bluuebunny/crossref_metadata_2025 huggingface dataset:
1398-P: Mortality Implications of Comorbid Health Status in Older Adults with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: ROONEY MARY R. , TANG OLIVE , WINDHAM B. GWEN , ECHOUFFO TCHEUGUI JUSTIN B. , LUTSEY PAMELA , GRAMS MORGAN , SELVIN ELIZABETH
Published: June 2020

Introduction: In older adults with diabetes, the potential risks of tight glycemic control are a major concern. The 2020 American Diabetes Association (ADA) guidelines suggest different A1C targets in older adults based on comorbid health status. However, the association of A1C levels with mortality by ADA health status categories is uncharacterized.

Methods: We conducted a prospective analysis of 2068 older participants (mean age 76±5; 57% women, 30% black) with diabetes in the ARIC Study (baseline, 2011-13). We categorized health status based on ADA criteria (see Table) and evaluated mortality risk overall and by A1C categories.

Results: In older adults with diabetes, 45% were classified as healthy, 39% were complex/intermediate, and 15% had very complex/poor health. Over 6 years of follow-up, those with complex/intermediate or very complex/poor health had higher mortality risk than those classified as healthy (Table). Regardless of health status, older adults with A1C <7% were not at significantly higher risk of mortality than those with A1C 7-<8%.

Conclusions: There were substantial differences in mortality based on the ADA health status categories but, within categories, those meeting more stringent A1C goals (<7%) were not at substantially elevated risk. Our results suggest that certain patients may safely achieve lower A1C goals even in older age.

Disclosure

M.R. Rooney: None. O. Tang: None. B. Windham: None. J.B. Echouffo Tcheugui: None. P. Lutsey: None. M. Grams: Other Relationship; Self; DCI. E. Selvin: None.

Funding

National Heart, Lung, and Blood Institute (T32HL007024)
1401-P: Life Expectancy of Individuals with Type 2 Diabetes Mellitus (T2DM) in the United States
Authors: KIANMEHR HAMED , YANG SHUANG , FONSECA VIVIAN , SHI LIZHENG , BROWN JOSHUA D. , GUO YI , SHAO HUI
Published: June 2020

The lifetable approach to estimate the life-expectancy of T2DM patients used a weak assumption on the continuum risk profiles by age group. To improve transparency and accuracy of lifetable estimation, this study aimed to use a microsimulation modeling approach to produce the life-expectancy of T2DM patients. We used the National Health and Nutrition Examination Survey (2011-2012) and linked the National Death Index to calibrate the mortality equation of the Building, Relating, Assessing, and Validating Outcomes (BRAVO) diabetes model, a person-level discrete-time microsimulation model, which has been extensively validated against 18 international trials before. Life expectancy was estimated under two treatment targets: population average: A1c 7.5%, SBP 130 mmHg, LDL 100 mg/dl, and BMI 30 kg/m2; recommended level: A1c 6.5%, SBP 120 mmHg, LDL 90 mg/dl, and BMI 25 kg/m2. Table 1 presents the life-expectancies of patients with type 2 diabetes by subgroups. Females in general lives 4 years longer than males, while racial-ethnic difference in life-expectancy was not significant among T2DM patients, conditional on the trajectories of risk factors across groups. The recommended goal of biomarkers prolongs life expectancy by 1.3-1.8 years, compared with the current population average. The new approach may generate more accurate statistics for national diabetes surveillance.

Disclosure

H. Kianmehr: None. S. Yang: None. V. Fonseca: Consultant; Self; Abbott, Asahi Kasei Corporation, AstraZeneca, Bayer Inc., Novo Nordisk Inc., Sanofi. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Stock/Shareholder; Self; Amgen, Bravo4health. L. Shi: None. J.D. Brown: None. Y. Guo: None. H. Shao: None.
142-OR: Tirzepatide, a Dual GIP and GLP-1 Receptor Agonist, Mediates Its Anorexigenic Effect in Mice Due to a Reduction in Homeostatic and Reward-Related Feeding
Authors: COSGROVE RICHARD , ANTONELLIS MEGHAN P. , DROZ BRIAN , ROELL WILLIAM C. , SLOOP KYLE , MOYERS JULIE , COGHLAN MATTHEW P. , EMMERSON PAUL , COSKUN TAMER , SAMMS RICARDO J.
Published: June 2020

Tirzepatide (TZP), a novel dual GIP and GLP-1 receptor agonist, has demonstrated clinically meaningful weight loss in type 2 diabetes mellitus (T2DM) patients. Preclinical data indicate that TZP lowers body weight due to a reduction in caloric intake; however, associated effects on feeding behavior have not been studied. To investigate how TZP affects homeostatic feeding, we examined its effect on markers of satiation (meal size), satiety (meal frequency) and hunger (time-interval between meals) in obese mice. Chronic treatment with TZP dose-dependently lowered body weight and food intake in high-fat fed mice. This reduction in total daily caloric intake was underlined by a reduction in meal size and frequency throughout a 14-day treatment period. Indicating that TZP’s effect on total energy intake is associated with reduced hunger and increased satiety. One driver of the current obesity epidemic is the consumption of highly palatable/calorically dense foods. To determine whether the anorexigenic action of TZP is associated with reward-related feeding, we exposed lean and obese mice to two-choice diet paradigms ((low-fat (6% of kcal from fat) vs. high-fat (40% or 60% of kcal from fat) diets). Importantly, we found that while TZP decreased total calories consumed, it also altered macronutrient preference by increasing the intake of a low-fat diet and reducing intake of a high-fat diet. Furthermore, when exposed to a series of two-choice bottle tests, TZP reduced the consumption of nutritive (fructose and sucrose) and non-nutritive (sucralose) tastants, suggesting that TZP’s anorexigenic action may be linked to the taste and caloric content of food. Taken together, these data indicate that TZP’s ability to lower daily energy intake is mediated by both a reduction in homeostatic and reward-driven food intake.

