bluuebunny/crossref_metadata_2025 huggingface dataset:
1108-P: Noninvasive Diabetes Risk Scores Identify Diabetes due to Insulin Resistance but Not ß-Cell Failure: The Africans in America Study
Authors: WENTZEL ANNEMARIE , PATTERSON ARIELLE , DUHUZE-KARERA M GRACE , WALDMAN ZOE C. , SCHENK BLAYNE R. , MABUNDO LILIAN , DUBOSE CHRISTOPHER , SUMNER ANNE E. , HORLYCK-ROMANOVSKY MARGRETHE F.
Published: May 2022

In low and middle-income countries in Africa, β-cell-failure in the absence of obesity is increasingly recognized as a frequent cause of type 2 diabetes (DM) . DM risk scores assume that insulin resistance (IR) is the primary cause of DM. Therefore, their ability to detect DM due to β-cell-failure is unknown. In 529 African-born Blacks living in the United States (age 38± (mean±SD) ; 64% male; BMI 28±5 kg/m2) , we assessed (1) DM prevalence, (2) prevalence of DM due to IR versus β-cell failure; and (3) the ability of six risk scores (Cambridge, FINDRISC, Kuwaiti, Omani, Rotterdam, and SUNSET) to detect previously undiagnosed DM due to either IR or β-cell-failure. DM was diagnosed by OGTT and/or HbA1c ≥6.5%. IR was defined by lowest quartile of the Matsuda index (≤2.04) . DM due to β-cell-failure required DM in the absence of IR. Data on BP, BMI, waist circumference (WC) , health behaviors, and medical history were collected. Area under the Receiver Operator Characteristics Curve (AROC) assessed discriminatory ability of each score. Criteria for AROC: no discrimination=0.50; poor=0.50-0.69; acceptable=0.70-0.79; excellent=0.80-0.89; outstanding=≥0.90. DM prevalence was 9% (46/529) . DM was due to IR in 57% (26/46) and β-cell-failure in 44% (20/46) . The IR group had higher BMI (31±5 vs. 27±4 kg/m2 P<0.001) , and higher WC (101±vs. 91±cm P<0.001) . Scores had poor to excellent detection of diabetes due to IR (AROC=0.67-0.81) . In contrast, detection of diabetes due to β-cell-failure had an AROC score in the range of no discrimination or poor (AROC=0.49-0.62) .

In summary, DM risk scores perform well for the detection of undiagnosed DM in Africans when the etiology is IR. However, scores fail to detect DM due to β-cell failure. Therefore, scores which evaluate DM risk when the cause is β-cell failure are urgently needed.

Disclosure

A.Wentzel: None. A.Patterson: None. M.Duhuze-karera: None. Z.C.Waldman: None. B.R.Schenk: None. L.Mabundo: None. C.Dubose: None. A.E.Sumner: None. M.F.Horlyck-romanovsky: None.
111-LB: CHM-273S Peptide Decreases Blood Glucose Level, Improves Insulin Sensitivity, and Induces Insulin Signaling Pathways in the Liver of Rats with Diet-Induced Metabolic Disorder
Authors: PAVSHINTSEV VSEVOLOD , MITKIN NIKITA , DORONIN IGOR , EMELIANOVA EKATERINA , LOVAT MAXIM , BABKIN GENNADY , MALYSHEV ANTON
Published: May 2022

CHM-273S is a novel peptide derived from proprietary milk hydrolysate. It demonstrated the ability to induce IRS2 expression in primary murine fibroblasts. IRS2 is one of the main components of insulin receptor signaling pathway, and its expression activation is associated with the changes in the functioning of insulin- and glucose-dependent intracellular mechanisms in general. Such effect is typical for the main antidiabetic drugs including metformin and GLP-1R agonists and potentially indicates that CHM-273S can regulate cellular response to glucose and insulin. In the present work, we studied the ability of CHM-273S to alleviate symptoms of metabolic disorder caused by a high-sucrose diet (HSD) . Sprague-Dawley male rats (N=50) were given free access to 30% sucrose solution for 5 weeks. Animals with symptoms of a metabolic disorder - a stable significant increase in blood glucose concentration - were tested in the glucose tolerance test (GTT) . Single 1 mg/kg and 10 mg/kg CHM-273S i.p. administration 12, 2 and 0 hours prior to oral glucose injection in GTT significantly reduced blood glucose level. Additionally, CHM-273S administration 2 and 12 hours before blood sampling led to a decrease in fasting blood insulin concentration measured by ELISA and insulin resistance index HOMA-IR elevated as a result of HSD. These data indicates the peptide’s ability to alleviate the HSD-caused insulin resistance in experimental animals. Finally, the rats received CHM-273S and after 12 hours were injected with insulin 3 minutes before liver samples collection. CHM-273S restored pAKT (Thr308) and induced p-AKT (Ser473) levels in the liver, which indicates the ability of the peptide to normalize insulin signaling. The effect of CHM-273S on insulin signaling pathways in liver cells highly correlates with the observed decrease in blood glucose level in GTT and HOMA-IR values and could underly the mechanism of these effects.

Disclosure

V. Pavshintsev: None. N. Mitkin: None. I. Doronin: None. E. Emelianova: None. M. Lovat: None. G. Babkin: None. A. Malyshev: None.
1113-P: Trends in Prevalence, Awareness, and Risk Perception among U.S. Adults with Prediabetes: NHANES 2005–2018
Authors: YAN ALICE , SHI ZUMIN
Published: May 2022

Introduction: Individuals with prediabetes (preDM) are at increased risk of developing type 2 diabetes and cardiovascular disease. Awareness and perceived risk of disease are key factors impacting lifestyle interventions. This study examined the prevalence, awareness, and perceived risk of preDM.

Methods: This nationally representative cross-sectional analysis of 2005-2018 National Health and Nutrition Examination Survey data was conducted on nonpregnant adults (aged≥20 years) . PreDM was based on fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) definitions recommended by the American Diabetes Association. We used fasting sample weight to generate nationally representative estimates. Measures also include sociodemographic, awareness, and perceived risk for DM or preDM. Analyses were accounted for the complex sample design and performed using Stata 17.

