bluuebunny/crossref_metadata_2025 huggingface dataset:
1209-P: Mapping the Characteristics of Gestational Diabetes Prevention Lifestyle Interventions
Authors: PENA ARMANDO , MILLER ALISON , CAMPBELL ANGELA G. , SCIFRES CHRISTINA M.
Published: June 2023

Introduction: The literature on gestational diabetes mellitus (GDM) prevention lifestyle interventions is conflicting with heterogeneity across study characteristics. The purpose was to map the sample, intervention, and physiologic outcome characteristics of randomized control trials (RCT).

Methods: Article inclusion criteria: lifestyle intervention RCTs (no medications), all ages and phenotypes, reported on GDM rates. We searched PubMed and CINAHL using key term combinations including lifestyle, physical activity, nutrition, exercise, dietary, intervention, program, gestational diabetes, diabetes during pregnancy, pregnant, pregnancy, nulliparous, gestation, prevention, prevent. Three reviewers considered 87 unique abstracts for full text review. Sample, intervention, and GDM-relevant physiologic outcome (beyond gestational weight gain) characteristics were mapped.

Results: We reviewed 19 studies. Common sample inclusion criteria across studies were gestational age (63% studies), chronological age and weight status (each 58%), singleton pregnancy (47%), and GDM risk factors (26%). Studies represented adults with overweight (M±SD, Age 30.5±1.8 y, pre-pregnancy BMI 29.3±4.3 kg/m2) and gestational age <20 wk. Latinas (n=1 studies) and Blacks (n=4) were underrepresented. Six studies (32%) used multi-disciplinary teams. Dietitians (44% studies), nurses (22%) and exercise specialists (16%) were common implementers with nutritionists, physicians, lifestyle coaches, and research staff each used in <12% studies. Few studies used theoretical frameworks: Social Cognitive Theory (n=3 studies), Control Theory (n=2), Health Belief Model (n=1). GDM criteria most used were ADA (68% studies) compared to WHO (16%). Insulin sensitivity was the most common GDM risk factor (n=5).

Conclusion: GDM prevention lifestyle interventions should prioritize high-risk racial/ethnic groups, multi-level frameworks, multi-disciplinary delivery, and novel biomarkers.

Disclosure

A.Pena: None. A.Miller: None. A.G.Campbell: None. C.M.Scifres: None.
1211-P: Development and Testing of Eating Habits Scale for GDM
Authors: AMAYA MARIKO , SEKIJIMA KAYOKO , KOYAMA YU , YOSHIOKA TAISHI , OHARA NOBUMASA , YAMADA TAKAHO , SODA SATOSHI , YAHATA KAZUAKI , SONE HIROHITO , ASAZAWA KYOKO , ARIMORI NAOKO
Published: June 2023

In the present study, we have attempted to develop an eating habits scale for gestational diabetes women for supporting diet therapy and maintaining QoL during pregnancy. By searching 552 previous articles, we developed a gestational diabetes scale consist of 44 items related to dietary life in women with gestational diabetes. Next, we introduced this scale into two surveys for evaluating the reliability and validity of the scale. The first survey conducted conforming factor analysis and exploratory factor analysis based on data from a purposive sample of 235 patients. The second survey confirmed the stability of data from 81patients by test-retest. The patients consisted of gestational diabetes women in diet. Scale development involved several phases, including item development, reliability testing, criterion-related validity, and construct validity testing. Construct validity was tested with exploratory factor analysis and resulted in 14 items with a 2-factor solution: “Diet therapy for gestational diabetes” and “Subjective health of gestational diabetes women”. The total score and subscale scores of eating habits scale showed excellent internal consistency. In addition, confirmatory factor analysis indicated that a 2-factor model for 235 patients. Cronbach’s α coefficient was 0.906 for the overall scale, confirming general internal consistency. The model showed approximately good fit to the data by confirmatory factor analysis (GFI = 0.924, AGFI = 0.883, RMSEA = 0.064). A significant correlation was observed between eating habits scale and SF-8 Physical Component Summary (r = 0.039) as well as SF-8 Mental Component Summary (r = 0.047). Sufficient criterion-related validity was not confirmed by the HbA1c value (r = -0.092). We could not show enough validity of eating habits scale for gestational diabetes women in this study. However, high reliability indicated by the stability indicated with repeated testing has shown, therefore, this scale may useful for evaluating eating habits for gestational diabetes women.

Disclosure

M. Amaya: None. K. Sekijima: None. Y. Koyama: None. T. Yoshioka: None. N. Ohara: None. T. Yamada: None. S. Soda: None. K. Yahata: None. H. Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K. Asazawa: None. N. Arimori: None.

Funding

Japan Society for the Promotion of Science (17K17476)
1212-P: Early A1C vs. Two-Step Method on Adverse Pregnancy Outcomes
Authors: BODYCOT KATHERINE C. , HUANG RACHEL , AL-KOUATLY HUDA B. , MCLAREN RODNEY
Published: June 2023

There is limited data on the optimal screening method for early gestational diabetes. We sought to determine whether an early A1c or two-step glucose tolerance test (GTT) better identified pregnancies with adverse outcomes.

This was a retrospective cohort study of patients who met the American College of Obstetricians and Gynecologist’s criteria for early screening and delivered between 2017-2020 at a single center. Patients with a A1c and/or the two-step (1-hr GTT, followed by 3-hr GTT) method at <20 weeks were included. Adverse pregnancy outcomes were compared between patients with A1c ≥5.7% and those with A1c <5.7% using univariate and multiple variable analyses. In a similar fashion, patients with a positive or negative two-step method were compared.

There were 883 patients who received either a A1c (N=259) or underwent the two-step method (N=624). Patients with an A1c ≥5.7% had higher rates of macrosomia (21.6% vs. 5.1%) but lower rates of neonatal hypoglycemia (3.4% vs. 14.7%) than those with a A1c <5.7%. Patients who had a positive two-step method had higher rates of cesarean delivery (56.1% vs. 34.5%) and preterm delivery <32 weeks (12.2% vs. 2.2%).

