bluuebunny/crossref_metadata_2025 huggingface dataset:
1546-P: Acute Pancreatitis (AP) with Canagliflozin (CANA) vs. Other Antihyperglycemic Agents (AHAs): An Observational Study
Authors: YUAN ZHONG , DEFALCO FRANK , WANG LU , HESTER LAURA L. , SWERDEL JOEL N. , FREEDMAN AMY , RYAN PATRICK , SCHUEMIE MARTIJN , QIU ROSE , YEE JACQUELINE , MEININGER GARY , BERLIN JESSE A. , ROSENTHAL NORM
Published: June 2019

Observational evidence suggests that patients with type 2 diabetes mellitus (T2DM) are at increased risk of AP. A small number of AP events were reported in clinical trials of the SGLT2 inhibitor CANA, with no imbalances noted between treatment groups. This observational study evaluated the risk of AP among new users of CANA vs. 6 classes of other AHAs. Three U.S. claims databases were analyzed based on a prespecified protocol approved by the European Medicines Agency. Propensity score adjustment controlled for imbalances in baseline covariates. Cox regression models were used to estimate the hazard ratio of AP with CANA vs. other AHAs using on-treatment and intent-to-treat (ITT) approaches. Sensitivity analyses assessed the robustness of study findings. Across the 3 databases, there were between 12,023 to 80,986 new users of CANA and the crude incidence rates of AP (events per 1000 person-years) were between 1.5 to 2.2 for CANA and 1.1 to 6.6 for other AHAs. AP risk in patients newly treated with CANA or other AHAs was generally similar (Table). Findings from the ITT approach and sensitivity analyses were qualitatively consistent with the on-treatment approach. In this large observational study, incidence rates of AP in patients with T2DM treated with CANA or other AHAs were generally similar, with no evidence to suggest that CANA is associated with an increased risk of AP compared with other AHAs.

Disclosure

Z. Yuan: Employee; Self; Janssen Research & Development. F. Defalco: Employee; Self; Janssen Research & Development. L. Wang: Employee; Self; Johnson & Johnson. L.L. Hester: Employee; Self; Janssen Research & Development. J.N. Swerdel: Employee; Self; Janssen Pharmaceuticals, Inc. A. Freedman: Employee; Self; Janssen Research & Development. P. Ryan: Employee; Self; Janssen Research & Development. M. Schuemie: Employee; Self; Janssen Research & Development. R. Qiu: Employee; Self; Janssen Research & Development. J. Yee: Employee; Self; Janssen Research & Development. G. Meininger: Employee; Self; Janssen Research & Development. J.A. Berlin: Employee; Self; Janssen Research & Development. Stock/Shareholder; Self; Janssen Research & Development. N. Rosenthal: Employee; Self; Janssen Research & Development.

Funding

Janssen Research & Development, LLC
1547-P: Early Intensive Glycemic Control Is Responsible for Long-Term Durable Glycemic Control and Lower Rate of Diabetic Complications in Newly Diagnosed Type 2 Diabetes Patients: A Six-Year Observational Study
Authors: KIM NAM HOON , KIM SIN GON , JANG HYE-MIN , KIM KYOUNG JIN , KIM HYE SUK
Published: June 2019

Objective: To evaluate whether the early intensive glycemic control is responsible for development of diabetic complications as well as to determine early target HbA1c achievement affects long-term durable glycemic control.

Methods: Of 194 patients with newly diagnosed type 2 diabetes between Jan 2011 and Mar 2013 in the original cohort, 145 were followed-up for > 6 years. Glycemic durability group was defined as the maintenance of optimal glycemic control (HbA1c < 7.0%) without an intensification of glucose-lowering treatment regimens during first 2-year. Microvascular and macrovascular complications were assessed by multiple logistic regression analysis.

Results: During a median follow-up of 6.53 (range 5-9) years, 66 microvascular and 14 macrovascular events occurred. Risk of composite microvascular complications (OR; 4.55, 95% CI; 1.74-11.91) and composite macrovascular complications (OR; 5.57, 95% CI; 0.84-36.78) were higher in the non-durability group than in the durability group. In addition, early achievement to target HbA1c (<3 months) was associated with maintenance of 6-year durable glycemic control (HR; 3.56. 95% CI; 1.14-11.16), and lower risk of microvascular complications (HR; 0.46, 95% CI; 0.26-0.82) compared to late achievement (> 6 months).

Conclusion: This real-world database analysis showed that early intensive glycemic control was associated with a sustained effect on glycemic durability as well as significant reduction in the risk of microvascular complications.

Disclosure

N. Kim: None. S. Kim: None. H. Jang: None. K. Kim: None. H. Kim: None.
1549-P: Factors Associated with Osteoporosis among Hospitalized Patients With and Without Diabetes
Authors: IZUORA KENNETH , ALLENBACK GAYLE , GEWELBER CIVON L. , NEUBAUER MICHAEL F.
Published: June 2019

Background: Diabetes (DM) is a risk factor for osteoporosis (OP). Patients with DM are known to have a higher prevalence of periodontal disease (PD). The aim of this study was to determine factors associated with OP in a cohort of patients with and without DM and to see if there is any relationship with PD.

Method: We administered a questionnaire, inspected the dentition and conducted chart review of consecutive hospitalized patients to gather demographic information, dental health history, smoking history and history or presence of osteoporosis. Data was analyzed using T-tests, Chi-square tests and logistic regression models.

Result: Out of 301 patients enrolled, 102 had DM. Overall; the prevalence of PD was 91% and OP was 10%. In uni-variate analyses, factors significantly associated with diagnosis of OP included older age (p <0.001), female gender (p=0.046), having more discharge medications (p=0.01) and presence of DM (p=0.049). There was no significant relationship between PD or number of healthy teeth and OP. In logistic regression analyses including the significant factors associated with OP, age remained a significant predictor of having OP overall and in the non-DM population. However, in the DM population, female gender was the only significant predictor for having OP, after adjusting for age.

Conclusion: There was no significant relationship between having PD and OP, in our sample. Overall, age was the only significant predictor of having OP. In the DM group, female gender was a stronger predictor of having OP than age. Earlier screening for OP in female patients with DM may be useful to help identify OP sooner in this group.

