bluuebunny/crossref_metadata_2025 huggingface dataset:
1138-P: Empagliflozin Ameliorates Kidney Injury in Diabetic Nephropathy via SIRT1 and TXNIP
Authors: LIANG RIYING , WANG MEIJUN , XU FEN , CAI MENGYIN
Published: June 2020

SGLT2 inhibitor empagliflozin can slower the decline of eGFR and reduce the occurrence rate of end-stage kidney disease according to EMPA-REG OUTCOME Clinical Trail. However, the mechanism is still poorly understood. Sirtuin 1 (SIRT1) and Thioredoxin-interacting protein (TXNIP) are known to play important roles in metabolism-related disease, including diabetic nephroathy. To illustrate whether SIRT1 and TXNIP play roles in empagliflozin ameliorates high-fat diet induced kidney injury. In our study, the mouse mesangial cell SV40 MES 13 was cultured in 5.6 mmol/L glucose (NG)or 30mmol/L glucose(HG) with or without 50,250,500 or 1000nmol/L empagliflozin (HG+Empa-50; HG+Empa-250; HG+Empa-500;HG+Empa-1000) for 48 hours. Western Blot analysis showed that empaglifozin (500 nmol/L and 1000 nmol/L, respectively) could reverse the protein of Cleaved caspased3 expression induced by HG in SV40 MES 13 cells. In addition, empaglifozin significantly decreased TXNIP(50,250,500 and 1000 nmol/L, respectively) and increased SIRT1 protein levels(50,250,500 and 1000 nmol/L, respectively) in HG-induced SV40 MES 13 cells. Above all, when we treat cells with empaglifozin(500nmol/L and 1000nmol/L), the apoptosis was ameliorated and the expression of SIRT1,TXNIP was reversed that induced by HG. Collectively, the data indicates that the effect of empaglifozin on renoprotection is correlated with ameliorating the apoptosis in the kidney which may be via SIRT1 and TXNIP.

Disclosure

R. Liang: None. M. Wang: None. F. Xu: None. M. Cai: None.
1185-P: A Telemedicine-CGM Recommendation System for Personalized Population Health Management
Authors: VALLON JACQUELINE , WARD ANDREW T. , PRAHALAD PRIYA , HOOD KOREY K. , MAAHS DAVID M. , SCHEINKER DAVID
Published: June 2020

CGM technology allows care teams to remotely monitor glucose levels of people with diabetes. Provider availability to monitor and contact people is limited. Individuals respond differently to CGM review calls; some people improve glucose control while others disengage. No mathematical framework exists to optimize population-level care while accounting for provider constraints and differences in people’s responses. We hypothesize that a care team’s call schedule can be optimized using predictive modeling and personalized recommendations.

We designed a recommendation tool that ranks people based on expected improvement in glucose management due to a call, incorporating people’s responsiveness. Individuals’ short- and long-term improvements after simulated previous calls were used to calculate the expected decrease in mean glucose due to a new call.

The tool is designed with 724,672 hours of CGM data from 120 individuals with T1D (63% new diagnosis, 57% ≤ 18 years), through Tidepool. For a daily capacity of 5 calls, the recommendation has a 29.1 mg/dL expected decrease in mean glucose in contacted people, while current practice has a 4.7 mg/dL decrease.

The tool allows for customizable care team constraints and adaptively learned responsiveness parameters. CGM and call data are currently being collected from pediatric patients with newly diagnosed T1D in our clinic, to tune and test the tool in a clinical setting.

Disclosure

J. Vallon: None. A.T. Ward: None. P. Prahalad: None. K.K. Hood: Research Support; Self; Dexcom, Inc. Speaker’s Bureau; Self; LifeScan, Inc., MedIQ. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care. D. Scheinker: None.
1189-P: Real-World Factors Associated with Use of Basal Insulin and Hypoglycemia in the Inpatient Setting
Authors: PANDYA ANJANI , NGUYEN STEFFANY , SALDIVAR VIDYA , SADHU ARCHANA R.
Published: June 2020

Per current guidelines, our institution advocates using basal-bolus insulin regimens for inpatient hyperglycemia. However, it is a challenging practice in the real-world setting. Hypoglycemia is an unwanted consequence and a national quality metric for hospitals. We sought to characterize the factors around use of basal insulin and hypoglycemic events (HE) in our hospital system for quality improvement and to develop preventative strategies.