Results: Overall, among 15,968 adults, the weighted prevalence of PreDM increased from 31.5% (95%CI 28.5-34.4) in 2005-20to 47.2% (95% CI 43.7-50.7) in 2017-2018 with a significant linear trend (p<;0.001) . The weighted prevalence of awareness of preDM increased yearly from 5.6% in 20- 20to 12.6% in 2017-2018 based on FPG/HbA1c definition (p<;0.001) . Similarly, among those with preDM, the perceived risk increased from 28.2% in 20- 20to 32.9% in 20- 20 and plateaued at 36.9% in 2017-2018 without a significant linear trend (p=0.142) . Black and Mexican Americans had a higher prevalence of preDM than White. Education was positively associated with awareness and perceived risk, but the income was not. Women were less likely to have preDM but more likely to be aware of preDM than men. Overweight/obesity, hypertension, and depression were positively associated with preDM, awareness, and perceived risk.

Conclusions: Findings suggest that from 20to 2018, the prevalence of preDM continues to rise. More national efforts are needed to raise awareness of diabetes risk and target those at higher risk.

Disclosure

A.Yan: None. Z.Shi: None.
1115-P: Does Spouse’s Diabetes Status Impact the Diabetes Care Cascade? A National Study of Couples in India
Authors: VARGHESE JITHIN SAM , PATEL SHIVANI A.
Published: May 2022

Background: Diabetes detection and treatment in married couples presents opportunities for designing dyadic interventions to improve screening and management.

Methods: Using data from 59237 heterosexual married couples (women: 18-49y, men: 21-54y) assessed in India’s National Family Health Survey (2015-16) , we estimated the diabetes care cascade as the percent diagnosed, treated, and controlled with measured high blood glucose (BG) by spouse’s diabetes status.

Results: The prevalence of high BG was 8.8% (men) and 14.2% (women) . In adults with high BG, the percent diagnosed, treated, and controlled was 22.6%, 18.7%, and 9.2% (men) and 22.5%, 18.0%, and 8.5% (women) , respectively. Of adults with high BG, the prevalence of diabetes diagnosis was higher in men (prevalence ratio [PR]: 1.85 [1.37, 2.49]) and women (PR: 2.03 [1.47, 2.8]) whose spouse was diagnosed (ref=spouse undiagnosed) . Among the diagnosed, the prevalence of being treated for diabetes did not differ by their spouse’s diagnosis status in men or women. Among the treated, the prevalence of blood glucose control was higher in women (PR: 1.45, [0.93, 2.25]) , but not men (PR: 0.96 [0.66, 1.40]) , whose spouse was diagnosed (ref=spouse undiagnosed) .

Conclusions: Spouse’s diabetes was associated with higher probability of detection of diabetes but not with treatment. Outreach among couples may improve medical management of diabetes in India.

Disclosure

J.Varghese: None. S.A.Patel: Research Support; Johnson & Johnson.
112-LB: In Vitro DILI Risk Assessment of IDG16177, a Potent and Selective GPR40 Agonist, for the Treatment of Type 2 Diabetes
Authors: YOON JONGMIN , SONG HAENGJIN , AN KYUNGMI , HONG CHANG-HEE , KWAK HYUN-JUNG , SONG HYO-JUNG
Published: May 2022

G protein-coupled receptor 40 (GPR40) , also known as free fatty acid receptor 1 (FFA1/FFAR1) , is expressed primarily on pancreatic β-cells and induces insulin secretion only at high glucose levels, making it a promising target for type 2 diabetes mellitus (T2DM) . Fasiglipam (TAK-875) , a partial agonist of GPR40, was discontinued in phase 3 due to hepatotoxicity despite its potent hypoglycemic effect. Previous studies of hepatic transporter inhibition, mitochondrial function, covalent protein binding and toxicity to human hepatocytes confirmed the lower drug-induced liver injury (DILI) potential of IDG16177 compared to fasiglifam, but bile acid (BA) analysis and transcription factor profiling were further performed.

In a 3D human liver model, we indirectly evaluated the accumulation of BA in the liver by measuring the secretion of glycolic acid (GCA) , which is a major component of human BAs and has been identified as a significant increase in patients with DILI. Fasiglifam induced a significant accumulation of GCA at 4 μM lower than the human Cmax of 10 μM, whereas IDG16177 showed no significant accumulation at 1 μM higher than the predicted human Cmax of 0.3 μM.

IDG16177 did not have a significant effect in quantitative evaluation of the activity of various transcription factors, whereas treatment with 10 uM fasiglifam for 24 hours significantly increased the activities of peroxisome proliferator activating receptor (PPAR) , activator protein 1 (AP-1) and nuclear respiratory factor 2 (NRF2) , which were highly correlated with liver disease pathogenesis/progression. Interestingly, treatment with 10 μM IDG16177 for 48 h increased the activity of FXR, a master regulator of BA metabolism that inhibits BA absorption system and BA synthesis and promotes BA enterohepatic circulation, by 1.58-fold.

These results show that IDG16177 has the advantage of having a low DILI potential compared to fasiglifam in addition to its potent efficacy for the treatment of type 2 diabetes.

Disclosure

J. Yoon: None. H. Song: None. K. An: None. C. Hong: None. H. Kwak: None. H. Song: None.
1134-P: Interlaboratory Standardization of C-Peptide Assays Using Certified Reference Material Corrected for Peptide Modifications
Authors: WU ZENGRU , KABYTAEV KUANYSH , MU JIANYING , CONNOLLY SHAWN , MCPHAUL MICHAEL J. , LITTLE RANDIE R.
Published: May 2022

The standardization of C-peptide assays is highly desirable objective. Our groups have employed the use of a Certified Reference Material (CRM) to calibrate their respective measurement procedures and comparison studies have demonstrated good agreement between the two laboratories [Figure]. Although it was the original choice, The National Metrology Institute of Japan (NMIJ) CRM has not always been available. However, a new material from Cerilliant (C-161-0.1ML) proved equally well defined. Both materials include known amounts of pure C-peptide and small amounts of deamidated and pyroglutamated forms (Cerilliant Lot# FN0422195.6% modified; NMIJ CRM 6901-b, Lot# 058 1.9% modified) . The C-peptide CRMs from Cerilliant and from NMIJ behave identically when the mass concentration of the unmodified C-peptide is used to assign calibrator concentrations. To avoid potential bias, we conclude that the mass concentration of unmodified C-peptide (not the mass concentration of total C-peptide) in CRM should be used when making calibrators for mass spectrometry C-peptide assays to achieve comparable patient results. Variation in the relative amount of modified C-peptide is an obstacle to standardization, especially when comparing mass spectrometry-based assays with immunoassays, which use total C-peptide for calibration.

