bluuebunny/crossref_metadata_2025 huggingface dataset:
1094-P: Awareness of Cardiovascular Disease Risk in People with Type 2 Diabetes
Authors: IMRISEK STEVEN D. , HOY-ROSAS JAMILLAH R. , LAVAYSSE LINDSEY M. , LEE MATTHEW , DACHIS JEFF , SEARS LINDSAY
Published: May 2022

Objective: Independent of other risk factors, type 2 diabetes (T2D) increases the risk of heart attack or stroke two-to-threefold and the risk of death twofold. Poorly managed diabetes and commonly comorbid conditions such as hypertension and hyperlipidemia multiply this risk. This cross-sectional study investigates differences in cardiovascular disease (CVD) risk awareness in a sample of people with T2D.

Methods: Participants with T2D paying for a subscription to One Drop for diabetes management completed a survey on their health. Three groups were identified: those who did not know their CVD risk, those who reported no risk, and those who reported being at risk for CVD. One-way ANOVA and chi-square tests compared groups on CVD risk factors (comorbidities, health behaviors, A1C, BMI) , self-care knowledge and interest in knowing more about risk.

Results: Of the 165 participants, 20.6% did not know their risk, 32.7% indicated no risk and 46.7% indicated they were at risk for CVD. The unknown risk group had the most interest in knowing more about their CVD risk (81.3%; p<.001) and the least engagement in diabetes self-care behaviors (p’s<.05) . The group self-reporting no risk had the lowest rates of hypertension (44% vs. 60%+, p<.02) and hyperlipidemia (26% vs. 50%+, p<.001) , the least knowledge of diabetes self-care behaviors (p=.004) , and the least interest in learning more about their CVD risk (34%; p<.001) . The group self-reporting risk had moderate interest in learning more about their risk (58%) . Groups did not differ on self-reported A1C (p=.23) or BMI (p=.18) .

Discussion: Over half of the sample reported unknown or no risk for CVD. Those who did not know their risk had high interest in knowing more about their risk but low engagement in risk-mitigating behaviors. Those reporting no risk had lower rates of comorbidities; however, there was no difference in diabetes-related risk factors between groups. These findings suggest that CVD prevention programs should be developed to complement diabetes-focused programs.

Disclosure

S.D.Imrisek: Employee; One Drop. J.R.Hoy-rosas: None. L.M.Lavaysse: Employee; One Drop. M.Lee: Employee; One Drop. J.Dachis: Board Member; One Drop, Employee; One Drop, Stock/Shareholder; One Drop. L.Sears: Employee; One Drop.
11-LB: A Prediction Model on Incident CKD among Individuals with T2D in the United States
Authors: LIN YILU , SHAO HUI , ANDERSON AMANDA H. , FONSECA VIVIAN , BATUMAN VECIHI , SHI LIZHENG
Published: May 2022

CKD is highly prevalent and costly in individuals with diabetes. Clinicians need to have a tool for early identification and prediction of incident CKD in individuals with diabetes. This study aimed to predict incident CKD among individuals with diabetes. A time-varying Cox model was derived from the ACCORD clinical trial data to predict the risk of incident CKD, defined as eGFR<60 mL/min/1.73 m2 or UACR>30 mg/g lasting for 3 months. A list of candidate variables was chosen based on literature reviews and experts’ consultation, including demographic characteristics, physical exam, laboratory, medical history, drug use, and healthcare utilization. Predictors were selected from candidate variables using a stepwise algorithm. Data were split into training and validation set. Model performance was evaluated by Brier score (BS) and C statistics. Confidence intervals (CI) was calculated using a bootstrap method. Decomposition analysis was conducted to assess the predictor contribution. External validation was performed on patient-level data of HARMONY Outcome clinical trial. A total of 6,006 diabetes patients free of CKD at baseline were used for model development, with a median follow-up of 3 years and 2,257 new onset CKD events. The CKD risk model identified age at T2D diagnosed, smoking status, BMI, HDL, VLDL, ALT, eGFR, UACR, hypoglycemia event, retinopathy event, CHF event, CHD history, antihyperlipidemic drug use, antihypertensive drug use, and hospitalization. The model demonstrated good discrimination (C-statistics 0.828 [95% CI 0.812-0.845]) and calibration (BS 0.0552 [95% CI 0.0474-0.0593]) performance. UACR, eGFR, and CHF event were the top 3 factors that contributed most to the prediction. A total of 8,221 patients free of CKD was selected from HARMONY Outcome trial with 1,288 CKD events and median follow-up of 2 years. The model demonstrated acceptable discrimination (C-statistics: 0.772 [95% CI 0.767-0.805]) and calibration (BS: 0.0504 [95% CI 0.0477-0.0531]) in external data. A risk prediction of incident CKD among T2D patients was developed and validated for use in decision support of CKD prevention.

Disclosure

Y. Lin: None. H. Shao: Board Member; BRAVO4HEALTH, LLC. A. H. Anderson: None. V. Fonseca: Consultant; Abbott, Asahi Kasei Corporation, Bayer AG, Novo Nordisk, Sanofi, Research Support; Fractyl Health, Inc., Jaguar Gene Therapy, Stock/Shareholder; Abbott, Amgen Inc., BRAVO4Health, Mellitus Health. V. Batuman: None. L. Shi: None.
110-LB: Management of Alpelisib-Induced Hyperglycemia
Authors: WEINTRAUB MICHAEL , LIU DAZHI , FLORY JAMES
Published: May 2022

The phosphoinositide 3-kinase (PI3K) pathway is a common target for oncologic therapies and mediates much of insulin’s action. The PI3Kα inhibitor alpelisib is effective in advanced breast cancer but causes hyperglycemia in up to 80% of patients. The FDA label recommends metformin as first-line treatment of alpelisib-induced hyperglycemia. There is no consensus on other options. This is a single-center, retrospective review of new alpelisib users at a cancer center in 2021. Manual chart review for periods of exposure to alpelisib and antidiabetic drugs identified 67 patients newly started on alpelisib. Average age was 59 years. Median exposure time to alpelisib was 103 days. Antidiabetic drugs were prescribed in 48% (32/67) of patients, with 25% (17/67) using 2 or more. Of patients who stopped alpelisib, 14% (5/35) were primarily due to hyperglycemia. Hyperglycemia was a contributing cause in another 3 cases. The only antidiabetic drugs significantly associated with glucose reduction in multivariable analysis were metformin (26 mg/dL reduction, 95% CI 6.4 - 45.6) and SGLT2 inhibitors (74 mg/dL reduction, 95% CI 42 - 104) . Diabetic ketoacidosis (DKA) occurred in 6% (4/67) of patients. There was a higher rate of DKA among SGLT2 inhibitor users compared to nonusers (p=0.019) . SGLT2 inhibitors are effective as second-line to metformin for alpelisib-induced hyperglycemia but with a higher rate of DKA.