Disclosure

R. Cosgrove: None. M.P. Antonellis: Employee; Spouse/Partner; Eli Lilly and Company. B. Droz: None. W.C. Roell: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. K. Sloop: None. J. Moyers: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. M.P. Coghlan: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. P. Emmerson: None. T. Coskun: Employee; Self; Eli Lilly and Company. R.J. Samms: Employee; Self; Eli Lilly and Company.
143-LB: The Impact of Rapid Inpatient Endocrinology Consultations on Hospital Outcomes
Authors: SHEAHAN KELSEY , ATHERLY ADAM , DAYMAN CAITLYN E. , SCHNURE JOEL J.
Published: June 2020

Introduction: It has been shown that hypoglycemia and hyperglycemia in hospitalized patients are associated with adverse patient outcomes including increased length of stay and higher readmission rates. With 25-30% of hospitalized patients having a diagnosis of diabetes, this is an important population to optimize glycemic control in.

Data: Data was drawn from the Electronic Medical Records (EMR) at a large academic medical center in the northeastern United States. The sample was all hospitalizations from 2013-2018 for persons identified as diabetic in the EMR. The sample was limited to admission to general medicine services with a stay of 48 hours or more and excluded those in the intensive care unit; for a total sample size was 6,732.

Methods: We measured the effect of inpatient endocrinology consultations (IEC) within the first 48 hours on total length of stay (LOS) in days, complications, and 30-day all cause readmissions. We controlled for patient characteristics (age, gender, severity of illness, risk of mortality, BMI) in our multivariate analysis. Results: IEC led to a statistically significant (p<.001) reduction in mean LOS, with a consultation leading to a 1.17-day shorter average LOS. IEC had no statistically significant effect on the rate of inpatient complications (p=0.60), but did reduce the probability of a readmission by 0.60 percentage points (p=0.20).

Conclusion: This study showed that for patients with diabetes being admitted to medicine services, obtaining an IEC within 48 hours of admission significantly reduced mean LOS by 1.17 days. This is an important finding that could not only improve diabetes care and outcomes, but also lessen the economic burden.

Disclosure

K. Sheahan: None. A. Atherly: None. C.E. Dayman: None. J.J. Schnure: None.
1443-P: Can the ADA Diabetes Risk Score Be Approximated Using Routine Data in the Electronic Health Record? Findings from a Federally Qualified Health Center
Authors: CHIMA CHARLES C. , ANIKPEZIE NNABUCHI , PONGETTI LAUREN S. , WADE BREANNA C. , POWELL THOMAS , BEECH BETTINA
Published: June 2020

Objective: Common diabetes risk screening tools like the American Diabetes Association Diabetes Risk Test (ADADRT) requires survey administration. We studied if diabetes risk can be assessed from routinely available data in the electronic health record (EHR).

Methods: ADADRT was administered to 169 participants without preexisting diagnosis of prediabetes or diabetes, following which the EHR was reviewed for information on ADADRT questions. Standard validation measures were calculated using HbA1c as the gold standard.

Results: About 27% of the sample had prediabetes or diabetes. Of the 7 ADADRT variables, physical activity was the least available in the EHR. We observed that modifying ADADRT by dropping physical activity and changing the risk threshold from ≥5 to ≥4 preserves its diagnostic accuracy. The modified ADADRT (cutoff at ≥4) was then approximated using EHR data, yielding the following validation measures: proportion of high-risk persons 56.8%, sensitivity 77.8%, specificity 50.8%, positive predictive value 36.5%, negative predictive value 86.3%, Youden Index 28.6, and area under the receiver-operating characteristic curve 0.64.

Conclusion: Diabetes risk score can be estimated using routine EHR data. This could mean a quicker eligibility determination for prediabetes testing and referral to the National Diabetes Prevention Program.

Disclosure

C.C. Chima: None. N. Anikpezie: None. L.S. Pongetti: None. B.C. Wade: None. T. Powell: None. B. Beech: None.
1464-P: Trends in Prevalence of Youth-Onset Type 1 and Type 2 Diabetes, 2001-2017: The SEARCH for Diabetes in Youth Study
Authors: LAWRENCE JEAN M. , LIESE ANGELA D. , SAYDAH SHARON , IMPERATORE GIUSEPPINA , JENSEN ELIZABETH T. , MAYER-DAVIS ELIZABETH J. , DABELEA DANA , PETTITT DAVID J. , MARCOVINA SANTICA M. , PIHOKER CATHERINE , DOLAN LAWRENCE M. , ISOM SCOTT , DIVERS JASMIN ,   FOR THE SEARCH FOR DIABETES IN YOUTH STUDY
Published: June 2020

Objective: To estimate change in prevalence of type 1 (T1D) and type 2 diabetes (T2D) among U.S. youth (<20 yrs.) from 2001 to 2017.

Methods: Diabetes cases prevalent in 2001, 2009 and 2017 were identified in geographic areas (Colorado, Ohio, South Carolina, Washington) and among managed health care members (California). Similar methods were used in each year. Prevalence (cases/1,000 youth) of physician-diagnosed T1D (0-19 years) and T2D (10-19 years) were calculated for each year. Population denominators were obtained from U.S. census data and membership counts. Race/ethnicity was categorized as non-Hispanic white (NHW), Hispanic (HSP), African American (AA), Asian/Pacific Islander (API) and American Indian (AI). Differences in proportions and annual percent change (APC) with 95% confidence intervals are reported.

Results: From 2001 to 2017, prevalence increased from 1.5 to 2.2/1,000 for T1D and from 0.3 to 0.7/1,000 for T2D (Table). Significant increases (p<0.05) in T1D and T2D were observed in each race/ethnicity group except T2D among AI (p=0.06). The greatest increases in T1D were among NHW and NHB and for T2D, among NHB, HSP, and API. APC was similar by sex within diabetes type.

Conclusions: While the prevalence of T1D is higher than youth-onset T2D, the APC is almost double for T2D. Efforts to identify and mitigate risk factors for onset of T1D and T2D remain vital public health priorities.

