUS , MARKGRAF DANIEL F. , JELENIK TOMAS , MASTROTOTARO LUCIA , SIMON MARIE-CHRISTINE , ZAHARIA OANA P. , BODIS KÁLMÁN , BÄRENZ FELIX , SCHMOLL DIETER , BURKART VOLKER , MUESSIG KARSTEN , SZENDROEDI JULIA , RODEN MICHAEL
Published: June 2019

Increased levels of branched-chain amino acids (BCAA) associate with insulin resistance and type 2 diabetes (T2D), which could result from dietary habits, gut microbiome composition or direct effects on cellular energy metabolism. We hypothesized that reduced dietary intake of BCAA improves whole body insulin sensitivity and hyperinsulinemia in patients with T2D. In a randomized, placebo-controlled, double-blinded, cross over trial, 12 metabolically well-controlled patients with T2D received an isocaloric diet (protein: 1 g/kg body weight), containing either the complete amino acid set (BCAA+) or a 60% reduction in BCAA (BCAA-) for 1 week each. Effects on glucose homeostasis were assessed from mixed meal tolerance tests (MMT) and hyperinsulinemic-euglycemic clamps (HEC, M-value), and pathways affecting insulin signaling were analyzed in muscle and adipose tissue biopsies. Microbiome composition was assessed by next generation sequencing. After the BCAA- diet, MMT-derived insulin secretion was 28% lower compared to the BCAA+ diet (p<0.05). After the BCAA- diet, MMT-derived insulin sensitivity (PREDIM, the validated predicted HEC-derived M-value from meal data), turned 23% higher (p<0.01), whereas HEC-derived insulin sensitivity (M-value) remained unchanged. Respiratory control ratio was 1.7-fold higher in adipose tissue (p<0.05), but unchanged in skeletal muscle. Mechanistic target of rapamycin (mTOR) was downregulated by 13% in adipose tissue (p<0.05). BCAA- diet was associated with a 40% increase of fecal Bacteroidetes and a 11% decrease of Firmicutes (both p<0.05).

In conclusion, a short-term dietary reduction of BCAA decreases insulin secretion, increases postprandial insulin sensitivity, which may relate to adipocyte mitochondrial efficiency and altered gut microbiome composition in patients with T2D.

Disclosure

Y. Karusheva: None. T. van Gemert: None. K. Strassburger: None. D.F. Markgraf: Research Support; Self; Sanofi. T. Jelenik: None. L. Mastrototaro: None. M. Simon: None. O.P. Zaharia: None. K. Bodis: None. F. Bärenz: None. D. Schmoll: Employee; Self; Sanofi-Aventis Deutschland GmbH. V. Burkart: None. K. Muessig: None. J. Szendroedi: None. M. Roden: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Poxel SA, Servier. Board Member; Self; Eli Lilly and Company. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi. Speaker's Bureau; Self; Novo Nordisk Inc.

Funding

Sanofi Aventis Deutschland GmbH
772-P: Effect of a Low n6/n3 PUFA Diet on Intrahepatic Fat Content in Obese Adolescents
Authors: VAN NAME MICHELLE A. , CHICK JENNIFER M. , SAVOYE MARY , PIERPONT BRIDGET , GALUPPO BRITTANY , FELDSTEIN ARIEL , SANTORO NICOLA
Published: June 2019

Recent literature suggests that the dietary imbalance between high omega-6 (n6) and low omega-3 (n3) polyunsaturated fatty acids (PUFA) intake, characteristic of the Western diet (average ratio 15:1), leads to development of fatty liver disease. We aimed to determine whether 12 weeks of a low n6/n3 PUFA ratio (4:1) normo-caloric diet might impact fatty liver (MRI assessed hepatic fat content ≥5.5%). Twenty obese adolescents with fatty liver were recruited (13.2±2.9y). Abdominal MRI and OGTT were performed at baseline and after 12-weeks intervention, the oxidized derivatives of linoleic acid (OXLAM) were measured every 4 weeks to assess compliance. Food was supplied to participants isocaloric to their pre-study diet. To control for weight change variable, weight was maintained stable throughout the study. Seventeen adolescents completed the study. After 12 weeks HFF%, decreased of about 26% (Figure 1). There was also a significant decrease in plasma concentrations of ALT (Figure 1), triglycerides (p=0.04) cholesterol (p=0.03), LDL (p=0.07) and an improvement of whole-body insulin resistance (p=0.01). There was a significant decrease of the OXLAM, 9- and 13-HODE (p=0.03 and p=0.01, respectively) and 9- and 13-oxo-ODE (p=0.05 and p=0.01, respectively). These data suggest that, independent of weight loss, a low n6/n3 PUFA diet is effective to ameliorate the metabolic phenotype of adolescents with fatty liver disease.