Disclosure

Z.Wu: Employee; Quest Diagnostics. K.Kabytaev: None. J.Mu: None. S.Connolly: None. M.J.Mcphaul: Employee; Quest Diagnostics. R.R.Little: None.

Funding

NIH/NIDDK (1UC4DK096587-01)
1141-P: HDL Particle Concentration, Cholesterol Efflux Capacity, and All-Cause Mortality in Type 1 Diabetes
Authors: COSTACOU TINA , MILLER RACHEL G. , ORCHARD TREVOR J. , VAISAR TOMAS
Published: May 2022

Recent evidence suggests that HDL particle concentration (HDL-P) and cholesterol efflux capacity (CEC) are better predictors of coronary artery disease than HDL-C in type 1 diabetes (T1D) . We hypothesized that these novel HDL markers also predict all-cause mortality better than HDL-C in T1D. HDL-P (calibrated ion mobility analysis) and CEC (validated cell-based assay) were quantified in the first available stored sample from 550 Epidemiology of Diabetes Complications study participants with childhood onset (<17 years) T1D (baseline mean age 27.8 years and T1D duration, 19.6 years) . Vital status was assessed as of September 30, 2019. During a median follow-up of 26 years, there were 167 deaths. At analytic baseline, deceased were older, with longer T1D duration and a worse cardiovascular risk factor profile compared with survivors. In Cox proportional hazards models, after multivariable adjustments including for HDL-C, the concentration of total HDL-P (T-HDL-P, HR=0.90, 95% CI: 0.84-0.96) and that of three of the four major HDL subpopulations - extra small (XS-HDL-P, HR=0.44, 0.21-0.90) , small (S-HDL-P, HR=0.74, 0.60-0.93) and medium (M-HDL-P, HR=0.80, 0.70-0.91) particles - were associated with a lower mortality risk. Marginal protective associations were also observed for the concentration of large-sized particles (L-HDL-P, HR=0.84, 0.68-1.06) , as well as for CEC (HRs per SD was 0.86 (0.74-1.00) and 0.86 (0.73-1.01) for overall J774 and ABCA1-specific CEC, respectively) . These results remained largely unchanged by further adjustment for HDL-P (in the case of HDL-C and CEC) or APOA1 and triglyceride concentrations (for HDL-P) and were similar by sex. HDL-C was not a significant predictor of mortality in either univariate or multivariable analyses. Our findings show that higher HDL-P concentrations are negatively associated with mortality in T1D independent of other risk factors.

Disclosure

T.Costacou: None. R.G.Miller: Stock/Shareholder; Becton, Dickinson and Company. T.J.Orchard: None. T.Vaisar: Consultant; AstraZeneca.

Funding

National Institutes of Health (R01HL130153 and R01DK034818) and the Rossi Memorial Fund.
1150-P: Ethnic Differences in 25-Year Risk of Incident Chronic Kidney Disease among People with Type 2 Diabetes in New Zealand
Authors: YU DAHAI , OSUAGWU UCHECHUKWU L. , BAKER JOHN , CUTFIELD RICHARD G. , ORR-WALKER BRANDON J. , ZHAO ZHANZHENG , PICKERING KAREN A. , JAYANATHA KALPA , SIMMONS DAVID
Published: May 2022

Background: Ethnic differences exist in the risk of end stage kidney disease in type 2 diabetes (T2DM) . We compared the risk of developing CKD stages II-V between Māori, Pasifika, and NZ Europeans (NZE) with T2DM in NZ over a 25-year period.

Methods: We linked a large primary care audit program to national registration databases. Those with CKD II-V were excluded. A tapered matching method was used to balance potential confounders. Comparative cohorts were formed separately between NZE and Māori, and between NZE and Pasifika. Cox regression tested for ethnic group differences in future risk of any and each CKD stage between 1994 and 2018.

Results: Compared with NZE (n=2028) , the hazard ratios (HR) for developing any CKD, CKD stages II thru V for Māori (n=2215) were 1.18 (95% CI: 0.99-1.41) , 1. (0.91-1.32) , 1.70 (1.19-2.43) , 3.93 (2.16-7.14) and 3.74 (1.74-8.05) respectively. The HR for Pasifika (n=3101) compared with NZE (n=2474) for developing any CKD, CKD stages II thru V were 1.31 (1.09-1.57) , 1.26 (1.05-1.52) , 1.71 (1.14-2.57) , 3.75 (1.40-10.05) and 4.96 (1.56-15.75) respectively. Figures A-D show the risks of CKD II and CKD IV/V among NZE (blue) and Māori/Pasifika over time.

Conclusion: Significant ethnic differences exist in the risk of progressing to each stage of CKD (especially stage V) among people with T2DM in NZ. Research into the mechanisms underlying these differences are warranted.

Disclosure

D.Yu: None. U.L.Osuagwu: None. J.Baker: n/a. R.G.Cutfield: None. B.J.Orr-walker: None. Z.Zhao: None. K.A.Pickering: None. K.Jayanatha: None. D.Simmons: Other Relationship; Elsevier, Research Support; Abbott, Hitachi, Ltd., Novo Nordisk, Speaker's Bureau; Sanofi.
1157-P: Mortality among People with Diabetes Experiencing Hypoglycemic and Hyperglycemic Crises
Authors: MCCOY ROZALINA G. , HERRIN JEPH , SWARNA KAVYA SINDHU , GALINDO RODOLFO J. , UMPIERREZ GUILLERMO E. , GOLDEN SHERITA , O'CONNOR PATRICK J.
Published: May 2022

Severe hypoglycemia and hyperglycemia (ketoacidosis, hyperglycemic hyperosmolar state) are common yet potentially preventable acute complications of diabetes. Our objectives were to use national data from OptumLabs® Data Warehouse, 2011-2020, to 1) characterize trends in all-cause mortality among adults with type 1 diabetes (T1D) and type 2 diabetes (T2D) experiencing emergency department visits or hospitalizations for hypoglycemia and hyperglycemia;2) extend analyses through 2020 to assess the impact of the COVID-pandemic; and3) examine racial/ethnic and gender disparities in subsequent mortality adjusted for relevant patient characteristics. Among 4,164 adults with T1DM experiencing hypoglycemia, 30-day and 1-year mortality increased from 0.5% to 0.9% and 4.7% to 6.1%. Among 49,931 adults with T2DM experiencing hypoglycemia, 30-day and 1-year mortality were stable at 2.1-2.0% and 16.2-16.1%. Among 4,698 adults with T1DM experiencing hyperglycemia, 30-day and 1-year mortality increased from 0.4% to 1.0% and 2.7% to 5.9%, respectively. Among 17,123 adults with T2DM experiencing hyperglycemia, 30-day and 1-year mortality increased from 2.5% to 3.0% and 11.5% to 13.1%. Table shows differences in mortality rates by age, race/ethnicity, gender. These results call for proactive engagement of high risk individuals experiencing severe hypoglycemia and hyperglycemia to reduce their risk of death.