Disclosure

J.M. Lawrence: None. A.D. Liese: None. S. Saydah: None. G. Imperatore: None. E.T. Jensen: None. E.J. Mayer-Davis: None. D. Dabelea: None. D.J. Pettitt: None. S.M. Marcovina: None. C. Pihoker: None. L.M. Dolan: None. S. Isom: None. J. Divers: None.

Funding

Centers for Disease Control and Prevention; National Institute of Diabetes and Digestive and Kidney Diseases (1U18DP006131, U18DP006133, U18DP006134, U18DP006136, U18DP006138, U18DP006139)
1471-P: Efficacy of Lifestyle Intervention in Preventing Diabetes in People with IGT with and without Impaired Fasting Glucose: A Secondary Analysis of Da Qing Diabetes Prevention Outcomes Study (DQDPOS)
Authors: GONG QIUHONG , ZHANG PING , WANG JINPING , CHEN YANYAN , AN YALI , FENG XINXING , CHENG YILING J. , MA JIXIANG , BENNETT PETER H. , LI GUANGWEI
Published: June 2020

Although major diabetes prevention trials show lifestyle intervention delays the onset of type 2 diabetes in persons with impaired glucose tolerance (IGT), impaired fasting glucose (IFG) is typically used in the real world as a more convenient way to identify eligible persons. Such practice includes many without IGT but excludes many with IGT who could benefit from intervention programs. DQDPOS is a long-term follow-up of the Da Qing Diabetes Prevention study, a randomized clinical trial to assess the efficacy of lifestyle intervention to prevent type 2 diabetes in persons with IGT in Da Qing China. We compared the effect of the intervention in those with baseline fasting plasma glucose (FPG) levels of <100 (“normal”, n=287,49.8%) vs. 100-139mg/dl (IFG, n=289,50.2%). Lifestyle intervention reduced diabetes incidence substantially and to a similar extent in both groups at the end of the 6-year intervention and throughout the 30 years of follow-up (hazard ratios 0.50-0.67) (Table). Our results indicate that although using only IFG to identify candidates for lifestyle intervention programs might achieve similar efficacy, its use alone will exclude large numbers of people with IGT but without IFG, who otherwise would benefit from lifestyle interventions.

Disclosure

Q. Gong: None. P. Zhang: None. J. Wang: None. Y. Chen: None. Y. An: None. X. Feng: None. Y.J. Cheng: None. J. Ma: None. P.H. Bennett: Advisory Panel; Self; World Health Organization. Stock/Shareholder; Self; Eli Lilly and Company, Pfizer Inc., Unilever, UnitedHealth Group. Other Relationship; Self; American Diabetes Association, European Association for the Study of Diabetes, European Diabetic Nephropathy Study Group, International Diabetes Federation, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. G. Li: None.
1476-P: Progression to Type 2 Diabetes from Normal or Impaired Fasting Glucose
Authors: EGAN AOIFE M. , WOOD-WENTZ CHRISTINA , BAILEY KENT R. , VELLA ADRIAN
Published: June 2020

The interaction of anthropometric variables with fasting blood glucose on progression from normal fasting glucose to overt diabetes (DM), is uncertain. In the Rochester Epidemiology Project (MN, USA), we identified 44,992 individuals with ≥ 2 fasting plasma glucose (FPG) tests from 2005-17, after excluding people who met criteria for DM (FPG > 125mg/dL) on/before their first FPG. The cohort was 58% female, had an age range of 18-65 yrs (44 ± 10, Mean ± SD) and BMI of 29 ± 7 kg/m2. Subjects who did not develop DM were censored at their last FPG value on/before Dec 31, 2017. Those who developed DM were assigned an event date as the first diagnostic value. Over a median follow-up of 7 yrs, 3888 (8.6%) developed DM. The Kaplan-Meier 10-year cumulative risk of incident DM was 12.8% (CI 12.4%-13.3%). As expected, multivariable Cox modeling identified elevated initial FPG [100-109mg/dL (HR 2.0; 1.9-2.2); 110-125mg/dL (HR 5.8; 5.4-6.3)] as conferring increased risk. Other independent risks were male sex (HR 1.30; 95% CI 1.22-1.38) and abnormal BMI [<18 kg/m2 (2.67; 1.96-3.63), 25-29.9 kg/m2 (1.37; 1.23-1.52), 30-34.9 kg/m2 (2.15; 1.92-2.39), ≥ 35 kg/m2 (3.59; 3.23-3.99)]. A very strong, nonlinear, age effect was also noted, with a fitted hazard ratio for age 60 versus 20 of 2.65. In this large cohort, male sex, age and abnormal category of BMI (including underweight) are associated with increased risk of progression to DM and additive to baseline FPG.

Disclosure

A.M. Egan: None. C. Wood-Wentz: None. K.R. Bailey: None. A. Vella: Advisory Panel; Self; vTv Therapeutics, Zealand Pharma A/S. Research Support; Self; Novo Nordisk A/S, Xeris Pharmaceuticals, Inc.
1478-P: Having Prediabetes before the Detection of Tuberculosis: Does It Have a Negative Influence on Treatment?
Authors: VISWANATHAN VIJAY , DEVARAJAN ARUTSELVI , KUMPATLA SATYAVANI , DHANASEKARAN MYTHILI , BABU SUBASH , KORNFELD HARDY
Published: June 2020

Aim: Coexistence of DM and TB influences TB treatment outcomes. TB increases hyperglycaemia due to inflammatory response. Effect of prediabetes (PDM) on TB treatment outcomes is unknown. The aim was to assess the effect of PDM on treatment outcomes after TB treatment.

Methods: This is a prospective observational cohort study (EDOTS - part of RePORT India Consortium) of 569 eligible New smear positive cases screened for DM between 2014 to 2018 in TB units in North Chennai, South India. Out of 569 subjects, 179 with a known history of DM were excluded.The remaining 390 screened TB subjects, 120 were excluded based on culture results and unwillingness to participate in the study. HbA1c was assessed at baseline and categorised into two groups (Gp): normoglycaemia (Gp1) (<5.7%) and PDM (Gp 2) (5.7 to 6.4%) and followed them at 3rd and 6th month and treatment outcomes were assessed at the end of the TB treatment.