Disclosure

M.A. Van Name: Research Support; Self; Novo Nordisk Inc. J.M. Chick: None. M. Savoye: None. B. Pierpont: None. B. Galuppo: None. A. Feldstein: None. N. Santoro: None.

Funding

National Institutes of Health; American Heart Association
774-P: Not Carbohydrate but Sucrose Intake Is Associated with Gut Dysbiosis in Japanese Patients with Type 2 Diabetes
Authors: HASHIMOTO YOSHITAKA , HAMAGUCHI MASAHIDE , KAJI AYUMI , SAKAI RYOSUKE , INOUE RYO , KASHIWAGI SAORI , MIZUSHIMA KATSURA , UCHIYAMA KAZUHIKO , TAKAGI TOMOHISA , NAITO YUJI , FUKUI MICHIAKI
Published: June 2019

Background: There is a close association between gut dysbiosis and type 2 diabetes (T2D). However, little is known about gut dysbiosis in Japanese patients with T2D and the association between gut dysbiosis and habitual dietary intake is also unknown.

Methods: In this cross-sectional study, 97 patients with T2D and 97 subjects without T2D matched by age and sex were selected. We obtained 16S rRNA metagenomic data from fecal samples. Habitual dietary intake of patients with T2D was evaluated by brief-type self-administered diet history questionnaire. Paired t test was used for the difference between patients with T2D and subjects without T2D. Spearman’s rank correlation coefficient was used for association between gut dysbiosis and habitual dietary intake.

Results: At the phylum level, the abundance of Actinobacteria or Firmicutes in patients with T2D was higher than that in subjects without T2D, whereas that of Bacteroidetes or Fusobacteria in patients with T2D was lower (Figure). Sucrose intake was associated with the abundance of Actinobacteria (r=0.29, p<0.01) or that of Bacteroidetes (r=-0.29, p<0.01), whereas carbohydrate intake was not (r=0.03, p=0.77 or r=-0.12, p=0.25, respectively).

Conclusion: The abundance of gut microbiota differs between patients with T2D and subjects without, and not carbohydrate but sucrose intake is associated with gut dysbiosis in Japanese patients with T2D.

Disclosure

Y. Hashimoto: Research Support; Self; Asahi Kasei Pharma. M. Hamaguchi: None. A. Kaji: None. R. Sakai: None. R. Inoue: None. S. Kashiwagi: None. K. Mizushima: None. K. Uchiyama: None. T. Takagi: None. Y. Naito: None. M. Fukui: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Johnson & Johnson, Kyowa Hakko Kirin Co., Ltd., Merck & Co., Inc., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi, Sanwa Kagaku Kenkyusho, Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; AstraZeneca, Eli Lilly and Company, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Merck & Co., Inc., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi, Sanwa Kagaku Kenkyusho, Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited.

Funding

Japan Society for the Promotion of Science (16675576 to Y.N.); Ministry of Agriculture, Forestry and Fisheries of Japan (16824414 to Y.N.)
777-P: Enteral Nutrition in Critically Ill Patients with Hyperglycemia: A Meta-analysis of Randomized Controlled Trials with Trial Sequential Analysis
Authors: KUMBIER MAGALI , SILVA FLAVIA MORAES , PINTO LANA C. , ALMEIDA JUSSARA , OELLEN FRANZOSI
Published: June 2019

