bluuebunny/crossref_metadata_2025 huggingface dataset:
138-LB: A Retrospective Algorithm to Identify Meal Intakes from CGM Time Series
Authors: CAMERLINGO NUNZIO , SHAAFI KABIRI NINA , PSALTOS DIMITRIOS , ISIK KARAHANOGLU F. , KHAN SHERAZ , MESSINA ISABELLE , WICKER MADISEN , KELLY MEREDITH , ZHANG HAO , MESSERE ANDREW , SANTAMARIA MAR , DEMANUELE CHARMAINE , CAOUETTE DAVID , THOMAS KEVIN C.
Published: June 2023

The accurate assessment of dietary behavior in clinical trials, including number and size of meal intakes, is essential to evaluate participants’ metabolic health which, in turn, might reflect an increased risk for developing diabetes. Traditional dietary assessments leverage handwritten/digital food logs, which are error-prone and time-consuming for both users and investigators. Instead, glucose timeseries unobtrusively collected by CGM could provide objective measures of meals’ consumption. Here we present a new algorithm to retrospectively identify meal intakes using CGM data only.

In the Geriatric Anorexia Study (NCT04858932), 50 healthy individuals (26 females, mean±SD age: 72.26±5.02 years, BMI: 24.96±3.33 kg/m2) were monitored in free-living conditions for 2 weeks with the Abbott FreeStyle Libre Pro, and recorded meal intakes using the Renpho Smart Food Scale. After removal of days with <2 meals recorded, a total of 1132 meals over 365 days were available for analysis. To identify meal intakes, the proposed algorithm scans CGM data, identifies local maxima, and measures their prominence, i.e., the relative height with respect to a neighborhood window of length L. Peaks with prominence higher than Pmin are labeled as meals. Subject data was divided into a ~70% training set (n=31, 775 meals), where L and Pmin are tuned, and ~30% test set (n=12, 357 meals), where the algorithm is evaluated in terms of absolute percent error (APE) between number of recorded and detected meals.

Across subjects, mean±sd daily APE is 25.1±9.70%. Similar values hold when considering only subjects with <3.5 meals/day (n=6, 144 meals, APE=24.5±13.2%) and ≥3.5 meals/day (n=6, 213 meals, APE=25.5±6.93%), demonstrating the reliability of the algorithm to identify the number of meals in subjects with different dietary behaviors.

These results evidence the suitability of CGM for the automatic quantification of meal intakes. Further assessment of the algorithm should be performed using more controlled meal intake recordings.

Disclosure

N. Camerlingo: Employee; Pfizer Inc. A. Messere: None. M. Santamaria: None. C. Demanuele: None. D. Caouette: Employee; Pfizer Inc. K. C. Thomas: None. N. Shaafi kabiri: None. D. Psaltos: Employee; Pfizer Inc. F. Karahanoglu: None. S. Khan: None. I. Messina: Research Support; Pfizer Inc. M. Wicker: None. M. Kelly: Research Support; Pfizer Inc. H. Zhang: Employee; Pfizer Inc.
1382-P: Relationship between Diabetes Diet–Related Quality of Life and Dietary Fiber Intake among People with Type 2 Diabetes—A Cross-Sectional Study
Authors: TAKAHASHI FUYUKO , HASHIMOTO YOSHITAKA , KONDO YURIKO , HAMAGUCHI MASAHIDE , YAMAZAKI MASAHIRO , FUKUI MICHIAKI
Published: June 2023

Introduction: This cross-sectional study investigated the association between diabetes diet-related quality of life (QoL) and diet intake in people with type 2 diabetes (T2D) (67.5±10.7 years and 62.2% men).

Methods: Diabetes diet-related QoL and nutritional intake were evaluated using the DDRQoL-R-9, including satisfaction with diet, perceived merits of diet therapy, and burden of diet therapy, and brief-type self-administered diet history questionnaire.

Results: Table shows that perceived merits of diet therapy were positively correlated with glycemic control, although burden of diet therapy was negatively correlated with glycemic control and that dietary fiber intake was negatively correlated with burden of diet therapy, although positively correlated with perceived merits of diet therapy. Dietary fiber intake was associated with perceived merits of diet therapy (β = 0.390, p < 0.001), burden of diet therapy (β = −0.215, p = 0.013), and satisfaction with diet (β = 0.177, p = 0.036), after adjusting for covariates.

Discussion: People who have poor glycemic control despite diet therapy may have been overburdened by the diet therapy. High dietary fiber intake may affect increased burden of diet therapy although the perceived benefits of the diet therapy.

Conclusion: Dietary fiber intake is associated with diabetes diet-related QoL in people with T2D.

Disclosure

F. Takahashi: None. Y. Hashimoto: Speaker's Bureau; Takeda Pharmaceutical Co., Ltd., Sanofi K.K., Kowa Company, Ltd., Novo Nordisk, Sumitomo Dainippon Pharma Co., Ltd., Nippon Boehringer Ingelheim. Y. Kondo: None. M. Hamaguchi: Research Support; Yamada Bee Company, Inc. M. Yamazaki: None. M. Fukui: None.
1383-P: Prevalence of Municipal Policies to Help Reduce Type 2 Diabetes Risk by Providing Environments That Facilitate Healthy Eating and Breastfeeding
Authors: ONUFRAK STEPHEN J. , GALUSKA DEBORAH , PIERCE SAMANTHA L. , MACGOWAN CAROL A. , MOORE LATETIA
Published: June 2023

Introduction: Communities with high diabetes burden may benefit from local policies that facilitate healthy eating and breastfeeding.

Methods: Data from the 2021 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living (CBS HEAL; n=1,927 municipalities) were linked to 2019 county level small area estimates of adult diabetes prevalence (the most recent available) from the Centers for Disease Control and Prevention. We estimated the percentage of US municipalities reporting policies to support healthier food access in supermarkets, convenience stores, and farmers markets and policies to support breastfeeding for municipal employees. Chi-Square tests were used to determine if the presence of policies differed by community diabetes burden.

