bluuebunny/crossref_metadata_2025 huggingface dataset:
1118-P: Engaging Data Teams in Electronic Medical Record Data Extraction for Diabetes Real-World Data and Improvement Projects
Authors: WIRSCH ANTON , MUNGMODE ANN , DAWSON JAMES , RIOLES NICOLE , EBEKOZIEN OSAGIE , COLLABORATIVE T1DX-QI
Published: June 2024

Introduction: The electronic medical record (EMR) is rich in valuable information, however extracting the data for real world insights is challenging and difficult for comparison studies. This study’s aim is to identify some of the common challenges and perspectives from 18 data teams participating in the T1D Exchange Quality Improvement Collaborative (T1DX-QI).

Method: T1DX-QI centers share patient-level, de-identified, individual-level EMR data with the coordinating center for real world studies, benchmarking, and quality improvement studies. Centers’ data teams liaise with T1DX-QI to map and extract over 120 pre-specified T1DX-QI data fields. T1DX-QI invited 22 centers that have recently completed the mapping process to participate in this assessment. Data teams responded to an online survey and participated in focus groups. T1DX-QI’s coordinating center reviewed data samples to identify common errors with significant deviation from the expected variable.

Results: Most centers (18 out of 22,82% response rate) participated in the study. The majority (61%) of the data teams conduct 6 or more EMR data extraction projects annually. Nearly half (45%) of centers reported that the diabetes data extraction and mapping process was about the same level of effort as other disease area extraction process. Most of these experienced centers thought the T1DX-QI mapping process was efficient (73%). The most common errors from the extraction process were incorrect values, incomplete documentation, missing variables, and incorrect formats. All errors were readily addressed in iterative review cycles and by implementing a comprehensive best practice checklist.

Conclusion: EMR data extraction for diabetes quality improvement and population health collaboration is feasible and achievable, as demonstrated by the T1DX-QI network.

Disclosure

A. Wirsch: None. A. Mungmode: None. J. Dawson: None. N. Rioles: None. O. Ebekozien: Advisory Panel; Sanofi, Medtronic. Research Support; Vertex Pharmaceuticals Incorporated. Speaker's Bureau; Vertex Pharmaceuticals Incorporated. Research Support; Medtronic, Lilly Diabetes, Abbott, Dexcom, Inc.

Funding

The Helmsley Charitable Trust
1125-P: Provider Experience Caring for Elderly Patients with Uncontrolled Type 2 Diabetes and Hospitalization
Authors: CHEPP VALERIE , MASIANO STEVEN P. , MILINOVICH ALEX , FOX JACQUELINE , PANTALONE KEVIN M. , MISRA-HEBERT ANITA D.
Published: June 2024

Introduction & Objective: Hospitalization may serve as an opportune time to address uncontrolled type 2 diabetes (T2D) in elderly patients. Our objective was to examine hospitalist and primary care provider (PCP) experience caring for patients > age 65 with T2D during or after hospitalization.

Methods: Utilizing the electronic medical record, we identified patients age >65 with T2D and A1c> 8%, with hospital discharge November 2022-April 2023 and identified the hospitalists and PCPs caring for these patients. Sixteen semi-structured interviews were conducted with providers within 90 days of patient discharge. Interviews were audio recorded, transcribed, and transcripts were thematically analyzed using an inductive approach.

Results: Hospitalists and PCPs both viewed hospitalization as an opportunity to make therapeutic changes for patients with uncontrolled T2D. A hospitalist described “an opportunity to ‘reassess’ medications previously set "on cruise control." Providers use blood sugar and A1c to inform decisions, but reported variation in data prompting medication change. Hospitalists expressed trepidation around “making drastic changes,” or one stating “⋯ I might tweak things a little bit and say⋯ ‘follow up with your PCP,” while PCPs draw upon their relationships with patients and see “the outpatient setting [as] where the care of diabetic patients takes place most of the time.” Yet PCPs may appreciate when changes are made in the hospital, one stating "It’s psychologically a little easier, if they’ve already started [medicines prescribed by hospitalists]."

Conclusion: PCPs and hospitalists both appreciate hospitalization as an opportune time to make T2D therapeutic changes but therapeutic inertia was identified among both provider types. Efforts to improve hospitalist-PCP communication about diabetes treatment as well as standardized protocols for treatment adjustment should be explored for older patients with uncontrolled T2D at the time of discharge.

Disclosure

V. Chepp: None. S.P. Masiano: None. A. Milinovich: Research Support; Novo Nordisk, Bayer Inc., Merck & Co., Inc., Twin Health, National Institutes of Health, Eli Lilly and Company, Pfizer Inc. J. Fox: None. K.M. Pantalone: Speaker's Bureau; AstraZeneca. Consultant; AstraZeneca. Board Member; Bayer Inc. Research Support; Bayer Inc. Speaker's Bureau; Corcept Therapeutics. Consultant; Corcept Therapeutics, Diasome, Eli Lilly and Company, Merck & Co., Inc. Speaker's Bureau; Merck & Co., Inc. Research Support; Merck & Co., Inc. Consultant; Novo Nordisk. Research Support; Novo Nordisk. Speaker's Bureau; Novo Nordisk. Research Support; Twin Health. Consultant; Sanofi. A.D. Misra-Hebert: Research Support; Bayer Inc., Merck & Co., Inc., Novo Nordisk.
1134-P: Randomized Controlled Trial Assessing PBI-4547's Impact on Glycemic Control, Diabetic Nephropathy, and Obesity in Type 2 Diabetes Mellitus Patients
Authors: AHMAD KHAWAJA A. , PRAKASH AKHOURI S. , CHANDRA ABHISHEK , JHA RAJESH K.
Published: June 2024

Introduction: The rising prevalence of diabetes and its complications, including diabetic nephropathy and obesity, demands innovative therapeutic strategies. PBI-4547, a novel antidiabetic and antifibrotic compound, offers potential benefits in this realm. This study investigates the efficacy and safety of oral PBI-4547 in managing diabetes, diabetic nephropathy, and obesity.

Methods: In this randomized, double-blind, placebo-controlled experiment, 150 patients with T2DM, diabetic nephropathy, and obesity were included. The participants were divided into three groups: low-dose, high-dose, and placebo. The study examined HbA1c, albuminuria, eGFR, and body weight during six months. Safety was assessed through the recording of adverse events.