Disclosure

M. Weintraub: None. D. Liu: Consultant; Invitae Corporation. J. Flory: None.

Funding

P30 CA008748
1101-P: Cardiovascular Risk Factors and Intraoperative Hypotension Predicted Development of Insulin Deficiency and Diabetes after Pancreatectomy
Authors: MOON SEOIL , LEE JUN SUH , SOHN HEEJU , HAN YOUNGMIN , KIM HONGBEOM , KWON WOOIL , YOON YOO-SEOK , HAN HO-SEONG , OH TAE JUNG , PARK KYONG SOO , JANG HAK CHUL , JANG JIN-YOUNG , JUNG HYE SEUNG
Published: May 2022

Objective: Ischemia in pancreatic islets is critical to beta cell function, however, clinical evidences on the implications for diabetes are lacking. Pancreatectomy can induce diabetes, but the mechanisms are not clearly elucidated. Therefore, we examined if cardiovascular disease (CVD) risk factors and intraoperative ischemia, which could cause perfusion insufficiency in pancreatic islets, are associated with insulin deficiency and diabetes after pancreatectomy.

Methods: From 2 prospective cohorts of pancreatectomy since 2007, participants were enrolled who had pre-operative HbA1c < 7% without antidiabetes. As for proximal pancreatectomy, those were selected whose HOMA-R increased after surgery. Insulin secretion was assessed by changes in HOMA-B for 1 year (ΔB) . The participants were divided into low- and high-ΔB groups, with stratification by operation type, pre-operative HbA1c, HOMA-B, HOMA-R, and ΔR. Then CVD risk factors and intraoperative ischemic events were compared between the 2 groups, and evaluated for diabetes incidence.

Results: A total of 237 patients were enrolled (men 44%, age 56 years, HbA1c 5.6% in average) . Low-ΔB (median -32% of baseline) and high-ΔB (5%) groups showed comparable baseline metabolic variables. According to logistic regression analyses and Cox regression model, a composite of IGT, hypertension, dyslipidemia and a reduction in intraoperative systolic BP significantly decreased HOMA-B after 1 year (RR, 9.52; 95% CI, 1.14-79.3) , and increased diabetes incidence (HR, 3.3; 95% CI, 1.2-8.9) , after adjustment with age, sex, BMI, HbA1c and operation.

Conclusion: We observed that chronic ischemia suggested by CVD risk factors and intraoperative ischemic insult were linked to development of insulin deficiency and diabetes after pancreatectomy.

Disclosure

S.Moon: None. K.Park: None. H.Jang: None. J.Jang: None. H.Jung: Advisory Panel; Novo Nordisk, Research Support; Jeil Pharmaceutical Co., Novo Nordisk. J.Lee: None. H.Sohn: None. Y.Han: None. H.Kim: None. W.Kwon: None. Y.Yoon: None. H.Han: None. T.Oh: None.

Funding

National Research Foundation of Korea (2019R1A2C1007397)
111-OR: Response to COVID-Vaccination and Infection in Islet Transplant Recipients
Authors: JUENGEL BRADEN , BACHUL PIOTR J. , PEREZ-GUTIERREZ ANGELICA , BASTO LINDSAY , PEREA LAURENCIA , WANG LINGJIA , TIBUDAN MARTIN , BARTH ROLF , FUNG JOHN , WITKOWSKI PIOTR
Published: May 2022

Background: Since response to COVID-vaccine among transplant recipients remains diminished comparing to general population, we decided to assess effect of COVID-specifically among islet transplant patients.

Methods: Response to COVID-infection and vaccine was assessed in a cohort of 20 islet transplant recipients: N=13 after islet transplant alone (ITx) , N=7 with islet after kidney (IAK) or pancreas after islet transplantation (PAI) . The median age was 48 years (25-62) . Maintenance immunosuppression included tacrolimus and an antimetabolite in addition to 5mg of Prednisone in IAK and PAI recipients. Nine patients received booster.

Results: Seven patients (38%) chose not to be vaccinated and 4 (57%) of them remained COVID-free with no SARS-CV-2 Spike total antibody (Spike ab) present in their blood. The other three patients (43%) developed only mild symptoms of infection with a high level of Spike ab (>2,500 U/ml) afterwards. In contrast, all remaining 13 patients (62%) , who were vaccinated while on immunosuppression for a median of 7 years (0.5-16) , remained COVID-free (p=0.11, Fischer) . The level of Spike ab in response to vaccine varied: undetected- (N=4) , in range 1-100U/ml (N=6) , around 400U/ml (N=2) , and above 2,500U/ml (N=1) . Presence of 5mg of Prednisone did not affect the outcomes. Booster was administered in patients and increased the level of Spike ab above 100U/ml in all of them, in 7 (78%) to over 2,500 U/ml. One patient responded neither to vaccine nor to booster. There were no SAEs related to the vaccination or booster. Islet graft function remained stable in all but one patient after initial vaccination or COVID-19.

Conclusion: Nearly half of unvaccinated islet transplant recipients developed Covid-19, however, all of them presented only with mild symptoms. In contrast, none of vaccinated transplant patients developed COVID-infection with 69% rate of seroconversion. Booster increased level of the Spike ab in those patients who responded to the original vaccination.

Disclosure

B.Juengel: None. P.Witkowski: Advisory Panel; Sernova, Corp., Vertex Pharmaceuticals Incorporated. P.J.Bachul: None. A.Perez-gutierrez: None. L.Basto: None. L.Perea: None. L.Wang: None. M.Tibudan: None. R.Barth: None. J.Fung: n/a.