Results: Among municipalities with the highest diabetes burden (≥10.1%), 33.8% had a policy for supermarkets, 9.3% had a policy for convenience stores, and 62.9% had a policy for farmers markets and the percent of municipalities reporting these policies did not differ significantly by diabetes burden. The percentage of municipalities that provided breastfeeding employees time and space to pump breast milk differed by diabetes burden (p=0.006) and ranged from 47.7% among those with the highest diabetes burden to 69.3% among municipalities with the lowest burden (≤6.5%). Among municipalities with the highest diabetes burden, 38.2% provided any paid maternity leave, and 19.9% provided ≥8 weeks of maternity leave. Frequency of maternity leave policies did not differ significantly by diabetes burden.

Conclusion: Among US municipalities healthy food retail policies did not differ by diabetes burden. Less than half of municipalities with the greatest burden reported policies to support breastfeeding for municipal employees. Opportunities exist to improve support for healthy eating and breastfeeding among communities with high burden of diabetes.

Disclosure

S.J.Onufrak: None. D.Galuska: None. S.L.Pierce: None. C.A.Macgowan: None. L.Moore: None.
1384-P: Trends in Prevalence, Awareness, and Treatment of Diabetes and Prediabetes among Young Adults in the U.S., 1988–2020
Authors: HUANG YUE , WANG HUI , ZHONG VICTOR W.
Published: June 2023

Objective: To estimate trends in prevalence, awareness and treatment of diabetes and prediabetes among young adults in the US.

Methods: Adults aged 20-44 years except pregnant women were included from the National Health and Nutrition Examination Survey between 1988-1994 and 2017-2020. Primary outcomes were diabetes and prediabetes defined according to self-reported diagnosis, fasting plasma glucose, or hemoglobin A1c. Secondary outcomes were awareness and treatment of diabetes and awareness of prediabetes. The prevalence trends of outcomes were assessed, and grouping variables (e.g., age, sex, race/ethnicity) were selected for subgroup analysis.

Results: Among young adults included, the estimated prevalence of diabetes increased from 3.1% [95% CI, 2.5%-3.7%] in 1988-1994 to 4.9% [95% CI, 4.0%-5.8%] in 2017-2020 (P=0.002). The estimated prevalence of prediabetes rose from 21.8% [95% CI, 19.7%-23.9%] in 1988-1994 to 28.7% [95% CI, 24.6%-32.8%] in 2017-2020 (P=0.001). The estimated prevalence of diabetes awareness decreased from 70.8% [95% CI, 60.4%-81.2%] in 1988-1994 to 64.9% [95% CI, 59.0%-70.8%] in 2010-2020 with no significance (P=0.25), and the estimated prevalence of diabetes treatment plateaued (P=0.64). In 2011-2020, among young adults with prediabetes, only 8.8% [95% CI, 6.5%-11.2%] reported being aware of their condition. During the study period, young adults aged 20-29 years had significant decrease in the prevalence of diabetes awareness and diabetes treatment, significant increase in the prevalence of prediabetes, and the lowest prevalence of prediabetes awareness.

Conclusions: Among young US adults, the estimated prevalence of diabetes and prediabetes increased significantly from 1988 to 2020, and their awareness of diabetes and prediabetes was insufficient, especially among adults aged 20-29 years. Comprehensive actions are needed to address the continuously rising burden of glycemic control among young adults in the US.

Disclosure

Y.Huang: None. H.Wang: None. V.W.Zhong: None.

Funding

Shanghai Municipal Education Commission (QD2020027, GWV-10.1-XK15)
1389-P: Life’s Essential 8, Socioeconomic Status, and Incidence of Nonalcoholic Fatty Liver Disease
Authors: LI XIANG , XUE QIAOCHU , MA HAO , WANG XUAN , FENG HAN , HEIANZA YORIKO , QI LU
Published: June 2023

Background: The American Heart Association (AHA) recently released a new cardiovascular health (CVH) metric, Life’s Essential 8 (LE8). Nonalcoholic fatty liver disease (NAFLD) shares many common risk factors with cardiovascular disease. We aim to analyze the relationship between LE8 and the risk of NAFLD; and assess the modification effects of socioeconomic status and genetic susceptibility.

Methods: We prospectively analyzed the association between LE8 and the risk of NAFLD among 141,504 participants from the UK Biobank. LE8 was defined by the AHA algorithm and categorized into low (0-49), moderate (50-79), and high (80-100) CVH.

Results: A higher LE8 score was associated with a significantly lower risk of NAFLD (p<0.001). Compared to individuals with a low CVH, the HR (95% CI) was 0.40 (0.34, 0.47) for those with a moderate CVH, and 0.12 (0.09, 0.16) for those with a high CVH. Townsend deprivation index (TDI) and education level modified the association between LE8 and NAFLD (p-int<0.001 for TDI and p-int=0.003 for education, Figure). The protective associations were more pronounced among those less deprived and those with higher education. Moreover, we observed a significant interaction between LE8 and genetic predisposition to NAFLD (p-int=0.023).

Conclusion: Adherence to a high LE8 is associated with a lower risk of NAFLD. Such relationships are modified socioeconomic status or lower genetic risk.

Disclosure

X. Li: None. Q. Xue: None. H. Ma: None. X. Wang: None. H. Feng: None. Y. Heianza: None. L. Qi: None.

Funding

National Heart, Lung, and Blood Institute (HL071981, HL034594, HL126024); National Institute of Diabetes and Digestive and Kidney Diseases (DK115679, DK091718, DK100383); Fogarty International Center (TW010790)
1390-P: Incidence and Predictors of Remission and Relapse of Type 2 Diabetes Mellitus (T2DM) in Japan—Analysis of Nationwide Patient Registry
Authors: FUJIHARA KAZUYA , MON KHIN LAY , MURAI KOSHIRO , MITSUMA YURIE , YAMAZAKI KATSUYA , MAEGAWA HIROSHI , TANAKA SHIRO , KODAMA SATORU , SONE HIROHITO
Published: June 2023