A1c ≥5.7% in early pregnancy was associated with higher rates of macrosomia compared to those with an A1c <5.7%. Despite treatment, screening positive by an early two-step method had higher rates of cesarean delivery and preterm delivery <32 weeks than those who tested negative by the same method.

Disclosure

K.C.Bodycot: None. R.Huang: None. H.B.Al-kouatly: None. R.Mclaren: None.
1217-P: Willingness to Deintensify in Patients with Type 2 Diabetes—The Diabetes and Aging Study
Authors: HAIDER SHANZAY , PARKER MELISSA M. , HUANG ELBERT , GRANT RICHARD W. , MOFFET HOWARD H. , LAITEERAPONG NEDA , LIU JENNIFER , LIPSKA KASIA J. , KARTER ANDREW J.
Published: June 2023

Background: The ADA recommends treatment de-intensification be considered in older patients with poor health, on complex regimens, or experiencing side effects. We examined factors associated with older patients’ willingness to de-intensify treatment.

Methods: Cross-sectional analysis of Diabetes Preferences and Self-Care Survey responses and EHR data in adults with type 2 diabetes from Kaiser Permanente Northern California. We calculated proportions of patients who responded to the survey question “I would be willing to take less medication for my diabetes” as willing, neutral, or unwilling. Willingness was contrasted across demographic, clinical, and health status factors.

Results: Analysis included 1,337 adults prescribed glucose-lowering medications (age 74.2 ± 6.0 years, 44% women, 54.4% non-Hispanic white). The proportions of willing, neutral, and unwilling to de-intensify treatment were 51.2%, 27.3%, and 21.5%, respectively. Willingness to de-intensify varied by age (p<0.001) with 54.2% of younger adults (age 65-74) willing to de-intensify compared to 38.5% of older adults (age 85+). Willingness varied by duration of diabetes (p<0.001) with 61.0% of adults with diabetes for 0-4 years willing to de-intensify compared to 44.2% of adults with diabetes for longer duration (>15 years). Willingness among those with good, intermediate, or poor health status (as defined by the ADA) was 54.2% vs. 47.5% vs. 55.1%, respectively. Individuals with an A1c greater than 9% were more willing to de-intensify treatment compared to individuals with A1c of 7%-9%, or <7%, (57% vs 51% vs 50%, p<0.001). Willingness to de-intensify decreased as number of medications increased (p<0.001) and little difference was noted in willingness among patients by insulin use or hypoglycemia history.

Discussion: Patterns of patient willingness to de-intensify treatment are misaligned with clinical guideline recommendations and highlight the influence of patient experience living with diabetes over time.

Disclosure

S.Haider: None. M.M.Parker: Research Support; Dexcom, Inc. E.Huang: Advisory Panel; Twin Health, Stock/Shareholder; AbbVie Inc., Cardinal Health, Amgen Inc. R.W.Grant: None. H.H.Moffet: Research Support; Dexcom, Inc. N.Laiteerapong: None. J.Liu: None. K.J.Lipska: Other Relationship; UpToDate. A.J.Karter: None.

Funding

National Institute on Aging (5R01AG063391)
1219-P: HDL Particle Concentration (HDL-P) and Cholesterol Efflux Capacity (CEC) Trajectories Relative to Age at Menopause in Women with Type 1 Diabetes
Authors: JU JINGHUI , MILLER RACHEL G. , ORCHARD TREVOR J. , COSTACOU TINA
Published: June 2023

A previous study in the general population reported adverse changes in the concentration of HDL-P and CEC during the menopausal transition. Similar data do not exist in women with T1D. Moreover, whether changes in HDL metrics over time at a similar age also occur among men, reflecting aging processes, is not well established. We thus quantified HDL-P (calibrated differential ion mobility analysis), total and ABCA1-specific CEC in individuals with T1D and samples available at baseline (or earliest available) and the 25-year follow-up visit of the EDC study (n=155; mean baseline age 27; T1D duration 19 years). Each female participant was age and duration matched (at the time of menopause) to a male participant. Mixed models were constructed to assess the longitudinal trends in HDL-C, HDL subfractions and CEC. Plots were created depicting trajectories of HDL metrics relative to the time of the final menstrual period in women. As shown in the Figure, HDL-C and HDL-P concentrations increased significantly over time in both sexes. In addition, both CEC measures as well as CEC per HDL-P decreased over time in both men and women. Our findings in T1D point to similar trajectories of HDL metrics in men and women (increasing HDL-C and HDL-P but decreasing CEC per HDL-P) suggesting that these changes partially relate to aging and not exclusively to menopause.

Disclosure

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

Funding

National Institutes of Health (R01HL130153, R01DK034818)
122-LB: Impact of Flash Glucose Monitoring on Behavior Modification, Quality of Life, and Treatment Satisfaction in Noninsulin Treated Patients with Type 2 Diabetes
Authors: SIMMONS MARSHA D. , SHIFFRIN ERIC J.
Published: June 2023

Introduction: CGM's have shown efficacy in the management of patients with T1D and T2D on multiple daily injections (MDI) and insulin pumps as a way to adjust insulin dosing. However, the benefit of CGM could extend beyond the dosing of insulin and has the potential to encourage lifestyle modification in non-insulin treated patients with type 2 diabetes.

Methods: This prospective study included flash glucose monitoring-naive adult patients with T2D with and A1c >7% and <9%. Participants were allowed any combination of oral antidiabetic medications and glucagon-like peptide 1 (GLP-1) injections. Participants received study provided Abbott Freestyle Libre for 12 weeks. HbA1c and weight were measured, and the Diabetes Treatment Satisfaction Questionnaire (DTSQ), Audit of Diabetes Dependent Quality of Life (ADDQoL), and Food Frequency Questionnaire were all completed at baseline and 12 weeks. The Experience with Continuous Glucose Monitoring questionnaire was completed at the end of 12 weeks.