Between April-June 2018, 4130 admissions receiving basal insulin (glargine, NPH, or Mixed 70/30, 75/25) were retrospectively reviewed for HE, defined as glucose <70 mg/dl. ICU and non-ICU patients were included. Insulin infusion or insulin pump therapy was excluded. Median age was 66 years, 48% were male and median A1C was 7.8%. In the entire cohort, 22% (923) had >/= 1 HE. Of those, 76% had 1-3 HE and 24% had >/= 4 HE per admission. The frequency of basal insulins were 75% glargine, 18% NPH, and 6% Mixed. Within 24 hours of the first HE, insulin dose was decreased in 42% receiving glargine, 66% NPH, and 59% mixed insulin by an average of 23%, 23% and 11%, respectively. Oral antidiabetic agents (OADs) were used concurrently in 16% of admissions with HE, of which sulfonylureas (SU) represented 43%, metformin 25%, and DPP-4i 26%. At the time of the HE, patients were on an oral diet in 73% of admissions, TPN or tube feeds in 6%, and NPO in 12%. In 75% of the HE, basal insulin was administered without the use of guideline-based hospital order sets and 83% of HE did not have an endocrinology consultation.

Our analysis demonstrates several key issues that need to be addressed around the recommended practice of basal insulin in the hospital setting. Among them, inadequate response in dose reduction after the first HE, underutilization of standardized order sets, concurrent use of OADs, particularly SU, add risk for HE. Endocrinology consultation is low, and the complicated nature of a basal-bolus insulin regimen as well as the many variables involved remain real world challenges.

Disclosure

A. Pandya: None. S. Nguyen: None. V. Saldivar: None. A.R. Sadhu: None.
120-LB: Small Molecule Activator of Pyruvate Kinase Regulates In Vivo Glucose Homeostasis
Authors: ABULIZI ABUDUKADIER , CARDONE REBECCA L. , SIEBEL STEPHAN , KUNG CHARLES , KIBBEY RICHARD
Published: June 2020

Background: Nonalcoholic fatty liver disease (NAFLD) is a major factor in the pathogenesis of type-2 diabetes (T2D). Liver pyruvate kinase (PK) inactivating mutations are associated with diabetes in human subjects and PK deficiency associated with severe liver dysfunction and fat accumulation.

Aim: To determine whether small molecule activators of PK (PKa) could improve liver metabolism in rats fed a high fat diet.

Methods: Sprague Dawley regular chow (RC) or high fat diet (HFD) rats were either treated acutely (IV bolus 11mg/kg/min then primed continuous 0.06 mg/kg/min) or chronically (50 mg/kg/day x 3 weeks). Insulin sensitivity was assessed by hyperinsulinemic-euglycemic clamp studies.

Results: PKa dose dependently suppressed glucose production from primary rat hepatocytes. Acute PKa infusion suppressed endogenous glucose production (EGP) by 20% in RC rats. Chronic PKa exposure did not affect body weight in HFD-fed rats. Three-week PKa treatment did not change activity, food intake, whole-body energy expenditure, or body weight in HFD-fed mice. Nevertheless, PKa improved whole-body insulin sensitivity compared with control HFD-fed rats (glucose infusion rate: control 11.8±1.4 vs. PKa 15.3±0.7 mg/(kg-min), P<0.05). Differences in whole-body insulin sensitivity were accounted for by a 15% reduction in EGP and increased insulin-stimulated peripheral glucose uptake (21.2±0.6 vs. 26.4±1.7 mg/(kg-min), P<0.05). Insulin-stimulated hepatic AKT phosphorylation was also significantly improved. Consistent with improving of peripheral insulin sensitivity, liver and muscle triglyceride content (liver: 27.2±2.6 vs. 16.9±1.5 mg/g, P<0.05. muscle: 9.8 ±1.4 vs. 6.7±1.0 mg/g, P<0.05) were improved in PKa-treated rats.

In conclusion, activation of pyruvate kinase in rodents protects against HFD-induced insulin resistance. By reducing EGP and insulin resistance, activation of PK may be an exciting potential therapeutic target for T2D.

Disclosure

A. Abulizi: None. R.L. Cardone: None. S. Siebel: None. C. Kung: Employee; Self; Agios Pharmaceuticals. Stock/Shareholder; Self; Agios Pharmaceuticals. R. Kibbey: None.