To determine the incidence/one year relapse from remission and associated factors in patients with T2DM. A total of 48,320 Japanese patients with T2DM with HbA1c ≥6.5% and/or glucose-lowering drug prescription were identified from databases of specialists’ clinics from 1989 and followed until September 2022. Remission was diagnosed according HbA1c <6.5% at least 3 months after cessation of glucose-lowering drug and relapse as failing to maintain remission for 1 year. Factors associated with remission/relapse were evaluated by logistic regression analysis. The overall incidence of remissions per 1,000 person-years was 10.5. Such values for those with HbA1c 6.5-6.9%, taking no glucose-lowering drugs at baseline, and a ≥10% BMI reduction in one year were 27.8, 21.7, 48.2, respectively (Fig.). Shorter duration, lower baseline HbA1c, higher BMI at baseline, higher BMI reduction at one year, and no glucose-lowering drugs at baseline were significantly associated with remission. Among 3,677 persons with remission, approximately two-thirds (2,490) relapsed within one year. Longer duration, lower BMI at baseline, and lower BMI reduction at one year were significantly associated with relapse. Results showed that the incidence of remission and predictors of relapse, especially baseline BMI were greatly different in East Asians compared to reports in Western populations.

Disclosure

K.Fujihara: None. L.Khin: None. K.Murai: None. Y.Mitsuma: None. K.Yamazaki: None. H.Maegawa: None. S.Tanaka: Research Support; Novo Nordisk. S.Kodama: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd.

Funding

Japan Society for the Promotion of Science (21K11569)
1397-P: Characterization of Adults with Newly Diagnosed Type 2 Diabetes by Levels of Early Glycemic Control
Authors: BOARD CHRISTINE , ALEXEEFF STACEY , KARTER ANDREW J. , GRANT RICHARD W. , GOPALAN ANJALI
Published: June 2023

Glycemic control for type 2 diabetes (T2D) in the US remains suboptimal, and the trajectory of improvement has plateaued over the past decade. The ability to use electronic health record (EHR) data available at the time of diagnosis to proactively risk-stratify newly diagnosed individuals could enable the targeting of more tailored, intensive initial care to high-risk individuals starting on day 1. As a first step we sought to explore the differences between patients by early sub-optimal glycemic control. Using data from a large healthcare system, we identified adults (21-74 years) diagnosed with T2D from 2010-2016. We use EHR-derived patient factors including clinical characteristics, sociodemographics, care utilization patterns, and health behaviors (assessed at T2D diagnosis). We defined suboptimal glycemic control using the time weighted HbA1c over the 5-years post diagnosis. We dichotomized people into those with a time weighted average HbA1c ≥ 8% vs. <8%. We used chi-square tests and t-tests to compare patient factors by level of glycemic control. Among 49,213 individuals, 6,677 (13.7%) had suboptimal glycemic control. Those with suboptimal glycemic control were more likely to be younger (mean age 47.5 vs. 55.1, p<0.001), male (60.3% vs. 50.9%, p<0.001), and Latino (32.1% vs. 20.8%, p<0.001), but less likely to have any prior HbA1c measurements (7.5% vs. 23.9%, p<0.001), an influenza vaccine during the year prior to diagnosis (39.1% vs. 58.3%, p<0.001), and to have a recent primary care provider (PCP) visit (88.3% vs. 95.2%, p<0.001). There were clear demographic and care utilization differences between optimal vs. suboptimal glycemic control which suggests patient and provider engagement may be important for achieving glycemic control. In future work we seek to determine if models leveraging a set of EHR-derived patient variables can predict suboptimal glycemic control. Such risk stratification can support healthcare systems in tailoring the intensity of initial T2D care.

Disclosure

C.Board: None. S.Alexeeff: Research Support; NIH - National Institutes of Health. A.J.Karter: None. R.W.Grant: None. A.Gopalan: Research Support; American Diabetes Association, National Institute of Diabetes and Digestive and Kidney Diseases.

Funding

National Institutes of Health (1R21DK130018-01)
1400-P: Low Blood Oxygen Saturation Is Associated with Impaired Glucose Control in Diabetes
Authors: LUZI LIVIO , MACRÌ CONCETTA , FERRULLI ANNA , BERRA CESARE C. , ROMANO CRISTINA , MASSARINI STEFANO
Published: June 2023

Low Blood Oxygen Saturation (BOS) is associated with increased overall morbidity / mortality and prevalence of diabetes is known to increase with altitude (lower 02 partial pressure). Individuals with complicated diabetes commonly have low blood oxygen saturation compared with nondiabetic patients. To unravel the link between low BOS and glucose metabolism, we investigated the correlation between BOS and glucose, BOS and HbA1c levels, BOS and VO2 consumption (Resting Energy Expenditure) in a cohort of adults with diabetes mellitus. The study included 1362 adults with diabetes (616 F, 746 M; 66.4 ± 14.2 years, range 18-85 years; BMI 27.6 ± 5.0 kg/m2, range 18-49.6 kg/m2; SpO2 97.2 ± 1.4%, range 88-100%; glucose 137.7 ± 45.0 mg/dl, range 50.0-323.0 mg/dl). A significant inverse correlation (Pearson) between the glucose (glucometer) and the BOS (pulsoximeter) (p<0.0001*; r = -0.1530). An inverse correlation (Pearson correlation) between the HbA1c levels and the BOS (n=1295; 568 F, 727 M; 67.5 ± 13.1 years, range 18-85 years; BMI 27.8 ± 5.2 kg/m2, range 18-49.8 kg/m2; HbA1c 52.9 ± 13.0, range 25-152 mmol/mol; p<0.0001*; r = -0.1351). In summary, we showed an inverse relationship between oxygen saturation and both glucose and glycosylated hemoglobin levels. Although the exact mechanisms behind lower blood oxygen saturation in diabetes are unknown, we speculate that a reduced pulmonary diffusion capacity as a consequence of pulmonary microvascular damage could play an important role. In conclusion, present preliminary data indicate the routine measurement of BOS along with glucose and glycosylated hemoglobin in the outpatient visit setting of diabetic patients as a biomarker of seriousness of disease.