Results: For participants (n=43) from one single diabetes center, HbA1c improved by 0.37% from 7.70%±0.56 (mean±SD) at baseline to 7.34%±0.57 at 12 weeks (paired t-test=3.65, p=0.0007). Glucose monitoring frequency improved, from 7.4 average number of fingersticks per week (SD: 7.74) to 4.7 flash glucose scans per day (SD: 3.09). Participants also demonstrated some glucose control with their blood sugar reading being within target range 79.44% of the time.

Conclusion: The study suggests that FreeStyle Libre in insulin naïve patients with T2D can influence a decrease in A1c. Participants were more aware of their blood sugar levels while using the FreeStyle Libre and were able to achieve greater glycemic control as evidenced by their percent of time in target range. Findings from this study can be used to advocate to insurance companies to cover the Freestyle Libre in T2D patients who do not use insulin.

Disclosure

M. D. Simmons: None. E. J. Shiffrin: None.

Funding

Abbott (TJU20-27)
1225-P: Biomarkers in Prediabetes Reflecting Sex Varying Pathways of Cardiovascular Risk
Authors: YOSHIDA YILIN , CHEN ZHIPENG , LI CHANGWEI , FONSECA VIVIAN , MAUVAIS-JARVIS FRANCK
Published: June 2023

Background: Women with diabetes (DM) had higher cardiovascular risk than men, partly due to women’s higher cardiometabolic risk factors before DM. We compared sex differences in biomarkers that reflect distinct pathophysiological pathways in prediabetes (PreDM).

Method: We conducted a cross-sectional analysis of similarly designed Atherosclerosis Risk in Communities Study and the Jackson Heart Study. We used multivariable linear regressions for the associations between sex and biomarkers (log(x)) representative of inflammation, cardiac injury/stress, lipoprotein, adipokine, kidney function, and glycemia adjusted for age, race, BMI, blood pressure, total cholesterol, smoking, hypertensive meds, and statins in CVD-free individuals with PreDM. We evaluated the effect modification of menopause and validated results in those who progressed into DM in follow-up. False discovery rate adjusted multiple comparisons.

Results: In 5765 people with PreDM at baseline, the mean age was 54 y, 47% women, and 35% non-Hispanic Blacks. Inflammatory c-reactive protein (β coefficient 0.3 P=5×10-51), fibrinogen (β 0.2 P=3×10-12), and lymphocyte count (β 0.2 P=7×10-8), and cardiac NT-proBNT (β 0.6 P=1×10-104) were higher in women than men with PreDM. Lipoprotein(a) (β 0.2 P=1×10-10) and apolipoproteins A1 (Apo A1) (β 0.6 P=5 x 10-115), and adipokines, leptin (β 1.1 P=3×10-112) and adiponectin (β 0.6 P=6×10-16) were higher in women. Men with PreDM had higher random urinary creatinine (β -0.6 P=2×10-61) and reduced eGFR (β 0.3 P=5×10-29). They also had higher inflammatory homocysteine (β -0.5 P=2×10-12), triglycerides (β -0.2 P<.0001), and Apo B (β -0.1 P<.0001). Fructosamine, glycated albumin, and HbA1c did not differ by sex in PreDM. Menopause modifies sex differences in LDL-c, Apo B, and fibrinogen. Results were generally unchanged in people who later became DM.

Conclusion: Overall, in PreDM, women had higher vascular inflammatory markers and adipokines, while men had higher kidney dysfunction markers.

Disclosure

Y.Yoshida: None. Z.Chen: None. C.Li: None. V.Fonseca: Consultant; Abbott, Corcept Therapeutics, Eli Lilly and Company, Other Relationship; BRAVO4HEALTH, LLC, Research Support; Fractyl Health, Inc., Stock/Shareholder; Amgen Inc. F.Mauvais-jarvis: None.

Funding

National Institutes of Health (K12HD043451)
1228-P: Comparison between Combination of Low- or Moderate-Intensity Statin with Ezetimibe and High-Intensity Statin Monotherapy for Primary Prevention of Cardiovascular Disease and All-Cause Mortalities in Patients with Type 2 Diabetes—A Propensity-Matched Natio
Authors: CHEOL HWANG YOU , YOUNG PARK SO , JEONG IN-KYUNG , JEUNG AHN KYU , YEON CHUNG HO
Published: June 2023

Background and Aims: Here, we compared the effects of combination therapy of low- or moderate-statin with ezetimibe and high-intensity statin monotherapy in patients with type 2 diabetes without previous cardiovascular disease (CVD) on incident CVD and all cause mortalities in a real-world setting.

Methods: Using the Korean National Health Insurance Service datasets, two cohorts comparing high intensity statin monotherapy with low- or moderate-intensity statin and ezetimibe combination therapy were constructed using a 1:1 propensity score matching procedure and were followed up for 3.4 years. The primary outcome was a composite of myocardial infarction (MI), stroke, and all-cause mortality. The secondary outcome was the occurrence of individual events.

Results: Compared to high-intensity statin monotherapy, moderate-intensity statin with ezetimibe combination therapy significantly reduced the risk of composite outcomes (hazard ratio [HR] 0.85, 95% confidence interval [CI] 0.74 - 0.98, P=0.029) as well as stroke (HR 0.70, 95% CI 0.52 - 0.93, P=0.014), but not MI or all cause mortalities. However, there was no significant risk reduction in composite outcomes following low-intensity statin therapy with ezetimibe (HR 1.02, 95% CI 0.75 - 1.39, P=0.882) than that after high-intensity statin monotherapy. The statin with ezetimibe combination showed a consistent efficacy regardless of diverse patients’ baseline characteristics. Conclusions: Moderate-intensity statin with ezetimibe combination therapy was superior to high-intensity statin monotherapy for CVD primary prevention, and low-intensity statin with ezetimibe showed a comparable efficacy to high-intensity statin monotherapy in patients with type 2 diabetes.

Disclosure

Y.Hwang: None. S.Park: None. I.Jeong: None. K.Ahn: None. H.Chung: None.
1230-P: Low Real-World Use of SGLT2 Inhibitors in People with Diabetes and Heart Failure—A Population Cohort Study
Authors: BUTALIA SONIA , WEN CHUAN , SENIOR PETER A. , SIGAL RONALD J. , QUAN HUDE , LUAN CHU MANH , KAUL PADMA
Published: June 2023

Background: One of the most striking benefits of sodium-glucose cotransporter 2 inhibitors (SGTL2is) in clinical trials has been the reduction in heart failure (HF) hospitalization. Thus, guidelines recommend SGLT2i use in people with diabetes and HF.