Results: Significant improvements in glycemic control were observed in both PBI-4547 groups compared to the placebo, with a mean HbA1c reduction of 1.2% in the high-dose group and 0.8% in the low-dose group (p<0.01). Albuminuria decreased by 30% in the high-dose group and 20% in the low-dose group (p<0.05). The high-dose group also exhibited an average weight loss of 5%, and the low-dose group reported moderate but significant weight loss. PBI-4547 was well-tolerated, with no serious adverse events reported.

Conclusion: Oral PBI-4547 significantly improved glycemic control, lessened albuminuria, and induced weight loss in obese T2DM patients, indicating its potential as an all-encompassing diabetes therapy. Further large-scale, long-term studies are needed to verify these outcomes and determine its safety profile.

Disclosure

K.A. Ahmad: None. A.S. Prakash: None. A. Chandra: None. R.K. Jha: None.
1137-P: Childhood Obesity Risk Increased with Increasing Neighborhood Deprivation Index during the Prenatal Period
Authors: CHEHAB RANA F. , FERRARA ASSIAMIRA , GREENBERG MARA , LEE CATHERINE , NGO AMANDA , ZHU YEYI
Published: June 2024

Childhood obesity is a growing epidemic with long-term sequelae including diabetes. Obesity is challenging to reverse, highlighting an urgent need to target upstream in utero risk factors. We examined associations of prenatal neighborhood deprivation index (NDI) with risk of childhood obesity from 2-10 years and the role of gestational diabetes (GDM) in modifying this association.

In a racially diverse cohort of livebirths (n=258,060) from 2011-2017 in Kaiser Permanente Northern California, we assessed risk of childhood obesity (sex-specific BMI-for-age ≥95th percentile using CDC growth charts) by quartiles (Q) of prenatal NDI (a validated census-based socioeconomic status measure) using modified Poisson regression.

Obesity affected 15.4%, 16.0%, and 21.7% of children aged 2-4, 5-7, and 8-10 years; respectively (Figure). Obesity risk at all ages increased with increasing prenatal NDI Q (P-for-trend <.0001). Specifically, the adjusted relative risk (95% CI) of obesity in children exposed prenatally to more (Q4) compared to less (Q1) deprived neighborhoods was 1.36 (1.31-1.42) at 2-4 years, 1.46 (1.39-1.53) at 5-7 years, and 1.47 (1.37-1.58) at 8-10 years. Similar yet stronger associations were observed in children of individuals with vs. without GDM.

The prenatal neighborhood environment may inform early risk stratification and targeted interventions to prevent childhood obesity.

Disclosure

R.F. Chehab: None. A. Ferrara: None. M. Greenberg: None. C. Lee: None. A. Ngo: None. Y. Zhu: None.

Funding

Diabetes Research for Equity through Advanced Multilevel Science Center for Diabetes Translation Research (DREAMS-CDTR) pilot and feasibility program supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [P30-DK092924]; Kaiser Permanente Northern California, Central Research Committee, Community Health project [RNG212200]; National Heart, Lung, and Blood Institute R01 grant [R01HL157666]
1169-P: Pediatric Type 1 Diabetes (T1D) Care Approaches Compared across International Clinics with Mean HbA1c <7% and ≥7%
Authors: CRISTELLO SARTEAU ANGELICA , GOPISETTY NIKHITA R. , SOURIS KATHERINE J. , BOWLBY DEBORAH , JAIN NINA , KING BRUCE R. , LIU WEI , MALIK FAISAL , PIHOKER CATHERINE , SMART CARMEL E. , TANDON NIKHIL , MAYER-DAVIS ELIZABETH J.
Published: June 2024

Introduction & Objective: Clinic-level factors that may influence HbA1c among youth with T1D have not been explored in-depth. We qualitatively investigated differences in practices between diabetes centers reporting mean clinic HbA1c <7% and ≥7%.

Methods: Semi-structured interviews based on the Donabedian model were conducted with endocrinologists, educators, dieticians, social workers, and psychologists at pediatric T1D centers selected from an existing international collaborative to represent diversity in practice. We used the rapid analysis matrix method for deductive consensus coding and thematic analysis.

Results: Thirty-one interviews were conducted at 7 T1D clinics across Australia (n=1), China (n=1), India (n=1), Sweden (n=1) and the United States (n=3) (2019-2023). Key clinic-and provider-level drivers of differences in youth HbA1c were the 1) extent to which education timelines and messaging were standardized and personalized 2) existence of protocols for care coordination and escalation 3) availability of patient and clinic-level data to inform decision-making (Figure 1).

Conclusion: Our exploratory study generates useful hypotheses about clinic-and-provider-level messaging, protocols and resources that may shape youth HbA1c. Further research should evaluate how much these factors influence health and the potential for translation across clinics.

Disclosure

A. Cristello Sarteau: None. N.R. Gopisetty: None. K.J. Souris: None. D. Bowlby: None. N. Jain: None. B.R. King: None. W. Liu: None. F. Malik: None. C. Pihoker: None. C.E. Smart: None. N. Tandon: None. E.J. Mayer-Davis: None.
1181-P: Differences in Hemoglobin A1c and CGM-Derived Glucose Management Indicator (GMI) in Youth with Type 1 Diabetes
Authors: SILLER ALEJANDRO F. , SICKLER JAMES K. , VILLEGAS CAROLINA , HUANG XIAOFAN C. , MINARD CHARLES G. , REDONDO MARIA J. , DESALVO DANIEL
Published: June 2024

Introduction: The relationship of A1c vs. GMI across race/ethnicity has significant differences between Non-Hispanic White (NHW) vs. Non-Hispanic Black (NHB) adults; however, data in ethnically diverse children are lacking. We assessed the correlation of A1c vs. GMI in a large, diverse pediatric population with T1D.

Methods: T1D youth with ≥70% CGM use over the prior 14 days at the time of A1c were included. Delta (defined as GMI minus A1c) was categorized as ≤-0.5%, >-0.5 to <0.5%, ≥0.5% with absolute value of ≥0.5% considered clinically significant. Proportional odds regression was used to evaluate if race/ethnicity was associated with larger difference category.