Disclosure

L. Luzi: Speaker's Bureau; A. Menarini Diagnostics, Amgen Inc., Boehringer Ingelheim and Eli Lilly Alliance. Advisory Panel; Eli Lilly and Company. Speaker's Bureau; Eli Lilly and Company. Research Support; Gelesis. Advisory Panel; Medtronic. Speaker's Bureau; Novo Nordisk, Novartis. C. Macrì: None. A. Ferrulli: None. C.C. Berra: None. C. Romano: None. S. Massarini: None.

Funding

IRCCS MultiMedica (Ricerca Corrente)
1407-P: Trends in Health Behaviors among U.S. Adults with Diabetes—2007–2018
Authors: SHAH MEGHA K. , GANDRAKOTA NIKHILA , SIEGEL KAREN R. , ALI MOHAMMED K.
Published: June 2023

Background: Understanding trends in health habits of people with diabetes can inform interventions to improve lifestyle management. Design: We used data from non-pregnant adults aged 18 and older with self-reported diabetes participating in cross-sectional National Health and Nutrition Examination Survey 2007-2010, 2011-2014, and 2015-2018. Self-reported lifestyle goals included: healthy eating (consumption of added sugar, fruits, vegetables, and whole grains), physical activity, weight management, sleep, alcohol consumption, and tobacco use.

Methods: For each period, proportions of adults with diabetes who met each recommended lifestyle goal were estimated overall and by sociodemographic characteristics.

Results: During 2007-2010, in adjusted analyses, 63.4% of adults with diabetes met added sugar recommendations, 68.8% did not smoke, 66.5% met alcohol consumption goals, 32.8% reported adequate sleep, 67.1% reported engaging in weight management, and 26.5% met physical activity goals. From 2007-2010 to 2015-2018, proportions of adults with diabetes meeting sleep (difference: +16.7; 95% CI: 10.6, 22.8) and physical activity (difference: +8.31; 95%CI: 3.8, 12.8) goals increased. Proportions meeting the added sugar goal (difference: -8.8; 95% CI -14.7,-2.9) decreased, while no significant changes in tobacco use, alcohol consumption, and weight management were seen. There were significant variations in added sugar consumption, physical activity, and weight management by older age, lower education level, and tighter glycemic control.

Discussion: There has been little improvement in health habits among most adults with diabetes, although adults aged 65 years and older or had lower educational attainment significantly increased sleep and physical activity.

Disclosure

M.K.Shah: None. N.Gandrakota: None. K.R.Siegel: None. M.K.Ali: Advisory Panel; Bayer Inc., Eli Lilly and Company, Research Support; Merck & Co., Inc.

Funding

National Institute on Minority Health and Health Disparities (5K23MD015088-03); Emory University School of Medicine; Doris Duke Charitable Foundation; COVID-19 Fund to Retain Clinical Scientists; National Institutes of Health (UL1TR002378)
1408-P: Use of Antihyperglycemic Medications among U.S. Patients with Limited English Proficiency
Authors: ALSHAARAWY OMAYMA , KOTTUTT JEPKOECH J. , BHANGU NIKITA , HOLMAN HARLAND , MUELLER FRANK
Published: June 2023

Language-concordant care enhances self-management and adherence of patients. In agreement, limited English proficiency (LEP) is adversely associated with glycemic control and cardiovascular health of patients with diabetes mellites (DM). New antihyperglycemic medications with high effectiveness and cardiovascular benefit are now available in the market. The STEPS analysis identifies simplicity of administration as an important parameter for assessing medications, and communication barriers can complicate prescribing decisions for patients with LEP. This study examines the pharmacologic management of DM by LEP status. Data are for non-pregnant adults recruited for the National Health and Nutrition Examination Survey (NHANES, 2003-18). The sample included 4645 participants with self-reported physician-diagnosed probable type 2 DM (age of diagnosis ≥ 20 years; not solely using insulin). Most participants completed the NHANES interview in English (90%), whereas 7% completed the interview in Spanish and 3% requested an interpreter. Approximately 20% of English-speaking, 27% of LEP-Spanish, and 15% of LEP-interpreter participants did not use any antihyperglycemic medication in the past 30 days (Rao-Scott χ2 p = 0.003). The use of medications with hypoglycemia risk (insulin and/or secretagogues) did not differ by LEP status (52%, 52%, and 57%; p = 0.6). Similarly, there were no differences in the use of metformin (69%, 73%, and 64%; p = 0.3) or newer medications (GLP1 agonists, SGLT2 and DPP4 inhibitors) with weight loss or cardiovascular benefits (12%, 10%, and 11%; p = 0.7) between the 3 groups. Medications with cardiovascular risk (thiazolidinediones) were more commonly used among English-speaking (14%) than LEP-Spanish (7%) and LEP-interpreter participants (12%; p = 0.04). Pharmacologic management of DM did not significantly differ based on LEP status, suggesting that access to effective antihyperglycemic medications does not explain the observed disparities in DM control.

Disclosure

O.Alshaarawy: None. J.J.Kottutt: None. N.Bhangu: None. H.Holman: None. F.Mueller: None.

Funding

National Institutes of Health (AT009156)
141-OR: Discrepancy between Genetically-Predicted and Actual Body Mass Index Predicts Incident Diabetes Mellitus
Authors: RHEE TAE-MIN , LEE HYUNSUK , CHOI JAEWON , LEE JUNESEONG S. , HEON KWAK SOO , SOO PARK KYONG
Published: June 2023

Background: Body mass index (BMI) is a key predictor of metabolic disorders including type 2 diabetes mellitus (T2D). Polygenic risk scores (PRS) derived from genome-wide association studies (GWAS) can predict BMI based on common variants, and genetically-predicted BMI (BMI-pred) could serve as a threshold for personal fat storage. We hypothesized that difference between BMI-pred and actual BMI (BMI-diff) could reflect severity of environmental factors affecting BMI and may predict incident T2D.

Methods: From the UK Biobank cohort, we selected participants of white British descent without a history of T2D (n=383,160). The PRS for BMI was calculated using polygenic prediction via Bayesian regression and continuous shrinkage priors (PRS-CS) with summary statistics from the Genetic Investigation of ANthropometric Traits consortium GWAS. According to the BMI-diff, the 10-year risk of T2D was assessed using multivariable Cox proportional-hazards model. Results were validated in an independent cohort from South Korea (n=8,840).