Disclosure

K. Izuora: None. G. Allenback: None. C.L. Gewelber: None. M.F. Neubauer: None.
1560-P: A History of CHF Predicts Adverse Outcomes of Hospitalizations for Hyperglycemic Crises—Data from National and Local Cohorts
Authors: AGARWAL MANYOO , JAIN NIDHI , KODE SUDHA , PODILA PRADEEP S. , KHOUZAM RAMI N. , IBEBUOGU UZOMA N. , REED GUY , DAGOGO-JACK SAMUEL
Published: June 2019

Background: The impact of a history of congestive heart failure (CHF) on the outcomes of DKA and HHS hospitalizations is unknown, and current guidelines provide no clear recommendations for patients with CHF history.

Objective: To test the hypothesis that a history of CHF impacts the outcomes of DKA/HHS hospitalizations.

Design: Retrospective cohort study of DKA/HHS hospitalizations using Nationwide Inpatient Sample (NIS) database 2003 to 2014 (n= 1,793,983) and University Hospital cohort (n= 1,528).

Outcomes: All cause in-hospital mortality, acute respiratory failure events, length of stay and post discharge utilization of nursing home.

Results: In the NIS cohort, a history of CHF was present in 83,173 (4.6%) patients among DKA/HHS hospitalizations and was associated with higher adverse outcomes (mortality: 2.8% in CHF vs. 0.6% in no-CHF, adjusted odds ratio (AOR) = 1.5, 95% confidence interval (CI) 1.4 to 1.6; acute respiratory failure- 9.8% vs. 2.2%, AOR = 2.1, 95% CI 2.0 to 2.2). CHF history also predicted higher utilization of post discharge nursing home services (19.6% vs. 5.2%, AOR = 1.4, 95% CI 1.3 to 1.5) even after extensive adjustment for patient demographics, Elixhauser comorbidities and Charlson comorbidity index. In the University cohort, CHF history was present in 129 (8.4%) patients among 1,528 HGc hospitalizations and was associated with higher in-hospital complications (in-hospital mortality and acute respiratory failure [(13.2% vs. 5.2%, AOR = 2.1, 95% CI 1.2 to 3.7)] and higher utilization of post discharge nursing home (15.2% vs. 2.6%, AOR = 2.5, 95% CI 1.3 to 4.7) when compared with those without CHF. Mean length of stay was higher in patients with CHF history compared with no-CHF history in both datasets.

Conclusions: A history of CHF is an under-recognized risk factor for adverse outcomes of hospitalizations for hyperglycemic crises. Prospective studies are warranted to better understand and mitigate these differences in outcomes.

Disclosure

M. Agarwal: None. N. Jain: None. S. Kode: None. P.S. Podila: None. R.N. Khouzam: None. U.N. Ibebuogu: None. G. Reed: Other Relationship; Self; Translational Sciences. S. Dagogo-Jack: Board Member; Self; Jana Care Inc. Consultant; Self; Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Sanofi-Aventis. Research Support; Self; AstraZeneca, Novo Nordisk Inc. Stock/Shareholder; Self; Dance Biopharm Holdings Inc.
1564-P: Prevalence of Sarcopenia in Community Dwelling Korean Older Adults with Diabetes
Authors: KANG SUNYOUNG , OH TAE JUNG , CHOI SUNGHEE , PARK KYONG SOO , CHUL JANG HAK
Published: June 2019

Objective: Diabetes has been suggested to be one of the risk factors of physical disability in older adults. The aim of this study is to examine the prevalence of sarcopenia in Korean older adults with diabetes compared to nondiabetic adults.

Methods: We analyzed 1,241 adults aged 70-84 years, who were enrolled in the Korean Frailty and Aging Cohort Study (KFACS). The skeletal muscle mass was assessed by dual-energy X-ray absorptiometry, and muscle strength was assessed by hand grip strength (HGS). Physical performance was assessed by the Short Physical Performance Battery (SPPB), and the Timed Up and Go (TUG) test. Sarcopenia was defined using the criteria of Asian Working Group for Sarcopenia (AWGS) and the Foundation for the National Institutes of Health (FNIH).

Results: The mean age of the subjects was 76.2 ± 9.3 years, and 46.8% were men. Prevalence of diabetes was 31.1% in men and 23.8% in women. Subjects with diabetes had higher levels of fasting glucose, insulin, HbA1c, and HOMA-IR, compared to the nondiabetic group. In men, the prevalence of sarcopenia and muscle mass index was not different between diabetic and nondiabetic groups, but the diabetic subjects had lower HGS and gait speed, and they took longer time on TUG test compared to the nondiabetic group. In women, the prevalence of sarcopenia defined by AWGS was higher in the diabetic group compared to the nondiabetic group. Women with diabetes had lower gait speed and SPPB score, and took longer time on TUG test compared to the nondiabetic group, although HGS and muscle mass index were not different between the two group.

Conclusion: Prevalence of sarcopenia was higher in older women with diabetes compared to nondiabetic group, but those are not different in men. In older adults with diabetes, physical performance and muscle strength were reduced, whereas muscle mass was relatively preserved compared to the nondiabetic group. Thus, in older adults, diabetes might be associated with developing sarcopenia, especially in a form of decreased muscle quality.