This systematic review with meta-analysis of randomized controlled trials (RCT) aimed to compare the effect of glycemic control-specific enteral formula specific and standard enteral formula on clinical outcomes in critically ill patients with hyperglycemia. The protocol was performed according to Cochrane Handbook and registered under PROSPERO-CRD42016036495. Databases were searched up to July 2018 using medical subject headings related to enteral nutrition, critically ill patients, hyperglycemia and RCT. The quality of studies was assessed using the six GRADE domains. Two reviewers performed all steps independently (M.C.C.K. and O.F.) and extracted the data of eligible studies through a standard form. A third researcher (F.M.S.) also settled any disagreements in all steps. Meta-analyses were performed at RevMan version 5.3 using the random effect model. The I2 test was performed to evaluate the magnitude of heterogeneity. Furthermore, we performed trial sequential analysis (TSA) of the identified studies (TSA software). In the initial search literature, 178 studies were identified and four of them were eligible. Diabetes-specific enteral formula reduced capillary glycemia (I2=62%; WMD=-25.68 mg/dL, 95% CI -47.21 to -4.17, p=0.02) in comparison to standard enteral formula. Plasma glucose, duration of mechanical ventilation, length of hospital stay, and incidence of death did not differ between groups. There was not publication bias identified. TSA meta-analysis showed a benefit trend, but it is not yet determined as the analysis points to insufficient information to confirm or refute the use of diabetes-specific enteral formula. Specific enteral formula for glycemic control reduced capillary glycemia when compared to the standard formula, but it did not have significant effect in others clinical outcomes in critically ill patients.

Disclosure

M. Kumbier: None. F.M. Silva: None. L.C. Pinto: None. J. Almeida: None. F. Oellen: None.
778-P: Positive Effects Including Prevention of Type 2 Diabetes by Making One Meal a Vegetarian Diet in Japanese—A Randomized Crossover Trial
Authors: NISHIMORI EITA , OGATA SATOSHI , NAKA MOTOJI
Published: June 2019

Background: Increased vegetable intake has been reported to lower the risk of developing various diseases including diabetes. In Japan, it is recommended to intake 350 g of vegetables a day (about 4.5 servings), but it has not been achieved. The aim of this study was to investigate that achieving 350 g of vegetables by making one meal of three a day had positive effects including prevention of diabetes.

Methods: 38 staff of Asama General Hospital without diabetes participated in a randomized crossover trial. Participants maintained a meal recommended in Japan during this study period (control arm). In the intervention arm, a meal that can consume 350 g of vegetables in one meal as lunch was offered (vege-one diet (VOD) arm). They were randomly assigned either VOD arm or control arm for 3 months with one-week washout.

Result: The average age of participants at the start was 46 years old, BMI 24 kg/m2, HbA1c 5.7%, LDL-cholesterol 127 mg/dL. There was no significant difference in nutrition component, body composition and biomarker between the VOD arm and the control arm after 3 months. Within the VOD arm, the total energy and carbohydrates decreased, and dietary fiber increased after 3 months significantly (P <0.05). In the diabetes risk group (HbA1c ≧5.6%, n = 24), the decrease of HbA1c and LDL-cholesterol were noted in the VOD arm as compared with the control arm. In the VOD arm, HbA1c significantly decreased in the diabetes risk group (P <0.05). In the VOD arm, prolongation of eating time, reduction of snacking, shortening of the interval of defecation and improvement of the form of the feces were significantly shown as compared with the control arm (P <0.05).

Conclusion: This study suggested that making one meal of three with vegetarian diet could contribute to positive effects including of prevention of diabetes, improvement of eating habits and defecation status.

Disclosure

E. Nishimori: None. S. Ogata: None. M. Naka: None.
779-P: Comparative Effects of Two Types of Pasta vs. White Rice on Postprandial Glucose Levels in Adults with Type 1 Diabetes
Authors: PINSKER JORDAN E. , ZAVITSANOU STAMATINA , MASSA JENNIFER S. , DESHPANDE SUNIL , CHURCH MEI MEI , ANDRE CAMILLE C. , DOYLE FRANCIS J. , MICHELSON ALICIA , CREASON JAMIE , DASSAU EYAL , EISENBERG DAVID M.
Published: June 2019

Background: Food choices are essential to successful glycemic control in persons with diabetes.

Methods: Twelve adults with type 1 diabetes (T1D) (age 58.7±14.2 years, HbA1c 7.5±1.3%) completed an in-clinic double-blinded crossover study comparing the glycemic response to higher protein pasta (10 grams protein/serving), regular pasta (7 grams protein/serving), and white rice. All meals contained 42 grams carbohydrate, were served with homemade tomato sauce, green salad and balsamic dressing, and were repeated in random order. Linear mixed effects models assessed the 5 h postprandial glycemic response.

Results: Compared to white rice, peak glucose levels were significantly lower for higher protein pasta (-32.6 mg/dL; 95% CI -48.4, -17.2; p<0.001) and for regular pasta (-43.2 mg/dL, 95% CI -58.7, -27.7; p<0.001). The difference between the two types of pastas did not reach statistical significance (-11 mg/dL; 95% CI -24.1, 3.4; p=0.17). Total glucose area under the curve for the 5 h postprandial period was significantly higher for white rice compared to both pastas (p<0.001) (Table 1).