Results: Participants (mean age 56.8 ± 8.0, male 45.3%) were randomly divided into train (n=268,041) and test set (n=115,119) to establish BMI-pred using PRS-CS. In the test set, the BMI-pred could explain 7.1% of the variance of BMI and T2D occurred in 3,599 (3.1%) cases during 10-year follow-up. The risk of T2D increased linearly according to the decrease of BMI-diff. Participants in the higher quintiles of BMI-diff (more obese than genetically-predicted), had significantly higher risk of T2D than those in the lowest quintile (less obese than genetically-predicted) regardless of their own BMI: adjusted HR (aHR) of 1st quintile 1.61, 95% confidence interval (CI) 1.26-2.05, P <0.001; aHR of 2nd quintile 1.48, 95% CI 1.21-1.81, P <0.001. Results were consistent when validated in the South Korean cohort.

Conclusion: Deviation of actual BMI from BMI-pred which reflects severity of environmental factors is a significant predictor of incident T2D.

Disclosure

T.Rhee: None. H.Lee: None. J.Choi: None. J.S.Lee: None. S.Kwak: None. K.Park: None.
1417-P: High Prevalence of Compensated Advanced Chronic Liver Diseases among Patients with Type 2 Diabetes Mellitus (CDL 2301)—A Prospective Community-Based Study
Authors: QI XIAOLONG , HE RUILING , LIU CHUAN , SUN CHAO , TENG GAOJUN
Published: June 2023

Objective: Considering that type 2 diabetes mellitus (T2DM) may be one of the strongest risk factors for promoting nonalcoholic steatosis to advanced fibrosis, we aimed to investigate the prevalence of steatosis and fibrosis, and identify risk factors associated with compensated advanced chronic liver diseases (cACLD) among Chinese adults with T2DM in the community.

Methods: This is a prospective large-scale study covering six cities in China. We enrolled T2DM patients registered in the community between June 2021 and November 2022, and collected baseline demographics and comorbidities. Furthermore, controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were measured by vibration-controlled transient elastography to assess hepatic steatosis and fibrosis.

Results: A total of 3,196 patients with T2DM in the community were included in the study. The prevalence of steatosis (CAP ≥248 dB/m) and cACLD (LSM ≥10 kPa) was 60% and 9%, respectively. Additionally, the prevalence of mild fibrosis (F1), moderate fibrosis (F2), severe fibrosis (F3) and cirrhosis (F4) was 12%, 7%, 7% and 3%, respectively. The distribution of mild (S1), moderate (S2), and severe (S3) steatosis was 14%, 8%, and 38%, respectively. Furthermore, 5% of patients with non-obesity (body mass index <30 kg/m2) nonalcoholic fatty liver disease related cACLD (12/252) presented with clinically significant portal hypertension (LSM ≥25 kPa) according to the renewing Baveno VII consensus, indicating a high risk of hepatic decompensation. In the multivariate logistic regression model, age>50 years, body mass index, and the presence of hypertension were independent predictors of cACLD among patients with T2DM in the community.

Conclusions: We found a considerable prevalence of steatosis and cACLD in community patients with T2DM. It is imperative to screen for these conditions to facilitate further intervention among T2DM patients.

Disclosure

X.Qi: None. R.He: None. C.Liu: None. C.Sun: None. G.Teng: None.
1419-P: Pandemic-Specific Associations of Maternal Exposure to Per- and Polyfluoroalkyl Substances and Glucose Metabolisms—A Cross-Sectional Analysis in Birth Cohort in Hong Kong
Authors: YANG AIMIN , TAM CLAUDIA H. , OZAKI RISA , LOWE WILLIAM L. , METZGER BOYD E. , TAM WING H. , WONG CHRIS K. , MA RONALD C.
Published: June 2023

Introduction: Per- and polyfluoroalkyl substances (PFAS) have adverse cardiometabolic effects.

Methods: We conducted a cross-sectional analysis in 1601 mothers who had joined the Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) study in Hong Kong in 2001-2006. All mothers underwent a 75g-oral-glucose-tolerance test at 24-32 weeks of gestation. We measured serum concentrations of six PFAS biomarkers using high-performance LC-MS-MS. We fitted linear-regression, weighted-quantile-sum (WQS) regression, and quantile-g-computation (qgcomp) models to estimate the associations of individual PFAS and their mixture with levels of HbA1c and plasma-glucose (PG). Subgroup analyses were performed based on the enrollment period by the severe-acute-respiratory-syndrome (SARS) epidemic in Hong Kong between March 2003 and May 2004.

Results: Maternal exposure to PFAS mixture was associated with increased HbA1c in both WQS (β=0.05, 95% CI: 0.02-0.07) and qgcomp models (β=0.04, 95% CI: 0.01-0.06). We did not observe significant associations of PFAS mixture with fasting PG, 1-h and 2-h PG in both models, except for 2-h PG in qgcmop model (β=0.074, 95% CI: 0.01-0.15). Pandemic-specific analyses showed a significant association of PFAS mixture with increased HbA1c in peri-SARS but not in pre-SARS and post-SARS epidemic period. Perfluorooctanoic-acid (PFOA) and perfluorooctane-sulfonic-acid (PFOS) were the main contributors to the overall positive effects on HbA1c. The level of PFOS was highest during the peri-SARS epidemic (median [IQR]: 24.7 [42.6-89.5] ng/mL) compared with pre-SARS (12.6 [20.0-49.8] ng/mL) and post-SARS (20.6 [27.8-46.4] ng/mL) epidemic.

Conclusions: Maternal exposure to PFAS mixture is associated with glucose metabolisms during pregnancy. Pandemic-specific associations call for further studies on its adverse health effects during the COVID-19 pandemic.

Disclosure

A.Yang: None. C.H.Tam: None. R.Ozaki: None. W.L.Lowe: None. B.E.Metzger: None. W.H.Tam: None. C.K.Wong: None. R.C.Ma: Advisory Panel; AstraZeneca, Merck & Co., Inc., Other Relationship; Bayer Inc., Boehringer-Ingelheim, Research Support; Tricida, Inc., Roche Diagnostics, Novo Nordisk.