Objective: We assessed the real-world dispensation of SGTL2is and the factors associated with their dispensation in people with diabetes and HF.

Methods: This retrospective, population-based cohort study identified people with diabetes and HF between Jan 1, 2014 to Dec 31, 2017 in Alberta, Canada (population ~ 4.3 million). Individuals were followed until Dec 31, 2020. The index date was the date of physician or hospitalization claim for HF. The primary exposure was SGTL2i dispensation after HF index date. Demographic and clinical characteristics were summarized, and multivariate logistic regression assessed the factors associated with SGTL2i dispensation adjusting for age, sex, baseline HbA1c, diabetes duration, chronic kidney disease (CKD), atherosclerotic cardiovascular disease (ASCVD), comorbidities (Charlson Comorbidity Index (CCI) score), material deprivation, and urban/rural residence.

Results: We identified 22,025 people (43.4% female, mean age 74.7 years ± 11.8 years) with diabetes and HF. Only 10.2% (n=2,247) of individuals with diabetes and HF were dispensed an SGTL2i. Male sex (aOR 1.55; 95% CI 1.39-1.72), age < 65 years (aOR 2.28; 95% CI 2.05-2.54), higher HbA1c (aOR 1.35; 95% 1.31-1.40), no CKD (aOR 3.11; 95% CI 2.78-3.49), ASCVD (aOR 1.48; 95% CI 1.33-1.64), and urban residence (aOR 1.17; 95% CI 1.05-1.31) were associated with SGTL2i dispensation while more co-morbidities were associated with less dispensation (CCI score ≥ 5 aOR 0.36; 95% CI 0.30-0.43).

Conclusions: Only 1 in 10 people with diabetes and HF were dispensed an SGTL2i. We identified several factors associated with SGTL2i dispensation and importantly this study highlights a significant opportunity to improve management in people with diabetes and HF.

Disclosure

S.Butalia: None. C.Wen: None. P.A.Senior: Advisory Panel; Novo Nordisk Canada Inc., Consultant; Novo Nordisk Canada Inc., Bayer Inc., Viatris Inc., Vertex Pharmaceuticals Incorporated, ViaCyte, Inc., Insulet Corporation. R.J.Sigal: Research Support; Novo Nordisk. H.Quan: None. M.Chu: None. P.Kaul: None.

Funding

Diabetes Canada (OG-3-22-5662-SB)
1234-P: Derivation of a Claims-Computable Major Adverse Cardiovascular Event Estimator (ACME) in Adults with Type 2 Diabetes
Authors: MCCOY ROZALINA G. , SWARNA KAVYA , DENG YIHONG , HERRIN JEPH , ROSS JOSEPH , KENT DAVID M. , BORAH BIJAN , CROWN WILLIAM , MONTORI VICTOR M. , UMPIERREZ GUILLERMO , GALINDO RODOLFO J. , BRITO JUAN , MICKELSON MINDY , POLLEY ERIC
Published: June 2023

Major adverse cardiovascular events (MACE) are a major cause of morbidity and mortality among adults with type 2 diabetes. Currently available risk prediction models estimate long-term risk (typically 10-year) and require clinical data not routinely available in real-world data sources, which limit their use on population level. Using de-identified claims data from OptumLabs® Data Warehouse for enrollees in private and Medicare Advantage health plans linked to 100% sample of Medicare fee-for-service beneficiaries between 2014 and 2021, we derived ACME to estimate annualized risk of non-fatal myocardial infarction, non-fatal stroke, or all-cause mortality in patients with type 2 diabetes aged ≥21 years (N=6,623,526). The Cox proportional hazards model, combined with an estimate of the baseline hazard using the Nelson-Aalen estimator to allow conditional survival predictions, included 28 covariates available in claims (age, sex, cardiovascular comorbidities, and cardiovascular medications). The study population had mean age 68.1 (SD, 10.6) years, 49.8% were women, and 73.0% were non-Hispanic White. ACME’s concordance index was 0.74 (se = 0.0002) and it performed comparably in all racial and ethnic groups. Strongest predictors of MACE were acute myocardial infarction and stroke within the past 3 months, heart failure hospitalization within the past year, and end-stage kidney disease. Overall, 4.2% of patients were predicted to have low (<1%) annualized MACE risk, 62.8% were predicted to have moderate (≥1 to <5%) annualized risk, and 33.0% were predicted to have high (≥5%) annualized risk. Other thresholds can be chosen for individualized applications. ACME can support population risk stratification and health management efforts at the health system and payer levels, participant identification for decentralized pragmatic clinical trials of cardiovascular disease and its prevention, and risk-stratified observational studies using real-world data.

Disclosure

R.G.Mccoy: Consultant; Emmi. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. J.Brito: None. M.Mickelson: None. E.Polley: None. K.Swarna: None. Y.Deng: None. J.Herrin: Consultant; Johnson & Johnson Medical Devices Companies. J.Ross: Research Support; Johnson & Johnson. D.M.Kent: Research Support; W.L. Gore. B.Borah: Consultant; Boehringer Ingelheim Inc., Exact Sciences. W.Crown: Consultant; Janssen Scientific Affairs, LLC, UnitedHealth Group, Viatris Inc. V.M.Montori: None.

Funding

Patient-Centered Outcomes Research Institute (DB-2020C2-20306)
1236-P: Patients with Diabetes Mellitus and Chronic Kidney Disease Affected by Nonalcoholic Fatty Liver Disease Have Greater Risk of Mortality and Worse Clinical Outcomes
Authors: KHOKHLOV LEONID , THAPA USHA , PEREIRA LEANNE , FATUYI MICHAEL , ALI MEHNAAZ , ABDULRAHMAN HUSSAIN FATIMA , ABOELNASR AMR , BROWN AMANDA C. , EERHART MICHAEL , AMIN ESHGHABADI MOHAMMAD , CONTRERAS CYNTHIA , SHEMISA KAMAL
Published: June 2023

Background: DM & CKD are affecting million patients worldwide. Nonalcoholic Fatty Liver Disease (NAFLD) is emerging disease predisposing to adverse outcomes. There is limited evidence of clinical outcomes of NAFLD in patients with DM&CKD. We sought to investigate this population.