Funding

American Diabetes Association (1-16-IBS-158 to R.K.); National Institutes of Health (R01DK108283-01A1)
1206-P: Preventable and Other Emergency Department Use in Adults with and without Diabetes, 2009-2017
Authors: UPPAL TEG S. , HAW JEEHEA SONYA , SHAH MEGHA K. , TURBOW SARA , NARAYAN VENKAT K.M. , ALI MOHAMMED K.
Published: June 2020

There are limited data comparing trends in overall and potentially preventable emergency department (ED) visits between adults with and without diabetes. We analyzed data from the Medical Expenditure Panel Survey and pooled cohorts for years 2009-12 and 2014-17. We identified adults with diabetes by self-report, diabetes-specific ICD-codes, or prescriptions for antidiabetic agents. Potentially preventable visits were identified using ICD-codes specific to Ambulatory Care Sensitive Conditions (ACSCs), a list of conditions that can be prevented by primary care interventions (e.g., Urinary Tract Infection, Heart Failure, and Bacterial Pneumonia). We used event-level data to estimate weighted age- and sex-adjusted rates of average annual ED visits per 1000 persons and calculated standardized rate ratios by years and diabetes status. Compared to 2009-12, rates of ED use were higher among adults without diabetes in 2014-17 compared to 2009-12 (RR: 1.11). Compared to 2009-12, adults with diabetes in 2014-17 had no significant change in rates of ED use. In 2014-2017, compared to adults without diabetes, those with diabetes had twice the rate of ED service use (RR: 2.07) and had a 47% higher rate of preventable visits (RR: 1.47). Further research is required to understand factors that might be associated with the higher rates of ED use among people with diabetes.

Disclosure

T.S. Uppal: None. J. Haw: None. M.K. Shah: None. S. Turbow: Research Support; Self; Gilead Sciences, Inc. K. Narayan: None. M.K. Ali: Research Support; Self; Merck & Co., Inc.
1237-P: The Type 1 Diabetes Identification Initiative: Improving the Care of Inpatients with Type 1 Diabetes
Authors: LOVERIDGE REBECCA , TORKAMANI NILOUFAR , PATTERSON SIMONE L. , CHURILOV LEONID , EKINCI ELIF I.
Published: June 2020

Background: Specialist care may improve outcomes for inpatients with diabetes. However, research specific to type 1 diabetes (T1D) is lacking. We aimed to investigate whether automatic alerts from the Electronic Medical Record (EMR) enable prompt review of inpatients with T1D by a specialist diabetes team.

Methods: The type 1 diabetes identification (“T1DI”) initiative was established to improve identification and review of inpatients with T1D by a specialist diabetes team. A specific T1DI code was entered into the EMR of patients with T1D. On subsequent admission, the specialist diabetes team received an automatic message and generated a list of inpatients requiring review. “T1DI” admissions of more than 1-day were analysed over a 1-year period (1 January-31 December 2018). The control group was T1D admissions as coded by health information services following discharge. Analysis was performed for patients admitted to units other than endocrinology to investigate review outcomes. Data was analysed using Chi2 (categorical), Wilcoxon rank sum (continuous) and random effects logistic or negative binomial regression models.

Results: There were 136 admissions of adults with T1D over the study period (T1DI n=67, control n=69). The median age was 49 (IQR 33-64) years; 53% were females. Specialist diabetes team review was more common in the T1DI cohort compared to the control group (endocrinology review AOR 10.27, CI 2.26-46.55, P=0.003; diabetes education review AOR 7.22, CI 2.73-19.10, P<0.001). Prompt endocrinology review (no later than day 2 of admission) was more likely in T1DI inpatients (AOR 2.77, CI 1.15-6.65, P=0.023).

Conclusion: The T1DI initiative was associated with improvements in occurrence and timing of specialist diabetes team review for inpatients with T1D. This initiative could be implemented in other hospitals with EMR systems, enabling more effective identification and management of T1D in the inpatient setting.

Disclosure

R. Loveridge: None. N. Torkamani: None. S.L. Patterson: None. L. Churilov: None. E.I. Ekinci: None.
1281-P: Pilot Study on the Feasibility of Weekly CGM Data Review in Youth with New-Onset Type 1 Diabetes
Authors: LEE MING YEH , LEVERENZ JEANNINE , LEVERENZ BRIANNA , PAGELER NATALIE M. , SCHEINKER DAVID , MAAHS DAVID M. , PRAHALAD PRIYA
Published: June 2020