Funding

Health and Medical Research Fund (13140761); Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institute of Diabetes and Digestive and Kidney Diseases (R01HD34242, R01HD34243); Research Grants Council of Hong Kong (473408, 471713)
142-OR: Adiposity and Mortality among U.S. Hispanic/Latino Adults
Authors: ZHANG YANBO , CHEN GUO-CHONG , SOTRES-ALVAREZ DANIELA , PERREIRA KRISTA M. , GALLO LINDA , LLABRE MARIA M. , CAI JIANWEN , XUE XIAONAN , ISASI CARMEN R. , KAPLAN ROBERT , QI QIBIN
Published: June 2023

Adiposity has been linked with mortality among Whites/Asians, but evidence from Hispanics is limited. We included 15855 adults from the Hispanic Community Health Study/Study of Latinos (2008-11). BMI, waist circumference (WC), waist-to-hip ratio (WHR), and body fat percentage (BF%) were measured, and Cox regressions estimated their relations with mortality. Over 153828 person years (median 10 years), 651 deaths occurred. With adjustment of sociodemographic and lifestyle covariates (Figure; Model 1), no dose-response relation of BMI or BF% with mortality was found. Compared with normal weight (BMI<25 kg/m2), only severe obesity (BMI≥35 kg/m2) was associated with higher mortality (HR=1.58, 95% CI 1.08-2.31). Central obesity was associated with higher mortality with HRs (95% CIs) of 1.41 (1.01-1.97) comparing WC of >102/88 cm (for men/women) vs ≤94/80 cm and 1.70 (1.14-2.53) comparing WHR of ≥0.90/0.85 vs <0.90/0.85. With further adjustment of baseline comorbidities (Figure; Model 2), only WHR remained associated with mortality. BMI was highly correlated with BF% and WC (r>0.84) but not WHR (r=0.54). WHR remained associated with mortality after further adjusting for BMI. Sex suggestively modified the relation of WHR with mortality which was stronger among women. Among US Hispanic/Latino adults, only severe obesity was associated with higher mortality. WHR could predict mortality better and should be evaluated in bodyweight management.

Disclosure

Y.Zhang: None. R.Kaplan: None. Q.Qi: None. G.Chen: None. D.Sotres-alvarez: None. K.M.Perreira: None. L.Gallo: None. M.M.Llabre: None. J.Cai: None. X.Xue: None. C.R.Isasi: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK119268, R01DK120870, P30DK111022); National Heart, Lung, and Blood Institute (HHSN268201300001I/N01-HC-65233, HHSN268201300004I/N01-HC-65234, HHSN268201300002I/N01-HC-65235, HHSN268201300003I/N01-HC-65236, HHSN268201300005I/N01-HC-65237)
1421-P: Ten-Year Trend in Socioeconomic Inequalities in the Prevalence and Incidence of Pharmacologically Treated Type 2 Diabetes in France—2010–2020
Authors: GUION MARIE , MANDEREAU-BRUNO LAURENCE , GORIA SARAH , FOSSE-EDORH SANDRINE , COSSON EMMANUEL
Published: June 2023

The aim was to describe the association between socio-economic inequalities (SEI) and the prevalence/incidence of pharmacologically-treated type 2 diabetes (T2D) in France over the 2010-2020 period. Diabetes cases were identified using a validated algorithm in the French national health data system. Analyses were restricted to adults ≥45 years to focus on T2D. SEI were measured, each year, via the French Deprivation index (FDep, by population quintiles; Q1: corresponding to the less deprived municipalities) for metropolitan France. The relative risks (RR) of being T2D (prevalence) and developing T2D (incidence) in Q2, Q3, Q4 and Q5 were estimated by sex over the period via Poisson regression. Denominators were the French health consumers (from 24,228,526 in 2010 to 29,772,928 in 2020) for prevalence and the at risk population for incidence. A positive gradient was observed in the RR of T2D prevalence and incidence by FDep quintiles in all years. The influence of SEI (reference Q1) on T2D prevalence increased over the period for men in Q2, Q3, Q4 and Q5, and for women in Q3, Q4 and Q5; and on T2D incidence for men in Q4 and Q5. To conclude, SEI were positively associated with the prevalence/incidence of pharmacologically-treated T2D in metropolitan France. Further, the association increased over last decade for prevalence, and only in most deprived men for incidence.

Disclosure

M.Guion: None. L.Mandereau-bruno: None. S.Goria: None. S.Fosse-edorh: None. E.Cosson: Board Member; Abbott, Medtronic.

Funding

Fondation de France (00107045)
1422-P: The Impact of Type 2 Diabetes Mellitus on the Clinical Outcome of Breast Cancer
Authors: JI KIM YU , GOAK INSUN , YONG JIN HEUNG , SUN PARK TAE , AE LEE KYUNG
Published: June 2023

Objectives: Women with breast cancer and diabetes have worse outcomes than those with breast cancer without diabetes. The objective of this study was to investigate the impact of pre-existing diabetes on breast cancer prognosis.

Methods and Materials: This was a retrospective observational study using Cancer database from a single tertiary center. The study population included women aged ≥20 years with breast cancer diagnosed between 1 January 2014 and 31 December 2018. Patients were categorized by diabetes status (T2D: n=111, non-T2D: n= 889). The clinicopathological features and outcomes were collected and compared between women with and without diabetes. Cox proportional hazard regression was used to estimate adjusted hazard ratios for overall mortality.

Results: Compared to non-T2D patients, T2D patients were significantly older, had higher BMI, were more post-menopausal state at breast cancer diagnosis, had more comorbid conditions, and were in lower educational states. There were no statistically significant differences in tumor characteristics, including metastasis, lymph nodes, grade, and extent of surgery. Women with T2D had a significantly increased risk of overall mortality after adjusting for demographic and traditional risk factors for breast cancer (HR=2.15; 95%CI=1.10-4.20). Compared to patients with pre-existing T2D (n=111), patients with newly diagnosed T2D after receiving a breast cancer diagnosis (n=34) had a lower risk of breast cancer recurrence (HR=0.30; 95%CI=0.10-0.94).