Results: In 969 youth (age 11.6 ± 3.8y; 53% female; T1D duration 4.4 ± 3.4y), mean A1c was 7.71% and mean GMI was 7.98%. Delta overall and across race/ethnicity are presented in Table 1. Hispanic (OR 2.17; 95% CI 1.44-3.26; p<0.001) and NHW (OR 2.22; 95% CI 1.53-3.22; p<0.001) youth had significantly higher likelihood of having Delta (GMI - A1c) of ≥0.5% compared to NHB youth.

Conclusion: In this diverse pediatric population with T1D, NHW and Hispanic youth were more likely to have a clinically significant discrepancy in which GMI is greater than A1c as compared to NHB youth. Clinical relevance of the A1c vs. GMI relationship, including which best predicts risk of micro- and macrovascular complications, warrants further study.

Disclosure

A.F. Siller: None. J.K. Sickler: None. C. Villegas: None. X.C. Huang: None. C.G. Minard: None. M.J. Redondo: None. D. DeSalvo: Advisory Panel; Insulet Corporation. Consultant; Dexcom, Inc.
1187-P: Increased C4B Gene Copy Number Is Associated with Increased Inflammation in Adolescent Type 1 Diabetes
Authors: DAMILANO CECILIA P. , ZHOU DANLEI , YU CHACK-YUNG , HOFFMAN ROBERT P.
Published: June 2024

Introduction: Cardiovascular disease will be the primary cause of future death for adolescents with type 1 diabetes (T1D). Increased systemic inflammation is likely to play a role in this. The complement system is part of the innate immune system regulating inflammation. C4 total gene copy number (GCN) and C4 subtype (C4A, C4B, C4Long, and C4Short) CGN have been associated with various aspects of the metabolic syndrome.

Objective: To determine if C4 GCN is associated with fasting and/or post-prandial inflammation in adolescents with T1D.

Methodology: 12 non-obese children and adolescents, 10-18 years old, with T1D were recruited from the Diabetes Clinic of Nationwide Children's Hospital. A randomized cross-over design for two subsequent visits was used. Fasting baseline blood samples were taken to measure glucose, TNFα, IL6, C3 and C4 protein levels and total C4, C4A, and C4B GCN. Rapid acting insulin was given to cover meal carbohydrate without glucose correction. Blood samples were repeated at 30, 60, 90, and 120 minutes. Visits 1 and 2 were identical except for GI of the meal. Visits were rescheduled if fasting glucose was > 200 mg/dl. Spearman’s correlation was used.

Results: Total C4 GCN C4A and C4 Long GCN did not correlate with TNFα, IL6, C3, or C4 levels pre or post prandially for either meal. C4 short CGN positively correlated with baseline TNFα for the high glycemic index meal (rs=0.80, p<0.001) but not the low glycemic index meal. C4B GCN positively correlated with baseline TNFα (rs=0.64; rs=0.68 p<0.02) and IL6 (rs=0.79, p<0.01; rs=0.67 p<0.02) levels and 30 min TNFα (rs=0.80; rs=0.70, p<0.01) for both the high and low glycemic index meals, respectively. C4B GCN also correlated with 60 min C4 levels for both meals (rs=0.80; rs=0.70 p<0.01).

Conclusions: High C4B GCN is associated with increased inflammatory markers (TNFα and IL6) in adolescent T1D. This association may indicate that individuals with high C4B GCN are at increased future risk for diabetes related cardiovascular disease.

Disclosure

C.P. Damilano: None. D. Zhou: None. C. Yu: None. R.P. Hoffman: Research Support; Pfizer Inc.
1196-P: CGM Metrics in Teens with Type 1 Diabetes and Diabetes Distress in the Promoting Resilience in Stress Management (PRISM) Trial
Authors: FERM MICHAEL L. , DESALVO DANIEL , ZHOU CHUAN , BRADFORD MIRANDA , MALIK FAISAL , O'DONNELL MAEVE B. , PIHOKER CATHERINE , ROSENBERG ABBY , YI-FRAZIER JOYCE P. , HILLIARD MARISA E.
Published: June 2024

Introduction & Objective: Many adolescents with T1D experience diabetes distress, which is related to suboptimal glycemic outcomes. PRISM is a skills-based psychosocial intervention that benefitted psychosocial and behavioral outcomes in youth with T1D but did not improve HbA1c. We explored whether PRISM impacted CGM metrics, given the greater glycemic specificity than HbA1c.

Methods: A 2-site, 1:1 RCT of PRISM vs. Usual Care (UC) included youth with T1D aged 13-18y with elevated diabetes distress (Problem Areas in Diabetes - Teen screener score ≥30). In an exploratory analysis of teens using CGM for routine T1D management (n = 114, 66% of total sample had ample CGM data), we used Wilcoxon rank sum exact tests to compare CGM values above, in, and below target range between PRISM vs. UC at baseline, 6, and 12 months.

Results: Table 1 summarizes CGM metrics at each time point. The difference reached statistical significance only for Level 1 Hypoglycemia at 6 months. There were no other significant group differences in CGM metrics.

Conclusion: The reduction in hypoglycemia suggests potential for psychosocial intervention to have glycemic benefit in youth with diabetes distress, though additional strategies are needed to sustain long-term improvement. Larger intervention studies with teens using CGM are needed to evaluate potential for improving CGM-derived glycemic outcomes.

Disclosure

M.L. Ferm: None. D. DeSalvo: Advisory Panel; Insulet Corporation. Consultant; Dexcom, Inc. C. Zhou: None. M. Bradford: None. F. Malik: None. M.B. O'Donnell: None. C. Pihoker: None. A. Rosenberg: None. J.P. Yi-Frazier: None. M.E. Hilliard: None.