Results: Prevalence of Prediabetes was 41.1%. There was no significant difference in the treatment outcomes between the groups(p=0.54). Total cure rate was 72.7% with no significant difference between the groups. There was a higher proportion of treatment failures (7.9%) amongGp1 as compared to Gp 2 (4.5%) (p = 0.33). There were 15.8 vs. 17.1% treatment defaulters. Higher proportion of deaths occurred during the course of DOTS in Gp 2 (7.2%) compared to Gp 1 (1.3%) (p = 0.06). At the end of intensive phase of DOTS treatment, about 23.8 % were observed to have positive sputum smear in Gp 2 compared to 8.6% in Gp 1 (p=0.019). The estimated relative risk to remain as sputum smear positive among prediabetes at the end of intensive phase was 3.0 (95% CI: 1.2-7.6).

Conclusion: Higher prevalence of prediabetes was evident among TB patients. Among those who had prediabetes, death rate was higher during the course of the treatment and higher proportion remained sputum smear positive at the end of the intensive phase of TB treatment.

Disclosure

V. Viswanathan: None. A. Devarajan: None. S. Kumpatla: None. M. Dhanasekaran: None. S. Babu: None. H. Kornfeld: None.

Funding

Government of India (BT/MB/INDO-US/REPORT/03/2013-140)
1484-P: A New, Alternative Risk Score for Sarcopenia in Chinese Patients with Type 2 Diabetes Mellitus
Authors: HE QINGHUA , GUO LIXIN
Published: June 2020

Objective: To develop a new, alternative sarcopenia risk score to screen for sarcopenia in type 2 diabetes patients in China and to demonstrate its validity.

Research Design and Methods: The data for this study came from a multicenter, cross-sectional study that had been designed to estimate the prevalence of sarcopenia among adults with type 2 diabetes and had been conducted in several hospitals in Beijing, China. A total of 1125 participants were randomly divided into two groups: an exploratory population and a validation population. A multivariable logistic regression model using the backward stepwise likelihood ratio method to estimate the probability of sarcopenia was fitted with candidate variables in the exploratory population. A new, alternative sarcopenia risk score was developed based on the multivariable model. The internal and external validations were performed in the exploratory and validation populations.

Results: The new, alternative sarcopenia risk score included seven variables: age, sex, BMI, glycosylated hemoglobin, insulin treatment or not, total caloric intake per day, and the proportion of calorie supplied by protein. The score ranged from -9 to 23. The area under the receiver operating characteristic (ROC) curve of the risk score for the prediction of sarcopenia in type 2 diabetes patients was 0.812 (95% CI 0.748-0.877) and 0.841 (95% CI 0.785-0.897) in the exploratory and validation populations, respectively. At the optimal cutoff value of 11, the sensitivity and specificity of the score for the prediction of sarcopenia were 74.5% and 78.0% in the exploratory population and 80.5% and 72.2% in the validation population, respectively. The Hosmer-Lemeshow goodness-of-fit test showed a good calibration with the risk score in external validation (χ2=1.687, P=0.989).

Conclusions: The new, alternative sarcopenia risk score appears to be an effective screening tool for the identification of sarcopenia in Chinese patients with type 2 diabetes in clinical practice.

Disclosure

Q. He: None. L. Guo: None.

Funding

Science and Technology Commission
1492-P: Urbanicity and Risk of Coronary Heart Disease among Adults with Diabetes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Authors: MALLA GARGYA , LONG D. LEANN , CHERRINGTON ANDREA , SAFFORD MONIKA , CUMMINGS DOYLE M. , MCALEXANDER TARA P. , SILVA SHANIKA DE , JUDD SUZANNE , HIDALGO BERTHA , LEVITAN EMILY B. , CARSON APRIL P.
Published: June 2020

Background: Diabetes (DM) is more prevalent among rural adults in the U.S. However, it is unclear if coronary heart disease (CHD) risk among adults with DM varies by urbanicity.

Methods: This study included 3,578 of the REGARDS Study participants with DM at baseline (2003-07). Each participant’s address was categorized as urban, large rural, small rural or isolated small rural tract using Rural and Urban Commuting Areas categories. Incident CHD events through 12/31/2016 were adjudicated. Cox regression with robust standard errors accounting for geographic clustering was used to obtain hazard ratios and 95% CIs.

Results: Mean age of participants was 64.8 years, 56% were women, and 60% were Black adults. At baseline, 82.5% lived in urban, 10.7% in large rural, 5.3% in small rural and 1.5% in isolated small rural tracts. During a median 9.4 years, 358 incident CHD events occurred. CHD incidence among those in isolated small rural tracts was doubled compared to urban tracts, while those in large or small rural tracts had similar rates as those in urban tracts (Table). Controlling for individual-level and community-level factors minimally attenuated the association.

Conclusion: Differences in the environmental attributes of these communities may contribute to the increased risk of CHD in isolated rural areas.

Disclosure

G. Malla: None. D. Long: None. A. Cherrington: None. M. Safford: None. D.M. Cummings: Research Support; Self; Novo Nordisk Inc. T.P. McAlexander: None. S. De Silva: None. S. Judd: None. B. Hidalgo: None. E.B. Levitan: Advisory Panel; Self; Amgen. Consultant; Self; Novartis Pharmaceuticals Corporation. Research Support; Self; Amgen. A.P. Carson: Research Support; Self; Amgen.