Conclusion: Our study showed that pre-existing T2D and T2D itself increase the risk of recurrence and total mortality among patients with breast cancer. These findings provide important prognostic information for the treatment of women with both T2D and breast cancer. Therefore, diabetes deserves additional attention to assess possible causal relationships that potentially could be modified to improve outcomes.

Disclosure

Y.Kim: None. I.Goak: None. H.Jin: None. T.Park: None. K.Lee: None.
1423-P: Glycemic Status at Three-Year Follow-up in LANDMARC—Longitudinal Nationwide Study on Real-World Outcomes of Type 2 Diabetes in India
Authors: JOSHI SHASHANK R. , DAS ASHOK K. , PRASANNA KUMAR K.M. , MITHAL AMBRISH , KALRA SANJAY , GOPALAKRISHNAN UNNIKRISHNAN AMBIKA , THACKER HEMANT , SETHI BIPIN , CHOWDHURY SUBHANKAR , SUGUMARAN AMARNATH , SATPATHY ASHWINI , GADEKAR ARVIND , MENON SHALINI K. , NEOGI RENUKA , CHODANKAR DEEPA , TRIVEDI CHIRAG , KUMAR WANGNOO SUBHASH , ZARGAR ABDUL H. , RAIS NADEEM
Published: June 2023

Glycemic change from baseline to 3 years was examined in LANDMARC — a prospective observational study (CTRI/2017/05/008452) — that included participants with type 2 diabetes (T2D) taking ≥2 antihyperglycemic medications (with/without glycemic control). Of 6222 evaluable participants (mean baseline values - age: 52.1 years, T2D duration: 8.6 years and A1C: 8.05%), 5273 completed 3-year follow-up visit. All glycemic parameters improved significantly (p<0.0001) from baseline (A1C: -0.68% [1.65]; FPG: -16.51 mg/dL [55.38]; and PPG -27.07 mg/dL [80.10]). The number of participants in the 7-7.9% A1C subgroup increased from baseline to the end of 3 years; 21.79% (1356/6222) achieved optimum glycemic control of A1C <7%. Glycemic control was not affected by cardiovascular risk factors; while in the subgroups of complications, participants with myocardial infarction, heart failure, and unstable angina showed suboptimal glycemic control (Table). In conclusion, although there was a significant improvement in all the glycemic parameters from baseline, a large majority of the participants remained uncontrolled in terms of achieving target HbA1c. This emphasizes the need for optimizing diabetes management in India.

Disclosure

S.R.Joshi: Advisory Panel; Biocon, Zydus Cadila, Torrent Pharmaceuticals Ltd, Franco India, Consultant; Glenmark Pharmaceuticals, Twin Health, Speaker's Bureau; Abbott Nutrition, Sanofi, Abbott, Novo Nordisk, Lupin Pharmaceuticals, Inc. A.Sugumaran: Employee; Sanofi. A.Satpathy: Employee; Sanofi. A.Gadekar: Employee; Sanofi. S.K.Menon: Employee; Sanofi. R.Neogi: Employee; Sanofi. D.Chodankar: Employee; Sanofi. C.Trivedi: None. S.Wangnoo: None. A.H.Zargar: None. N.Rais: Advisory Panel; Bayer Consumer Care AG, Board Member; Abbott, Biocon. A.K.Das: n/a. K.Kumar: None. A.Mithal: Advisory Panel; Eris Lifesciences Ltd., Consultant; Glenmark Pharmaceuticals, Lupin Pharmaceuticals, Inc., USV Private Limited, Research Support; Sanofi, Speaker's Bureau; Novo Nordisk, Boehringer-Ingelheim, AstraZeneca, Sun Pharmaceutical Industries Ltd., Novartis. S.Kalra: Speaker's Bureau; Abbott, Bayer Inc., Novo Nordisk, Sanofi. A.Unnikrishnan: Speaker's Bureau; Sanofi, AstraZeneca, Boehringer-Ingelheim, Intas Pharmaceuticals Ltd. H.Thacker: None. B.Sethi: None. S.Chowdhury: None.

Funding

Sanofi India
1426-P: Socioeconomic Disparities in Mortality among Young Adults with Diabetes—A Nationwide Cohort Study in South Korea
Authors: YOON KIM JI , HOON KIM NAM , GON KIM SIN
Published: June 2023

Objectives: This study aimed to estimate the overall and cause-specific mortality risk according to socioeconomic status (SES) and age among patients with diabetes.

Research Design and Methods: From the Korean National Health Insurance Service Cohort (2008-2019), 1,240,780 adults aged 20-79 years (604,975 patients with diabetes and 635,805 controls without diabetes) were included. The risk of mortality from any causes, cardiovascular disease, diabetes, and cancer was estimated according to the patients’ SES and compared with age- and sex-matched controls without diabetes. The SES was categorized into three groups (tercile) by subjects’ income. Subgroup analyses were done according to the individuals’ age group (20-39, 40-59, and 60-79 years).

Results: Overall, 48,420 deaths occurred during a follow-up. Compared with individuals without diabetes, the adjusted hazard ratios (HR) of all-cause mortality of patients with diabetes were 1.25 (95% confidence interval (CI), 1.23-1.28) in the highest SES, 1.56 (95% CI, 1.53-1.59) in the middle SES, and 1.78 (95% CI, 1.74-1.82) in the lowest SES group. The inverse relationship between SES and mortality risk was prominent in younger patients; the HRs of all-cause mortality in the lowest SES group were 4.00 (95% CI, 3.25-4.93) in patients aged 20-39 years, 2.71 (95% CI, 2.59-2.84) in those aged 40-59 years, and 1.58 (95% CI, 1.54-1.62) in those aged 60-79 years. A similar association was observed in cause-specific mortality.

Conclusion: Low SES increased the risks of all-cause mortality and mortality from cardiovascular disease, diabetes, and cancer in patients with diabetes. This association is more prominent in younger patients than in older patients.