Funding

NIDDK P30 DK020595
112-OR: Metabolic Outcomes One Year after Total Pancreatectomy with Islet Autotransplantation after Early Pump Initiation
Authors: TELLEZ SIOBHAN E. , HORNUNG LINDSEY , COURTER JOSHUA D. , ABU-EL-HAIJA MAISAM , NATHAN JAIMIE D. , LAWSON SARAH , ELDER DEBORAH A.
Published: May 2022

Background: We previously published that insulin pump initiation immediately after IV insulin therapy was associated with improved post-surgical glycemic outcomes compared to multiple daily injections (MDI) in pediatric patients following total pancreatectomy with islet autotransplantation (TPIAT) . We investigated metabolic outcomes of this population at 1 year post-TPIAT to assess if the improved outcomes in the early pump group were sustained over time.

Methods: We retrospectively reviewed 40 patients post-TPIAT previously studied at days post-surgery (14 used MDI and 26 used pump therapy immediately post-ICU, all discharged on pump therapy) . Data analyzed included: demographics, islet equivalents per kilogram (IEQ/kg) transplanted, exogenous insulin use, and baseline vs. 1 year (via mixed meal testing) HgA1C, fasting glucose, insulinogenic index and area under the curve (AUC) for insulin and c-peptide.

Results: More patients were off insulin at 1 year in the early pump group compared to the MDI group (43% vs. 14%, p=0.08) . Of all patients off insulin, 100% of the early pump users weaned off by 6 months post-TPIAT compared to 30% of the MDI users. Two known variables associated with favorable insulin outcomes, lower age and higher IEQ/kg were not significantly different between groups. Fasting glucose was lower in the early pump group compared to the MDI group (median 97.5 vs. 122 mg/dL, p=0.01) while AUC c-peptide was greater in early pump users at 1 year post-TPIAT but did not reach significance (median 65.3 vs. 49.5 ng/mL x minutes, p=0.07) . Other metabolic outcomes did not differ between groups.

Conclusion: Despite lower median age and higher IEQ/kg in the MDI group, the early pump group had a lower fasting glucose. Though not significant, the early pump group had a higher proportion off insulin and greater AUC c-peptide secretion. This study was limited by sample size. Early pump use may have long term benefits in post-TPIAT endogenous insulin secretion.

Disclosure

S.E.Tellez: None. L.Hornung: None. J.D.Courter: None. M.Abu-el-haija: None. J.D.Nathan: None. S.Lawson: None. D.A.Elder: None.
1120-P: Pilot Study Comparison of Newly Developed Pastry Sugar Tolerance Test with the OGTT: Africans in America Study
Authors: DUHUZE-KARERA M GRACE , YANG SHANNA , SCHENK BLAYNE R. , WENTZEL ANNEMARIE , PATTERSON ARIELLE , WALDMAN ZOE C. , DUBOSE CHRISTOPHER , MABUNDO LILIAN , JAGANNATHAN RAM , COURVILLE AMBER B. , SUMNER ANNE E.
Published: May 2022

As undiagnosed diabetes (DM) rises in Africa and A1C performs suboptimally, attention turns to the OGTT. Obtaining Glucola (75g glucose) for the OGTT is difficult. Analyzing Africans in America data, we previously found that duplicate OGTT were highly reproducible for DM detection (k=0.84) ; and moderate for preDM (k=0.51) . Diagnostic reproducibility for preDM was lowest if fasting glucose was 90-1mg/dL (OR: 5, P=.02) . In the current study, 12 Africans had an OGTT and 1 week later a Pastry Sugar Tolerance Test (PSTT) with pastry sugar (75g glucose) which is inexpensive and widely available (Figures 1 & 2) . DM reproducibility was excellent (k=0.99) , and moderate for preDM (k=0.40) . The three individuals who transitioned out of preDM had fasting glucose of 90-99 mg/dL. For detecting DM, the PSTT may become an OGTT alternative.

Disclosure

M. Duhuze-Karera: None. S. Yang: None. B.R. Schenk: None. A. Wentzel: None. Z.C. Waldman: None. C. DuBose: None. L. Mabundo: None. R. Jagannathan: None. A.B. Courville: None. A.E. Sumner: None.
1121-P: The Combination of the ELF and FIB-4 Scores Have High Predictive Performance for Significant or Advanced Fibrosis in Patients with NAFLD
Authors: YOUNOSSI ZOBAIR , FELIX SEAN , JEFFERS THOMAS , YOUNOSSI ELENA , NADER FATEMA , RACILA ANDREI , LAM BRIAN P. , STEPANOVA MARIA
Published: May 2022

Background: Patients with nonalcoholic fatty liver disease (NAFLD) and fibrosis stage ≥ 2 (F2-F4) are at risk for adverse outcomes and considered to be candidates for clinical trials. We aimed to use two NITs combined to rule in and rule out fibrosis stages F2-F4 among patients with NAFLD.

Methods: Data were collected from patients with NAFLD diagnosis. The Enhanced Liver Fibrosis (ELF) and FIB-4 NITs were calculated. Liver biopsies were read by 1 hepatologist; scored by NASH CRN criteria. Significant fibrosis stage was ≥ F2, advanced fibrosis was ≥ F3.

Results: There were 463 NAFLD patients: 48±13 years old, 31% male, 35% type 2 diabetes, 39% had significant fibrosis and 24% advanced fibrosis. In comparison to those without significant fibrosis, patients with significant fibrosis were older (mean age 52 vs. 45 years) , more commonly male (38% vs. 26%) , and had more components of metabolic syndrome (type 2 diabetes, hypertension, hyperlipidemia) as well as higher ELF and FIB-4 scores; similar trends were observed for patients with vs. without advanced fibrosis (p<0.05) . The performance of the two NITs in identifying NAFLD patients with significant fibrosis was as follows: AUC (95% CI) = 0.78 (0.74-0.82) for ELF, 0.79 (0.75-0.83) for FIB-4; for advanced fibrosis AUC = 0.81 (0.77-0.85) for ELF, 0.83 (0.79 - 0.86) for FIB-4. A combination of ELF score ≥9.8 and FIB-4 ≥1.96 returned PPV of 95% which can reliably rule in significant fibrosis (sensitivity 22%, specificity >99%) , while an ELF score ≥7.7 and FIB-4 ≥0.30 had NPV of 95% which can be used to rule out significant fibrosis (sensitivity 98%, specificity 22%) . For advanced fibrosis, similar rules were ELF ≥9.8 and FIB-4 ≥2.90 (PPV 95%, sensitivity 18%, specificity >99%) to rule in; ELF ≥7.2 and FIB-4 ≥0.74 (NPV 95%, sensitivity 92%, specificity 49%) to rule out.