Disclosure

S. Kang: None. T. Oh: None. S. Choi: None. K. Park: None. H. Jang: None.
157-LB: Mealtime Insulin “Rescue” with Canagliflozin
Authors: PHILLIPS LAWRENCE S. , MOREHEAD FOLAYAN , SAVOYE LOUISE P. , RHEE MARY K. , OLSON DARIN , BURGESS ELIZABETH H. , CUI XIANGQIN , CALHOUN PETER , BAILEY RYAN
Published: June 2019

Many type 2 diabetes patients require mealtime insulin to help maintain glycemic control, but this carries a risk of hypoglycemia. Since the glucose-lowering mechanism of SGLT2 inhibitors does not require beta-cell function, we asked if addition of the SGLT2 inhibitor canagliflozin (CANA) could “rescue” patients from the need for mealtime insulin. In a pilot study, after 2 week run-in, 26 pts requiring QID basal-bolus insulin with negative GAD antibodies were randomized, double-blind, to CANA or placebo (PLBO); dosage was 100 mg/d for 2 week, then 300 mg/d for 22 week. At baseline, the groups were similar: mean age 64 year, BMI 31.2, 100% male, 64% black, HbA1c 8.0%, insulin 107 units/day, CGM time in range (TIR, 70-180 mg/dl) 75.5%, hypoglycemia (<54 mg/dl) 0.41%, and hyperglycemia (>180 mg/dl) 22.8% (all p>0.05). Over 24 weeks, insulin was adjusted weekly in all pts to improve control but avoid hypoglycemia. One PLBO pt had a penile infection and d/c’d study drug, but other adverse events were similar, and there was no severe hypoglycemia. Among 13 CANA and 11 PLBO pts who followed the protocol for 24 week, during the last 12 week, despite a 27% reduction in insulin dosage to 78 units/day with CANA vs. a 7% increase to 112 units/day with PLBO (p=ns), 37% of CANA pts were able to d/c mealtime Rx entirely, and 4% to switch to glipizide, for >1 meal/day, vs. 32% and 8% with PLBO, respectively (p=ns); CGM metrics were better with CANA as well, TIR 79% vs. 74%, hypoglycemia 0.58% vs. 0.84%, and hyperglycemia 18.7% vs. 23.9% with CANA vs. PLBO, respectively, all p=ns, and HbA1c was 7.4% with CANA vs. 7.6% with PLBO (p=ns).

Conclusions: Addition of canagliflozin to the regimens of patients using basal-bolus insulin, allows some patients to discontinue mealtime medication entirely, and others to switch from insulin to an oral agent, for at least one meal/day, with concomitant improvement in glycemic control, although differences from placebo were not statistically significant in this pilot study. Intensive management allows many patients to reduce their need for mealtime insulin.

Disclosure

L.S. Phillips: Advisory Panel; Self; Janssen Pharmaceuticals, Inc. Research Support; Self; AbbVie Inc., GlaxoSmithKline plc., Kowa Pharmaceutical Europe Co. Ltd., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Pfizer Inc. Stock/Shareholder; Self; Diasyst Inc. Other Relationship; Self; Diasyst Inc., Janssen Pharmaceuticals, Inc. F. Morehead: None. L.P. Savoye: None. M.K. Rhee: None. D. Olson: None. E.H. Burgess: None. X. Cui: None. P. Calhoun: Stock/Shareholder; Self; Dexcom, Inc. R. Bailey: None.

Funding

U.S. Department of Veterans Affairs; National Institutes of Health
157-OR: Is Metformin Associated with Frailty in Older Veterans with Diabetes?
Authors: GUERRA JULIANA FERRI , MILYANI RANEEM , APARICIO-UGARRIZA RAQUEL , SHAH AAKASHI , POTLURI SRIRAVALI , BHARATULA PRAVALLIKA , VALENCIA WILLY , FLOREZ HERMES , RUIZ JORGE G.
Published: June 2019

Diabetes mellitus (DM) may promote accelerated aging fostering the development of frailty, a state of vulnerability to stressors resulting in higher morbidity, mortality and healthcare utilization, particularly among Veterans. Metformin may reduce the development of frailty by decreasing inflammation and insulin resistance. The aim of this study was to determine whether metformin is associated with a lower risk of frailty in older Veterans with DM. In a cross-sectional study, we evaluated 775 Veterans, 56.4% white, 77% non-Hispanic, 98.1% male, mean age was 72.73 (SD=6.83) years. Frailty was assessed using a 44-item frailty index (FI), which was constructed using the following variables: socio-demographic, medical and psychological comorbidities, number of medications, laboratory tests, and activities of daily living. Most patients were frail (FI≥0.21, n=393, 50.7%), followed by pre-frail (0.10> FI <0.21, n=359, 46.3%) and a few were robust (FI≤ 0.10, n=23, 3%). We evaluated the association using binomial logistic regression models with frailty status dichotomized as non-frail (robust and prefrail) and frail as the outcome variable and use of metformin as the independent variable. After adjusting for age, race, ethnicity, BMI, use of hypoglycemic drugs (insulin or sulfonylureas), DM complications, levels of glycemic control, and comorbidities, metformin use was associated with a lower risk of frailty (OR=0.520, 95% CI=.383-.707, p<.0005). These results suggest that metformin may reduce the risk of frailty in older adults with DM. Further studies assessing the benefits of metformin to prevent functional decline and promote healthier aging may be warranted.

Disclosure

J. Ferri Guerra: None. R. Milyani: None. R. Aparicio-Ugarriza: None. A. Shah: None. S. Potluri: None. P. Bharatula: None. W. Valencia: None. H. Florez: None. J.G. Ruiz: None.

Funding

Miami VA Healthcare System Geriatric Research Education and Clinical Center
1582-P: Exploring the Heterogeneity of Inner-City African-American Patients with Diabetes and Food Insecurity Using Cluster Analysis
Authors: DAVIS GEORGIA , FLINT KRISTEN L. , PENG LIMIN , UMPIERREZ GUILLERMO E.
Published: June 2019

Food insecurity (FI) is associated with diverse socioeconomic factors and negatively impacts glycemic control in patients with diabetes (DM). Previous interventions have successfully improved food security status and access to nutritious food, but have not consistently shown improvement in glycemic control. This suggests an underlying heterogeneity in the FI population that may impact glycemic control. We explored characteristics of FI in patients with DM. Unsupervised cluster analysis was performed using survey data from non-Hispanic African American (AA) patients with FI in an urban safety-net DM clinic. Among 117 patients with FI, two distinct groups emerged. Group 1 was younger with worse glycemic control, lower food security status and less economic support, but more supplemental nutritional assistance program (SNAP) income and DM knowledge. Group 2 was older with better glycemic control, more federal economic and insurance support, but less SNAP assistance and lower medication adherence. Our results highlight the heterogeneity of FI-associated characteristics among AA patients with DM. Insurance status, economic and financial support may confer some protective effect for adequate glycemic control in the face of food insecurity.