Despite advances in diabetes technology and treatment, many youth with type 1 diabetes (T1D) continue to have hemoglobin A1c (HbA1c) above target. Consistent use of continuous glucose monitors (CGM) improves HbA1c and time in range (TIR 70-180 mg/dl) glucose, while minimizing hypoglycemia in youth with T1D. A previous study suggested that long-term HbA1c outcomes may be determined early in the course of T1D. Thus, increased awareness of glucose trends and frequent insulin dose adjustments early in the course of T1D is hypothesized to improve long-term HbA1c and health outcomes. We have initiated CGM in the first month of T1D diagnosis. In March 2019, we added weekly remote review of CGM data by a pediatric endocrinologist or certified diabetes educator to provide dose adjustments. Data sharing is facilitated by using a custom platform including Apple HealthKit to transmit data from the Dexcom G6 mobile app to Epic MyChart. Inclusion criteria were diagnosis of T1D within the past 30 days and intention to follow in our clinic. During the initial 8 months of this study, we enrolled 43 youth (age at diagnosis 9.2±4.2 years, 57% male, 78% on private insurance, 42.5% non-Hispanic White, initial HbA1c 12.0±2.0%). Twenty-eight youth had at least 1 documented data review with an average of 15.8±8.1 reviews/patient and 5.4 dose adjustments/youth (∼1 dose adjustment every 3 weeks) via phone calls or secure MyChart messages. Based on CGM downloads, users had a high percentage of time of CGM wear (88±11% of time over 2-week periods), high percentage of TIR glucose (72.2±18.4%), and low incidence of hypoglycemia (32±54 min/day, 2.2±3.8%). This pilot study demonstrates that implementing routine data review as part of a new onset program increases the frequency of insulin dose adjustments. Tools should be developed to allow for efficient data review for population health management. Further follow up is needed to determine long-term outcomes, scalability, and sustainability of this new onset program.

Disclosure

M. Lee: None. J. Leverenz: None. B. Leverenz: None. N.M. Pageler: None. D. Scheinker: None. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care. P. Prahalad: None.

Funding

Stanford Diabetes Research Center (P30DK116074)
1287-P: Psychosocial and Racial Predictors of Hemoglobin A1c in Teenagers with Type 1 Diabetes Mellitus
Authors: GUARNERI ALISSA , SINHA SUNIL K. , HONG K. MING , HOFFMAN ROBERT P.
Published: June 2020

Background: Glycemic control (HbA1c) in teens with type 1 diabetes mellitus (T1DM) can be affected by several variables including race, insurance type, depression (PHQ-9 score), and diabetes distress (Paid-T score). This analysis sought to explore how these variables interact to affect HbA1c.

Methods: 301 patients with T1DM age 13 years and older were grouped by race (white = W, African American = AA, bi-racial = BR) and by insurance type (State Insurance = SI, or Private Insurance = PI). Mean HbA1c values were calculated according to race and insurance type. Analysis of Variance (ANOVA) testing was done to evaluate for any differences in HbA1c and race. Tukey’s Test was then performed to evaluate for a statistical difference between individual race variables (W, AA, BR).

Results: Mean HbA1c significantly varied by race (W 8.7 ± 0.1, AA 10.3 ± 0.5, BR 8.8 ± 0.5%, p<0.001 (mean ± SEM)). Tukey’s Test proved a statistically significant difference in HbA1c in AA compared with W (p<0.001) and in AA compared with BR (p=0.036), however there was not a significant difference in HbA1c in W compared with BR (p=0.976). HbA1c also differed in those with PI (8.3 ± 1.6) versus SI (9.7 ± 2.3), p<0.001 (mean ± SD). Diabetes distress scores (30.4 ± 16.3 in SI, 25.1 ± 13.2 in PI) and depression scores (4.6 ± 5.0 in SI, 2.3 ± 3.5 in PI) were greater in patients with SI versus PI, however there were no racial differences. ANOVA testing showed that there is no racial difference in depression score (p=0.284) or in distress score (p=0.201). When all factors were considered together, insurance status and distress score had the highest impact on HbA1c (p<0.001), depression score had a mild impact (p=0.02), and race was not significant (p=0.08).

Discussion: These results demonstrate that psychological factors such as diabetes distress and depression, and socioeconomic factors such as insurance status, have a bigger impact on HbA1c than race in teens with T1DM.