Conclusions: There is a significant difference in postprandial glycemic response in persons with T1D between rice and both types of pasta when consumed in equal amounts of carbohydrate. Persons with T1D need to be aware of the relative impact of commonly consumed carbohydrates in the setting of real-life meals.

Disclosure

J.E. Pinsker: Research Support; Self; Ascensia Diabetes Care, Dexcom, Inc., Insulet Corporation, LifeScan, Inc., Roche Diabetes Care, Tandem Diabetes Care. Speaker's Bureau; Self; Tandem Diabetes Care. S. Zavitsanou: Employee; Self; Novo Nordisk A/S. J.S. Massa: None. S. Deshpande: None. M. Church: None. C.C. Andre: None. F.J. Doyle: Consultant; Self; ModeAGC. Other Relationship; Self; Insulet Corporation. A. Michelson: None. J. Creason: None. E. Dassau: Consultant; Self; Eli Lilly and Company, Insulet Corporation. Research Support; Self; Dexcom, Inc., DreaMed Diabetes, Ltd., Insulet Corporation, Roche Diabetes Care, Tandem Diabetes Care, Xeris Pharmaceuticals, Inc. Speaker's Bureau; Self; Roche Diabetes Care. Other Relationship; Self; ModAGC. D.M. Eisenberg: Advisory Panel; Self; Barilla Center for Food & Nutrition Foundation. Consultant; Self; Campus for H (Japan), Infinitus (China) Company LTD., Nutrition Development Group, LLC.

Funding

Barilla Center for Food & Nutrition Foundation
787-P: Prevalence of Metabolic Syndrome in Indian Women with Polycystic Ovarian Syndrome (PCOS) and the Correlation of Dietary Nutrient Composition and Physical Activity on Components of the PCOS—A Pilot Study
Authors: MEHTA RUCHA , VARMA HETI
Published: June 2019

Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrine problem in women of reproductive age group and has been linked to infertility, insulin resistance, obesity, hypertension, dyslipidemia and diabetes.

Objective: In this pilot study we seek to study the impact of meal time habits and physical activity on the prevalence of metabolic syndrome(Met Syn) in Indian women with PCOS.

Methods: 36 women (age: 28±1.4 years, BMI: 31.7 ± 0.84 kg/m2) with a diagnosis of PCOS (NIH criteria) participated in a detailed questionnaire with dietary habits and physical activity. Anthropometric measurements and fasting blood glucose, lipid profile, HbA1c were obtained in all subjects.

Results: In this group of women with PCOS, the prevalence of Met Syn was 43% and only 2 women had lean PCOS (BMI<25kg/m2). The prevalence of diabetes and impaired fasting glucose was 9% and 30% respectively. Of the components of Met Syn, all subjects had low HDL and high waist circumference, 25% had hypertension. Dietary history revealed that majority (84%) had a daily breakfast and only 16% skipped the breakfast. However, there was no difference in prevalence of metabolic abnormalities between those who had versus those who did not have breakfast. On the other hand women who were more physically active (>1 hour of physical activity/day) had lower BMI, systolic blood pressure (125± 3.4 vs. 112± 5.4, p<0.05 mm of Hg), a lower triglyceride level and a lower prevalence of Met Syn.

Conclusions: The prevalence of Met Syn was very high in our pilot group of relatively young Indian women with PCOS. Women with lower physical activity had a higher prevalence of metabolic abnormalities suggesting the significance of increasing physical activity to prevent Met Syn in PCOS. Larger studies are indicated to develop dietary and physical activity guidelines specific to this "ethnic" high risk Indian group to prevent future diabetes.

Disclosure

R. Mehta: Advisory Panel; Self; Abbott, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes. Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc. H. Varma: None.
798-P: The Prevalence and Impact of Food Insecurity on Glycemic Control in Low-Income Latinos with Type 2 Diabetes
Authors: FLORES INA CECILIA , PORRAS FIMBRES DENISSE CRISTINA , HAW J. SONYA , MIGDAL ALEXANDRA , ROTBERG BRITT , WANG HEQIONG , GALINDO RODOLFO J. , UMPIERREZ GUILLERMO E.
Published: June 2019

The reported prevalence of food insecurity (FI), defined as the lack of consistent access to enough food for an active, healthy life, among Latino households is twice the national average. Using the U.S. Household Food Security Survey Module, we determined the prevalence, associated factors, and impact of FI on glycemic control among Latinos attending the Emory Latino Diabetes Education Program (ELDEP), a nationally accredited bilingual education program that provides free DSME classes for Latinos with low socioeconomic status in Atlanta, Georgia.