Funding

National Institutes of Health (R01DK121224); National Institute of Diabetes and Digestive and Kidney Disease (K26DK138332)
123-OR: MiR103 as a Potential Inhibitor for Dyslipidemia through Modulation of ANGPTL8 Level
Authors: ABUBAKER JEHAD , CHERIAN PREETHI T. , AL-KHAIRI IRINA , ABU-FARHA MOHAMED
Published: June 2024

There is increasing interest in the role of epigenetic factors in obesity and its impact on diabetes and dyslipidemia. Earlier report found that miR-103 suppresses de novo lipogenesis (DNL) and dampens the development of obesity/diet-induced fatty liver through targeting at Fasn and Scd1 genes in mouse liver. On the other hand, lipid regulating hormone angiopoietin-like 8 (ANGPTL8) is a known regulator of triglycerides through its inhibition of the lipoprotein lipase activity through its interaction with ANGPTL3. We aimed to study the miR-103 expression in the blood and adipose tissue in a cohort of obese and non-obese people and confirm its binding and regulation to ANGPTL8. miR-103 expression levels were investigated using RT-PCR in 144 participants, 82 who were non-obese (body mass index [BMI] <30) and 62 who were obese (BMI >30). Overexpression and luciferase assays were used to confirm the binding between miR-103 and ANGPTL8. The plasma levels of ANGPTL8 were also measured by ELISA. The miR-103 levels were significantly lower in obese than in non-obese individuals (P = 0.002). In vitro analysis confirmed miR-103 binding to and repression of the ANGPTL8 transcript and protein. Obesity leads to alterations in miR-103 expression. Its downregulation in obese humans was inversely correlated with ANGPTL8, a protein involved in lipid metabolism. Further, miR-103 plasma levels were inversely correlated with TG levels (P = 0.011), and ANGPTL8 levels were positively correlated with TG levels. miR-103 can be used as an inhibitor of ANGPTL8 to reduce the TG plasma level and mitigate dyslipidemia.

Disclosure

J. Abubaker: None. P.T. Cherian: None. I. Al-khairi: None. M. Abu-farha: None.
1246-P: Maternal Proinflammatory Markers Associate with Obesity and Glycemic Measures in Pregnancy
Authors: VAZQUEZ LAURA , VAZQUEZ ARREOLA ELSA , LOOKER HELEN C. , HANSON ROBERT L. , WASAK DOROTA , CABALLERO RACHEL , SINHA MADHUMITA
Published: June 2024

Introduction & Objective: Both maternal adiposity and dysglycemia induce low-grade inflammation that impacts the fetal intrauterine milieu. We examined the association between maternal proinflammatory markers with gestational glycemia, and pregestational BMI.

Methods: From the Early Tracking of Childhood Health Determinants (ETCHED) longitudinal observational study, data on 66 pregnant Hispanic (73%) and American Indian women were available (May 2022-Sep 2023); 33% had diabetes. We analyzed baseline glycemic measures (fasting glucose, insulin, C-peptide, HbA1c), proinflammatory biomarkers (IL-6, hsCRP), and maternal leptin.

Results: Mean age was 29.9 years (SD ±6.3), mean pregestational BMI was 33.1 kg/m2 (SD±9.4). Table 1 shows significant positive Spearman correlations between maternal serum IL-6 and hsCRP with pregestational BMI, insulin, HbA1c, C-peptide, and leptin. There was no significant correlation between pregestational BMI and offspring birth weight. In a subset (n=40) of matched samples maternal IL-6 was correlated with cord-blood leptin (r=0.34, p=0.03) and TNF-α (r=0.31, p=0.04).

Conclusion: Gestational maternal proinflammatory cytokines were elevated in women with excess adiposity and hyperglycemia. Maternal IL-6 associated with fetal adipocytokines, however, additional data are needed to explore this relationship and its impact on fetal growth and development.

Disclosure

L. Vazquez: None. E. Vazquez Arreola: None. H.C. Looker: None. R.L. Hanson: None. D. Wasak: None. R. Caballero: None. M. Sinha: None.
125-OR: New Lipid Biomarkers for Worsening Glucose Tolerance in Nondiabetic Relatives of People with Type 2 Diabetes
Authors: SYED ISMAIL , SLUIS KENNETH , ARYAL PRATIK , SOLOMON ZACHARY , PATEL RUCHA , KONDURI SRIHARI , SIEGEL DIONICIO , SMITH ULF , KAHN BARBARA B.
Published: June 2024

There is a growing need for early biomarkers for Type 2 diabetes (T2D). Fatty Acid esters of Hydroxy Fatty Acids (FAHFAs) are bioactive lipids with >580 regioisomers in human tissues. Some FAHFAs such as Palmitic Acid Hydroxy Stearic Acids (PAHSAs) have anti-diabetic and anti-inflammatory effects. PAHSA levels are lower in serum and adipose tissue of insulin-resistant versus insulin-sensitive humans and strongly correlate with insulin sensitivity. Since PAHSAs and palmitic acid esters of hydroxy oleic acids (PAHOAs) are among the most abundant FAHFAs in human serum, we aimed to determine whether these FAHFAs predict worsening glucose tolerance in people with an increased T2D risk, i.e. first-degree relatives of people with T2D. All participants had normal glucose tolerance (NGT) at baseline. Throughout a rolling enrollment period, 27 participants remained NGT (NGT-NGT) and 21 developed impaired glucose tolerance (NGT-IGT). In the group that remained NGT, followup serum PAHSA regioisomers and total PAHSA levels were similar to baseline. In contrast, total serum PAHSA and most regioisomers concentrations decreased in participants who developed IGT. The change in total PAHSAs (R=-0.476; p=0.0006), 5-PAHSA (R=-0.506; p=0.0002), and 9-PAHSA (R=-0.356; p=0.013) correlated tightly with worsening glucose tolerance. Multivariate analysis showed the decrease in PAHSAs predicted worsening glucose tolerance independent of BMI and age. The levels of total PAHOAs and most PAHOA isomers were similar at enrollment and follow-up in the NGT-NGT group. In NGT-IGT, initial and followup PAHOA levels were higher than in participants who remained NGT. Initial total PAHOA levels were: NGT-NGT (15.63±0.79) vs NGT-IGT (28.19±2.27) p<4.48E-07. Followup total PAHOA levels NGT-NGT (14.70±0.62) vs NGT-IGT (31.07±2.73) p<2.88E-08.

Conclusion: A fall in PAHSA levels serves as a biomarker for worsening glucose tolerance while high PAHOA levels predict worsening glucose tolerance and IGT.