Disclosure

R.G.Mccoy: Consultant; Emmi. J.Herrin: Consultant; Johnson & Johnson Medical Devices Companies. K.Swarna: None. R.J.Galindo: Advisory Panel; Sanofi, WW International, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk. G.E.Umpierrez: Research Support; AstraZeneca, Dexcom, Inc., Novo Nordisk. S.Golden: Advisory Panel; Abbott Diabetes, Medtronic. P.J.O'connor: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases grant number K23DK114497
1161-P: Race-Stratified Association between Hyperglycemia Severity and Control and Microalbuminuria
Authors: VISARIA AAYUSH , HAMEED FARIHA , REDDY SHIVANI , RAVAL BRINDA A. , SHARMA AKARSH , NAGARAJ BHARATH
Published: May 2022

Background: It is unclear how hyperglycemia severity & control impact the likelihood of microalbuminuria (MA) , an early sign of microvascular damage, across different races/ethnicities.

Methods: We included 14,355 adults aged ≥20 years with eGFR ≥60 ml/min/1.73 m2, urine albumin-creatinine ratio (ACR) <300 mg/g, and without CVD from the 2011-2018 National Health and Nutrition Examination Surveys. MA was defined in this study as ACR ≥20 mg/g. We assessed the impact of HbA1c% (divided into sextiles) , disease stage, and diabetes (DM) control, on odds of MA using multivariable logistic regression, adjusting for covariates, accounting for survey design, and stratifying by race/ethnicity (Table) .

Results: Across all race/ethnicities, prediabetes, controlled & uncontrolled DM, and untreated DM were associated with increased odds of MA, albeit of varying significance (Table) . Asians with prediabetes had 46% higher adjusted odds of MA. DM control modified the effect of DM on odds of MA (p-interaction <0.001) . There was a dose-dependent increase in MA with increasing sextile of HbA1c% (p-trend<0.0001) . The increase in MA was significant at HbA1c%≥5.4% among Hispanics and Asians, ≥5.6% among Whites, and ≥6.0% among Blacks (Table) .

Conclusions: Patients with prediabetes may have increased likelihood of MA, with potentially lower HbA1c thresholds among Asian American and Hispanic adults.

Disclosure

A.Visaria: None. F.Hameed: None. S.Reddy: None. B.A.Raval: None. A.Sharma: None. B.Nagaraj: None.
1162-P: Clinical Characteristics and Outcomes in Patients Hospitalized with Diabetic Ketoacidosis
Authors: ELEDRISI MOHSEN , ABOAWON MALK K. , ALKABBANI HAIFAA M. , ALI AYA A. , ALABDULRAZZAK IMAD , ELHAJ MAAB F. , AHMED ASHRAF O.E. , ALQAHWACHI HAZIM , DAGHFAL JOANNE , BESHYAH SALEM A.
Published: May 2022

Background: Diabetic ketoacidosis (DKA) is an acute complication of uncontrolled diabetes that is associated with increased morbidity and mortality.

Objective: We aimed to examine clinical characteristics and care outcomes for patients hospitalized for DKA.

Methods: We reviewed the hospital database for patients who were admitted with DKA from 2015 to 2020 in government hospitals in Qatar. Clinical characteristics, laboratory data, the severity of DKA, complications, need for admission to the intensive care unit, length of hospital stay, time to resolution of DKA, and mortality rates were evaluated in patients with type 1 diabetes (T1DM) compared to those with type 2 diabetes (T2DM) .

Results: A total of 1613 episodes of DKA in 1330 patients (39.3% with T1DM and 60.7% with T2DM) were evaluated. Non-adherence to therapy was the commonest cause (40.5%) of DKA in patients with T1DM, while infection was the commonest cause (32.9%) in those with T2DM. There was no difference in the severity of DKA, mean serum glucose, mean serum sodium, and arterial pH on presentation in both groups of patients. Both groups had poorly controlled glucose (mean HbA1c of 10.1% and 10.5% in T1DM and T2DM groups respectively) . There was no difference in the time to resolution of DKA (18 hours in the T1DM group and 20 hours in the T2DM group) . Patients with T2DM had higher rates of admission to the intensive care unit (39.1% vs. 26.9% for T1DM, p<0.001) , longer hospital stay (mean 5 days vs. 2 days in the T1DM group, p<0.001) , while patients with T1DM had higher rates of recurrent DKA (35.6% vs. 21.2% in the T2DM group, p<0.001) . Mortality rates were significantly higher in patients with T2DM compared to those with T1DM patients (7.6% vs. 0.95%, respectively, p<0.001) .

Conclusion: In this cohort study, poorly controlled glucose was prevalent among patients admitted with DKA. Despite higher rates of recurrent DKA in patients with T1DM, those with T2DM had more complicated hospital course and higher mortality.

Disclosure

M.Eledrisi: None. S.A.Beshyah: None. M.K.Aboawon: None. H.M.Alkabbani: None. A.A.Ali: None. I.Alabdulrazzak: None. M.Elhaj: None. A.O.E.Ahmed: None. H.Alqahwachi: None. J.Daghfal: None.
1170-P: Long-Term Effects of Lifestyle Changes in Subjects with Prediabetes and Type 2 Diabetes on Cardiovascular and All-Cause Mortality: A Systematic Review with Meta-analysis of Randomized Clinical Trials
Authors: ZUCATTI KELLY P. , TEIXEIRA PAULA P. , WAYERBACHER LAURA F. , FRANKENBERG ANIZE D. , GUERRA BRUNO A. , PICCOLI GIOVANA F. , MORESCO KARLA S. , FARENZENA LAURA , MADURE MICHELLE G. , FONSECA NATASHA , CORREIA POLIANA , BRIETZKE ELISA , HALPERN BRUNO , COLPANI VERÔNICA , GERCHMAN FERNANDO
Published: May 2022