Results: Among 711 participants, a total of 295 (41.5%) were found to have FI. At baseline, there were no differences in age (50±11 vs. 50±12 years, p=0.86), gender (63% female vs. 68% male, p=0.18), BMI (31.4 vs. 31.3 kg/m2, p=0.64), insurance status (10% vs. 13%, p=0.85), annual household income <$20,000 (90% vs. 86%, p=0.40), or unemployment status (47% vs. 47%, p=0.88) between FI and non-FI patients. FI patients consumed fewer vegetables at their main meal, with 54% vs. 44% consuming <1/4 of a plate, respectively; p<0.03. Participants with FI had higher HbA1c (9.5±2.3% vs. 8.1±2.1%, p<0.001), higher rates of Spanish illiteracy (19% vs. 11%, p=0.005), lower English literacy level (9% vs. 14%, p=0.25), and a greater history of depression (36% vs. 26%, p=0.03). Despite higher HbA1c at baseline, Latinos with FI experienced a greater reduction in HbA1c at 3 months (-2.5±2.8% vs. -1.0±2.4%, p<0.06) and 6 months (-2.5±2.4% vs. -0.5±0.9%, p<0.01) of follow up compared to non-FI patients.

Conclusion: FI is common among Latino patients with type 2 diabetes in Georgia. Latino patients with FI significantly improved their diabetes control with access to our culturally sensitive Spanish diabetes education program. Diabetes education programs should be culturally tailored and individualized to take into consideration literacy, language fluency and food insecurity to improve diabetes self-management.

Disclosure

I.C. Flores: None. D. Porras Fimbres: None. J. Haw: None. A. Migdal: None. B. Rotberg: Employee; Self; Insulet Corporation, Novo Nordisk A/S. H. Wang: None. R.J. Galindo: Advisory Panel; Self; Abbott, Novo Nordisk Inc., Sanofi US. Research Support; Self; Novo Nordisk Inc. G.E. Umpierrez: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc. Research Support; Self; AstraZeneca, Merck & Co., Inc., Novo Nordisk Inc., Sanofi US.

Funding

Sanofi
799-P: Vascular Structure and Functional Responses to Consecutive High-Fat Feeding between Insulin Treatment Regimens in Adults with Type 1 Diabetes and Matched Controls
Authors: O'MAHONEY LAUREN L. , STAVROPOULOS ANTONIS , BIRCH KAREN , AJJAN RAMZI , PRICE OLIVER J. , CAMPBELL MATTHEW
Published: June 2019

Background: Impaired vascular health is prevalent in type 1 diabetes (T1D); however, it remains unknown whether different insulin treatment regimens mediate indices of vascular structure or function.

Methods: Sixteen individuals with T1D receiving either multiple daily injection therapy (MDI; n=8; age: 32±13years; BMI:26.0±5.9kg.m2; HbA1c:53.7±11.2mmol/mol [7.1±3.2%]) or continuous subcutaneous insulin infusion (CSII; n=8; age:35±18years; BMI:26.3±4.6kg.m2; HbA1c: 58.6±9.7mmol/mol [7.5±3.0%]) and ten matched controls (CON; age:31±13years; BMI: 24.3±2.9kg.m2) consumed two high fat (HF) meals at 4-hour intervals. Carotid artery intima-media thickness (CIMT) and flow mediated dilation (FMD) was assessed at baseline, with further FMD assessment at 3-hours following the ingestion of each meal using high resolution B-mode ultrasound. Bolus insulin dose was standardized using the carbohydrate-counting method.

Results: CIMT was significantly higher in individuals with T1D compared to controls (p=0.039); treatment stratification within T1D revealed MDI mediated this effect (MDI vs. CON: p=0.049; CSII vs. CON: p=0.112). FMD remained unchanged following the first meal (p=0.204) but was significantly impaired following the second meal (p=<0.001); post hoc analysis revealed MDI mediated this effect of impaired FMD after the second meal (MDI vs. CON: p=0.048; CSII vs. CON: p=0.416).