Funding

National Institute of Neurological Disorders and Stroke; National Institutes of Health; Department of Health and Human Services (U01NS041588); Centers for Disease Control and Prevention (U01DP006302)
1503-P: Assessment of Erectile Dysfunction in Men with Type 2 Diabetes Mellitus Using the International Index of Erectile Function (IIEF) Questionnaire
Authors: GUPTA MUKULESH , CHANDRA KUMAR PRAFULL , PANDE ARUNKUMAR , AWASTHI RAJIV , TEWARI AJOY , AGARWAL VIVEK , KUMAR DINESH , GUPTA NITIN R. , CHAUBEY SANTOSH K. , CHOWDHARY SANDEEP , ANSARI MOHAMMAD S.
Published: June 2020

Introduction: Erectile dysfunction (ED) is an important complication of diabetes which is under-reported with well known association with CAD. ED is also considered as one of the earliest markers of endothelial dysfunction.

Material and Method: 458 sexually active males of age >18 Years, with diabetes were enrolled. The English and Hindi (regional language) translated version of The International Index of Erectile Function (IIEF) Questionnaire was used. Subjects were to respond to IIEF based on their subjective feeling related to ED, Orgasmic function, Sexual desire, Intercourse satisfaction and overall satisfaction in past 4 weeks. Study was conducted from August 2018 to April 2019 at 11 centers of a large metropolitan city, Lucknow in North India after ethics committee approval.

Result: Mean age of the patients was 47.64 years (±9.59), weight 74.6 Kg (± 13.2) BMI 26.8 Kg/M2 (±3.97) and abdominal circumference 97.06cm (±10.79). The prevalence of ED and Orgasmic function defect (OFD) was found to be 32% and 43.8% respectively.27.8% had both and 48.4% either ED or OFD. ED was found to be significantly associated with age (p=0.0006), duration of diabetes (p=0.0101), age of onset of diabetes (p=0.0096), macrovascular complications (p=0.0032), serum creatinine (p=0.0141) and use of beta blocker (p=0.032). ED was not significantly associated with hypertension (p=0.091), hypoglycaemia (p=0.2066), HbA1c (p=0.305), statin (p=0.2044), mean platelet volume (p=0.5822) and microvascular complications of diabetes (p=0.0865).

Conclusion: ED was present in nearly one third subjects with diabetes. Nearly half subjects have ED/OFD. Patients with longer duration of diabetes, higher age and with macrovascular complications should proactively be asked about their sexual function and an objective assessment should be done with IIEF questionnaire to unearth this complication. These subjects should be considered for other macrovascular complication screening.

Disclosure

M. Gupta: None. K. Chandra: None. A. Pande: None. R. Awasthi: None. A. Tewari: None. V. Agarwal: None. D. Kumar: None. N.R. Gupta: None. S.K. Chaubey: None. S. Chowdhary: None. M.S. Ansari: None.
1529-P: State-Level Prevalence of ABC Control among Adults with Self-Reported Diabetes in 2013-2016
Authors: CHEN YU , ROLKA DEBORAH B. , XIE HUI , SAYDAH SHARON
Published: June 2020

Individuals with diabetes (DM) are at high risk of heart attack and other diabetes complications. Control of Hemoglobin A1c, Blood Pressure, and Cholesterol (ABC) can be effective in preventing these complications. However, studies that assess the state-level prevalence of ABC control within the DM population are lacking. This study aims to estimate the state-level proportions of adults with self-reported diagnosed DM meeting the goals of ABC control in the 50 U.S. states and the District of Columbia. We applied weighting adjustments to data from 2013-2016 National Health and Nutrition Examination Survey (NHANES), 2016 American Community Survey (ACS), and 2016 Behavioral Risk Factor Surveillance System (BRFSS) to create state-level estimates. To adjust NHANES national weights to reflect the demographic characteristics of states, we used raking to adjust BRFSS weights to the ACS on age, sex, race, health insurance status, education and income, and then used the propensity score method to adjust NHANES to the ACS-adjusted BRFSS on these variables plus self-reported overall health status. We defined ABC control as A1C < 9%, blood pressure (BP) < 140/90 mmHg, and non-HDL cholesterol (non-HDL-C) < 130 mg/dL. Among adults with DM, 38% (95% CI 30.8%-45.2%) of patients met the goal of ABC control, with the highest rate of 43.7% (36.1%-51.3%) in South Dakota and the lowest rate of 32.9% (27.3%-38.5%) in the District of Columbia. Control rates of A1C were highest in each state, followed by BP and non-HDL-C. Overall, 86.6% (82.3%-90.9%) of patients had controlled A1C, 72.6% (67.0%-78.2%) had controlled BP, and 58.7% (52.9%-64.5%) had controlled non-HDL-C. Control rates for each individual goal varied by state. ABC control is suboptimal among adults with DM and varies by state. Our estimates provide data that public health departments could use in their planning efforts to improve ABC control and thus reduce DM-related complications at the state level.

Disclosure

Y. Chen: None. D.B. Rolka: None. H. Xie: None. S. Saydah: None.
1532-P: Investigating Biomarkers of the Immune Response and Tissue Remodeling in Patients with Type 2 Diabetes with Microalbuminuria
Authors: RASMUSSEN DANIEL G.K. , HANSEN TINE W. , MØLLER ALEXANDRA , FRIMODT-MØLLER MARIE , VON SCHOLTEN BERNT JOHAN , JACOBSEN PETER K. , PARVING HANS-HENRIK D. , KARSDAL MORTEN A. , ROSSING PETER
Published: June 2020