Methods: We queried NIS 2017-2020 for adults hospitalized with DM&CKD & NAFLD. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, GIB, intubation, LOS & total hospital charge. Multivariable logistic regression analysis was used to estimate clinical outcomes.

Results: There were 11,254,722 hospitalizations with DM&CKD and 542,140 (4.8%) had NAFLD. NAFLD & non-NAFLD cohorts were with mean age of 53.3 vs. 54.0 yrs; males 53.3% vs 54.0%; Caucasians 58.7% vs 57.7%; HF 49.4% vs 49.5%; PH 11.4% vs 9.0%; AKI 51.9% vs 43.7%; obesity 24.9% vs 27.0%; HLD 47.0% vs 61.1%; anemia 23.6% vs 20.1%; ACS 10.6% vs 10.3%; stroke 1.8% vs 3.0%, respectively.

Conclusion: DM&CKD cohort showed significantly higher mortality, worse clinical outcomes & resource utilization (Table 1). They were younger, obese, female, Caucasian, & with more PH, AKI, anemia, ACS. NAFLD is associated with greater risk for MACE, GIB, & ICU care. NALFD is an important risk factor among patients with DM&CKD that predicts adverse outcomes.

Disclosure

L. Khokhlov: None. U. Thapa: None. L. Pereira: None. M. Fatuyi: None. M. Ali: None. F. Hussain: None. A. Aboelnasr: None. A.C. Brown: None. M. Eerhart: None. M. Eshghabadi: None. C. Contreras: None. K. Shemisa: Speaker's Bureau; Pfizer Inc., Boehringer Ingelheim (Canada) Ltd., Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Amarin Corporation, Bayer Inc.
1241-P: Examination of Direct and Indirect Pathways between Food Insecurity and ABC’s of Diabetes
Authors: WALKER REBEKAH J. , AMJAD RABIA , EGEDE LEONARD E.
Published: June 2023

Background: Food insecurity is associated with health outcomes in adults with diabetes. The goal of this study was to investigate pathways through which food insecurity influences the ABC’s of diabetes (HbA1c, blood pressure, and cholesterol-lipids) in an effort to inform intervention development.

Methods: National Health and Nutrition Examination Survey (NHANES) from 2011-2018 was used. Adults who self-reported a health professional telling them they had diabetes were included in the analysis (n=4,058). HbA1c, blood pressure, and cholesterol-lipids were measured by NHANES and analyzed as continuous measures. Food insecurity was scored based on the USDA scale. Preliminary analyses investigated indicators for body composition, anthropometrics, and healthy eating. Structural equation modeling using Stata v17 with standardized estimates was used to investigate direct and indirect relationships for the hypothesized pathway of food insecurity leading to lower healthy eating, higher waist circumference, and ultimately higher HbA1c, blood pressure, and cholesterol-lipids.

Results: For the pathway with HbA1c, higher food insecurity was directly associated with lower healthy eating (B=-0.09, p<0.001), higher waist circumference (B=0.03, p<0.03), and higher HbA1c (B=0.09, p<0.001). For the pathway with lipids, higher food insecurity was directly associated with lower healthy eating (B=-0.09, p<0.001), higher waist circumference (B=0.05, p=0.002), and higher lipids (B=0.06, p<0.001). Significant indirect effects also existed for the hypothesized pathway for both HbA1c and lipids. However, significant pathways did not exist for the relationship between food insecurity and blood pressure.

Conclusions: Food insecurity appears to exert its effect via healthy eating and anthropometrics. Strategies that optimize dietary intake and lifestyle modification for weight management will be most beneficial in improving ABC’s for food insecure adults with diabetes.

Disclosure

R.J.Walker: None. R.Amjad: None. L.E.Egede: None.

Funding

National Institutes of Health (R01DK118038, R01DK120861, R01MD013826)
1242-P: Obesity Disparities in a Multiracial Sample of Asian American and Pacific Islander (API) Adults
Authors: BACONG ADRIAN M. , GIBBS SOPHIA L. , FRANKLAND TIMOTHY B. , LI JIANG , DAIDA YIHE G. , FORTMANN STEPHEN P. , PALANIAPPAN LATHA
Published: June 2023

Background: Asians have higher diabetes rates than Non-Hispanic white (NHW) people, despite having lower BMI. Studies on Asians often present monoracial groups. We examined obesity rates among mono- and multiracial APIs.

Methods: We examined obesity and other factors by self-reported race using case-control data from two integrated healthcare systems with large API populations.

Results: Obesity varied by race, ranging from 8.5% (Chinese) to 53.5% (Other Pacific Islander) (Table 1). Obesity was high for multiracial API. Demographic, behavioral, and clinical factors explained some, but not all the differences in obesity rates (Table 2).

Conclusion: Multiracial API people had higher obesity rates than monoracial API and NHW people. Robust data on multiracial people are needed to understand health disparities among this group.

Disclosure

A.M.Bacong: None. S.L.Gibbs: None. T.B.Frankland: Research Support; Pfizer Inc., Stock/Shareholder; AbbVie Inc., Pfizer Inc., CVS Health Corp, Regeneron Pharmaceuticals Inc. J.Li: None. Y.G.Daida: Research Support; GlaxoSmithKline plc. S.P.Fortmann: Research Support; Pfizer Inc. L.Palaniappan: None.

Funding

National Heart, Lung, and Blood Institute (R01HL126172)
1245-P: Heart Failure Biomarkers in Diabetes—A National Reference Laboratory Study
Authors: ALFEGO DAVID , VALCOUR ANDRE , SHAJANI-YI ZAHRA , YOUNG RANDOLPH M. , SULLIVAN RENEE M.
Published: June 2023

Background: Recent guidelines1,2 recommend yearly biomarker screening (BNP, NT-proBNP or hs-cardiac troponin) of patients with diabetes at-risk for heart failure (HF) and team-based care with a cardiovascular specialist if elevated1-3.