Disclosure

G. Davis: None. K.L. Flint: None. L. Peng: None. 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.
1587-P: Prevalence and Impact of Food Insecurity on Clinical Outcomes in Inner-City African-American Patients with Diabetes
Authors: FLINT KRISTEN L. , DAVIS GEORGIA , PENG LIMIN , CAMPBELL SARAH H. , UMPIERREZ GUILLERMO E.
Published: June 2019

Food insecurity (FI), or the uncertain or limited availability of nutritious food, disproportionately affects lower income and minority populations. To determine the prevalence and impact of food insecurity in non-Hispanic African American (AA) patients with diabetes (DM) in an urban safety-net diabetes clinic, we conducted a prospective, comprehensive analysis using validated surveys measuring FI severity, education, mental health, and socioeconomic factors. Parameters of glycemic control and DM complications were collected from the electronic medical record. Factors contributing to food insecurity and clinical outcomes were compared by food security status.

Among 243 AA patients surveyed, 53% of patients had FI. More FI patients had low income and gaps in insurance. FI patients also had worse self-reported physical and mental health, more complications of DM, and more hypoglycemia. Despite having more complications and hypoglycemia, there were no significant differences in glycemic control (HbA1c 8.7% ± 2.5 vs. 8.7% ± 2.3, p=0.88) or insulin use (75% vs. 74%, p=0.92) between patients with and without FI.

Our results indicate that FI affects over half of inner-city AA patients with DM and is associated with higher rates of diabetic complications, hypoglycemia and a lower quality of life. FI represents a common and significant challenge in treating low-income AA patients with DM.

Disclosure

K.L. Flint: None. G. Davis: None. L. Peng: None. S.H. Campbell: None. 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.
1589-P: Trends in Prediabetes Prevalence and Incidence among Immigrants in Ontario, Canada, 2011-2015: A Population-Based Study
Authors: FAZLI GHAZAL , MOINEDDIN RAHIM , SHAH BAIJU R. , WU CAIXIA FANGYUN , BOOTH GILLIAN
Published: June 2019

The burden of prediabetes appears to be increasing worldwide. We aimed to examine temporal trends in prediabetes prevalence and incidence among immigrants to Ontario, Canada between 2011 and 2015 using linked administrative health and immigration databases. Comprehensive laboratory data were used to identify individuals without prior diabetes who underwent diabetes screening (N=511,357 in 2011 and 557,081 in 2015). We used logistics multivariate regression and direct age and sex standardization methods with 2011 Canadian census data to calculate prediabetes prevalence and incidence. Using World Health Organization criteria to define prediabetes (fasting plasma glucose (PG) 110-125 mg/dl, 2-hour PG 140-199 mg/dl on a 75 gm OGTT, HbA1c6.0-6.4%), the age- and sex-adjusted prevalence of prediabetes decreased from 15.8% to 12.2% over the 5-year period (p<0.001). These patterns were consistent across all ethnic groups, except immigrants from Sub-Saharan African and the Caribbean, where a rise in prevalence from 14.1 to 15.3% was observed. The largest declines were observed among South Asians and Latin Americans (20.1% to 15.3% and 16.1% to 9.4%, respectively in 2011 vs. 2015, p<0.001). Age- and sex-adjusted prediabetes incidence exhibited similar trends, declining from 11.1 to 9.6 per 100 person-years, with similar patterns by ethnic group as observed for prevalence. These patterns were generally consistent across age groups.

In summary, the prevalence and incidence of prediabetes in Canadian immigrants appears to be declining, which may relate to changes in the underlying risk of diabetes in these populations or in screening and prevention practices.

Disclosure

G. Fazli: None. R. Moineddin: None. B.R. Shah: None. C.F. Wu: None. G. Booth: None.
159-OR: Changes in Dairy Product Consumption and Risk of Type 2 Diabetes among U.S. Men and Women
Authors: DROUIN-CHARTIER JEAN-PHILIPPE , LI YANPING , ARDISSON KORAT ANDRES V. , DING MING , LAMARCHE BENOÎT , MANSON JOANN E. , RIMM ERIC , WILLETT WALTER C. , HU FRANK
Published: June 2019

Background: The relationship between changes in dairy product consumption and risk of type 2 diabetes (T2D) has not been evaluated.

Objective: We evaluated the association of 4-year changes in dairy product consumption with subsequent 4-year risk of T2D among U.S. men and women.

Methods: We followed-up 35,148 men in the Health Professionals Follow-up Study (1986-2012), 78,357 women in the Nurses’ Health Study (1986-2012), and 82,937 women in the Nurses’ Health Study II (1991-2013). Diet was assessed using validated food frequency questionnaires every 4 years. Cox proportional regression models were used to calculate hazard ratios (HRs) for T2D associated with 4-year changes in dairy product consumption, with adjustment for initial dairy intake and multiple T2D risk factors including BMI and diet quality. Results of the 3 cohorts were pooled using an inverse variance-weighted, fixed-effect meta-analysis.

Results: During 2,849,389 person-years of follow-up, we documented 12,007 incident T2D cases. Changes in milk consumption during a 4-year period were not associated with T2D risk in the following 4 years. Increasing yogurt consumption by >0.5 serving/day was associated with a 13% (95% CI: 6%, 19%) lower risk of T2D compared with maintaining a stable consumption. Increasing cheese consumption by >0.5 serving/day was associated with an 8% (95% CI: 2%, 16%) higher risk of T2D. Substituting reduced-fat milk for whole milk or low-fat cheese for high-fat cheese was not associated with subsequent T2D risk. However, increasing intake of yogurt or reduced-fat milk by 1 serving/day and concomitantly decreasing cheese intake by 1 serving/day was associated with a 16% (95% CI: 10%, 22%) and 11% (95% CI: 7%, 15%) lower risk of T2D, respectively.

Conclusion: Increasing yogurt consumption was associated with a moderately lower risk of T2D, while increasing cheese consumption was associated with a moderately higher risk. Substituting yogurt or reduced-fat milk for cheese was associated with lower risk of T2D.