Long-term RCTs have shown that lifestyle interventions (LI) can prevent T2DM in individuals with prediabetes, improve glycemic control in individuals with T2DM, as well as improve lipid profile and lower blood pressure in both. However, the impact of these interventions on cardiovascular (CV) and total mortality is still not clear. Therefore, we conducted a systematic review with meta-analysis to determine the long-term efficacy of LI on CV and all-cause mortality in subjects with prediabetes and T2DM. We searched PubMed, Cochrane CENTRAL, Embase, Web of Science, protocol records, and reference lists of relevant publications until December 2021. We selected RCTs including adults with prediabetes and T2DM that evaluated LI with at least 2 years of duration, with or without post-trial follow-up. The main outcomes consisted of CV and all-cause mortality. We used the RoB 2.0 tool to evaluate the risk of bias and the GRADE approach for the overall certainty of evidence. Meta-analysis was conducted using a random effects method. We identified 22,900 records, of which studies registred all-cause mortality events (16,554 participants, mean age 55.5 years, mean BMI 30.5 Kg/m2, 9.9 years of follow-up) , and 5 reported CV mortality events (11,017 participants, mean age 54.5 years, and mean BMI 31.8 Kg/m2, 14.8 years of follow-up) . LI did not reduce the risk of CV mortality (RR 0.95; 95% CI 0.74 to 1.21; I2=38%; moderate certainty of the evidence) and all-cause mortality (RR 0.94; 95% CI 0.85 to 1.03; I2=15%; high certainty of the evidence) compared with usual care. This meta-analysis of RCTs demonstrated that intensive LI was not superior to usual care in reducing CV and all-cause mortality for subjects with prediabetes and T2DM. However, there is still insufficient evidence demonstrating the effect of long-term cardioprotective LI on mortality in this specific population.

Disclosure

K.P.Zucatti: None. N.Fonseca: None. P.Correia: None. E.Brietzke: Speaker's Bureau; Daiichi Sankyo, Janssen Pharmaceuticals, Inc. B.Halpern: None. V.Colpani: None. F.Gerchman: None. P.P.Teixeira: None. L.F.Wayerbacher: None. A.D.Frankenberg: None. B.A.Guerra: None. G.F.Piccoli: None. K.S.Moresco: None. L.Farenzena: None. M.G.Madure: None.
1178-P: Current Situations in Dietary Intake and Physical Activity in Japanese Patients with Type 2 Diabetes: JDCP Study
Authors: HORIKAWA CHIKA , TSUDA KINSUKE , SATOH JO , HAYASHINO YASUAKI , TAJIMA NAOKO , NISHIMURA RIMEI , SONE HIROHITO
Published: May 2022

Medical nutrition therapy and exercise therapy are the cornerstones of treatment for patients with type 2 diabetes; however, there has not been a nationwide study on the actual dietary intake and physical activity status of patients since the 2000s. We aimed to clarify this in Japanese patients with type 2 diabetes using data from the Japan Diabetes Complication and its Prevention prospective (JDCP) , a nationwide study launched in 2007. A total of 1,992 patients with type 2 diabetes, aged 40-75 years, completed either the Brief-type, self-administered Diet History Questionnaire (1,643 patients) or International Physical Activity Questionnaire (1,834 patients) , and their data were analyzed in this study. Mean daily energy intake for all participants was 1686.8 kcal/day, and the mean proportions of carbohydrate, protein, and fat comprising total energy intake were 60.2, 16.2, and 23.6%, respectively. The patients in this study had similar energy and nutrient intake status to patients in the 1996 Japan Diabetes Complications Study; however, Japanese patients still had higher carbohydrate and lower fat consumption than patients with diabetes in Western countries. Only 10.5 % of the patients had equal to or more than 20 g/day of dietary fiber and 7.5% consumed less than 6 g of salt. Weekly physical activities of male and female patients were 2344.5±2700.9 and 1948.3±2209.3 METs·min/week in women, respectively (p <0.001) . As for exercise, 31.0% of patients did not do it habitually; this was particularly noticeable in female patients and patients under the age of 65. BMI increased from 22.7 to 24.1 kg/m2 in men and 23.2 to 24.8 kg/m2 in women from 1996 to 2007, respectively. The reason for this increment is suggested to be due to energy intake remaining unchanged despite a decrease in physical activity level. The balance between dietary energy intake and energy expenditure based on physical activity has become more important in Japanese patients with type 2 diabetes in recent years.

Disclosure

C.Horikawa: None. K.Tsuda: None. J.Satoh: None. Y.Hayashino: None. N.Tajima: None. R.Nishimura: Speaker's Bureau; Abbott Diabetes, Astellas Pharma Inc., AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Merck & Co., Inc., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Sanofi, Taisho Pharmaceutical Holdings Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited, Terumo Corporation. H.Sone: Research Support; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Takeda Pharmaceutical Company Limited.

Funding

Japan Diabetes Society
1185-P: Low Birth Weight Is Associated with a Nongenetic Higher Incidence Rate of Type 2 Diabetes
Authors: WIBAEK RASMUS , ANDERSEN GREGERS S. , LINNEBERG ALLAN , GRARUP NIELS , HANSEN TORBEN , BRØNS CHARLOTTE , VISTISEN DORTE , VAAG ALLAN A.
Published: May 2022

Background: Low birth weight, indictive of a poor fetal environment, is a risk factor for type 2 diabetes (T2D) . Most previous studies were based on cross sectional prevalence data and not designed to study the timing of onset of T2D in relation to birth weight (BW) . Furthermore, earlier studies have not adjusted for common genetic variation influencing BW. We aimed to examine associations of BW with age-specific incidence of T2D using BW polygenetic risk scores (BWPRS) to adjust for genetic confounding.

Methods: Adults (30-60 years) enrolled in the Inter99 cohort from 1999-20with information on BW from original birth records, and without diabetes at baseline were eligible. Birth records were linked with individual-level data on T2D incidence from the Danish Diabetes Register and key covariates from the Inter99 study. Incidence rates of T2D as a function of age, sex and BW were modelled using Poisson regression and adjusted for adult BMI, socioeconomic status, maternal history of diabetes and BWPRS.

Results: Among 4584 participants there were 438 incident cases of T2D during a mean follow-up of 18 years. BW was inversely associated with T2D with a higher incidence in men. T2D incidence increased with age and the rate of increase was higher in persons with lower BW compared with higher BW in a dose-response manner.