Disclosure

I. Syed: None. K. Sluis: None. P. Aryal: Employee; Cellarity. Z. Solomon: None. R. Patel: Employee; Novo Nordisk. S. Konduri: None. D. Siegel: None. U. Smith: None. B.B. Kahn: Advisory Panel; Janssen Pharmaceuticals, Inc. Consultant; Vida Ventures Advisors, Arrowhead Pharmaceuticals, Inc.

Funding

NIH K01 DK118041 (IS).Joslin Pilot & Feasibility Grant P30 DK046200 (IS).NIH R01 DK106210 (BBK).JPB Foundation (BBK).
130-OR: Mediterranean Diet and Gestational Diabetes—What Is the Role of Exposure to Persistent Organic Pollutants
Authors: YU GUOQI , WEI PANG WEI , YANG JIAXI , ZHANG CUILIN
Published: June 2024

Background: Healthy diet, such as greater adherence to Mediterranean diet (aMED), has been associated with a lower risk of gestational diabetes mellitus (GDM). However, foods characterizing aMED, such as fish and vegetables, are high in certain persistent organic pollutants (POPs) that are known to increase GDM risk. As such, it is critical to examine the joint associations of healthy dietary patterns and POPs exposure with GDM risk.

Methods: The study is based on a prospective multi-racial pregnant cohort in the U.S., the NICHD Fetal Growth Study (N=2,802). aMED in peri-conception/early pregnancy was derived using validated food frequency questionnaire. In total, 76 POPs of different classes were measured using blood samples collected at 8-13 gestational weeks. Pregnant individuals were categorized into four mixed groups based on the median values of aMED and POP concentrations. Binary logistic regression models were utilized to evaluate the joint associations of aMED and POPs with GDM.

Results: aMED and POPs exposure are jointly associated with GDM risk, with the lowest risk among women of high aMED score and low POP levels. For instance, the risk of developing GDM was ~80% lower among women with a high aMED score and low Polychlorinated Biphenyls (PCBs) levels as compared to those with a lower aMED score and high PCB levels [OR (95% CI): 0.18 (0.04, 0.86) (p-interaction=0.041)]. Further, high POP levels appeared to diminish the beneficial role of aMED on lowering GDM risk: women with a higher aMED score and high PCBs did not have a reduced GDM risk compared to those with a higher aMED score and low PCBs.

Conclusions: This study is one of the first to examine the association of healthy diet in early pregnancy with GDM while considering POP levels, and results suggest that future endeavours for promoting a healthy diet for the prevention of GDM may consider optimizing environmental contaminants such as POPs simultaneously.

Disclosure

G. Yu: None. W. Pang: None. J. Yang: None. C. Zhang: None.
1331-P: High Pancreatic Steatosis Prevalence in Type 2 Diabetes Mellitus—What Are the Potential Associated Factors?
Authors: DE ALMEIDA PAULA , PULZ GEORGIA T. , JUNG MAITHÊ K. , COPATTI VITÓRIA , MULLER GUILHERME R. , FRIEDRICH MARIANGELA G. , DE FRAGA RAQUEL S. , FACCIN CARLO S. , LEITAO CRISTIANE B.
Published: June 2024

Introduction and Objectives: T2DM is linked to ectopic fat storage. Data on pancreatic steatosis (PS) and its associated factors in T2DM are scarce. This study aims to determine PS prevalence in T2DM population and to assess clinical, laboratory or body composition associated factors.

Methods: Adults over 18 years attending the outpatient T2DM clinic were included in this cross-sectional study. Clinical, biochemical, anthropometric and body composition data were collected. PS and stiffness were evaluated by ultrasound and elastography (shear wave 2D). Data were analyzed with x2 and student t test.

Results: Out of 664 reviewed medical records, 204 individuals met the inclusion criteria and consented to participate. So far, 86 individuals have been evaluated and PS evaluation was possible in 83 (96%), being present in 78 [94%; mild n = 33 (38%); moderate n = 43 (50%) and severe n = 2 (2%)]. As the majority exhibited some PS degree, we compared subjects with no/mild vs. moderate/severe PS (Table 1). Waist circumference (WC) was the only variable associated with greater PS. Pancreatic stiffness evaluation was possible in 44 (53%) participants (median = 7 kPa), being similar in both groups.

Conclusion: PS evaluation by ultrasound is feasible and highly prevalent in the T2DM population. WC was the only variable associated with PS. Pancreatic stiffness evaluation was possible in half of the sample and was not associated with PS.

Disclosure

P. de Almeida: None. G.T. Pulz: None. M.K. Jung: None. V. Copatti: None. G.R. Muller: None. M.G. Friedrich: None. R.S. De Fraga: None. C.S. Faccin: None. C.B. Leitao: None.
1348-P: Trends and Independent Correlates of Cardioprotective Antihyperglycemic Agent Use in U.S. Adults with Cardiovascular-Kidney-Metabolic Syndrome
Authors: OZIEH MUKOSO N. , THORGERSON ABIGAIL , EGEDE LEONARD E.
Published: June 2024

Cardiovascular-kidney-metabolic syndrome (CKMS) includes those at risk for and those with CVD. Cardioprotective antihyperglycemic agents (CAA) have beneficial effects on CKMS. The goal of this study is to examine trends and correlates of CAA use among US adults with CKMS. Data from the Medical Expenditure Panel Survey (2008-2021) representing a weighted population of 30,583,033 US adults aged >=18 years with CKMS were used for this analysis. CKMS was defined as individuals diagnosed with type 2 diabetes, CKD, or CHF. The dependent variable was CAA use defined as GLP-1RAs or SGLT2i use (yes/no). Proportion of CAA use over time was examined overall and by demographic characteristics (age, sex, race/ethnicity, poverty, and insurance) controlling for time. Logistic regression models were used to examine the association between CAA use adjusting for relevant covariates. Analyses were conducted using R v 4.3.1 and significance was p-value<0.05. The prevalence of CAA use in 2008 was 6% (n=2,811) in this population. Use of CAA significantly increased overall from 6 to 61% from 2008 to 2021 (p<0.01). After controlling for time, there were significant differences in CAA use by age (p=0.03), sex (p=0.03), race/ethnicity (p=0.01), poverty (p<0.01), and insurance (p=0.04). In fully adjusted model, independent correlates of CAA use were age 45-64years [OR 1.58 (1.24, 2.02)], non-Hispanic Black [OR 0.71 (0.59, 0.89)], college education [OR 1.62 (1.32, 1.99)], unmarried status [OR 0.83 (0.72, 0.96)], unemployment [OR 0.83 (0.72, 0.96)], low poverty [OR 0.76 (0.62, 0.92)], uninsured [OR 0.46 (0.30, 0.69)] or publicly insured [OR 0.79 (0.69, 0.92)], and survey year. CAA use has increased over time however utilization remains suboptimal among US adults with CKMS. Targeted multilevel interventions including policy-level, health system-level, provider-level, and patient-level focusing on individuals most at risk who have CKMS are critical.