Type 2 diabetes (T2D) is a common risk factor for the development of renal fibrosis and chronic kidney disease. Owing to the nature of diabetes, an increased inflammation and an altered turnover of extracellular matrix (ECM) proteins is seen. Despite ample evidence, few studies have focused on an integrated comparison of various biomarkers of the immune response, growth factors and ECM turnover. We evaluated a comprehensive list of biomarkers including interleukin-1, 6, and 8, VCAM-1, ICAM-1, TNFα, E- and P-selectin, FGF23, YKL40, NT-proBNP, type III collagen degradation (C3M) and type VI collagen deposition (PRO-C6) in 190 patients with T2D with microalbuminuria followed for 6.1 years. Investigated endpoints included all-cause mortality (n=26), a composite of cardiovascular events (CVE; n=37), and decline in eGFR of >30% (deGFR, n=41). Using forward selection in Cox proportional hazard analysis we investigated which biomarkers and traditional risk factors (sex, age, systolic blood pressure, LDL-cholesterol, smoking, HbA1c, creatinine and urinary albumin excretion rate) that were retained in the final model for predicting the outcomes. Hazard ratios with 95% confidence intervals are presented per one standard deviation. For all-cause mortality, smoking (3.85 [1.68-8.83], p=0.002), PRO-C6 (1.53 [1.15-2.03], p=0.004), NT-proBNP (1.59 [1.22-2.08], p=0.0006) and ICAM-1 (1.36 [1.06-1.73], p=0.014) were retained in the final model. For CVEs, age (2.00 [1.21-3.30], p=0.007), LDL (1.37 [1.05-1.78], p=0.02), NT-proBNP (1.42 [1.11-1.81], p=0.006) and TNFα (1.35 [1.13-1.60], p=0.0007) were retained. For deGFR, urinary albumin excretion rate (1.31 [1.00-1.71], p=0.049), PRO-C6 (1.41 [1.09-1.83], p=0.009) and NT-proBNP (2.05 [1.54-2.74], p<0.0001) were retained.

In conclusion, our investigations highlight that the best models for predicting outcome may be found by combining biomarkers of cardiac injury, ECM remodeling and the immune response.

Disclosure

D.G.K. Rasmussen: Employee; Self; Nordic Bioscience. T.W. Hansen: None. A. Møller: None. M. Frimodt-Møller: None. B. von Scholten: Employee; Self; Novo Nordisk A/S. P.K. Jacobsen: None. H.D. Parving: None. M.A. Karsdal: Stock/Shareholder; Self; Nordic Bioscience. P. Rossing: Advisory Panel; Self; Sanofi. Consultant; Self; Astellas Pharma Inc., AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Boehringer Ingelheim International GmbH, Gilead Sciences, Inc., Novo Nordisk A/S. Research Support; Self; Novo Nordisk A/S. Speaker’s Bureau; Self; Eli Lilly and Company. Stock/Shareholder; Self; Novo Nordisk A/S.

Funding

Danish Research Foundation
1544-P: Associations between Dietary Factors and Serum Aryl Hydrocarbon Receptor Bioactivity as a Biomarker of Persistent Organic Pollutants in Prediabetic Population
Authors: CHON SUK , LIM HYUNJUNG , KIM JIEUN , OH SEUNGJOON
Published: June 2020

Aim: Many studies suggest that the persistent organic pollutants (POPs) is a risk factor of type 2 diabetes. The relationship between dietary factors and POPs has been explored recently. POPs are fat-soluble substances that accumulate through the consumption of high fat diets, fish, meat and dairy products. Vegetables and fruits are known to prevent the accumulation of POPs. We aimed to examine the associations between dietary factors and serum cumulative bioactivity of AhR ligand mixture (AhRB) as a biomarker of POPs in subjects at high risk for type 2 diabetes.

Methods: We performed a cross-sectional analysis of 304 prediabetic subjects using the Korea National Diabetes Program cohort data. AhRB was divided into quartiles according to the concentrations. (Q1 (the lowest quartile): (Q1 (the lowest quartile): 1.7±0.3, Q2: 2.4±0.2, Q3:3.1±0.2, Q4 (the highest quartile): 3.9±0.2). Socio-demographic, health related-behaviors, and dietary factors were assessed. Dietary factors were collected from the 3-day dietary records and food frequency questionnaire.

Results: Starting with the Q1 of AhRB, adjusted mean concentrations of serum triglycerides were 147.06±12.97, 151.30±12.64, 125.80±13.19 and 166.78±13.76 mg/dL for ascending quartiles, respectively (P< 0.05). In the 3Q of AhRB, the highest consumption of sugars (Q3: 13.6±11.6g, P=0.016) and dairy products (Q3: 117.0±126.6g, P=0.032) were shown compared to those of other three groups. On multiple linear regression analysis, high consumption of dairy products (P< 0.05) and fried fish with oil (P < 0.05) were significantly positive associated with serum AhRB concentration after adjusting covariates.

Conclusion: This study found an association between dietary factors and AhRB level, however, further longitudinal studies are needed to clarify the effects of these dietary factors on POP levels.

Disclosure

S. Chon: None. H. Lim: None. J. Kim: None. S. Oh: None.
1549-P: Race and Gender Differences in the Initiation of Recently Approved Diabetes Drugs by Privately-Insured U.S. Adults
Authors: MCCOY ROZALINA G. , HOUTEN HOLLY VAN , DUNLAY SHANNON M. , YAO XIAOXI , DEMPSEY TIMOTHY , NOSEWORTHY PETER , SANGARALINGHAM LINDSEY R. , LIMPER ANDREW H. , SHAH NILAY
Published: June 2020

Three new classes of glucose-lowering drugs were introduced into practice over the past 15 years. DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors have low hypoglycemia risk, do not cause weight gain, and GLP-1RA and SGLT2i have additional cardiovascular and renal benefits. We previously found low rates of early SGLT2i use by women and black patients, but more recent data and data for other drugs were lacking. Using OptumLabs Data Warehouse, a de-identified dataset of commercially-insured and Medicare Advantage beneficiaries, we identified adults with type 2 diabetes who first started a DPP-4i (n=140,933), GLP-1RA (n=107,331), SGLT2i (n=112,892), or any other diabetes drug (n=1,743,484) between 2013-2018. Odds of starting each medication class were examined in separate logistic regression models for white women (WW), non-white men (NM), and non-white women (NW) compared to white men, adjusting for other factors affecting drug choice (Figure). Results were mixed, as depicted by the Figure. Our study design cannot identify the causes of preferential use of DPP-4i among non-white patients, or the preferential avoidance of SGLT2i among women and NM and of GLP-1RA among NW. Because these drugs have important safety and efficacy benefits, our findings call for closer examination of potential implicit biases surrounding medication prescribing and diabetes management.