Conclusions: Our findings indicate that patients treated with MDI therapy have higher CIMT (a structural marker of subclinical atherosclerosis) compared to controls but not CSII therapy. FMD was impaired following a second HF meal irrespective of a diabetes status. Considering the pre-existing heightened cardiovascular disease risk in T1D therapeutic strategies to reduce postprandial risk warrants further research.

Disclosure

L.L. O'Mahoney: None. A. Stavropoulos: None. K. Birch: None. R. Ajjan: Consultant; Self; Abbott. Research Support; Self; Abbott, LifeScan, Inc. O.J. Price: None. M. Campbell: None.
802-P: Text Messaging as a Behavioral Intervention Component for Adolescents and Young Adults with T1D
Authors: MONAGHAN MAUREEN , WONG CONNIE , STREISAND RANDI
Published: June 2019

PREP-DC (Planning, Reflecting, and Engaging with Providers for Diabetes Care) is a multicomponent behavioral intervention aimed at promoting optimal health communication between adolescents and young adults (AYAs) with T1D and health care providers (HCPs). In the PREP-DC pilot, we examined engagement with text messaging and utilized AYA feedback to revise text messages for a randomized trial. AYAs with T1D>1 year (n=16; M age=18.8 years; 50% male; 44% Caucasian) participated in the pilot, consisting of 2 intervention sessions and 3 related text messages/week delivered between 2 T1D medical visits (∼16 weeks). The study team and an AYA stakeholder created a library of 72 text messages to reinforce T1D communication skills and self-care. Texts were sent via secure messaging platform. HCPs rated AYA communication at baseline and follow-up medical visits (∼16 weeks post-baseline) using the Independent Behaviors during Consultation Scale (IBDCS). A1c was taken from the medical chart. Participants received a mean of 45 texts. One text/week posed a question and encouraged AYA response (M=15.5 texts); 69% responded ≥1 text (M responses=4±4.2 texts). Intervention outcomes differed by text response. AYAs with no responses had worsening A1c (10.4% to 11.2%; p<.05) and stable HCP-rated communication (IBDCS; 20.8 to 20.0; p=ns) from baseline to follow-up. AYAs with ≥ 1 response had stable A1c (9.6% to 9.6%; p=ns) and improved HCP-rated communication (IBDCS; 19.6 to 24.9; p<.01) from baseline to follow-up. AYAs reported high satisfaction with text messages. Feedback was used to revise text messages, including new response prompts, graphic content (e.g., memes), and more message tailoring. Text messaging was a promising component of this intervention pilot, and an indicator of text message engagement was related to intervention response. Future studies should further examine engagement with text messages, including analytics on opening texts and message content associated with higher AYA response.

Disclosure

M. Monaghan: Research Support; Self; American Diabetes Association. C. Wong: None. R. Streisand: None.

Funding

American Diabetes Association/Pathway to Stop Diabetes (1-18-ACE-27 to M.M.); Children's National
809-P: Comparison of the Acceptability and Psychometric Properties of Scales Assessing the Impact of Type 1 Diabetes on Quality of Life: Results of the Your SAY: QoL Study
Authors: SPEIGHT JANE , HOLMES-TRUSCOTT ELIZABETH , HENDRIECKX CHRISTEL , COATES ELIZABETH , HELLER SIMON R. , COOKE DEBBIE
Published: June 2019

Aims: To compare the acceptability, reliability and validity of five contemporary diabetes-specific quality of life (QoL) scales.

Methods: Adults with type 1 diabetes in the UK (N=1139) and Australia (N=439) completed a cross-sectional, online survey including: ADDQoL, DCP, DIDP, DSQoLS and QoL-Q diabetes (scales randomised to control for order effects). Participants rated each scale for clarity, relevance, ease of completion, length, and comprehensiveness. Scales were compared in terms of acceptability, response patterns, structure, reliability and validity. To assess cross-country reproducibility, analyses conducted on the UK sample were replicated in the Australian sample.

Results: Findings (summarized in Table 1) were largely consistent between countries. The strongest scale overall was the DIDP, a brief (7-item), neutrally-worded scale with balanced response options. ADDQoL and QoL-Q diabetes also performed well across most criteria.

Conclusions: This is the first empirical study to compare the user acceptability and psychometric properties of five contemporary diabetes-specific QoL scales. These findings may inform assessment of diabetes-specific QoL in routine care and clinical trials, but should be considered in the context of published evidence of the development and responsiveness of the scales.