Conclusions: The combination of ELF and FIB-4 can provide an easy algorithm with high predictive value to detect significant or advanced fibrosis in NAFLD.

Disclosure

Z.Younossi: Consultant; Bristol-Myers Squibb Company, Gilead Sciences, Inc., Intercept Pharmaceuticals, Inc., Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk, Quest Diagnostics, Siemens. S.Felix: None. T.Jeffers: Stock/Shareholder; Neurometrix. E.Younossi: None. F.Nader: None. A.Racila: None. B.P.Lam: Consultant; Intercept Pharmaceuticals, Inc. M.Stepanova: None.
1124-P: Hemoglobin A1c and BMI Are Not Correlated in Patients with Prediabetes
Authors: SINGH GURDEEP , HOWLAND TIMOTHY , SHAKJIRI BURIM , BUSH BERNARD , FATTARUSSO LOUIS , STEIN SARAH
Published: May 2022

The correlation between the hemoglobin A1C and BMI in patients with type 2 diabetes is well established. The present study was undertaken to examine whether a similar correlation is present in patients with prediabetes. Between 2017 and 2021, patients within the Ascension Lourdes primary care network were screened for prediabetes and diabetes using the hemoglobin A1C. Patients on any blood sugar lowering medication other than metformin were excluded from observation. A total of 5,1patients between the ages of 18 - 79 with an A1C between 5.7-6.4%.were identified. From this 5,1patient group, a subgroup of 2687 patients had at least two encounters where concurrent BMI and HbA1C values were recorded. A correlation analysis was performed where findings showed a low correlation between the BMI and A1C (n = 2,687, r =0.1, R Squared = 0.01, p < 0.05) . Only 1.1% of the variance in A1C values is explained by the BMI. In addition, there was no significant correlation between the A1C and BMI in subgroups divided by BMI classification and age. Additionally, there was not a statistically significant correlation in patients who developed one A1C greater than 6.4. (n =322 , r = 0.17, R Squared=0.03, p < 0.05)

Conclusion: Among patients with an A1C between 5.7 - 6.4%, BMI does not account for concurrent changes in the hemoglobin A1C. BMI may therefore be of limited utility in predicting which patients with prediabetes are most likely to develop diabetes.

Disclosure

G.Singh: Stock/Shareholder; Gilead Sciences, Inc., Pfizer Inc., Tandem Diabetes Care, Inc. T.Howland: None. B.Shakjiri: None. B.Bush: None. L.Fattarusso: None. S.Stein: None.
1128-P: Prevalence of Obstructive Sleep Apnea in T2DM
Authors: AYYAGARI USHA , NK NARAYANAN , RM MANIKANDAN , NATARAJAN KANNAN , THUMALA BOOCHANDRAN S. , SELVARAJAN RAJA , ERUKULAPATI RAVI S. , DAS SAMBIT , DUVURU SHANTHARAM , RP RAJESH , KRISHNAMOORTHY MOHAN , JAGANMOHAN BALAJI , ASWATHIAH SRINATH , KARUPPAN BALAMURUGAN , PANDIAN SELVA , DASH KALPANA , YR SRINIVAS , MADHAVDAS DEEPAKLAL M. , S VENKATARAMAN , SESHADRI KRISHNA
Published: May 2022

Prevalence of Obstructive Sleep Apnea (OSA) is reported as 23% in T2DM. OSA and T2DM share a bidirectional relationship, the effects of which are exacerbated by obesity, a common, shared comorbidity. Diagnosis and treatment improve glycemic, CV, and other outcomes, including mortality. Therefore, ADA recommends screening for OSA at least annually as part of routine care in DM. Polysomnography, the gold standard for diagnosing OSA is cumbersome, expensive, resource intensive, and impractical to implement in daily clinical practice. The STOP-Bang questionnaire is a validated, 8 question, easy-to-use, reliable screening tool for OSA. A score ≥ 3 has sensitivity 93% and 100% to detect moderate-severe and severe OSA respectively. Risk scoring is as in fig 1. High risk can also be scored as YES to 2 or more STOP questions AND male gender/BMI > 35/neck circumference > 40cm. We present screening data and highlight the prevalence of OSA in T2DM in routine clinical practice. Median age 55, median BMI 26.03, male 55%. From this screening n=1358 (58.94%) have intermediate or high risk of OSA and should be further investigated with polysomnography. Our data suggest that intermediate to high risk of OSA occurs at a lower BMI (26) in the population screened, with a majority (91%) having a neck circumference <40cm, and highlights the need to screen for OSA rigorously in daily clinical practice, even in people that would otherwise have been “eye-balled” as low risk

Disclosure

U.Ayyagari: None. R.Rp: None. M.Krishnamoorthy: None. B.Jaganmohan: None. S.Aswathiah: None. B.Karuppan: None. S.Pandian: None. K.Dash: None. S.Yr: None. D.M.Madhavdas: Speaker's Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk, Sanofi. V.S: None. N.Nk: n/a. K.Seshadri: Speaker's Bureau; Abbott, Biocon, Boehringer Ingelheim International GmbH, Cipla Inc., Eli Lilly and Company, Merck & Co., Inc., Novartis AG, Novo Nordisk, USV Private Limited. M.Rm: None. K.Natarajan: None. B.S.Thumala: None. R.Selvarajan: None. R.S.Erukulapati: None. S.Das: n/a. S.Duvuru: None.
113-OR: The Best Insulin Delivery System Remains a Human Pancreas
Authors: MCCUNE KASI R. , DUBE GEOFFREY , RATNER LLOYD E.
Published: May 2022

Purpose: Patients referred for pancreas transplantation represent a subset of difficult to treat diabetics, who may have clinical factors preventing them from achieving a goal Hgb A1C of ≤7%. Advanced insulin delivery systems with continuous glucose monitor (CGM) have been developed to offer less invasive treatment options in this population. We wanted to see how pancreas transplant performed compared to alternative modalities.