Disclosure

R.G. McCoy: None. H. Van Houten: None. S.M. Dunlay: None. X. Yao: None. T. Dempsey: None. P. Noseworthy: None. L.R. Sangaralingham: None. A.H. Limper: None. N. Shah: None.

Funding

National Institutes of Health (K23DK114497)
1581-P: Circulating Metabolites Are Associated with Glycemic Measures in South Asians
Authors: GADGIL MEGHANA D. , SANDS CAROLINE , LEWIS MATTHEW R. , KANAYA ALKA M. , KANDULA NAMRATHA R. , HERRINGTON DAVID M.
Published: June 2020

South Asians are at higher risk for diabetes (DM) than many other racial/ethnic groups. Circulating metabolites are measurable products of metabolic processes that may explain the etiology of elevated risk. We characterized metabolites associated with prevalent DM and incident glycemic measures in South Asians. We included 717 participants in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, aged 40-84 years. We used baseline fasting serum for metabolomics and demographic, behavioral, glycemic data from baseline and at 5 years. We performed LC-MS untargeted metabolomic and lipidomic analysis with targeted integration of known signals. Individual linear and ordinal logistic regression models were adjusted for age, sex, BMI, diet, exercise, alcohol, smoking and family history of DM followed by elastic net regression to identify metabolites most contributory to the outcome. There were 258 metabolites with detectable signal in >98% of samples. Fifty-nine metabolites were associated with prevalent DM, 32 with fasting glucose and 45 with HbA1c at follow-up [FDR < 0.05]. An elastic net model identified a subset of important metabolites (Table 1). Predominant metabolites associated with glycemic measures in South Asians were sphingomyelins, tri- and di-acylglycerols and carnitines. Future work will externally validate our findings and determine the effects of modifiable risk factors for DM.

Disclosure

M.D. Gadgil: None. C. Sands: None. M.R. Lewis: None. A.M. Kanaya: None. N.R. Kandula: None. D.M. Herrington: None.

Funding

National Institutes of Health (1K23DK119404-01A1)
159-LB: Early Introduction of Continuous Glucose Monitoring Is Well Accepted by Youth and Parents
Authors: ADDALA ANANTA , HANES SARAH , ZAHARIEVA DESSI , NEW CHRISTIN , PRAHALAD PRIYA , MAAHS DAVID M. , HOOD KOREY K. , TANENBAUM MOLLY L.
Published: June 2020

Early introduction of continuous glucose monitoring (CGM) may be one strategy to improve glucose control in youth with type 1 diabetes. We aimed to evaluate perceptions of CGM initiated <1 month after diagnosis using validated surveys and focus groups.

We conducted surveys of parents and youth before the start of CGM and conducted parent focus groups after at least three months of CGM use to evaluate perceptions of early CGM initiation. Parents completed a 21-item Diabetes Distress Scale (DDS) parent. Youth aged ≥11 years completed the DDS-2, diabetes technology attitudes (DTA), PROMIS Global Health (PGH), and CGM benefits (BenCGM) and burdens (BurCGM) surveys.

Before starting CGM, parents (n=7, 2 male, age 45.63.4 years, 4 non-Hispanic white) and youth (n=16; 8 male; age 15.3±2.0 years, diabetes duration 11.5±6.9 days, 6 non-Hispanic white) reported low levels of diabetes distress (DDS parent 0.7±0.5, DDS-2 1.7±0.8). Youth reported good global health (PGH 25.6±3.4), few barriers to CGM use (BurCGM 1.9±0.7), positive attitudes towards CGM (BenCGM 3.8±1.3) and diabetes technology (DTA 18.5±2.2). In focus groups, 9 parents (1 male, child’s age 11.7±4.4 years, child’s diabetes duration 11.3±5.1 months) reported overwhelmingly positive attitudes toward CGM technology generally and with starting their child on CGM soon after diagnosis. Parents differed in their preferences on the optimal number of days after diagnosis to start CGM, with some advocating starting immediately and others preferring a week to adjust to the diagnosis and learn basic diabetes management. Parents wanted additional support for the first sensor change at home as well as the timing and method of follow up education. Finally, the majority endorsed decreased stress and worry as a result of using CGM, particularly overnight.

These data provide initial evidence that parents and youth newly diagnosed with type 1 diabetes demonstrate a readiness to start CGM shortly after diagnosis and perceive a sustained benefit from the use of CGM.

Disclosure

A. Addala: None. S. Hanes: None. D. Zaharieva: Speaker’s Bureau; Self; Ascensia Diabetes Care, Insulet Corporation, Medtronic. C. New: None. P. Prahalad: None. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care. K.K. Hood: Research Support; Self; Dexcom, Inc. Speaker’s Bureau; Self; LifeScan, Inc., MedIQ. M.L. Tanenbaum: None.
161-OR: Association of Frequency of Hypoglycemic Episodes with Incident Cardiovascular Events in Adults with Type 2 Diabetes Mellitus: A National Database Study
Authors: ALABER OMAR A. , CHANDAR APOORVA K. , DAHASH BASMA A. , ZUZEK ALEONA C. , RAJPAL AMAN
Published: June 2020

Introduction: Hypoglycemia has been linked to increased cardiovascular (CV) events, however there is limited data about frequency of hypoglycemic episodes and CV outcomes. We aimed to evaluate the association of frequent hypoglycemic episodes (> 5/year) with incident CV events in adults with type 2 diabetes mellitus (T2DM).

Methods: We queried a national database (IBM Explorys Solutions, IBM, Inc.) for adults with T2DM who had >5 hypoglycemic episodes (cases) vs. 1 to 5 hypoglycemic episodes (controls) in one year. Primary outcomes were overall CV adverse events, acute myocardial infarction (MI), cerebrovascular accident (CVA) and cardiac arrhythmias. Odds ratios (OR) and 95% confidence interval (CI) for the OR were calculated for the risk of association between number of hypoglycemic episodes and incident CV events.