Disclosure

J. Drouin-Chartier: Other Relationship; Self; Dairy Farmers of Canada. Y. Li: None. A.V. Ardisson Korat: None. M. Ding: None. B. Lamarche: Advisory Panel; Self; Dairy Farmers of Canada. J.E. Manson: None. E. Rimm: Advisory Panel; Self; Take C/O, US Highbush Blueberry Council/USDA. W.C. Willett: None. F. Hu: None.

Funding

National Institutes of Health (UM1CA186107, UM1CA176726, UM1CA167552, DK112940, HL60712, HL118264); Canadian Institutes of Health Research (BPF-156628)
1593-P: Time Trends in Diabetes Incidence and Obesity Prevalence in Six Countries
Authors: HIRD THOMAS R. , CHEN LEI , ISLAM RAKIBUL M. , PAVKOV MEDA E. , GREGG EDWARD , TABESH MARYAM , KOYE DIGSU , BARR ELIZABETH L. , SHAW JONATHAN E. , MAGLIANO DIANNA J. ,   GLOBODIAB WRITING GROUP
Published: June 2019

Data from several countries have shown a stabilization or decrease in diabetes incidence since the mid-2000s. It is intuitively appealing to think that trends in risk factors for diabetes would parallel these changes, although such trends have not been explored. We compared age-standardized (WHO standard population) trends in obesity prevalence, from nationally representative cross-sectional surveys, with trends in diabetes incidence, from national diabetes registries or administrative data sources, in six countries where data was available for both national obesity prevalence and diabetes incidence between 1990-2015. In 5 out of 6 countries, diabetes incidence increased until the mid-2000s followed by a decreasing trend; in Korea incidence decreased across the whole time period for which data were available. An increasing trend in obesity prevalence was observed in all 6 countries with no evidence for a fall in obesity prevalence, although the rate of increase in obesity prevalence slowed in United Kingdom in the early 2000s. Among the datasets in this study, current evidence on trends in obesity prevalence do not appear to explain the recent decrease in diabetes incidence, suggesting an uncoupling of these trends. Further research on trends in other major diabetes risk factors, such as prediabetes, and the influence of diagnostic guidelines and practice may provide additional insights into trends in diabetes incidence.

Disclosure

T.R. Hird: None. L. Chen: None. R.M. Islam: None. M.E. Pavkov: None. E. Gregg: None. M. Tabesh: None. D. Koye: None. E.L. Barr: None. J.E. Shaw: Advisory Panel; Self; Abbott, Merck Sharp & Dohme Corp. Speaker's Bureau; Self; AstraZeneca, Mylan, Roche Diabetes Care, Sanofi-Aventis. D.J. Magliano: None.

Funding

Centers for Disease Control and Prevention
1600-P: Duplicate Oral Glucose Tolerance Tests Reveal Excellent Reproducibility for Detection of Diabetes but Inconsistent Results for Prediabetes: A Study of Africans
Authors: BRIKER SARA M. , HORLYCK-ROMANOVSKY MARGRETHE F. , ADUWO JESSICA Y. , MUGENI REGINE , DUBOSE CHRISTOPHER , MABUNDO LILIAN , CHUNG STEPHANIE T. , HA JOON , SHERMAN ARTHUR , SUMNER ANNE E.
Published: June 2019

As both diabetes (DM) and prediabetes (preDM) reach epidemic proportions in sub-Saharan Africa, there is growing need for reliable diagnostic tests. Although the OGTT is time-consuming, it is unaffected by hemoglobinopathies which are common in Africa and interfere with other methods of detection. However, the reproducibility of the OGTT in Africans is unknown. Therefore, our goal was to perform duplicate OGTTs in Africans and determine if the diagnosis made at the first OGTT was confirmed by the second. One-hundred and five African-born blacks (64% male (67/105), age 39±11y (mean±SD), BMI 27.4±4.5 kg/m2) living in the Washington, DC area had two OGTTs performed 11±7 days apart. Glucose tolerance status was defined by glucose criteria for the OGTT. κ-statistic was used to assess reproducibility (slight: 0.00 to 0.20; fair: 0.21 to 0.40; moderate: 0.41 to 0.60; substantial: 0.61 to 0.80, excellent: 0.81 to 1.0). At OGTT-1, DM, preDM and normal glucose tolerance (NGT) occurred in 23% (24/105), 26% (27/105) and 51% (54/105), resp. At OGTT-2, DM, preDM and NGT occurred in 19% (20/105), 26% (27/105) and 55% (58/105) resp. Reproducibility for the diagnosis of DM was excellent (κ=0.88). No one transitioned from DM to NGT. Further, all participants with DM at OGTT-2 had also been diagnosed with DM at OGTT-1. In contrast, reproducibility for the diagnosis of preDM was only moderate (κ=0.48). Between OGTT-1 and OGTT-2, 10% (11/105) of people transitioned from preDM to NGT; and 7% (7/105) transitioned from NGT to preDM. However, 78% (14/18) of the people who transitioned between NGT and preDM had fasting glucose levels between 90 and 99 mg/dL. Overall, as duplicate OGTTs provided highly reproducible results for the diagnosis of DM, detection of DM by a single OGTT should trigger health care consideration. Diagnosis of preDM was not consistent, but fasting glucose between 90 mg/dL and 99 mg/dL suggests that transition from NGT to preDM is likely.

Disclosure

S.M. Briker: None. M.F. Horlyck-Romanovsky: None. J.Y. Aduwo: None. R. Mugeni: None. C. DuBose: None. L. Mabundo: None. S.T. Chung: None. J. Ha: None. A. Sherman: None. A.E. Sumner: None.
1604-P: Diabetes, Glycemic Control, and Risk of Infection Morbidity and Mortality: A Cohort Study
Authors: CHANG CHIA-HSUIN , WANG JIUN-LING , WU LI-CHIU , CHUANG LEE-MING , LIN HSIEN-HO
Published: June 2019

Background: Diabetic patients have an elevated risk of infection, but the optimal level of glycemic control with the lowest infection risk remains unclear, especially among the elderly. We conducted a cohort study to investigate the relation between fasting plasma glucose (FPG) level and risk of infection-related morbidity and mortality.