Disclosure

A. Guarneri: None. S.K. Sinha: None. K. Hong: None. R.P. Hoffman: Research Support; Spouse/Partner; Provention Bio, Inc.
1319-P: Evaluation of Engagement with an Incentivized Text Messaging (TM) Intervention in Teens with T1D and Suboptimal Glycemic Control
Authors: KAUSHAL TARA , LIPMAN TERRI , KATZ LORRAINE E. , LAFFEL LORI M.
Published: June 2020

Background: Among digital health interventions, TM can be a useful tool in teens with T1D. However, attrition remains a major issue, with engagement decreasing over time. We aimed to describe patterns of engagement in an incentivized TM intervention and to assess impact of engagement on A1C in teens with T1D and suboptimal control randomized to the TM arm.

Methods: Of 165 teens (12-18 years old, T1D duration >1 year, A1C ≥8%) recruited into a 6-month RCT, 83 were assigned to TM intervention and received daily educational/motivational TMs using the MyDiaText™ platform. Socio-demographic and clinical data were obtained from medical record review. Participants were rewarded biweekly for the most consecutive TM responses. TM response rate (RR) was defined as number of responses/total messages received. High RR was defined as >50%. Paired t-tests, ANOVA, and Pearson correlation were used in statistical analysis.

Results: At entry, teens (57% males, 52% white) had a mean(±SD) age of 16±2 years, T1D duration 7±4 years; 55% were pump-treated, 65% used CGM, and A1C was 10±1.9%. Clinical concerns for depression were seen in 28%. The mean overall RR was 58.6%(±28.9%), and the high RR group included 66% of participants. High and low RR groups did not differ by sex, race, age, T1D duration, use of technology, baseline A1C, or clinical depression. Over the 6 months, A1C improved significantly to 9.2±1.8% (p=0.00), with 35% improving by ≥1%. High responders were twice as likely to improve A1C by ≥1% than low responders (p=0.18). There was a significant decline in RR over time (r2=0.9, p=0.00).

Conclusions: In teens with T1D and suboptimal control, socio-demographic factors did not predict engagement with a financially incentivized TM intervention. However, high responders tended to improve their A1C, likely due to increased engagement in self-care. There remains a need to create a digital health intervention that maintains engagement over extended periods for teens with T1D.

Disclosure

T. Kaushal: None. T. Lipman: None. L.E. Katz: None. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US.

Funding

National Institutes of Health (P30DK036836, K12DK094721, 2T32DK063688)
1337-P: Metabolomic Profile Associated with Obstructive Sleep Apnea Severity in Obese Pregnant Women with Gestational Diabetes
Authors: REUTRAKUL SIRIMON , CHIRAKALWASAN NARICHA , CHAROENSRI SURANUT , AMNAKKITTIKUL SOMVANG , SAETUNG SUNEE , CHEN HUI , CHLIPALA GEORGE E.
Published: June 2020

Background: Obstructive sleep apnea (OSA) is prevalent in obese women with gestational diabetes (GDM). In non-pregnant population, metabolomics profiles have been shown to differ between those with and without OSA. This study explored associations between OSA severity and metabolites in women with GDM.

Methods: Eighty-two obese women with diet-controlled GDM had OSA assessment by a home monitor (mean gestational age, GA, 28 weeks). OSA severity was assessed by apnea hypopnea index (AHI). Metabolic profile was assayed from fasting serum samples via LC-MS using an untargeted approach. The metabolites were extracted and subjected to an Agilent 1290 UPLC coupled to an Agilent 6545 Q-TOF MS. Data were acquired using electrospray ionization (ESI) in positive and negative ion modes. The raw LC-MS data were processed using the OpenMS toolkit to detect and quantitate features and these LC-MS features were annotated using the Human Metabolite Database (HMDB) as a reference. The feature data were compared with OSA status, AHI, BMI and GA using limma in R. Correlation analyses of the continuous covariates (AHI, BMI, GA) were performed using Kendall’s Tau test. P-values were adjusted for multiple testing using Benjamini-Hochberg’s FDR correction.

Results: Forty-three women (52.4%) had OSA, with a median AHI of 9.4. There were no significant differences in metabolomics profiles between those with and without OSA. However, differential analyses modeling in GA and pre-pregnancy BMI found 12 features that significantly associated with AHI. These features could be annotated to estradiols and phospholipids (e.g., Lysophospholipids, long-chain acyl carnitine, methyl-branched fatty acids) with higher levels related to higher AHI.

Conclusion: Biomarkers including estradiols and phospholipids may be involved in pathogenesis of OSA in pregnant women with GDM. Targeted approach may help further identify these metabolites to better understand their role in OSA in this population.

Disclosure

S. Reutrakul: None. N. Chirakalwasan: None. S. Charoensri: None. S. Amnakkittikul: None. S. Saetung: None. H. Chen: None. G.E. Chlipala: None.