Methods: We conducted a retrospective review of pancreas transplantation at our institution from January 1, 20 through August 1, 2021. All patients were ≥18 years who underwent either simultaneous kidney pancreas (SPK) , pancreas after kidney (PAK) , or pancreas transplant alone (PTA) . Outcomes were assessed by HgbA1C level at evaluation (eval) , at transplant (pre) , between 3-5 months posttransplant (post) and the most recent (MR) (avg 62 months SD 75.4 months) .

Results: 133 patients underwent pancreas transplant during the study period, 85 SPK (62%) 39 PAK (30%) and PTA (8%) . (14%) patients suffered graft loss in the first year and were excluded from analysis. Overall, 1, and 5-year pancreas graft survival was 86% and 82%. 96 (84%) had type 1 diabetes (T1D) and 18 (16%) had type 2 diabetes (T2D) . Of the 114 patients, 33 (29%) utilized CGM with or without pump (CGM) prior to transplant and had a lower Hgb A1C (%) than those without (nonCGM) (8.18 SD 1.5 vs. 8.75 SD 1.9 p=0.04) . Hgb A1C then improved for the nonCGM group during their time on the waitlist (8.75 to 8.36 SD 1.8 p=0.004) but not the CGM group (8.18 to 8.SD 1.3 p=0.24) . Post-transplant saw significant improvement in CGM pre 8.to post 5.0 (SD.6 p=2.7E-17) and MR 5.3 (SD 0.7 p=9.9E-14) and in nonCGM pre 8.4 to post 5.2 (SD 0.62 p= 2.9E-29) and MR 5.4 (SD 0.7 p= 7.3E-29) .

Conclusion: Considering the clinical challenges of staying in range for difficult to treat diabetes, leading to HgbA1C goal of ≥7%, solid organ pancreas transplantation offers superior glycemic control compared to advanced insulin delivery systems with CGM.

Disclosure

K.R.Mccune: None. G.Dube: None. L.E.Ratner: Advisory Panel; CareDx, Immunocore, Ltd., Natera, Stock/Shareholder; Gilead Sciences, Inc., Hansa BioPharma.
1132-P: Classification and Prediction of Diabetes Using Electronic Health Records and Wearable Devices for Clinical Decision Support
Authors: SHAHIDEHPOUR ANDREW , FRITSCHI CYNTHIA , RASHID MUDASSIR , CINAR ALI , QUINN LAURIE T.
Published: May 2022

Introduction: Diagnosis of T2DM necessitates clinical tests that are time-consuming and expensive. Machine learning (ML) techniques can accelerate the diagnosis and classification of T2DM and allow clinicians to personalize treatments based on blood glucose concentrations (BGC) , physical fitness (PF) , and diabetes distress patterns observed in daily life. Analyzing electronic health records (EHR) , physiological variables collected with wearable devices, and patient-reported outcomes (PROs) using ML techniques can lead to the development of clinical decision support tools that provide a comprehensive picture of an individual’s diabetes management needs.

Methods: Clinical experimental data (n=85, F:40/M:45, HbA1c: 7.83±2.16; age: 57±7.72: BMI: 33.kg/m2±6.72; means and SDs) were used to identify clusters of subjects based on medical tests, and ML models were developed using readily measured data to classify new subjects to the identified clusters. Latent variable methods and k-means clustering were used to identify clusters based on HbA1c, physical performance tests, and PROs. ML models, including logistic regression (LR) and support vector machines (SVM) , were developed to assign new subjects to the identified clusters using the readily measured input variables from wearable devices, EHR and PROs.

Results: Three distinct subject clusters were identified within the study cohort based on the descriptive variables. New subjects were assigned to the identified clusters with 87% and 91% accuracy for LR and SVM, respectively.

Conclusion: EHRs, wearable device data, and PROs can be used to accurately and conveniently identify a person’s overall BGC, PF, and diabetes distress to aid in clinical decision-making. In the future, clinical decision support tools can be developed for personalized treatment suggestions based on cluster membership.

Disclosure

A.Shahidehpour: None. C.Fritschi: None. M.Rashid: None. A.Cinar: None. L.T.Quinn: n/a.
1143-P: Lifetime Risk, Life Expectancy, and Years of Life Lost to Type 2 Diabetes in a Global Modelling Study of Six Countries
Authors: TOMIC DUNYA , CHEN LEI , MORTON JEDIDIAH I. , GREGG EDWARD W. , PAVKOV MEDA E. , ARFFMAN MARTTI , CHENG YILING J. , HA KYOUNG HWA , KIM DAE JUNG , PILDAVA SANTA , SHAW JONATHAN E. , MAGLIANO DIANNA J.
Published: May 2022

Lifetime risk, life expectancy and years of life lost provide a meaningful perspective on the burden of type 2 diabetes to guide public health interventions. We estimated these metrics using population datasets from six high income countries, for two time-points five years apart per country in the period 2009-2019. We included 96,718,000 person-years and 448,1incident diabetes cases in life-table models. Each life-table simulated progression of a cohort of 20-year-olds free of diabetes, followed until death or age 100. Poisson regression was used to estimate incidence and mortality rates for each single year of age in males and females. Using microsimulation, 95% uncertainty intervals around lifetime risk, life expectancy and years of life lost were produced. Lifetime risk of diabetes decreased for both sexes in all countries (Table) , most notably in Israeli females from 58.1% (57.0 - 59.1) in 2010-to 45.9% (44.7 - 47.1) in 2015-16. Life expectancy for people with diabetes increased for both sexes in all countries, generally in line with the increase seen in those without diabetes. Years of life lost to diabetes at age 20 varied from 2.4 (1.4 - 3.4) in Latvian males in 2015-16 to 8.6 (8.3 - 8.9) in Israeli males in 2015-16. These findings show declining lifetime risk of type 2 diabetes in many countries, however, years of life lost to the disease remains substantial for the average person with diabetes.