Conclusion: A lower birth weight is associated with a greater increase in incidence rate of T2D in a non-genetic manner.

Disclosure

R.Wibaek: Stock/Shareholder; Novo Nordisk A/S. G.S.Andersen: Stock/Shareholder; Novo Nordisk A/S. A.Linneberg: None. N.Grarup: None. T.Hansen: None. C.Brøns: Stock/Shareholder; Novo Nordisk. D.Vistisen: Research Support; Bayer AG, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi, Stock/Shareholder; Novo Nordisk A/S. A.A.Vaag: Stock/Shareholder; AstraZeneca.

Funding

Danish Diabetes Academy, which is funded by the Novo Nordisk Foundation (NNF17SA0031406)
1189-P: The Intersection of Food Insecurity and Diet Quality in Association with Diabetes ABCs Management among U.S. Adults, 2013–2018
Authors: CASAGRANDE SARAH , BULLARD KAI M. , SIEGEL KAREN R. , LAWRENCE JEAN M.
Published: May 2022

The ADA recommends that people with diabetes (PWD) consume a high-quality diet to achieve diabetes treatment goals, however, food insecurity may prevent consumption of a high-quality diet. Cross-sectional, national data from 2,351 participants aged ≥20 years with self-reported diabetes that completed the National Health and Nutrition Examination Surveys between 2013-2018 were analyzed. Diet quality was assessed using quartiles of the 2015 Healthy Eating Index. Adjusted odds ratios (aOR, 95% CI) were calculated from logistic regression models to determine the association between individual food insecurity/diet quality and A1c, blood pressure (BP) , and cholesterol control (ABCs) while controlling for sociodemographics, health care utilization, smoking, diabetes, BP, and cholesterol medication use, and BMI. Overall, 17.6% of PWD were food insecure/low diet quality; 14.2% were food insecure/high diet quality; 33.1% were food secure/low diet quality; and 35.2% were food secure/high diet quality. PWD who were food insecure/low diet quality were younger, non-Hispanic black race or Hispanic ethnicity, and uninsured vs. those who were food secure/high diet quality (all p<0.001) . In comparison with PWD with full food security/high diet quality, those with food insecurity/low diet quality were significantly more likely to have A1c ≥7.0% (aOR=1.84, 1.23-2.76) , A1c ≥8.0% (aOR=1.76, 1.02-3.02) , low HDL (aOR=1.70, 1.24-2.33) , and high triglycerides (aOR=3.13, 1.71-5.71) ; food insecurity/high diet quality was significantly associated with A1c ≥7.0% (aOR=1.69, 1.14-2.51) , A1c ≥8.0% (aOR=1.83,1.12-2.98) and high triglycerides (aOR=2.44, 1.15-5.16) ; and food security/low diet quality with A1c≥7% (aOR=1.55, 1.07-2.24) . Both food insecurity and low diet quality are associated with both poor glycemic and lipid management. Screening for and interventions that address food insecurity and diet quality may help support PWD in their diabetes management.

Disclosure

S.Casagrande: None. K.M.Bullard: None. K.R.Siegel: None. J.M.Lawrence: None.

Funding

National Institutes of Diabetes and Digestive and Kidney Diseases (GS-10F-0381L)
1194-P: Gender Differences in Incidence of Prediabetes and Diabetes in South Asians
Authors: NARAYAN K.M. VENKAT , KONDAL DIMPLE , STAIMEZ LISA R. , ANJANA RANJIT MOHAN , GUJRAL UNJALI , DEEPA MOHAN , PATEL SHIVANI A. , ALI MOHAMMED K. , PRABHAKARAN DORAIRAJ , CHANG HOWARD H. , TANDON NIKHIL , MOHAN VISWANATHAN
Published: May 2022

Background: Among South Asians, women have higher prevalence of diabetes than men, but few studies have examined gender differences in incidence.

Methods: We analyzed data from 2714 adults aged ≥20 years, enrolled in the Chennai site of prospective Cardiometabolic risk reduction in South Asia (CARRS) study. We defined normal glucose tolerance (NGT) , isolated impaired fasting glucose (iIFG) , impaired glucose tolerance (IGT) , and diabetes based on ADA criteria. We estimated incidence densities for: NGT (n=2205) to iIFG and iIFG (n=641) to diabetes; NGT (n=2205) to IGT; and IGT (n=341) to diabetes.

Results: Prevalence of iIFG was higher in women (20.5% vs. 11.8%) , while prevalence of IGT was lower (6.6% vs. 8.5%) than in men. During median 2.6 y (IQR: 0.7, 5.8) of follow-up, 316 individuals progressed from NGT to iIFG, 239 from NGT to IGT, 155 from iIFG to diabetes, and 135 from IGT to diabetes. Overall, incidence (95% CI) of NGT to iIFG was higher than incidence of NGT to IGT (36.3 [32.5, 40.5] vs. 27.4 [24.1, 31.1] per 1,000 person-years [PYR], respectively) . However, the incidence of iIFG to diabetes was lower than incidence of IGT to diabetes (47.3 [40.4, 55.4] vs. 77.1 [65.1, 91.3] per 1,000 PYR, respectively) . Compared with men, women had higher conversion from NGT to iIFG (42.1 [36.9, 48] vs. 27.7 [22.7, 33.8]) , but lower incidence of NGT to IGT, 22.9 (19.2, 27.4) vs. 34.2 (28.5, 40.9) . Women had higher conversation both from iIFG to diabetes [49.0 (40.8,58.8) vs. 43.1 (31.6,58.7) ] and IGT to diabetes (87.7 [70.5,109.0] vs. 65.3 [50.0,85.2]) . In Cox models adjusting for age, BMI and family history of diabetes, women were 1.41 times (95% CI: 1.07,1.84) likely to convert from NGT to iIFG compared to men, but, men are 1.76 (1.33, 2.34) times at risk from NGT to IGT. There was no gender difference for conversion from iIFG or IGT to diabetes.

Conclusion: Prevalence and incidence of iIFG is higher in South Asian women than men, while prevalence and incidence of IGT is higher in men. Conversion from iIFG or IGT to diabetes is similar among genders.