Methods: Using de-identified laboratory results from Labcorp® patients (2015-2022), we studied diabetes and HF ICD incidence via HbA1c and subsequent BNP/NT-proBNP (in pg/mL). Patients were classified as A1c consistent with no diabetes, prediabetes, or diabetes and newly diagnosed HF if they had no HF-associated ICD on/before date of initial HF testing and assigned one on a later date. Distribution of HF by cohort was evaluated by chi squared and likelihood by odds ratios (OR).

Results: There were 805,512 unique patients with A1c and either BNP/NT-proBNP performed. Using published cutoffs1-3, new diagnosis of HF by ICD was significantly different among cohorts for all cutoffs (p<0.001) and more likely in patients with diabetes compared to those without (OR 1.48 by BNP ≥ 35, 1.45 by BNP ≥ 50, 1.37 by NT-proBNP). As BNP cutoff increased, patients meeting criteria decreased. NT-proBNP > 125 had similar proportional yield of HF diagnosis to BNP ≥ 35.

Conclusion: Patients with diabetes (by A1c) were more likely to have a new diagnosis of HF on subsequent testing than patients without diabetes. The BNP cutoff utilized has meaningful implications for the number of patients referred to team-based care.

Disclosure

D.Alfego: Employee; LabCorp. A.Valcour: Employee; LabCorp. Z.Shajani-yi: Employee; LabCorp. R.M.Young: Employee; LabCorp. R.M.Sullivan: Employee; LabCorp.
1246-P: Magnitude of Intentional Weight Reduction and Associated Clinical Outcomes
Authors: KAN HONGJUN , BENGTSON LINDSAY , AHMAD NADIA , BAE JAY P. , GRONROOS NOELLE , LANDIS CHRISTINA , CHINTHAMMIT CHANADDA , OWORA ARTHUR H. , GLETSU MILLER NANA A. , DUNN JULIA P.
Published: June 2023

Purpose: To describe the association of BMI reduction with clinical outcomes (medication utilization, HbA1c, and blood pressure) in adults undergoing medical intervention for weight reduction.

Methods: Optum’s Market Clarity database (Study Period: 2007-2020) was used to identify adults with overweight/obesity with a medical intervention for weight reduction (surgery, procedure, anti-obesity medication, or lifestyle) whose weight after a 3-year period was less than or equal to their pre-intervention weight (date of weight: index). Patients were grouped by percent BMI change (Figure 1). Outcomes included change in 6-month pre-index versus 6-month follow-up (starting after the 3-year period) for HbA1c and blood pressure in patients with measures in both periods, and change in condition-specific pharmacy utilization for patients with the condition during pre-index.

Results: There were n=127,267 patients meeting study criteria. Mean Rx utilization during follow-up decreased (relative to pre-index) as BMI reduction increased, (p<0.001; Figure 1a-1c) with groups achieving ≥15% BMI reduction having lower mean utilization in follow-up versus pre-index. Greater BMI reduction was also associated with improvements in HbA1c and blood pressure (p<0.001; Figure 1d-1f).

Conclusions: Higher BMI reduction groups had greater mean improvements in clinical measures while mean medication utilization decreased.

Disclosure

H.Kan: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. J.P.Dunn: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. L.Bengtson: Other Relationship; Eli Lilly and Company. N.Ahmad: Employee; Eli Lilly and Company. J.P.Bae: None. N.Gronroos: Other Relationship; Eli Lilly and Company. C.Landis: Other Relationship; Eli Lilly and Company. C.Chinthammit: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. A.H.Owora: None. N.A.Gletsu miller: Research Support; Lilly.
1247-P: Mildly Elevated Triglyceride Levels Are Associated with Increased Risk for Major Adverse Cardiovascular Events in Statin-Naïve Rheumatoid Arthritis Patients—A Nationwide Cohort Study
Authors: CHOI WONSUK , KANG JI-HYOUN , YONG PARK JI , RAM HONG A. , YOON JEEHEE , KIM HEEKYUNG , KANG HO-CHEOL
Published: June 2023

Objectives: To investigate the association between the four components of the lipid profile at baseline and major adverse cardiovascular events (MACEs) in statin-naïve rheumatoid arthritis (RA) patients with no previous history of cardiovascular events compared to non-RA controls.

Methods: This nationwide population-based cohort study was performed on a total of 15,216 statin-naïve RA patients and 60,864 non-RA controls. The end point was a composite of clinical events, including myocardial infarction (MI), stroke, coronary revascularization, and cardiovascular death. We compared the incidence of and risk for clinical events according to each lipid variable.

Results: During follow-up (median 4.70 years in RA group and 5.05 years in non-RA group), the incidence of MACE per 1000 person-years was 7.27 in the RA group and 7.16 in the non-RA group. Among the four lipid components, only higher baseline triglyceride (TG) levels were significantly associated with increased risk for MACE in the RA group. The risk for MACE was significantly higher in the third (adjusted hazard ratio (HR), 1.31 [95% confidence interval (CI), 1.00-1.71]) and highest quartiles (adjusted HR, 1.71 [95%CI, 1.30-2.23]) of baseline TG level versus the lowest quartile. In contrast, higher baseline total cholesterol, TG, and low-density lipoprotein cholesterol, and lower high-density lipoprotein cholesterol levels were significantly associated with increased MACE risk in the propensity score-matched non-RA group.

Conclusions: In statin-naïve RA patients, increased TG level is associated with increased risk for MACE. Therefore, screening and intervention for increased TG level may be clinically beneficial in this population.

Disclosure

W.Choi: None. J.Kang: None. J.Park: None. A.Hong: None. J.Yoon: None. H.Kim: None. H.Kang: None.