Disclosure

D.Tomic: None. S.Pildava: None. J.E.Shaw: Advisory Panel; Abbott Diagnostics, AstraZeneca, Eli Lilly and Company, Pfizer Inc., Roche Diagnostics, Research Support; AstraZeneca, Boehringer Ingelheim International GmbH, Speaker's Bureau; AstraZeneca, Eli Lilly and Company, Novo Nordisk, Sanofi. D.J.Magliano: None. L.Chen: None. J.I.Morton: None. E.W.Gregg: None. M.E.Pavkov: None. M.Arffman: None. Y.J.Cheng: None. K.Ha: None. D.Kim: None.
1146-P: SGLT2 Inhibitors and the Risk of Early Bladder Cancer Events
Authors: ABRAHAMI DEVIN , TESFAYE HELEN , YIN HUI , YU ORIANA HOI YUN , PLATT ROBERT W. , SCHNEEWEISS SEBASTIAN , PATORNO ELISABETTA , AZOULAY LAURENT
Published: May 2022

SGLT2 inhibitors (SGLT2is) have been shown to reduce the risk of cardiovascular and mortality events in large cardiovascular outcome trials in patients with type 2 diabetes. However, their safety profile is controversial, with some trials reporting imbalances in bladder cancer events, all of which occurred relatively soon after randomization. To address this safety concern, we used 3 US healthcare claims databases and 1 UK primary care database (01/2013-12/2020) . In each database, we identified adults newly treated with either SGLT2is (total n=453,726) or GLP-1 receptor agonists (GLP1RAs, n=375,990) (comparison #1) , and SGLT2is (n=347,055) or DPP-4 inhibitors (DPP4is, n=854,141) (comparison #2) . Propensity score-based fine stratification was used to reweigh the cohorts, adjusting for a wide range of patient characteristics at baseline. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for bladder cancer in each database using Cox proportional hazards models. After a median follow-up of 1.8 years, use of SGLT2is may slightly reduce the risk of bladder cancer, compared to GLP1RAs [HR (95% CI) =0.90 (0.81-1.00) ]. Compared to use of DPP4is, SGLT2is are not associated with bladder cancer incidence [HR (95% CI) : 1.00 (0.91-1.11) ] after a median follow-up of 2.0 years (Table) . Overall, the results of this large international cohort study provide reassurance on the short-term effects of SGLT2is on bladder cancer incidence.

Disclosure

D.Abrahami: None. H.Tesfaye: None. H.Yin: None. O.Yu: None. R.W.Platt: Consultant; Amgen Inc., Biogen, Merck & Co., Inc., Nant Pharma, Pfizer Inc. S.Schneeweiss: None. E.Patorno: Research Support; Boehringer Ingelheim International GmbH, National Institutes of Health, Patient-Centered Outcomes Research Institute. L.Azoulay: Consultant; Pfizer Inc.

Funding

Canadian Institutes of Health Research (PJT-169040)
1149-P: Stress Hyperglycemia Is an Independent Marker of Both Acute Illness and Diabetes Risk
Authors: SUKKARI MOHAMAD ANAS , FANG SHUYANG , AIYEDIPE SAMUEL , KHAKHARIA ANJALI , EASLEY KIRK A. , PHILLIPS LAWRENCE S. , RHEE MARY K.
Published: May 2022

Stress hyperglycemia [inpatient hyperglycemia in patients without known diabetes (DM) ] is associated with poor outcomes, but not well characterized. To fill this gap in knowledge, we evaluated a retrospective national cohort of 240,047 Veterans, hospitalized ≥3d in 2002-14, with regular care before/after admission, and without pre-admission (preAdm) DM [defined by ICD code + DM Rx use, or A1c ≥6.5% or random plasma glucose (RPG) ≥200 mg/dl) . Mean age was 74 yr and BMI 28 kg/m2; 96% were male; 76% white, 16% black. Inpatient RPG was analyzed as ordinal mg/dl categories of the second highest inpatient RPG (iRPG) . We found that 44% had iRPG ≤1mg/dl, 37% had iRPG 111-140 mg/dl, and 19% had ≥ 141 mg/dl. Demographic factors were not clinically different between iRPG groups, but those with second highest preAdm RPG (paRPG) ≥115 mg/dl were more likely to have iRPG ≥140 mg/dl than those with paRPG ≤1mg/dl (26% vs. 16%, p<0.001) . The prevalence of inpatient composite cardiovascular disease (CVD) and organ damage (acute MI, acute kidney injury, acute respiratory failure) , but not infection, increased with higher iRPG (CVD: OR 1.for iRPG 140-149 mg/dl and OR 1.62 for iRPG ≥200 mg/dl; organ damage: OR 1.and 1.96, respectively, p<0.001, compared to iRPG ≤1mg/dl, adjusted for demographics, Elixhauser score, glucocorticoid use) . The prevalence of inpatient critical illness and incident DM post-discharge also rose with iRPG, (critical illness: OR 1.15 for iRPG 110-1 and OR 4.for iRPG ≥200 mg/dl; 3 yr incident DM: OR 1.81 and 11.06, respectively, p<0.001) . iRPG >140 mg/dl was associated with 9.6% 3yr DM incidence. Compared to those without incident DM, the incident DM group had a 21 mg/dl higher mean iRPG (p <0.001) and more CVD at lower iRPGs (38% CVD for iRPG ≤120 vs. 29%) . Conclusion: Stress hyperglycemia is associated with inpatient CVD, critical illness and organ damage, as well as incident DM post-discharge. Moreover, iRPG >140 mg/dl identifies high risk patients for DM who should undergoing close screening.

Disclosure

M.Sukkari: None. S.Fang: None. S.Aiyedipe: None. A.Khakharia: None. K.A.Easley: None. L.S.Phillips: Other Relationship; Cystic Fibrosis Foundation, Diasyst Inc., Research Support; Abbott Diabetes, AbbVie Inc., Janssen Pharmaceuticals, Inc., Janssen Scientific Affairs, LLC, Pfizer Inc. M.K.Rhee: Research Support; Kowa Company, Ltd.
115-OR: The Impact of Pretransplant and Posttransplant Diabetes on the Incidence of Cardiovascular Events in Kidney Transplant Recipients
Authors: LEE SEJEONG , HONG SUKCHUL , LEE MINYOUNG , KIM YOUNG-EUN , KIM HAE KYUNG , LEE HYANGKYU , LEE JAE GEUN , KANG EUN SEOK
Published: May 2022