Funding

National Center for Advancing Translational Sciences (UL1TR002003); Mahidol University
1343-P: Objectively Measured and Self-Reported Physical Activity in the First Trimester of Pregnancy, Glucose Tolerance, and Gestational Diabetes in Women with Overweight/Obesity
Authors: EHRLICH SAMANTHA F. , HEDDERSON MONIQUE M. , BROWN SUSAN D. , CROUTER SCOTT E. , HIBBING PAUL , FENG JUANRAN , TSAI AI-LIN , FERRARA ASSIAMIRA
Published: June 2020

Data on physical activity (PA) and the risk of gestational diabetes (GDM) are inconsistent. We examined whether physical activity (PA) during the first trimester of pregnancy was associated with glucose tolerance and GDM in women with overweight/obesity. Participants (n=261) were a subsample from the GestationaL Weight Gain and Optimal Wellness (GLOW) trial conducted at Kaiser Permanente Northern California in 2014-2016 to test whether a lifestyle intervention prevents excess gestational weight gain compared to usual care. Participants wore an ActiGraph wGT3X-BT accelerometer for 7 days on the non-dominant wrist to estimate mean daily minutes of moderate to vigorous intensity PA (MVPA), and completed a pregnancy PA questionnaire assessing sports and exercise activity. Plasma glucose values from random 50-g 1-hour glucose challenge tests (GCT) and GDM diagnosed by the Carpenter and Coustan thresholds for the 100-g, 3-hour oral glucose tolerance test were obtained from electronic health records. Associations with PA, by accelerometer and questionnaire (i.e., square root transformed), were estimated by linear and logistic regression models and adjusted for age, race-ethnicity, BMI category, and GLOW randomization (i.e., intervention vs. usual care). Participants had a median 38 minutes per day (IQR= 37) of MVPA by accelerometry and self-reported a median 9 MET hours per week (IQR= 14) of sports and exercise activity on the questionnaire, both assessed at mean 11 weeks’ (SD= 1.4) gestation. Median plasma glucose on the GCT performed at 24-28 weeks’ gestation was 112 mg/dl (IQR= 35); 14 participants (5.4%) developed GDM. Neither PA variable was statistically significantly associated with GCT glucose or GDM (p > .05). Objectively measured MVPA and self-reported sports and exercise activity assessed in the first trimester do not appear to impact glucose tolerance or GDM in women with overweight/obesity.

Disclosure

S.F. Ehrlich: None. M.M. Hedderson: None. S.D. Brown: None. S.E. Crouter: None. P. Hibbing: None. J. Feng: None. A. Tsai: None. A. Ferrara: None.

Funding

National Institutes of Health (K01DK105106)
137-LB: Early Performance Under SGLT2 Inhibitors in High-Risk Patients: EARLY PUSH Study: A Prospective Double-Blind Comparative Study
Authors: DUMARTIN MARINE , FRUNDI DEVINE S.
Published: June 2020

The purpose of this study was to evaluate the changes in physical performance under new treatment with SGLT2 inhibitors during in-patient rehabilitation over 28 days.

The study included 200 patients with type II diabetes mellitus which were divided in 2 groups of 100 patients: the first group was put under SGLT2 inhibitors and the second group had other diabetic regimen without SGLT2 inhibitors. The 6-minute walk test and the modified Borg scale (Range 0 - 10) were used to assess physical performance and the rate of dyspnea.

Compared to baseline, the change in the mean distance covered in the 6 minute walk test at 14 days in the SGLT2-inhibitor group was +70.1 ± 60.9 m vs. + 55.7 ± 64.8 m in the non SGLT2 inhibitor group; p=0.16. At 28 days, change in the first group was +104.5 ± 76.7 m vs. + 80.8 ± 82.9 m in the second group; p=0.03 (Figure 1) The mean modified BORG scale in the first group at baseline was 5.2 ± 2.3 and declined to 4.8 ± 2.1 at 14 days and further declined to 4.2 ± 2.4 at 28 days; p=0.007, whereas in the second group the BORG scale at baseline was 4.4 ± 2.4 and changed to 4.8 ± 2.2 at 14 days and remained unchanged at 4.8 ± 2.4 at 28 days; p=0.23

In conclusion, the introduction of an SGLT2-inhibitor was associated with a measurable improvement in physical performance and concomitant decline in the rate of perceived exertion within the first month despite having inadequate glycemic control at baseline.