Disclosure

M.N. Ozieh: None. A. Thorgerson: None. L.E. Egede: None.

Funding

National Institute of Diabetes and Digestive Kidney Disease (R21DK131356, PI: Ozieh; R01DK118038 and R01DK120861 PI: Egede) and the National Institute for Minority Health and Health Disparities (K23MD016448, PI: Ozieh; R01MD013826, PI: Egede/Walker; R01MD018012 and R01MD017574, PI: Egede/Linde)
1351-P: Relationship between Body Mass Index (BMI) or Waist Circumference (WC) and Risk of Severe Diabetic Complications in Patients with Diabetes (DM)
Authors: YAGUCHI YUTA , FUJIHARA KAZUYA , YAMADA MAYUKO H. , MATSUBAYASHI YASUHIRO , YAMADA TAKAHO , KITAZAWA MASARU , YAMAMOTO MASAHIKO , KODAMA SATORU , SONE HIROHITO
Published: June 2024

Although weight management plays a central role in diabetes treatment, the associations between two major anthropometric obesity indicators (i.e., BMI and WC) and severe diabetic complications have not been fully elucidated. Thus, we investigated the relationship between BMI or WC and the risk of severe diabetic complications in patients with DM. Analyzed were 113,336 patients with DM (mean age 52 y, HbA1c 7.2%) without prior treatment-requiring diabetic eye disease (TRDED), dialysis, coronary artery disease (CAD), cerebrovascular disease (CVD), heart failure (HF) or amputation. Patients were divided into 6 categories according to BMI or WC (Table). Risk of diabetic complications was analyzed by a multivariate Cox regression model. High BMI was associated with an increased risk of HF but decreased risk of TRDED and initiation of dialysis. Conversely, low BMI was associated with a reduced risk of CAD but increased risks of initiation of dialysis, CVD and HF. A U-shaped relationship between HF and BMI was observed. Risk of amputation was not significantly associated with BMI and initiation of dialysis. Results for WC were similar to those for BMI. The relationship between BMI or WC and the risk of diabetic complications differed greatly among complications, suggesting that the target weight should be individualized according to complications most likely to occur.

Disclosure

Y. Yaguchi: None. K. Fujihara: None. M.H. Yamada: None. Y. Matsubayashi: None. T. Yamada: None. M. Kitazawa: None. M. Yamamoto: None. S. Kodama: None. H. Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kowa Company, Ltd., Kyowa Kirin Co., Ltd., Eisai Inc., Sumitomo Dainippon Pharma Co., Ltd.
1365-P: Key Characteristics and Predictive Ability for HbA1c Improvement—A Latent Class Analysis of 912 Patients
Authors: GAN YU , LENG LOW LIAN , HENG KWAN YU
Published: June 2024

Introduction & Objectives: Type 2 Diabetes Mellitus (T2DM) strains healthcare. As mobile health (mHealth) interventions gain prominence in T2DM self-management, understanding the HbA1c response of diverse patient subgroups is crucial. This study aimed to classify T2DM patients into distinct latent classes and assess their predictive ability for 12-month HbA1c reduction.

Methods: Latent class analysis was applied to 912 T2DM patients using Fitbit-measured step tracker, aged ≥ 40 years old with HbA1c ≥ 7%. Exclusion criteria involved insulin treatment and cognitive impairment. Indicators comprised patients’ use of mHealth interventions, age, education, living arrangement, baseline levels of HbA1c, step count, and motivation (Patient Activation Measure). 12-Month HbA1c reduction was assessed with regression models.

Results: Within cohort (mean [SD] age 55.5 [7.6] years old; 55.9% male; 61.2% Chinese, 25.3% Malay, 9.8% Indian), Class 3 had the most significant HbA1c improvement, while lower baseline HbA1c and motivation suggest the contrary. Class 4, despite high baseline HbA1c, exhibited a significantly lower HbA1c improvement (Table 1).

Conclusion: Younger patients who are motivated and educated are most likely to be tech savvy to use and benefit from mHealth interventions. Patients with poorer control can make a more significant improvement in HbA1c through behavioural change.

Disclosure

Y. Gan: None. L. Low: None. Y. Kwan: None.

Funding

AI Singapore Programme (AISG-GC-2019-001-2A); Singapore Ministry of Health's National Medical Research Council (HCSAINV21jun-0004)
1370-P: The Association between Fatty Liver Disease Remission and Food Consumption among Chinese Adults—A Prospective Cohort Study
Authors: YI NING , DEHAO ZHANG , BI BO
Published: June 2024

Background and Aims: Diet as a modifiable factor for remission of fatty liver disease (FLD) is rarely investigated. Therefore, this study investigated the association between FLD remission and 18 food items consumption.

Methods: This is a prospective open cohort study. Participants included 11,927 health examination participants from the Beijing MJ healthcare aged ≥ 18 years with diagnosis of FL by abdominal ultrasound examination at baseline. Semi-quantitative food frequency questionnaire was used to assess 18 food items intake during the follow-up. The percentage of energy from food items were divided by quartile. Hazard ratios (HRs) and 95% CIs of FLD remission across food items consumption were estimated with Cox proportional hazard regression models, adjusted for age, sex, total energy, and major confounding factors, and further stratified by non-alcoholic fatty liver disease (NAFLD).