Diabetes mellitus (DM) and cardiovascular disease (CVD) are major public health challenges and also leading causes of post-transplant mortality following renal transplantation. In transplant patients, pre-transplant diabetes as well as newly developed diabetes after transplantation is associated with poor post-transplant outcomes. In this study, we aimed to investigate the effect of pre-transplant diabetes (Pre-DM) and post-transplant diabetes (PTDM) on cardiovascular events in kidney transplant recipients. We analyzed 1930 patients who underwent kidney transplantation at tertiary care hospital between 1979 and 2020. Subjects were classified into the 3 groups (Pre-DM, PTDM, Non-DM) according to whether diabetes was diagnosed and the date of diagnosis was before or after surgery. A Cox proportional hazard model was used to investigate the association between the type of DM (vs. Non-DM) and the incidence of four-point major adverse cardiovascular events (4P-MACE) . During the study follow-up period (median 6.5 years) , 4P-MACE occurred in 36 (3.1%) patients with Non-DM, 65 patients (14.3%) with Pre-DM and 33 (10.7%) patients with PTDM. Pre-DM was significantly associated with increasing risk of cardiovascular events after adjustment for confounding factors including age, sex, BMI, waiting time, ABO incompatibility, number of HLA mismatch, previous cardiovascular disease, donor age and donor type (living or deceased) (hazard ratio (HR) 3.62, 95% confidence interval (CI) 2.29-5.74, p<0.001) . In the Kaplan-Meier curve of the cumulative incidence of 4P-MACE, subjects with Pre-DM had the highest risk of cardiovascular events and those with PTDM had intermediate risk of events. The presence of both Pre-DM or PTDM significantly increased the risk of cardiovascular events in kidney transplant recipients. This suggests the need for management to minimize the long-term impact of pre-existing DM and PTDM in transplant patients.

Disclosure

S.Lee: None. S.Hong: None. M.Lee: None. Y.Kim: None. H.Kim: None. H.Lee: None. J.Lee: None. E.Kang: None.

Funding

Severance Hospital Research fund for Clinical excellence (SHRC) (C-2021-0007)
1151-P: Improved Liver Steatosis Scores in T2DM after Randomization to Bariatric Surgery Related to Improvement in Insulin Sensitivity and Cardiometabolic Risk
Authors: KODALI ALIMITHA MONALI , LUNDHOLM MICHELLE D. , VANGOITSENHOVEN ROMAN , KIRWAN JOHN P. , AMINIAN ALI , SCHAUER PHILIP , KASHYAP SANGEETA
Published: May 2022

NAFLD is common in T2DM, linked to insulin resistance and beta-cell dysfunction, and can be assessed with validated liver scores for steatosis and fibrosis. The longitudinal impact of weight loss with or without bariatric/metabolic surgery (BMS) on NAFLD in T2DM is not clear. Patients with T2DM (N=52, age 48±9 yrs, 30 (58%) female, BMI 36.3±2.9 kg/m2, T2DM duration of 8.3±5.0 yrs, A1c 9.7±1.7%) were randomized to intensive medical therapy (IMT, n=15) alone or IMT with laparoscopic Roux-en-Y gastric bypass (RYGB, n=18) or sleeve gastrectomy (SG, n=19) . The hepatic steatosis index (HSI) , NAFLD/liver fat score, FIB-4 index, and AST-to-platelet ratio index (APRI) were calculated at baseline and 24 months and correlated to baseline and change in weight, body fat percent (assessed with iDXA) , insulin sensitivity, beta-cell function (DI) and adipocytokine measurements during mixed meal tolerance testing. Baseline steatosis liver scores were abnormal in 52 patients (100%) by HSI and 38 (73%) by NAFLD/LFS. Abnormal liver scores at baseline were correlated with higher HOMA-IR, lower adiponectin levels, and higher blood pressure. At 24 months, HSI only normalized in 10/37 (27%) BMS patients (p=0.046) . NAFLD/LFS normalized in 21/27 (78%) BMS patients and 1/ (9%) medical patients (p=0.001) . Normalization of HSI and NAFLD/LFS were associated with weight and body fat reduction (p<0.001) . Normalization of HSI was associated with improvement in Disposition index (DI) (P = 0.08) , CRP (p=0.001) , and leptin levels (p=0.016) ; change in NAFLD/LFS was associated with HOMA-IR (p<0.001) . Liver steatosis was prevalent in all T2DM undergoing BMS and medical therapy and improved in a majority of subjects who underwent BMS but not IMT. Normalization of liver scores was associated with improvement in body weight, insulin sensitivity, beta-cell function, and markers of CVD risk. These data support the use of liver scores when assessing T2DM for BMS.

Disclosure

A.Kodali: None. M.D.Lundholm: None. R.Vangoitsenhoven: Speaker's Bureau; Boehringer Ingelheim International GmbH, Goodlife Pharma, Lilly, Mundipharma, Novo Nordisk, Sanofi. J.P.Kirwan: None. A.Aminian: Consultant; Medtronic, Research Support; Medtronic. P.Schauer: Advisory Panel; GI Dynamics, Keyron Ltd., Persona Nutrition, Consultant; Ethicon, Inc., Medtronic, Research Support; Ethicon, Inc., Medtronic, Pacira BioSciences, Inc., Stock/Shareholder; Mediflix, Inc., SE Healthcare LLC. S.Kashyap: Advisory Panel; Fractyl Health, Inc., GI Dynamics, Research Support; Janssen Pharmaceuticals, Inc.
1154-P: Leisure-Time Physical Activity Environment and Odds of Glycemic Control over Time among Veterans with New-Onset Type 2 Diabetes
Authors: ORSTAD STEPHANIE L. , LOPEZ PRISCILLA M. , ADHIKARI SAMRACHANA , LEE DAVID C. , KANCHI RANIA , SCHWARTZ MARK D. , ALEMI FARROKH , ELBEL BRIAN , THORPE LORNA
Published: May 2022