Disclosure

M. Dumartin: None. D.S. Frundi: None.
1447-P: Random Glucose May Be an Effective Tool to Screen for Undiagnosed Diabetes: The Africans in America Study
Authors: SHOUP ELYSSA M. , OSEI-TUTU NANA H. , HORMENU THOMAS , HOBABAGABO ARSENE F. , DUBOSE CHRISTOPHER , MABUNDO LILIAN , CHUNG STEPHANIE T. , HORLYCK-ROMANOVSKY MARGRETHE F. , SUMNER ANNE E.
Published: June 2020

The high prevalence of undiagnosed diabetes (DM) in Africa calls for the identification of effective, efficient, and feasible screening tests. Emerging data suggests that random plasma glucose≥100 mg/dL (RPG≥100) may be a valuable screening tool and equivalent to or better than standard ADA criteria, which requires fasting blood samples, knowledge of family history, anthropometrics and blood pressure. Since RPG≥100 as a screening tool for DM has not been tested in Africans, our goals were twofold: first, to compare the diagnostic performance of RPG≥100 to ADA criteria; second, to determine for RPG≥100 the number needed to screen to find a single case of DM. Hence, African-born blacks who self-identified as healthy and were living in America (n=469, 66% male, age: 38±10y (mean±SD), BMI: 27.6±4.5 kg/m2) had random plasma glucose levels measured. One week later, an OGTT was performed. Glucose criteria for the OGTT was used to diagnose DM. Area under the receiver operating characteristic curve (AROC) was used to assess the performance of RPG≥100 and ADA criteria (age≥45y, BMI≥25 kg/m2, HDL<35mg/dL, TG>250mg/dL, SBP≥140mmHg, DBP≥90mmHg, and family history of DM). The number of people needed to screen to correctly identify one case of undiagnosed DM was calculated by the formula: 1/(proportion correctly diagnosed - proportion incorrectly diagnosed). DM was identified in 7% (31/469) of the participants; whereas RPG≥100 occurred in 15% (68/469). For the prediction of DM, RPG≥100 tended to be superior to the ADA criteria (AROC 0.80 vs. 0.68, P=0.09). RPG≥100 was 71% sensitive and 89% specific. ADA criteria was 90% sensitive and 37% specific. For RPG≥100, the number needed to screen to correctly identify a single case of DM was two. Overall, RPG≥100 as a screening tool for DM is effective, more cost-efficient, and less time-consuming than ADA criteria. In short, RPG≥100 may be an important way forward for the detection of DM in Africans and further study is warranted.

Disclosure

E.M. Shoup: None. N.H. Osei-Tutu: None. T. Hormenu: None. A.F. Hobabagabo: None. C. DuBose: None. L. Mabundo: None. S.T. Chung: None. M.F. Horlyck-Romanovsky: None. A.E. Sumner: None.
1457-P: Clinical, Biochemical, and Genetic Profile of Patients with Young-Onset Diabetes in North India
Authors: REDDY PAVAN K. , JEVALIKAR GANESH , SINGHAL ALKA A. , KAUR PARJEET , GUPTA ADITI , MISHRA SUNIL K. , WASIR JASJEET S. , KUCHAY MOHAMMAD S. , BANSAL BEENA , FAROOQUI KHALID , KAUR HARMANDEEP , MITHAL AMBRISH
Published: June 2020

Background: Increasing prevalence of diabetes (type 1 and type 2) and obesity along with declining age of onset of type 2 diabetes, often create a diagnostic error in subtyping patients with young onset diabetes. Correct diagnosis of type of diabetes in this age group has clinical implications for management and longterm prognosis. In this study, we aimed to profile all consecutive young onset diabetes patients with respect to their clinical, biochemical, and genetic characteristics.

Material and Methods: In this prospective study, conducted at a tertiary facility, all patients with diabetes onset between 18-30 years and diabetes duration less than 5 years were included. Assessment included detailed clinical and biochemical evaluation, autoantibody testing, c-peptide and genetic screening.

Results: Total 100 patients were studied, out of which 80% were males and 55% were obese. Mean age of onset and median duration of diabetes were 24.98 ± 3.27 years and 18.0 months respectively. Initial clinical presentation was weight loss and osmotic symptoms in 58%, diabetic ketoacidosis in 5% and 25% patients were incidentally diagnosed. 20.8% of clinically autoimmune diabetes patients had negative antibody testing, 35.5% of clinically nonautoimmune diabetes had positive antibody testing. Overall, evidence of autoimmunity and decreased insulin secretion were found in 45% and 45% patients respectively. Ultrasound abdomen revealed small/atrophic pancreas in 9% of patients out of which nearly half did not had history of pancreatitis. Three patients were detected as MODY (1 = HNF1A and 2 = PAX4 mutations). One patient had Wolfram like syndrome (WFS1 mutation), 30 patients had variants of unknown significance.