Funding

National Research Foundation of Korea (2022R1C1C1006021)
125-OR: Disparities in Access to Sodium–Glucose Cotransporter-2 Inhibitors (SGLT2i)
Authors: ZHANG DONGLAN S. , RAJAN ANAND , ISLAM SHAHIDUL , CHARYTAN DAVID M. , JACOBSON ALAN M. , DIVERS JASMIN
Published: June 2023

SGLT2i are shown to improve diabetes control and delay the onset of diabetes-related complications. However, socioeconomic (SES) factors may influence access to SGLT2i. We assessed trends and differences in SGLT2i prescription rates by race, ethnicity, and insurance type at a large academic medical center (AMC). Data were extracted from the electronic health records at a large AMC from January 2014 to December 2021. The study outcome was SGLT2i prescription rates over time. Race and ethnicity were classified as Non-Hispanic White (NHW), NH Black (NHB), Hispanics, and Asian/Pacific Islanders (API), and insurance type as Private, Medicare, and Medicaid. Negative binomial regressions were used to estimate the prescription rates by year. Between 2014-2021, 30,030 type 2 diabetes patients received an SGLT2i prescription, and the prescription rates increased significantly from 0.25% to 11.47%, with the rates increasing fastest in Medicare patients. Privately-insured and Medicare patients were more likely to be prescribed SGLT2i than Medicaid patients (p<0.001). NHB, and Hispanic patients were less likely to be prescribed SGLT2i than NHW and API patients (p<0.001). Although SGLT2i prescription rates increased after FDA approval, substantial variations by race, ethnicity, and insurance type exist. Future studies are needed to explore how SES factors drive observed differences in access to SGLT2i.

Disclosure

D.S.Zhang: None. A.Rajan: None. S.Islam: None. D.M.Charytan: Advisory Panel; Merck & Co., Inc., CSL Behring, GlaxoSmithKline plc., Consultant; Novo Nordisk, Gilead Sciences, Inc., AstraZeneca, Other Relationship; Boehringer Ingelheim and Eli Lilly Alliance, zogenix, medtronic, Research Support; Amgen Inc. A.M.Jacobson: None. J.Divers: None.

Funding

Doucette Innovation Fund
1253-P: Differences in Screening-Detected Type 2 Diabetes—Evidence from Two Campaign Setups in Denmark
Authors: CAYUELAS MATEU NURIA , THYBO TANJA
Published: June 2023

Background: Early detection of type 2 diabetes mellitus (T2DM) increases life expectancy of T2DM patients and reduces societal health care costs. Targeted screening campaigns are used for early detection of T2DM, but different campaign setups may yield different detection results.

Methods: Between June and November 2022, the Danish Diabetes Association offered free capillary A1c tests to individuals at high risk of developing diabetes based on the Leicester’s Risk Score questionnaire (score ≥ 16 points). Two campaign setups were applied: a) an event-based community screening campaign in 20 of the largest Danish cities using a portable Point of Care Testing analyzer and b) a social media campaign offering at-home self-sampling tests using mailed Hemoglobin Capillary Collection System.

Results: A total of 1,337 and 2,655 individuals at high risk were tested through the community and the social media setup, respectively. The proportion of men and women in both setups were evenly balanced across all age groups. However, compared to the social media setup, in the community setup the proportion of individuals aged below 60 years was 14 percentage points lower, while the proportion of individuals aged 70 years or older was 14 percentage point higher. While 2.6% of the participants in both setups had A1c values ≥ 48 mmol/mol, 8.8% in the community setup and 15.6% in the social media setup had A1c values of 42-47 mmol/mol. The relative difference in the proportion of participants with A1c values of 42-47 mmol/mol was balanced across all age groups.

Conclusions: Targeted community and social media screening campaigns are complementary. While older individuals (70 years or above) tend to participate in the community screening campaign, younger individuals (below 60) tend to participate in social media screening campaign. However, social media campaigns for at-home self-sampling prove highly efficient in detecting individuals with A1c values of 42-47 mmol/mol compared to community campaigns.

Disclosure

N.Cayuelas mateu: Other Relationship; Abbott Diagnostics. T.Thybo: Other Relationship; Abbott Diagnostics.
1255-P: Prevalence Trends of Diabetes Subgroups in Mexico—A Data-Driven Analysis of Nationally Representative Surveys Spanning 2016–2021
Authors: EDUARDO ANTONIO VILLA NEFTALI , YAXMEHEN BELLO-CHAVOLLA OMAR , RAMÍREZ-GARCÍA DANIEL , FERMIN CARLOS , VARGAS-VÁZQUEZ ARSENIO , BASILE-ALVAREZ MARTÍN R. , NUÑEZ ALEJANDRA , PAZ CABRERA CÉSAR D. , FERNÁNDEZ CHIRINO LUISA , ENRIQUE CABALLERO A. , SEIGLIE JACQUELINE A.
Published: June 2023

Background: Diabetes subgroups are a promising framework for characterizing diabetes heterogeneity but data on the epidemiology and sociodemographic profile of these subgroups in the Mexican population are sparse.

Methods: We conducted a serial cross-sectional analysis of the National Health and Nutrition Survey in Mexico (2016-2021). Diabetes subgroups (obesity related [MOD], severe-insulin deficient [SIID], severe-insulin resistant [SIRD], and age-related [MARD]) were classified using self-normalizing neural networks using HbA1c, time since diabetes diagnosis, HOMA2-IR, HOMA2-B, and BMI. Sociodemographic inequalities were proxied with the social lag index, which captures state-level social disadvantage.

Results: Diabetes prevalence in Mexico increased from 13.3% (95%CI 11.5-15.1) in 2016 to 15.8% (95%CI 13.6-17.9) in 2021, with the highest increases in the Northern-Pacific, Central-Pacific, and Center regions. SIDD was the most prevalent diabetes subgroup in Mexico, followed by MOD, MARD, and SIRD. Increases in diabetes prevalence were primarily attributed to MOD and SIRD. SIID had higher aggregation in states with higher social lag (Fig. 1).

Conclusion: Diabetes subgroups in the Mexican population display geographic and sociodemographic differences, which may help identify populations at higher risk of health disparities and adverse outcomes.