Disclosure

K.Narayan: n/a. H.H.Chang: None. N.Tandon: None. V.Mohan: None. D.Kondal: None. L.R.Staimez: None. R.Anjana: None. U.Gujral: None. M.Deepa: None. S.A.Patel: Research Support; Johnson & Johnson. M.K.Ali: Advisory Panel; Bayer AG, Research Support; Merck & Co., Inc. D.Prabhakaran: None.

Funding

The National Heart, Lung, and Blood Institute (NHLBI) , National Institutes of Health (HHSN268200900026C)
1195-P: Investigating the Data Sufficiency, Prevalence, and Population Characteristics of Type 2 Diabetes Remission Using Laboratory Value-Enriched Claims Data
Authors: SHEILS NATALIE , JARVIS MEGAN , BANGERTER LAUREN , ASCH DAVID , CLARK CALLAHAN
Published: May 2022

The application of the 2021 international consensus statement, defining type 2 diabetes remission as A1c less than 6.5% at least 3 months after stopping glucose-lowering therapy, remains unexplored in retrospective claims-based studies. We used de-identified administrative claims enriched with laboratory values from commercial and Medicare Advantage plans to identify the (1) proportion of individuals with insufficient data to be assessed for remission (2) prevalence of diabetes remission and (3) sensitivity of remission definitions to changes in claims-based logic. We designed three alternative definitions adapted to claims by varying the glycemic, temporal, and pharmacologic components. Among 524,076 adults with a type 2 diabetes claim and an available A1c value of at least 6.5%, 185,285 (35.4%) had insufficient additional laboratory values and/or enrollment data to assess for remission. Of the 338,791 who were assessable for remission, 10,694 (3.2%) met the consensus statement definition. The proportion meeting the three alternative definitions ranged from 0.8% to 2.3%, demonstrating the feasibility of a laboratory-value enriched claims-based assessment of remission. Establishing stable claims-based markers of remission can enable population assessments and evaluate the association between remission and clinical outcomes.

Disclosure

N.Sheils: Employee; UnitedHealth Group, Stock/Shareholder; UnitedHealth Group. M.Jarvis: Employee; UnitedHealth Group, Stock/Shareholder; UnitedHealth Group. L.Bangerter: Employee; UnitedHealth Group. D.Asch: Other Relationship; UnitedHealth Group, VAL Health. C.Clark: Employee; UnitedHealth Group, Stock/Shareholder; UnitedHealth Group.
1199-P: Racial/Ethnic and Socioeconomic Disparities in the Look AHEAD Trial
Authors: CROMER SARA JANE , MEIGS JAMES B. , WEXLER DEBORAH J.
Published: May 2022

Background: It is unknown whether the benefits of intensive lifestyle interventions (ILI) are equally distributed among participants with type 2 diabetes of different races/ethnicities or educational attainment. We hypothesized that individuals of White race/ethnicity and greater educational attainment (EA) would receive greater benefit from ILI within a clinical trial.

Methods: Using data from the Look AHEAD trial which assigned adults with T2D to an ILI or diabetes support and education (DSE) , we examined weight outcomes (achievement of the 7% weight loss goal, percent weight change) , stratified by race/ethnicity and EA. Differences between groups are described using univariate analyses and multivariable linear and logistic regression adjusted for age, sex, treatment arm, and baseline insulin use.

Results: Among 4,640 participants (mean age 59 years, 58% women) , 17% were non-Hispanic Black, 14% were Hispanic, and 13% did not have a high school degree. Black and Hispanic participants were less likely to achieve the weight loss goal in both the ILI (45.8% vs. 60.7%, p<0.0 and 53.0% vs. 60.7%, p=0.01, respectively) and DSE arms of the trial and achieved lesser percent weight loss in the ILI arm. By contrast, participants with lower EA (less than a high school degree) were more likely to achieve the weight loss goal in the ILI but numerically less likely to achieve it in the DSE arm, with evidence of an arm by education interaction (p for interaction 0.015) , suggesting greater benefit from the ILI in this subgroup. Participants with lower EA also achieved greater percent weight change than peers in the ILI at both 1 year and 4 years after randomization, with ongoing evidence of an arm by education interaction at 4 years.

Conclusions: Black and Hispanic participants experienced less weight loss in both arms of the Look AHEAD trial, whereas those with lower EA experienced superior benefits in the ILI compared to other groups. Individuals with low EA may receive relatively greater benefits from ILIs, compared to those with higher EA.

Disclosure

S.Cromer: Other Relationship; Johnson & Johnson Medical Devices Companies, Research Support; National Institute of Diabetes and Digestive and Kidney Diseases. J.B.Meigs: Consultant; Quest Diagnostics. D.J.Wexler: Other Relationship; Elsevier, Novo Nordisk, UpToDate.

Funding

NIDDK F32DK127545
1206-P: Association of Hepatic Steatosis Index (HSI) and Fibrosis (Fib) -4 Score with Prediabetes Risk in the POP-ABC Study: Potential Mechanisms
Authors: BARRETO BRIGIDA COLON , EBENIBO SOTONTE , DAGOGO-JACK SAMUEL
Published: May 2022

Nonalcoholic fatty liver disease (NAFLD) is prevalent in people with type 2 diabetes (T2D) . Here, we evaluated the association of NAFLD (assessed by HSI and Fib-4 score) with prediabetes risk and related mechanisms in healthy, normoglycemic (NGT) White and Black offspring of parents with T2D enrolled in the Pathobiology of Prediabetes in a Biracial Cohort (POP-ABC) study. The primary outcome of POP-ABC was progression from NGT to prediabetes during ∼5-yr followup. Baseline assessments included clinical exam, OGTT, LFTs, hsCRP and adiponectin levels. Assessments during year 1 included insulin sensitivity (ISI, euglycemic clamp) and insulin secretion (AIR) . Baseline HSI ([8 × ALT/AST] + BMI + [2 if female]) and FIB-4 score ([age × AST]/[platelets count × √ALT]) values were used to stratify the cohort by quartiles (Q1 to Q4) .