Methods: Data of participants from a community-based health screening program in Taiwan during 2005-2008 (n=118,645) were analyzed. Incidence of hospitalization for infection and infection-related death was ascertained from the National Health Insurance Database and National Death Registry. Cox proportional hazards regression modelling was used to estimate the hazard ratio (HR) between FPG and risk of infection, adjusting for major risk factors of infection. Separate analyses were also performed to evaluate the risk of hospitalization among the elderly (> 65 years).

Results: During a median follow-up of 8.13 years, 14,372 cases of hospitalization for infection and 422 infection-related deaths occurred. The incidence rate of hospitalization for any infection was 36.33 and 14.26 per 1,000 person-years among diabetics and nondiabetics in the total study population, but increased to 70.02 and 45.21 per 1,000 person-years in the elderly. In the Cox regression analysis, the adjusted HR comparing diabetics to nondiabetics was 1.59 (95% CI: 1.52-1.67) for any hospitalization for infection and 1.71 (95% CI: 1.36-2.16) for infection-related mortality. The hazard for infection morbidity and mortality was higher at both extremes (<80 and >200 mg/dl) of FPG. The above relations were consistently observed in older people and across different sites of infection.

Conclusion: The U-shape association between glycemic control and infection risk suggested that very tight glucose control may not provide additional benefits in risk reduction. In older adults, the absolute risk of infection associated with diabetes was high.

Disclosure

C. Chang: None. J. Wang: None. L. Wu: None. L. Chuang: None. H. Lin: None.

Funding

Taiwan Ministry of Science and Technology (MOST105-2628-B-002-025-MY3)
1609-P: High Adiponectin Levels at Baseline and Increasing Adiponectin Levels over 2.4 Years Follow-Up Lower Risk of Metabolic Syndrome in Men
Authors: HUH JI HYE , KIM WONJIN , KIM MIN KYUNG
Published: June 2019

Aim: We aimed to assess the impact of change in adiponectin levels on incident metabolic syndrome (MetS) in healthy Korean adults.

Methods: A prospective cohort study was conducted in 1,110 subjects without MetS at baseline. Plasma adiponectin levels were measured at baseline and again after a median follow-up 2.4 years. The subjects were categorized into 4 groups according to sex-specific adiponectin median levels at baseline and changes in adiponectin level at follow-up. The hazard ratio (HR) of new-onset MetS was calculated using Cox models.

Results: During the median 2.4-year follow-up period, 180 (16.2%) developed MetS. Compared to the low adiponectin at baseline and decreased adiponectin during follow-up group, the fully adjusted HR (95% CI) for new-onset MetS was the lowest in high adiponectin at baseline and increased adiponectin during follow-up group [0.33, (0.17-0.63)], followed by high adiponectin at baseline and decreased adiponectin during follow-up group [0.58,(0.40-0.84)], and low adiponectin at baseline and increased adiponectin during follow-up group [0.63, (0.41-0.93)], in that order (P for trend < 0.001). This phenomenon was more prominent in men than in women. Among MetS components, increased adiponectin levels during follow-up were significantly associated with lower risk of incident low-HDL cholesterol and high blood pressure.

Conclusion: An increase in adiponectin level over 2.4-year follow-up period is significantly associated with a lower risk of developing MetS regardless of baseline adiponectin levels especially in men. These findings suggest that change in adiponectin level as well as adiponectin level at baseline might have a clinical role in developing MetS among men.

Disclosure

J. Huh: None. W. Kim: None. M. Kim: None.
1625-P: Characteristics of the Oral Glucocorticoid-Induced Diabetes Mellitus (GIDM) in Miners with Compromised Lung Function in a Limited Resource Setting
Authors: REDKAR VIVEK , REDKAR SAGAR , INAMDAR MANOHAR , INAMDAR ANIKET , REDKAR SUPRIYA , JAGTAP MOHAN , RANE SHRADDHA , KULKARNI SHRIRAM V. , DESHPANDE JAYSHREE , WADHWA U.
Published: June 2019

Oral glucocorticoids are efficacious for treating respiratory diseases but with a high risk to induce diabetes. We analysed a subset of patients from the Redi iron ore miners from a rural setting (n=25,500), who were newly diagnosed diabetics on extensive chronic methylprednisolone equivalent glucocorticoid dose of ≥4 mg/day for at least 3 months for treatment of respiratory ailments due to occupational hazard (n=1100, males= 660, females=4400). t test and Fisher's exact test were used for the statistical analysis. The mean HbA1c was 7.1% (SD ± 0.62, 95% CI 7-7.3), mean age 51 years (SD ± 14, 95% CI 48 - 54), mean BMI 26 kg/m2 (SD ± 3.6, 95% CI 25 - 27), mean Fasting Plasma Glucose 146 mg/dl (SD ± 49, 95% CI 136-155) mg/dl, mean Post Prandial Glucose 207mg/dl (SD±74, 95% CI 192 - 221). HbA1c at diagnosis in the relatively low risk group (young - normal weight group with age < 40 years, BMI <25 kg/m2) (n=231) was less than the high risk group (older - overweight with age > 40 years, BMI >25 kg/m2) (n=616); mean HbA1c 6.7% (SD±0.33, 95% CI 6.5 - 6.8) vs. mean HbA1c 7.3% (SD±0.65, 95% CI 7.1 - 7.5) (p<0.0001). There was a significant correlation for a high propensity of relatively younger <50 years (n=506) and near normal weight people with BMI < 26 kg/m2 (n=594) to develop GIDM (p=0.006). We observed that high incidence of GIDM (4.31%) is an alarmingly harmful problem which has pronounced comorbid implications, especially in the younger, economically productive population in the limited resource setting. The health care professionals need to be educated to limit the use of glucocorticoids to inhalational therapy with minimal systemic effects. Specific pathophysiological approach to address the steroid induced insulin resistance in this population, makes the treatment of GIDM difficult, which calls for action to limit the mining activities and mitigate the risk of chronic complications due to diabetes.