Disclosure

J. Speight: Research Support; Self; AstraZeneca, Medtronic, Sanofi. Speaker's Bureau; Self; Novo Nordisk A/S, Roche Diabetes Care. E. Holmes-Truscott: Research Support; Self; Sanofi. Speaker's Bureau; Self; Novo Nordisk Inc. C. Hendrieckx: None. E. Coates: None. S.R. Heller: Advisory Panel; Self; Eli Lilly and Company, Novo Nordisk A/S, Sanofi-Aventis, Takeda Pharmaceutical Company Limited, Zealand Pharma A/S. Consultant; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Eli Lilly and Company, Novo Nordisk A/S. D. Cooke: None.

Funding

UK National Institute for Health Research (RP-PG-0514-20013 to S.R.H.)
818-P: Diabetes-Specific Family Functioning and Implications for Adults with Type 2 Diabetes
Authors: MAYBERRY LINDSAY S. , GREEVY ROBERT A. , HUANG LI-CHING , ZHAO SHILIN , BERG CYNTHIA
Published: June 2019

Family involvement affects adults’ management of T2D. Profiles of diabetes-specific family functioning across multiple interrelated dimensions can provide a more complete picture than any single measure.

We queried EMR data to send eligible outpatient adults with T2D a survey link and obtain deidentified data. Participants completed measures of diabetes-specific family functioning (collaborative coping, helpful and harmful involvement, criticism, autonomy support, effectiveness, satisfaction), diabetes distress (Problem Areas in Diabetes-5), and adherence (Adherence to Refills and Medications Scale for Diabetes). K-means clustering identified types with >70% stability. We used sampling weights to correct for imbalance between participants and non-participants in regression models examining associations between type and outcomes, adjusted for sociodemographics, diabetes duration, and insulin status.

Eleven percent (495/5545) of eligible patients accessed the survey and 379 participated. Half were female, 80% were white, with median [IQR] age 59 [50, 67] years, and EMR A1c values taken -9 [-77, 34] days from the survey were 6.9% [6.2, 7.8]. Four types were identified and named: Happily Involved (high collaboration and helpful involvement, high effectiveness and satisfaction), Don’t Need ‘Em (very low collaboration and involvement, low effectiveness and high satisfaction), Feel Alone (very low involvement, effectiveness and satisfaction); and Critically Involved (very high criticism and harmful involvement, moderate effectiveness and satisfaction). Type was independently associated with diabetes distress, adherence, and A1c (all p<.01). Happily Involved and Critically Involved had best and worst outcomes, respectively (all p<.05).

Our empirical typology of diabetes-specific family functioning is relevant to adults’ diabetes distress, adherence, and glycemic control. Types can be used to inform intervention development, tailoring, and evaluation.

Disclosure

L.S. Mayberry: None. R.A. Greevy: None. L. Huang: None. S. Zhao: None. C. Berg: None.

Funding

National Institutes of Health (R03DK113329, K01DK106306)
82-OR: A T1D Genetic Risk Score Combined with Clinical Features and Autoantibodies Enables Accurate Diabetes Classification in a Racial/Ethnically Diverse Population: The Search for Diabetes in Youth Study
Authors: ORAM RICHARD A. , SHARP SETH A. , PIHOKER CATHERINE , FERRAT LAURIC A. , IMPERATORE GIUSEPPINA , SAYDAH SHARON , WILLIAMS ADRIENNE H. , WAGENKNECHT LYNNE E. , LAWRENCE JEAN M. , WEEDON MICHAEL N. , DAGOSTINO RALPH , HAGOPIAN WILLIAM , DIVERS JASMIN , DABELEA DANA
Published: June 2019

Accurate classification of diabetes type guides correct treatment. We recently showed a type 1 diabetes (T1D) genetic risk score (GRS-1), combined with clinical features and biomarkers discriminates between T1D and type 2 (T2D) and MODY in European adults. We aimed to test the ability of an improved 67 SNP T1D score (GRS-2) to discriminate T1D in an ethnically diverse U.S. pediatric population.