Disclosure

N.Antonio villa: None. A.Caballero: None. J.A.Seiglie: Consultant; BDMT Global, Techspert Expert Network. O.Bello-chavolla: None. D.Ramírez-garcía: None. C.Fermin: None. A.Vargas-vázquez: None. M.R.Basile-alvarez: None. A.Nuñez: None. C.D.Paz cabrera: None. L.Fernández chirino: None.
1262-P: Circulating Lysophosphatidic Acid Levels Suggest a Metabolic Pathway in T3cDM and Distinguish It from T2DM
Authors: KETAVARAPU VIJAYASARATHY , ASLAM MOHSIN , TALUKDAR RUPJYOTI , AMANCHY RAMARS , SRIPADI PRABHAKAR , POWERS ALVIN C. , VENKAT NARAYAN K.M. , COATE KATIE C. , STAIMEZ LISA R. , JAGANNATHAN RAM , REDDY D NAGESHWAR , SASIKALA MITNALA
Published: June 2023

Introduction: Diabetes associated with chronic pancreatitis (T3cDM) has distinct clinical features. We investigated metabolomics signature to distinguish T3cDM from T2DM.

Methods: Study participants (n=200); treatment naïve nonalcoholic calcific chronic pancreatitis [CP] patients (n=106, age 34.4±11.1 years, BMI 20.9±2.8), T2DM patients (n=68, age 46±10.7 years BMI 27.0±5.8), healthy controls (n=26, age 31.0±5.3 years, BMI 25.0±2.8) were recruited prospectively. OGTT was performed to define diabetes (ADA criteria) with 60% CP patients being normoglycemic, 19% having prediabetes and 21% with diabetes. Metabolomics was done on fasting plasma samples using liquid chromatography/mass spectrometry and quantifications were measured on tandem mass spectrometry. Student’s t-test, PLS-DA, ROCs were used to compare and compute to assess the performance of identified metabolites in distinguishing diabetes subtypes (T3cDM and T2DM). Regression analysis was employed to develop a prediction model.

Results: A total of 5493 and 4104 metabolites were detected in T3cDM and T2DM respectively. Untargeted metabolome profiling identified significant differences in fatty acid conjugates in CP. Fatty acid conjugates were 28% in normoglycemic CP, 60% in prediabetic CP, 13% in T3cDM as compared to 42% in controls. Among them, 57 fatty acid conjugates showed increased peak intensities. Comparison of absolute quantifications identified higher lysophosphatidic acid (LPA) in T3cDM 40.50±6.55, T2DM 21.65 ± 1.75; p=0.01 in comparison to controls 16.20±3.4 ng/ml. Sensitivity and specificity for LPA were 81.8%, 78.6% with AUC 80% (p<0.0001), 95% CI (70.6-87.8). Prediction model (null and full model p<0.0001) and its performance (Hosmer-Lemeshow test p=0.9) indicated high accuracy (AUC 87%; 95% CI, 77.8-92.7).

Conclusion: Increased Lysophosphatidic acid levels implicate glycerolipid pathway in the pathogenesis of T3cDM and can be used to distinguish T3cDM from T2DM.

Disclosure

V. Ketavarapu: None. M. Aslam: None. R. Talukdar: None. R. Amanchy: None. P. Sripadi: None. A.C. Powers: None. K. Narayan: None. K.C. Coate: None. L.R. Staimez: None. R. Jagannathan: None. N. D: None. M. Sasikala: None.

Funding

Science and Engineering Research Board, India Project (CRG/2019/005125)
1266-P: Validation of a Predictive Model of Diabetes in People with Overweight and Obesity
Authors: TURCHIN ALEXANDER , SHUBINA MARIA , MORRISON FRITHA J. , AHMAD NADIA , NEFF LISA M. , KAN HONGJUN
Published: June 2023

Obesity is the most common chronic disease in the U.S. A substantial subset of people with obesity are at high risk for type 2 diabetes mellitus (T2DM) and many of their risk factors for T2DM are modifiable. It is important to identify this at-risk subset to appropriately direct treatment and resources for earlier intervention and the prevention of T2DM. The original model was developed using EMR data of 338,653 adults < 65 years old with BMI ≥ 25 kg/m2 and without baseline T2DM between 2000 and 2019. Variables were selected from a literature-based pool of risk factors for T2DM using LASSO penalized Cox regression. A Cox model (adjusted for the competing risk of death) was developed using an 80% training dataset with selected variables and internally validated on a held-out 20% dataset of EMR data. This model was then externally validated on a dataset of 103,419 participants of the Nurses’ Health Study (NHS) and Health Professionals Follow-Up Study (HPFS). Over a mean of 7.0 years of follow-up, 30,100 (8.9%) patients in the EMR dataset developed T2DM (1.3% annual incidence). The predictive model included BMI (HR 1.47 for 5 kg/m2; 95% CI 1.46 - 1.49), age, history of hypertension, systolic blood pressure and family history of diabetes. The model achieved a Harrell’s C-statistic of 0.76 on the held-out EMR dataset and the calibration slope for 10-year estimates was 1.09. In the NHS-HPFS external validation dataset, 12,402 (12.0%) individuals developed T2DM over a mean 14.2 years of follow-up (0.85% annual incidence). On this dataset, the model achieved Harrell’s C-statistic of 0.72 and the calibration slope for 10-year estimates of 0.78. It is feasible to use predictive modeling to identify people with overweight and obesity at high risk of T2DM. This approach could be utilized to guide population management and clinical treatment decisions.

Disclosure

A.Turchin: Consultant; Proteomics International, Covance, Research Support; AstraZeneca, Edwards Lifesciences Corporation, Eli Lilly and Company, Novo Nordisk, Stock/Shareholder; Brio Systems. M.Shubina: None. F.J.Morrison: None. N.Ahmad: Employee; Eli Lilly and Company. L.M.Neff: Employee; Eli Lilly and Company, Research Support; Aegerion Pharmaceuticals, Stock/Shareholder; Eli Lilly and Company. H.Kan: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company.

Funding

Eli Lilly and Company