Disclosure

V. Redkar: None. S. Redkar: None. M. Inamdar: None. A. Inamdar: None. S. Redkar: None. M. Jagtap: None. S. Rane: None. S.V. Kulkarni: None. J. Deshpande: None. U. Wadhwa: None.
1626-P: Alcohol Use and Clinical Outcomes in the T1D Exchange
Authors: ALESSI SHEILA M. , FOSTER NICOLE C. , RASH CARLA , VAN NAME MICHELLE A. , TAMBORLANE WILLIAM V. , WAGNER JULIE
Published: June 2019

Alcohol consumption has serious potential consequences for persons with type 1 diabetes (T1D). This study examined associations between alcohol consumption status and diabetes outcomes. Participants were N=933 adults at Type 1 Diabetes Exchange Registry clinics who completed an emailed set of standardized self-report instruments that included items on alcohol use; A1c values were extracted from charts and reported by clinics. Participants were on average (SD) age 38 (16) years, 61% female, and 90% non-Hispanic white, and mean (SD) A1c was 7.8% (1.5%). The sample was 61% (n = 567) current non-binge drinkers, 19% (n = 174) current binge drinkers, 11% (n = 103) had never consumed alcohol, and 9% (n = 89) former drinkers. After controlling for relevant covariates, there was a trend toward higher diabetes self-care scores in never drinkers compared to current non-binge drinkers, current binge drinkers, and former drinkers, and a trend towards lower diabetes distress scores relative to current non-binge drinkers and former drinkers. The odds of a history of severe hypoglycemia, and odds of a neuropathy diagnosis, were lower among never drinkers relative to former drinkers (adjusted p < .04). Never drinkers did not differ from other drinking status groups on frequency of self-monitoring blood glucose, A1c, history of diabetic ketoacidosis, or nephropathy diagnosis (adjusted p’s≤.01). BMI was higher among never drinkers compared to former drinkers and non-binge drinkers (adjusted p > .05). These results suggest that experiencing severe hypoglycemia and being diagnosed with neuropathy may motivate some drinkers to stop drinking, and that never drinkers have more salutary self-care and distress, but higher BMI. Strategies to help patients with T1D manage alcohol are warranted.

Disclosure

S.M. Alessi: None. N.C. Foster: None. C. Rash: None. M.A. Van Name: Research Support; Self; Novo Nordisk Inc. W.V. Tamborlane: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic MiniMed, Inc., Novo Nordisk Inc., Sanofi, Takeda Pharmaceutical Company Limited. J. Wagner: None.
1629-P: Changes in the Prevalence of Diabetes, Its Management, and Complications over 15 Years in a Rural Australian Population
Authors: SIMMONS DAVID , GLENISTER KRISTEN , MAGLIANO DIANNA J. , BOURKE LISA
Published: June 2019

Objective: Diabetes screening and management guidelines have changed over the last 15 years. We compared diabetes prevalence, management, metabolic control and complications in 2 surveys, conducted 15 years apart.

Methods: Repeat cross-sectional studies 2001-2003 (XRDS1) and 2016-2018 (XRDS2) across 4 rural Australian towns with previously low access to primary care, involving a household survey followed by biomedical assessments (including OGTTs) among randomly selected individuals.

Results: Overall, household survey/clinic responses were >60% involving 4464/1042 and 2315/748 residents in XRDS1 and 2 respectively. The prevalence of known diabetes increased overall (5.4% to 10.4% p<0.001), in those <50, 50-59, 70+ years; but not 60-69 years (2.5% vs. 4.8% p<0.001, 6.5% vs. 9.7% p<0.05, 9.9% vs. 18.4% p<0.001; 12.8% vs.13.4%). Proportions with undiagnosed diabetes and IFG/IGT were not significantly different (2.3% vs. 1.5%; 11.7% vs. 10.0%). Diabetes screening increased from 48.9% to 59.5% (p<0.001). Among those with known diabetes age (59±16 vs. 63±16 p<0.01), lipid testing (84.8% vs. 92.8% p<0.05), hypertension (52.2% vs. 65.8% p<0.01) and dyslipidaemia (21.9% vs. 55.8% p<0.001) diagnoses, increased. Age at diagnosis (53±15 vs. 52±16 years), BMI (30.4±6.9 vs. 30.8±7.1 kg/m2), glycaemia testing (97.1 vs. 95.3%) and BP testing (98.4% vs. 98.2%) were similar. Mean HbA1c and diastolic BP were similar but systolic BP (143±24 vs. 136±19 mm Hg p<0.05) and total cholesterol (4.8±0.9 vs. 4.4±1.1 mmol/l p<0.05) were lower. Complication rates were similar (nephropathy 27.8% vs. 22.4%, non-fatal stroke 6.2% vs. 5.0%) or increased (depression 14.1% vs. 33.5% p<0.01; cardiac condition 24.1% vs. 32.4% p<0.05).

Conclusions: Over 15 years, diabetes prevalence increased, CVD risk management improved but complications were unchanged or increased. Further work is required to understand the extent to which changing survival, migration, access to care and ageing have contributed to these patterns.

Disclosure

D. Simmons: Speaker's Bureau; Self; Sanofi-Aventis. Other Relationship; Self; Medtronic. K. Glenister: None. D.J. Magliano: None. L. Bourke: None.

Funding

National Health and Medicine Research Council of Australia
1633-P: State-Specific Incidence of Type 2 Diabetes Treated with Medication in the Privately Insured, United States, 2001-2017
Authors: ROGERS MARY A.M. , IMPERATORE GIUSEPPINA , BASU TANIMA , KIM CATHERINE , BENOIT STEPHEN R. , ROLKA DEBORAH B. , SAYDAH SHARON
Published: June 2019

While type 2 diabetes is one of the most common chronic diseases in the United States, nationwide figures for incidence are difficult to obtain. We used data from a large national health insurer (Clinformatics Data Mart Database, years 2001-2017) to estimate the incidence of type 2 diabetes by state of residence at first diagnosis. Cases were adults, ages 20 years, with type 2 diabetes (ICD-CM codes with antidiabetic medication). Individuals with type 1 diabetes or secondary diabetes were excluded. The incidence rate per 100,000 person-years ranged from 450.9 in Texas to 164.1 in South Dakota (incidence rate ratio (IRR) 2.7; 95% CI: 2.5, 3.1). The states with the highest incidence were Texas, Mississippi and Alabama. States with the lowest incidence included South Dakota, North Dakota and Massachusetts. For men, the incidence rate of type 2 diabetes ranged from 524.9 in Mississippi to 212.8 in North Dakota (IRR 2.5; 95% CI: 2.2, 2.8). There was greater variation in the incidence for women; it ranged from 409.2 in Alabama to 109.8 in South Dakota (IRR 3.7; 3.1, 4.5). The median age at diagnosis was 54 years in men and 56 years in women.