The cohort (N 376; 159 White, 217 Black) mean age at baseline was 44.2 ± 10.6 yr, BMI 30.2 ± 7.23 kg/m2, with 343 (91%) evaluable subjects. The baseline fasting glucose was 90.9 ± 7.70 mg/dl and 2-hr glucose was 125 ± 26.5 mg/dl. During 5 years of followup, prediabetes occurred in 16.2, 21.6, 31.5 and 30.6% among participants in Q1 to Q4 of baseline HSI, respectively. Kaplan-Meier analysis showed higher probability of prediabetes with increasing baseline HSI (P=0.02) . Fib-4 scores were uncoupled from prediabetes rates. HSI correlated robustly with ISI (r=−0.438, P <0.0001) ; FIB-4 correlated weakly with ISI (r=0.14, P= 0.0459) , and both showed weak correlation with AIR that was insignificant after controlling for ISI. HSI (r=0.456, P <0.0001) and Fib-4 (r=0.164, P=0.0032) associated directly with hsCRP and inversely with adiponectin (HSI: r=−0.235, P <0.0001; Fib-4: r=−0.156, P=0.0051) . Hepatic steatosis increases incident prediabetes risk via mechanisms that involve insulin resistance and inflammation.

Disclosure

B.Colon barreto: None. S.Ebenibo: None. S.Dagogo-jack: Consultant; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Medtronic, Merck & Co., Inc., Sanofi.

Funding

American Diabetes Association (7-07-MN-13) ; National Institutes of Health (R01 DK067269)
123-LB: Extended Fasting Reveals Effect of Canagliflozin to Mobilize Ketones in Canines
Authors: ADER MARILYN , SEDIGHI RASHIN , KABIR MORVARID , BERGMAN RICHARD N.
Published: May 2022

SGLT2 inhibitors (SGLT2i) improve glycemic control by inhibiting renal proximal tubular glucose reabsorption. SGLT2i may also elevate ketones. Fasting is expected to increase endogenous ketones, and SGLT2i may enhance ketosis. We asked if SGLT2i alters circulating ketones (β-hydroxybutyrate; BOHB) and disrupts glycemia during prolonged fasting. Dogs (n=7) were studied with a crossover design. Dogs received either canagliflozin (CANA; 300 mg) or placebo (PL) once/day for 7 d, after which a 48 h fast was performed while treatment was continued. To begin the fast, after morning feeding (9 am to noon) , remaining food was removed (“t=0”) . Blood was sampled at regular intervals over a 48 h period of total fasting (urine collected over final 3 h) . After the fast, dogs were fed over 3 h. Treatment was then discontinued for 2 wk washout, and dogs were then assigned to the alternate treatment (CANA or PL) for 7 d, after which fasting experiment was repeated. Glycemia was sustained in both treatment groups during initial 22 h of fasting, presumably due to reduction of insulin (↓50.7±13.1% and ↓49.5±21.5% for CANA and PL, respectively; p<0.035 for both) . But marked effects of CANA alone were revealed after 22 h of fasting, when glucose declined markedly in CANA (52.9±3.4 mg/dl at t=48 h) , but not PL (86.6±2.5 mg/dl at 48 h; p=0.0002 vs. CANA) , due to drug-induced glycosuria (13948±543 vs. 19.6±1.5 mg/dl; p<0.0001) . After 22 h of fasting, CANA induced ∼5-fold increase in FFA (p<0.03) and marked increase in plasma BOHB that persisted for duration of fast (CANA: 0.560±0.065 mM, PL: 0.048±0.006 mM; p<0.0001) . After refeeding, glucose and BOHB normalized, although BOHB remained higher in CANA (p<0.0007) .

In conclusion, effect of SGLT2i on ketones is manifest after 24 h of total food restriction. CANA treatment induces glycosuria, after which reduction in carbohydrate stores switches animals to fat-based metabolism, characterized by increased FFA and ketosis. CANA appears to induce ketosis when carbohydrate stores are depleted.

Disclosure

M. Ader: None. R. Sedighi: None. M. Kabir: None. R. N. Bergman: Consultant; Fractyl Health, Inc., Novo Nordisk, Research Support; AstraZeneca, Janssen Research & Development, LLC.

Funding

Janssen Pharmaceutica, Inc.; NIH (DK29867, DK27619)
1239-P: Predictors for COVID-Severity among Hospitalized Patients with Diabetes in Japan
Authors: SHOJI MAYUMI , TERAMOTO NAOYA , HAYASHI AIKO , MAEDA YUKARI , OCHIAI HIDETOSHI , TSUKAGOSHI AYANO , MAEZAWA YOSHIRO , KOSHIZAKA MASAYA , YOKOTE KOUTARO
Published: May 2022

Background: COVID-is a pandemic disease caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) . Diabetes is a major risk factor for the severe progression and outcome of COVID-infection. Although some risk factors have been revealed, determining undetected risk factors for severe infection would enable identifying patients who may benefit from aggressive supportive care and early intervention.

Methods: A retrospective observational study of 100 diabetes patients who were admitted with confirmed COVID-infection was conducted. The patients were divided into two groups - severe and moderate - based on intensive care unit (ICU) admission. The differences between the groups were analyzed with multivariable logistic regression to reveal the risk factors.

Results: Of 100 patients, the mean (SD) age was 62.1 (13.0) years, 70 (70.0%) were male, and 48 (48.0%) were ≥ 65 years. Among patients with severe COVID-infection, 25 (25%) were admitted to ICU, and one patient died. Patients with severe infection had a significantly lower albumin level (severe 2.81 ± 0.37 g/dL vs. moderate 3.39 ± 0.50, p<0.01) , and a higher blood glucose (221.5 ± 91.3 mg/dL vs. 178.9 ± 73.4, p=0.02) , white blood cell count (8969 ± 5002 /μL vs. 6227 ± 2644, p=0.01) , C-reactive protein (CRP) (12.5 ± 9.2 mg/dL vs. 6.4 ± 5.5, p<0.01) , and lactate dehydrogenase (572.5 ± 165.9 U/L vs. 353.5 ± 150.9, p<0.01) level than did patients without severe infection. There was no significant difference with hypertension, dyslipidemia, smoking, obesity, and HbA1c. Patients with severe infection had significantly lower total protein and albumin levels. On multivariable logistic regression analysis, risk factors for severe infection included CRP on admission (odds ratio [OR], 1.090; 95% CI, 1.005-1.183) , age (OR, 0.944; 95% CI, 0.899-0.991) , and albumin (OR, 0.036; 95% CI, 0.007-0.191) .

Conclusions: In patients with diabetes, albumin was an independent predictor for the development of severe COVID-19.

Disclosure

M.Shoji: None. N.Teramoto: None. A.Hayashi: None. Y.Maeda: None. H.Ochiai: None. A.Tsukagoshi: None. Y.Maezawa: None. M.Koshizaka: None. K.Yokote: None.