Disclosure

J.Kim: None. N.Kim: None. S.Kim: None.
1428-P: Type 2 Diabetes Drug Utilization by Claims-Based and Self-Reported Weight Status
Authors: WOLLERSHEIM PAUL , BACON SAM , THOMPSON NELS , CLARK CALLAHAN
Published: June 2023

Background: Weight is an increasingly important component of care goals and treatment selection for people with type 2 diabetes (T2D). Over 80% of people with T2D have obesity, yet population-level assessments can be challenging as weight is often underreported in administrative data.

Methods: We conducted a cross-sectional descriptive analysis of 8,680 commercially insured adults enrolled in a virtual specialty clinic (Level2) for at least one year using de-identified administrative claims and patient-reported BMI in a research database. Diabetes drug prevalence was measured using fill rates and stratified by claims-based and self-reported weight, to describe differences. Claims and diabetes drug fills from 9/15/2021 to 9/15/2022 were included.

Results: Overall, 25.1% (n = 2183) had an obesity-related claim. Of the subset with a self-reported BMI, 76.3% (n = 366) had obesity and 50.1% (n = 187) had at least one obesity-related claim. Diabetes drug fills (Table 1) varied by class, BMI strata, and BMI source. After biguanides, GLP-1 RAs were the most filled class, with utilization varying from 21% (self-reported BMI 25 to 30 kg/m2) to 34% (claims-based BMI > 40 kg/m2).

Conclusion: Despite the importance of weight in T2D care, it remains underreported in administrative data assets. Using administrative data together with accurate measures of weight, including from self-report, can inform T2D practice and program design.

Disclosure

P.Wollersheim: Employee; Level2. S.Bacon: Employee; Optum Labs, Research Support; Level2. N.Thompson: Employee; Level2, Stock/Shareholder; UnitedHealth Group. C.Clark: Employee; UnitedHealth Group, Stock/Shareholder; UnitedHealth Group.
1429-P: Newly Diagnosed Diabetes Is Associated with Higher Mortality and Longer Length of Stay in Hospitalized Patients
Authors: JANG SEOL A. , MIN KIM KYOUNG , SIK KIM CHUL , WON PARK SEOK
Published: June 2023

Several studies have shown that hyperglycemia and a history of diabetes mellitus (DM) are liked to poor outcomes in hospitalized patients. However, about one third of patients with diabetes are left undiagnosed until they admitted to the hospital. The impacts of undiagnosed or newly diagnosed diabetes on hospitalization-related outcomes are not well studied. In this study, we aimed to evaluate hospitalization-related outcomes in hospitalized patents according to their diabetic status at admission. This is a retrospective cohort study, and all subjects aged 20 years or older admitted to Yongin Severance hospital between March 2020 and February 2022 were included. Subjects were divided into no DM group, known DM group by a history of diabetes or taking any antidiabetic medications, and newly diagnosed DM group by results of laboratory test including HbA1c. We compared hospitalization-related outcomes such as in-hospital mortality rate and the length of hospital stay. A total of 33,166 subjects was enrolled. At hospitalization, 6,572 (19.8%) subjects were classified as known DM and another 2,634 (7.9%) subjects were classified as newly diagnosed DM. In-hospital mortality was highest in newly diagnosed DM group (hazard ratio [HR] 5.81, 95% confidence interval [CI] 4.90-6.89, p<0.001) followed by known DM group (HR 2.08, 95% CI 1.74-2.47, p<0.001) compared to no DM group. The length of hospital stay was significantly increased in newly diagnosed DM (15.5±19.3 days) compared with no DM (6.5±7.9 days) and known DM group (8.6±11.1 days) (p<0.001). After adjusting for multiple covariates, newly diagnosed diabetes was independently associated with increased in-hospital mortality (p<0.001). In conclusion, diabetic status at admission was associated with poor outcomes in hospitalized patients. Those with a newly diagnosed diabetes showed particularly high risk of in-hospital mortality and even longer length of hospital stay.

Disclosure

S.A. Jang: None. K. Kim: None. C. Kim: None. S. Park: None.
1430-P: Early Real-World Experiences with Tirzepatide
Authors: LAMBERT NATALIE , JARVIS MEGAN , FESTER JENNA , MCCOY ROZALINA G. , ARD JAMY D. , CLARK CALLAHAN
Published: June 2023

Online communities offer real-world data about interactions with new treatments prior to visibility in clinical or administrative data assets. We evaluated early tirzepatide initiation experiences reported in online health narratives after its May 2022 FDA approval for type 2 diabetes. At data extraction, < 10 tirzepatide claims were in OptumLabs’ deidentified administrative data. We extracted all publicly available posts (N=786) from r/Mounjaro (5/22 to 9/22), a Reddit community of 16,200 members. Categorical coding (agreement = .99) assessed the demographics, clinical history, treatment effects, and side effects from SURPASS trials and captured open-ended details of experiences. Most posts (67.3%) posed a question and included the r/Mounjaro users’ tirzepatide status (78.1%). Of narratives describing active tirzepatide use (N=465; 59.2%), common SURPASS side effects were decreased appetite (21.9%), nausea (11.2%), abdominal discomfort (5.8%), and diarrhea (5.2%). Common poster-defined side effects were fatigue (6.5%), body aches/stiffness (4.1%), and burping (4.1%). Posters reported tirzepatide use for weight (8.4%) more than glucose (0.4%) and obtained prescriptions from virtual clinics (7.1%) more than primary care (4.1%) or obesity specialists (0.4%). While missing some clinical details, online health narratives offer accelerated insights and can inform practice prior to traditional observational data availability.

Disclosure

N.Lambert: Employee; Optum Labs. M.Jarvis: Employee; Optum Labs, UnitedHealth Group, Stock/Shareholder; Oramed Pharmaceuticals, UnitedHealth Group, Dexcom, Inc., Apple, Hologic Inc., Intuitive Surgical. J.Fester: None. R.G.Mccoy: Consultant; Emmi. J.D.Ard: Advisory Panel; Novo Nordisk, Consultant; Eli Lilly and Company, Intuitive Surgical, Regeneron, Other Relationship; Optum Labs, Weight Watchers International, Research Support; Nestlé Health Science, Boehringer Ingelheim Inc., Epitomee, KVK Tech. C.Clark: Employee; UnitedHealth Group, Stock/Shareholder; UnitedHealth Group.