Results: Out of a total of 61,917,780 patients in Explorys, 4,882,710 had T2DM. Patients with >5 hypoglycemic episodes in 1 year (cases) had a higher incident risk of overall CV adverse events when compared to controls (OR: 1.61, 95% CI: 1.558, 1.663). In the stratified analysis, patients with frequent hypoglycemic episodes had a significantly higher incidence of cardiac arrhythmias, acute MI, and CVA (Table 1).

Conclusion: Adults with T2DM with frequent hypoglycemic episodes (>5/year) tend to have higher incidence of adverse CV events.

Disclosure

O.A. Alaber: None. A.K. Chandar: None. B.A. Dahash: None. A.C. Zuzek: None. A. Rajpal: None.
1611-P: Mortality in Patients with Glucose Derangements after ICU Admission
Authors: ZAMAN ADNIN , MCDERMOTT MICHAEL T. , MANSFIELD VICTORIA V. , WANG CECILIA C. LOW
Published: June 2020

Objective: Dysglycemia during an intensive care unit (ICU) stay has been correlated with hospital complications and increased mortality. The objective of this study was to examine how glucose derangements during an ICU admission affect length of stay (LOS) and mortality in patients with and without diabetes mellitus.

Methods: Patient-level data for adults (>/=18 years old) admitted to any ICU within our hospital system for at least 24 hours between 5/5/2011 to 11/6/2017 (6.5 years) were pulled from the electronic database. Patients were categorized into four glucose groups: 1) no hyper/hypoglycemia, 2) hyperglycemia only (blood glucose [BG] >180mg/dL), 3) hypoglycemia only (BG <70mg/dL), and 4) both hyper/hypoglycemia. Diabetes status was determined from diagnosis codes prior to the ICU stay. Dates of hospitalization were used to calculate LOS in days. Mortality was examined through the end of the analysis period.

Results: A total of 16,345 encounters were included in this analysis (mean age 57.7 years); only a few patients had multiple encounters. Over one-quarter of patients had diabetes (26.1%). A majority of encounters involved some form of dysglycemia: 16.4% hypoglycemia, 42.4% hyperglycemia, and 12.0% with both hyper/hypoglycemia. The overall average LOS was 6.03 days. Patients without diabetes but with any form of dysglycemia had longer LOS and higher mortality compared to patients with diabetes. Patients with both hyper/hypoglycemia had the least favorable outcomes (no diabetes vs. diabetes, LOS mean±SD: 16.2±23.5 vs. 12.9±16.3 days, p <0.01; mortality: 64.9% vs. 43.6%, p <0.01). Conversely, those with diabetes without any dysglycemia had the shortest LOS and lowest mortality (LOS 2.5±3.2; mortality 11.3%).

Conclusion: Glucose derangements in the ICU were associated with longer LOS in all patients. However, ICU patients without diabetes but with dysglycemia had longer LOS and higher mortality compared to patients with diabetes.

Disclosure

A. Zaman: None. M.T. McDermott: Advisory Panel; Self; Novo Nordisk Inc., Savvy Sherpa. V.V. Mansfield: Employee; Self; UnitedHealth Group. C.C. Low Wang: Research Support; Self; CellResearch Corporation.

Funding

UnitedHealth Group; University of Colorado Health Care Innovation Center
1628-P: Extreme Survival in a Low SES Population with Early-Onset Diabetes
Authors: CAMPOS ERIC , KEENAN HILLARY A. , LOPES-VIRELLA MARIA F. , BLOT WILLIAM J. , CONWAY BAQIYYAH
Published: June 2020

Low-income African Americans (AA) and Whites with extreme duration of young-onset diabetes (YODM) are a unique population. Traits of this population surviving w/DM for 50 yrs can provide clues to longevity in YODM, particularly in the poor and underserved. Persons ≥50 yrs old (59% female, 60% AA) from the Southern Community Cohort Study diagnosed w/DM < age 30 (n=649), classified by DM duration ≥ 50 yrs (extreme duration, n=96) or <50 yrs (shorter duration, n=553), or w/o DM (n=33,939) at cohort entry were included. We used multinomial logistic regression (OR, 95% CI) to compare traits across groups and Cox models (HR, 95% CI) to assess mortality risk and factors linked w/survival after cohort entry. Mean age was 63, 54, and 57 in those w/extreme, shorter and no DM, respectively. Mean age at DM diagnosis was 5 and 23 in those w/extreme and shorter duration. Compared to shorter duration, those w/extreme duration had a lower BMI at age 21 (OR=0.93, 0.89-0.98) but higher BMI (OR=1.04, 1.01-1.08) at study entry. They were 40 to 50% less likely to have glaucoma and cataracts, but no difference in hx of stroke or CAD. By contrast, they had 1.5 to 3-fold greater risk vs. those w/o DM. In Cox models, those w/shorter duration YODM were at 3.2 times greater mortality risk vs. those w/o DM (HR=3.23, 2.76-3.77), but risk increased only marginally in extreme duration vs. those w/o DM (HR=1.39, 0.98-1.98). No racial difference in survival was seen in extreme (HR=1.04, 0.39-2.77) or shorter duration DM (HR=1.04, 0.72-1.49), though AA w/o DM were at slightly increased mortality risk vs. Whites (HR=1.09, 1.03-1.16). In YODM, diagnosis before age 6 was linked w/lower mortality (HR=0.57, 0.33-0.96) vs. those ≥ age 6. This low-income population w/extreme duration of YODM diagnosed mainly in very early childhood is characterized by a relatively lean BMI in young-but not later adulthood, and appear relatively protected from certain DM and age-related complications. Our data also suggests that in the low SES, AA are not any less likely to survive ≥50 yrs w/DM than Whites.

Disclosure

E. Campos: None. H.A. Keenan: None. M.F. Lopes-Virella: None. W.J. Blot: None. B. Conway: None.

Funding

5U01CA202979-04