In conclusion, there is considerable interstate variability in the incidence of type 2 diabetes for the privately insured. Although many of the high incidence states were in the southern census region of the U.S., incidence rates were also high in Hawaii and Arizona.

Disclosure

M.A.M. Rogers: None. G. Imperatore: None. T. Basu: None. C. Kim: None. S.R. Benoit: None. D.B. Rolka: None. S. Saydah: None.

Funding

Centers for Disease Control and Prevention
1635-P: Risk of Pancreatitis among Patients with Type 2 Diabetes Receiving DPP-4 Inhibitors: Nationwide Case-Control Study
Authors: LEE MINYOUNG , SUN JIYU , HAN MINKYUNG , KIM JIN HEE , KIM YOUJIN , LEE INKUK , LEE SANG BAE , BAE JAEHYUN , CHO YONGIN , LEE JI-YEON , KIM CHUL HOON , NAM CHUNG MO , EUN SEOK KANG
Published: June 2019

Dipeptidyl peptidase-4 inhibitors (DPP-4i) are widely used antidiabetic incretin-based drugs. There remain concerns about the pancreatic safety of DPP-4i due to its pleiotropic effects on the exocrine pancreas. We studied whether DPP-4i are associated with acute and chronic pancreatitis using nationwide population-based cohort study. This study included patients with newly diagnosed type 2 diabetes being treated with antidiabetic drugs (n = 33,208) from 2007 to 2013, from the sample cohort (n = 514,866) of the ***** National Health Insurance Service-Health Screening Cohort database. A Cox proportional hazards model with time-dependent covariates was used to calculate the risk. Lag time of 6 months was applied to reflect a cumulative effect of DPP-4i. Subgroup analyses were also performed according to various confounding factors. Of the 33,208 subjects, 10,210 new DPP-4i users and 22,998 new users of antidiabetic drugs other than DPP-4i were included. DPP-4i significantly increased the risk for pancreatitis (adjusted hazard ratio (aHR) 1.26, 95% CI 1.06-1.50) even after adjusting for age, sex, BMI, smoking and alcohol status, Charlson comorbidity index, and residential region. With a drug-use lag exposure of 6 months, aHR for pancreatitis was still statistically significant as similar (aHR 1.23, 95% CI 1.01-1.51) In subgroup analyses, the risk of pancreatitis was apparent only in subjects with a higher comorbidity score, suggesting a clinical factor which increases the risk of pancreatitis by DPP-4i use. In an analysis of data from a large nation-wide cohort database, we found that DPP-4i are associated with the increased risk of pancreatitis in patients with newly diagnosed type 2 diabetes.

Disclosure

M. Lee: None. J. Sun: None. M. Han: None. J. Kim: None. Y. Kim: None. I. Lee: None. S. Lee: None. J. Bae: None. Y. Cho: None. J. Lee: None. C. Kim: None. C. Nam: None. E. Kang: None.
164-LB: A Randomized Controlled Trial to Compare the Glycemic Effects of Dapagliflozin, a Sodium-Glucose Cotransporter 2 Inhibitor, and Gliclazide Modified Release, a Sulfonylurea, Assessed by Continuous Glucose Monitoring among People with Type 2 Diabetes
Authors: VIANNA ANDRE G.D. , SILVA DE LACERDA CLAUDIO , MUNIZ PECHMANN LUCIANA , GARCIA POLESEL MICHELLE , CESTARI MARINO EMERSON , CRISTINE DETSCH JOSIANE , RAMOS MARQUES KLEBER , PINHEIRO ROCHA CLAUDIA
Published: June 2019

Aims: This study aims to evaluate whether there is a difference between the effects of dapagliflozin and gliclazide MR (modified release) on glycemic variability (GV) and control, as assessed by continuous glucose monitoring (CGM), in individuals with uncontrolled type 2 diabetes (T2DM).

Methods: An open-label, randomized study was conducted in uncontrolled T2DM individuals drug naïve or on steady-dose metformin monotherapy which were treated with 10 mg dapagliflozin once daily or 60 to 120 mg of gliclazide MR once daily. CGM and GV indices calculation were performed at baseline and after 12 weeks.

Results: In total, 97 patients (age: 57.9 ± 8.7 years, male sex: 50.5%, baseline glycated hemoglobin (HbA1c): 7.9 ± 0.9) were randomized and 94 completed the 12-week protocol. Per protocol analysis demonstrated that the reduction of GV, as measured by the mean amplitude of glycemic excursions (MAGE), was superior in the dapagliflozin versus gliclazide MR group (-17.8 ± 33.3 vs. -3.3 ± 42.9 mg/dL, mean ± SD, p= 0.037). The improvement of GV, as measured by the coefficient of variation (CV) and the standard deviation (SD) was also superior in the dapagliflozin group (p=0.021 and 0.024, respectively). Moreover, dapagliflozin increased the time in range (TIR, between 70-180 mg/dL) by 28.6 ± 24.4% vs.19.8 ± 33.1 % (p=0.041). The intention-to-treat (ITT) analysis was also performed and did not alter the significance of the results.

Conclusions: Dapagliflozin reduced glycemic variability and increased the TIR more efficiently than gliclazide MR in individuals with T2DM after 12 weeks of treatment as demonstrated by continuous glucose monitoring evaluation.

Disclosure

A.G.D. Vianna: Board Member; Self; Abbott, Novo Nordisk Inc. Research Support; Self; AstraZeneca. Speaker's Bureau; Self; Lilly Diabetes. C.S. de Lacerda: None. L.M. Pechmann: None. M.G. Polesel: None. J.C. Detsch: None. K.R. Marques: None. C.P. Rocha: None.

Funding

AstraZeneca