We included 1818 SEARCH Study participants who had a C-peptide at a median (IQR) of 8 (6-9) years post diagnosis. T1D was defined based on severe insulin deficiency (fasting C-peptide <0.25 ng/ml) at follow-up. We generated genetic risk scores from SNP data, and assessed discriminative power of the T1D GRS-2 using the area under the receiver operating curve (AUC) in the three largest ethnic groups in SEARCH: white (n=1101, 95% T1D), black (n=228, 59% T1D) and Hispanic (n=257, 77% T1D). We then assessed the discriminative power of GRSs combined with autoantibody and clinical data.

The T1D GRS-2 was discriminative of T1D across all three ethnic groups AUC (95% CI) for GRS-1 vs. GRS-2 was 0.88 (0.84, 0.93) vs. 0.88 (0.83, 0.92) in white, 0.82 (0.77, 0.87) vs. 0.87 (0.83, 0.92) in blacks, and 0.87 (0.82, 0.92) vs. 0.9 (0.86, 0.95) in Hispanics). Combined risk scores were most accurate at classifying T1D. AUC for different scores were: 0.93 (0.91, 0.95) for type assigned by provider at diagnosis, 0.95 (0.93, 0.96) for age and BMI, 0.95 (0.94, 0.97) for GAD/IA-2/ZNT8 autoantibodies, and 0.99 (0.99, 1.00) for a combined approach using autoantibodies, GRS-2 and clinical features. These results were similar across all race/ethnic groups.

A new T1D GRS-2 is discriminative of T1D in a racial/ethnically diverse pediatric population. Using GRS2 in a combined model of clinical features, autoantibodies and genetics offers near perfect classification of T1D and could be used to accurately classify diabetes type.

Disclosure

R.A. Oram: Other Relationship; Self; Randox Laboratories Ltd. S.A. Sharp: None. C. Pihoker: None. L.A. Ferrat: None. G. Imperatore: None. S. Saydah: None. A.H. Williams: None. L.E. Wagenknecht: None. J.M. Lawrence: None. M.N. Weedon: None. R. Dagostino: Consultant; Self; Acelity, Amgen Inc. W. Hagopian: Research Support; Self; Novo Nordisk A/S. J. Divers: None. D. Dabelea: None.

Funding

National Institutes of Health (UC4DK108173)
823-P: Characteristics of Type 1 Diabetes (T1D) Patients Attending a Young Adult Diabetes Clinic (YADC) as a Component of Transition from Pediatric to Adult Diabetes Care
Authors: JOARDER FARAHNAZ , NAGRA HARPREET , ROCHA LOLIS , ANDREAS LAURA , GUTTMANN-BAUMAN INES , AHMANN ANDREW J.
Published: June 2019

Objectives: Transition age patients with T1D age 17 to 25 are at high risk of acute and chronic complications and poor glycemic control. Surveys of youth with T1D transitioning to adult care indicate they desire a formal transition process, orientation and introduction to an adult provider team. To address the needs of young adults with T1D, the YADC was created at the Harold Schnitzer Diabetes Health Center (HSDHC).

Methods: The YADC is a comprehensive half day clinic which includes group orientation with peers, behavioral health screening, diabetes education assessment and a medical provider visit. Youth referred for an appointment are given the option to schedule into the YADC. The YADC is part of the larger program Movin’ Up Movin’ On for transition age youth with T1D at the HSDHC.

Results: Thirty-four of 129 referred patients attended the YADC between November 2017 and December 2018. Half transferred care internally from pediatric to adult providers. Patients were predominantly from an urban area. Thirty eight percent had state medical insurance; 62% had commercial insurance. Mean a1c was 9.1. Five of 22 patients with available microalbumin levels screened positive for microalbuminuria. No patients reported retinopathy. Seventeen of 34 patients experienced inpatient admission or an ED visit between 2016 and 2018. Six patients had DKA in the year prior to their clinic visit. Greater than half the patients (20 of 34) had history of depression, anxiety or substance abuse listed in their medical record.

Conclusions: Transition of pediatric to adult care is associated with high risk for acute and chronic complications. This data illustrates the high-risk nature of the YADC attendees and highlights in particular the predominance of behavioral health challenges in this group.

Disclosure

F. Joarder: None. H. Nagra: None. L. Rocha: None. L. Andreas: None. I. Guttmann-Bauman: None. A.J. Ahmann: Advisory Panel; Self; Eli Lilly and Company, MannKind Corporation, Novo Nordisk Inc., Sanofi-Aventis. Consultant; Self; Dexcom, Inc. Research Support; Self; Dexcom, Inc., Medtronic.