Physical activity is protective against type 2 diabetes (T2D) incidence and supports T2D management. Access to local facilities such as gyms and parks enables leisure-time physical activity (LTPA) . We examined associations between T2D patients’ access to LTPA facilities and parks and whether repeated A1C follow-up tests were within a desired range. We analyzed data on 271,5 patients from the Veterans Administration Diabetes Risk Cohort who developed T2D from 2008-2018. We measured an A1C test as in-range if 5.0-7.0 (<80 years of age) or 5.0-8.5 (≥80 years of age) , density of facilities within street network buffers, and population-weighted distance to the closest 7 parks. We used generalized estimating equations with a logit link function to predict the log odds of an in-range vs. out-of-range A1C test. We tested environment-by-time interactions, controlling for individual and neighborhood demographics and baseline A1C. On average, patients were 60 years of age, male (95%) , white (71%) , and had A1C tests during follow-up. Higher facility density, but not park distance, was narrowly associated with lower odds ofan in-range A1C test (ORdensity=.99, 95% CI=.98, 1.0) . As years since T2D diagnosis increased, the odds of an in-range A1C test decreased (ORtime=.88, 95% CI=.88, .88) . For those living in higher facility density, the odds of an in-range A1C decreased over time by only a slightly lower factor than for those living in lower facility density (P<.0 for interaction term) . For those living farther from parks, the odds of an in-range A1C decreased over time by only a slightly higher factor than for those living closer to parks (P=.001) . As odds of in-range A1C tests decline over time, broader access to facilities and parks may not soften the decline since the modified effects were clinically negligible. Viable interventions for maintaining healthy A1C after diagnosis may include efforts to both increase access to and promote the use of the LTPA environment.

Disclosure

S.L.Orstad: None. P.M.Lopez: None. S.Adhikari: Research Support; Johnson & Johnson. D.C.Lee: None. R.Kanchi: None. M.D.Schwartz: None. F.Alemi: None. B.Elbel: None. L.Thorpe: None.

Funding

This study was funded by the Centers for Disease Control and Prevention (5 U01DP006299-02-00; PI: Lorna Thorpe)
1155-P: Incidental Findings on Chest CT Are Not Associated with Type 1 Diabetes Status
Authors: KINNEY GREGORY L. , CONWAY REBECCA B. , YOUNG KENDRA , LI YISHA , SNELL-BERGEON JANET K.
Published: May 2022

Background: Spirometry assessed pulmonary function has been shown to be mildly reduced in type 1 diabetes (t1d) and while this reduction appears to be chronic it doesn’t appear to be progressive. This suggests that functional reduction may not be a microvascular complication of t1d despite the enormous capillary bed in the lungs. CT imaging of the lungs of people with t1d evaluated for pulmonary function is essentially unexplored. We examined CT imaging of participants with and without t1d to explore lung morphology as it relates to t1d.

Methods: The CACTI study conducted CT imaging of the chest as well as pulmonary function testing via spirometry (PFT) . Imaging included the majority of the lungs but does not include the apexes or bases. These lung fields were assessed in a systematic way by a single clinician for incident and these observations were text mined in order to capture the most frequently observed morphologies. PFT results are reported as % predicted values for forced expiratory volume 1 second (FEV1%p) and Forced Vital Capacity (FVC%p) .

Results: 525 CT scans (2t1d, 316 control) were matched to PFT and compared for each of the most common morphologies (nodules (66) , calcified nodes (25) , emphysema (19) , atelectasis (28) , ground glass (13) , airway thickening (34) and granulomatous disease (28) were the most frequently observed) . Participants with t1d had lower FEV1%p (85.9%p vs. 94.4%p, p <0.0001) , lower FVC (87%p vs. 95.5%p, p<0.0001) , were equally likely to be current and former cigarette smokers (28% vs. 27%, p=0,6) , significantly less likely to have calcified nodes (1.6% vs. 4.2%, p=0.03) or granulomatous disease (1.8% vs. 4.6%, p=0.02) but were not different on any of the other incidental findings on CT.

Conclusions: People with t1d have reduced pulmonary function but CT scans of the central lungs do not show morphological changes that may explain this reduction.

Disclosure

G.L.Kinney: None. R.B.Conway: None. K.Young: None. Y.Li: Employee; Vertex Pharmaceuticals Incorporated. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc.
116-LB: Interaction between Iron Stores and Metformin Action
Authors: MCCLAIN DONALD A. , USOH CHINENYE O. , LORENZO FELIPE , HARRISON ALEXANDRIA V.
Published: May 2022

The mechanism of action of MET (MET) remains controversial. MET induces an iron starvation response in yeast, so we hypothesized that tissue iron might influence MET responsiveness in higher organisms. We reviewed electronic health records to correlate MET responsiveness in diabetic humans with serum ferritin, a measure of iron stores. Both higher and subnormal serum ferritin were associated with decreased HbA1c response to MET (N=80, p<0.001) , and MET responsiveness was lost entirely at higher than normal ferritin. Mice were placed on diabetogenic diets with different iron contents, and treated or not with MET. MET responses of fasting glucose values were superior in mice on low-normal and normal iron diets compared to those on high iron: Fasting glucose decreased 60.4 mg/dL on low-normal iron (N=9, p<0.001) , 40.5 mg/dL on normal iron (N=23, p<0.01) and 2.6 mg/dL on high-normal iron (N=27, p=NS) , with significant interaction between iron and MET (p=0.0015, ANOVA) . Other effects of iron (e.g. leptin expression) are known to be mediated by protein modification by O-linked N-acetylglucosamine (O-GlcNAc) . MET increased O-GlcNAc levels 200% in mice on normal iron (p=0.04) but not high-normal iron diets (-8%, p=NS) . In mice with elevated O-GlcNAc resulting from heterozygous deletion of the O-GlcNAcase gene, MET’s ability to decrease fasting glucose levels in mice on high iron was restored, with differences between MET and placebo being 30.3, 61.3, and 56.5 mg/dL on low-normal, normal, and high-normal iron diets (p<0.0001 by ANOVA) ; in contrast to wild type mice, the significant effects of iron and its interaction with MET were lost (p=0.13 and 0.47) . We conclude that tissue iron affects glycemic responses to MET, supporting the hypothesis that MET induces an iron starvation response but that high iron overwhelms that signal. The results on protein O-GlcNAc modification suggest that it mediates the interaction of iron and MET. MET responsiveness in patients with diabetes could be optimized by modulating iron stores.

Disclosure

D. A. Mcclain: None. C. O. Usoh: None. F. Lorenzo: None. A. V. Harrison: None.

Funding

VA Research Service 2I01 BX001140; NIH 1P30DK12472