Results: During a median follow-up of 1.3 years (interquartile range, 1.0-2.5), 4,541 individuals occurred FLD remission. The HRs (95%CI) for FLD remission comparing the highest with the lowest quartile of food items group were 1.19(1.09-1.30) for milk, 1.15(1.06-1.26) for eggs, 0.89(0.82-0.98) for fishery products, 0.89(0.82-0.98) for dark green vegetable, 1.19(1.09-1.31) for bread, 0.83(0.76-0.90) for sugar sweeten beverage, 0.82(0.74-0.91) for ultra processed food. Egg, fishery products, dark green vegetable, bread, and ultra processed food were all displayed linear dose-response relationships with FLD remission (P for non-linearity >0.05). Similar results were found by NAFLD.

Conclusions: A high intakes from milk, egg, dark green vegetables, and bread, and a low intakes from fishery products, sugar-sweetened beverages, and ultra-processed food can independently improve fatty liver. These findings emphasize that patients can modify their dietary intake to alleviate FLD.

Disclosure

N. Yi: None. Z. Dehao: None. B. Bi: None.

Funding

Research Foundation for Advanced Talents of Hainan (820RC649)
1371-P: Examining Correlates of MyPlate Awareness and Use in Adults with Prediabetes in the United States
Authors: FOLIVI KEVIN , ANGUZU RONALD , WYCKOFF CARLIE , WALKER REBEKAH J.
Published: June 2024

Objective: Given that 38% of adults in the United States have pre-diabetes, there is a demand for culturally tailored nutrition education as an effective intervention. The MyPlate system introduced by the USDA offers customizable portion control guidance. This study investigates correlates of MyPlate use among US adults aged 20 and older with pre-diabetes.

Methods: Weighted National Health and Nutrition Examination Survey data from 2017 to March 2020 were analyzed. Pre-diabetes was defined as individuals with HbA1c between 5.7% to 6.4% and having answered no if ever been told they had diabetes. Outcome was defined as indicating yes to awareness of MyPlate and no to use of MyPlate. Logistic regression was run with age, sex, race/ethnicity, insurance status, BMI, food insecurity, hypertension, and high LDL as possible correlates.

Results: Among 5,610 adults aged ≥20, prevalence of pre-diabetes was 21.2%. Among 2,359 adults who heard of MyPlate, 67.4% used it. Correlates of awareness of MyPlate but lack of use included age (60-80 years 0.52, 95%CI 0.29,0.93), female (0.37 and 95%CI 0.24,0.57), non-Hispanic Black (0.38 and 95%CI 0.19,0.75), and food-insecurity (2.10 and 95%CI 0.99,4.47).

Conclusions: Findings suggest tailoring MyPlate education to offer culturally relevant strategies for older adults, women, non-Hispanic black adults, and food-insecure individuals may be an effective strategy for improving outcomes for adults with pre-diabetes.

Disclosure

K. Folivi: None. R. Anguzu: None. C. Wyckoff: None. R.J. Walker: None.
1410-P: Natural History and Progression of Liver and Cardiac Health in Older Adults, a UK Biobank Study
Authors: DIAMOND CHARLIE , MCGONIGLE JOHN , JAYASWAL ARJUN , GATTU SUREKA , PANDYA PRASHANT , THOMAIDES-BREARS HELENA B. , DENNIS ANDREA
Published: June 2024

Surveillance of cardiovascular and renal health is often prioritised in the care of diabetes with liver health often under recognised. We sought to determine how characteristics of the liver and heart progress over time in older adults from the general UK population, using quantitative magnetic resonance imaging. Clinical and imaging data were acquired on 2325 volunteers from the UK Biobank at two visits approximately 2.2 years apart between 2017 and 2021. Liver MRI scans were analysed using LiverMultiScan (for fat, iron content and disease activity, measured by iron-corrected T1, cT1). Paired cardiovascular magnetic resonance data for left ventricular ejection fraction (LVEF) was available on a subset of 709 volunteers. For groupwise statistical comparisons, Wilcoxon rank sum tests were applied for continuous variables and Fishers exact tests for categorical variables. At baseline, the 2325 volunteers were characterised by the following demographics: mean age 63 (SD 7) years, 48% male, mean BMI 26 (SD 4) kg/m2, 15% obese, 4.1% self-reported diabetic and 24% self-reported hypertensive. Elevated liver fat was common with a prevalence of 25%. Liver disease activity was rare in this cohort, mean liver cT1 was 694ms with only 3.4% abnormally high (≥800ms) and 2.9% with steatohepatitis. Mean liver iron levels were 1.24mg Fe/g (2% clinically high). Mean LVEF was 56% at baseline and abnormally low in 10%. At follow-up 2.2 years later, we observe no overall significant changes in prevalence of diabetes, BMI, liver fat, liver iron content or LVEF values. Overall, liver cT1 significantly increased by a mean of 5ms (SD 32) (p = <0.001). Although significant, this increase is not clinically meaningful, except in 9% with increases above and 5% decreases below the repeatability coefficient. This longitudinal dataset provides evidence for the stability of quantitative liver (cT1, fat and iron) and cardiac (LVEF) MRI metrics in a low disease population of older adults, to power future studies.

Disclosure

C. Diamond: Employee; Perspectum Ltd. J. McGonigle: Employee; Perspectum Ltd. A. Jayaswal: Employee; Perspectum Ltd. Stock/Shareholder; Perspectum Ltd. S. Gattu: None. P. Pandya: Employee; Perspectum Ltd. H.B. Thomaides-Brears: Employee; Perspectum Ltd. Stock/Shareholder; Perspectum Ltd. A. Dennis: Employee; Perspectum Ltd.
1420-P: Global Burden and Trend of Type 2 DM in 38 OECD Countries from 1990–2019—A Benchmarking Systematic Analysis
Authors: MARKANDU KEETHANSHAN , DEKHNE ANUSHKA , ISLAM HAMZA , ISLAM RABIA , MADDINENI KAVYA , POTLURI GEETHIKA , PARISAPOGU ANUSHA , TEJA CHINTHAPALLI MRUNAL , DINESHBHAI DESAI HARDIK
Published: June 2024

Introduction: Type 2 Diabetes Mellitus (T2DM) is a significant public health concern across the world, notably as the 8th leading cause of death after Colorectal cancer in OECD countries in 2019.

Method: Using the Global Burden of Disease approach, this study analyzes T2DM in terms of incidence, prevalence, mortality, and DALYs over 30 years (1990-2019) across 38 OECD countries, stratified by age, sex, year, and location.

Results: The study shows a significant increase in T2DM from 1990-2019: the annual percentage of change (APC) in prevalence of cases surged by 147%, deaths rose by 60%, and DALYs doubled. Notably, Latvia experienced the highest rise in T2DM-related deaths (347%), followed by the Republic of Korea (279%). The highest incidence rates were observed in Luxembourg (439%) and Ireland (411%). The data indicates a consistently higher burden of T2DM on males compared to females over the past three decades. Additionally, individuals under 70 years of age saw a 34% increase in T2DM-related deaths, whereas those aged 70 and above experienced a 74% rise from 1990 to 2019.

Conclusion: In 2019, T2DM accounted for 2.67% of deaths from all causes. The findings underscore the urgent need for targeted public health interventions, especially in lower-resource countries. Clinicians are advised to closely monitor the ongoing burden of T2DM and to implement preventive measures and surveillance strategies.

Disclosure

K. Markandu: None. A. Dekhne: None. H. Islam: None. R. Islam: None. K. Maddineni: None. G. Potluri: None. A. Parisapogu: None. M. Chinthapalli: None. H. Desai: None.
1426-P: Type 2 Diabetes Phenotypes and Their Association with Mortality in South Asians—Findings from the Center for Cardiometabolic Risk Reduction in South Asia (CARRS) Study
Authors: TIWARI PRADEEP K. , MOHAN ANJANA RANJIT , JAGANNATHAN RAM , KONDAL DIMPLE , DEEPA MOHAN , GUJRAL UNJALI , WALIA GAGANDEEP K. , RADHA VENKATESAN , PANDEY RAJESH , SENGUPTA SHANTANU , SUN YAN , ALI MOHAMMED K. , PRABHAKARAN DORAIRAJ , MOHAN VISWANATHAN , TANDON NIKHIL , VENKAT NARAYAN K M
Published: June 2024

Background: Characterizing heterogeneity of type 2 diabetes (T2D) is essential for precision diabetes. We investigated phenotype clusters within T2D and their associations with mortality in South Asians.

Methods: In 2,639 individuals diagnosed with T2D from the CARRS cohort, we characterized T2D phenotypes by applying k-means clustering on age at diabetes diagnosis, BMI, HbA1c, HOMA-B, and HOMA-IR. All-cause mortality outcomes within these phenotypes were assessed over a median follow-up of 11-years using the Cox proportional hazard model.

Results: Three distinct phenotypes were identified: Mild Obesity-related Diabetes (MOD; 22.6%), characterized by high BMI but good HbA1c control; Mild Insulin Deficient Diabetes (MIDD; 54.5 %), observed in older individuals with lower BMI, lower HbA1c, and mild insulin deficiency; and Severe Insulin Deficient Diabetes (SIDD; 22.9 %) characterized by young age of onset of diabetes and severely impaired beta-cell function. Compared to individuals with normal glucose tolerance, SIDD exhibited the highest mortality rate followed by MIDD and MOD (Table).

Conclusion: Our data indicate that insulin deficiency phenotypes (MIDD and SIDD) are the primary drivers of T2D in South Asians and account for 82.5% of mortality.

Disclosure

P.K. Tiwari: None. R. Anjana: None. R. Jagannathan: None. D. Kondal: None. M. Deepa: None. U. Gujral: None. G.K. Walia: None. V. Radha: None. R. Pandey: None. S. Sengupta: None. Y. Sun: None. M.K. Ali: Advisory Panel; Eli Lilly and Company. D. Prabhakaran: None. V. Mohan: None. N. Tandon: None. K. Narayan: None.

Funding

National Institutes of Health (P01HL154996)
1449-P: Identification of Type 1 Diabetes by an Electronic Health Records Algorithm from the CURE-CKD Registry
Authors: GREENBAUM CARLA , REYNOLDS CHRISTINA L. , JONES CAMI , KORNOWSKE LINDSEY , DARATHA KENN B. , ALICIC RADICA Z. , NEUMILLER JOSHUA J. , TUTTLE KATHERINE R.
Published: June 2024

Introduction & Objective: Electronic health records (EHR) are a valuable source of real-world data for clinical research. Reliable methods are needed to identify type 1 diabetes (T1D) by EHR. The study aim was to develop an EHR algorithm for T1D using diagnosis codes and clinical characteristics validated by manual chart review.

Methods: Data from the Center for Kidney Disease Research, Education, and Hope (CURE-CKD) Registry were used to identify persons ≥12 years of age with T1D by diagnosis codes, ketoacidosis encounters, insulin pump and short-acting insulin use during 2013-2022. Manual chart review was performed on a subset of 100 participants to verify selection criteria; 40 from “very likely” category, 40 from “likely” category, and 20 from “unlikely”.

Results: T1D cohorts (N=31,695) were divided into likelihood categories based on confirming criteria (Figure). The cohort was 48.5% female and 75.7% White race identity. Their mean±SD for age was 42±19 years with HbA1c 8.2±2.1% and BMI 27.5±6.3 kg/m2. Positive predictive values were 100% for very likely, 98% for likely, and 40% for unlikely categories.

Conclusions: T1D can be reliably identified by the CURE-CKD algorithm using clinical EHR data. Pending further validation, this algorithm can be used for T1D cohort selection in real-world studies of epidemiology, diagnosis, and treatment.

Disclosure

C. Greenbaum: Other Relationship; Sanofi, Takeda Pharmaceutical Company Limited, Bristol-Myers Squibb Company, Imcyse. C.L. Reynolds: None. C. Jones: None. L. Kornowske: None. K.B. Daratha: None. R.Z. Alicic: Advisory Panel; Bayer Inc., Boehringer-Ingelheim. Research Support; AstraZeneca, Bayer Inc., AstraZeneca, Novo Nordisk, Traveere Pharmaceuticals. J.J. Neumiller: Advisory Panel; Bayer Inc., Boehringer-Ingelheim, Eli Lilly and Company, Proteomics International. K.R. Tuttle: Consultant; Lilly Diabetes. Research Support; Boehringer-Ingelheim. Consultant; AstraZeneca. Research Support; Novo Nordisk, Bayer Inc., Traveere Pharmaceuticals. Consultant; Pfizer Inc.

Funding

CDC (75D301-21-P-12254)