Conclusion: Evidence of autoimmunity was seen in 45%, monogenic diabetes in 4%, obesity in 55% of the study population. Higher incidence and aggressive nature of diabetes in young individuals are probably due to contributing effect of autoimmunity accompanied by increasing prevalence of obesity.

Disclosure

P.K. Reddy: None. G. Jevalikar: None. A.A. Singhal: None. P. Kaur: None. A. Gupta: None. S.K. Mishra: None. J.S. Wasir: None. M.S. Kuchay: Speaker’s Bureau; Self; Abbott, Boehringer Ingelheim International GmbH, Novo Nordisk A/S. B. Bansal: None. K. Farooqui: None. H. Kaur: None. A. Mithal: Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Johnson & Johnson, Lilly Diabetes, Novo Nordisk A/S.
1475-P: CA19-9, miR-200, and GIP in Patients with Diabetes Mellitus and Pancreatic Cancer
Authors: SKRHA PAVEL , HORINEK ALES , SKRHA JAN
Published: June 2020

Introduction: Nearly 80 % of patients with pancreatic cancer (PAC) have diabetes mellitus or prediabetes (DM). New-onset DM can be the first symptom of PAC in majority of them. We compared CA 19-9, microRNAs and glucose-dependent insulinotropic polypeptide (GIP) as the PAC biomarkers in DM.

Patients and methods: Forty nine patients with and 31 without PAC were enrolled. All had DM confirmed by ADA criteria and PAC was histologically proven. Twenty five healthy persons were evaluated, too. CA 19-9, miR-192, -196, -200 and GIP were measured in serum samples. Mann-Whitney U test and Kruskal-Wallis ANOVA were used for statistical evaluation. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were determined in the individual markers and in their combinations.

Results: In DM patients with PAC the serum concentrations of CA 19-9 and miRNAs were elevated (p<0.0003) and GIP decreased (p<0.001) in comparison with both DM patients without PAC and non-DM controls. Sensitivity, specificity, PPV and NPV were calculated (Table). While CA 19-9 was not increased in 16 % of patients with PAC, its combination with GIP and miR-200 confirmed PAC diagnosis in all of them.

Conclusion: Addition of miR-200 and GIP to CA 19-9 caused an increase of NPV to 100 % meaning that three combined biomarkers could exclude the diagnosis of PAC. Combination of these biomarkers could be used for PAC screening in DM patients in risk.

Disclosure

P. Skrha: None. A. Horinek: None. J. Skrha: None.

Funding

Charles University
1491-P: Migrant Disparities in Atherosclerotic Cardiovascular Complications among Persons with Type 2 Diabetes
Authors: ANDERSEN GREGERS S. , BYBERG STINE , BJØRKMAN ANNE-SOFIE D. , ISAKSEN ANDERS A. , AMADID HANAN , CARSTENSEN BENDIX , JØRGENSEN MARIT E.
Published: June 2020

Background: Non-western (non-w) migrants in Europe are at increased risk of type 2 diabetes (T2D) but it is not known if this translates into increased risk of atherosclerotic cardiovascular disease (ASCVD). We calculated age- and sex-specific incidence rates (IR) of ASCVD following T2D among 1st generation migrants in Denmark compared with Danish-born citizens.

Methods: Data were obtained from nationwide registers. A total of 346,947 people diagnosed with T2D between 1997-2016 were followed for a median (IQR) of 6.7 (8.8) yr, and classified as Danish-born citizens, western- or non-w migrants according to country of birth. IR of first ASCVD event and death from other causes were estimated separately using Poisson regression with risk time as offset, adjusting for T2D duration and education.

Results: Non-w migrants (n=27,693) were younger at T2D diagnosis than Danish-born (mean [SD], 50.8 [11.8] vs. 61.6 [13.5] yr). In total, 104,286 persons (30.1%) developed ASCVD. In adjusted models, ASCVD rates were higher for non-w migrant women at 40-60 yr but lower for both genders at 60-80 yr, compared to western migrants and Danish-born (Figure 1A-B). Non-ASCVD related mortality was also lower among non-w migrants (Figure 1C).

Conclusion: Non-w migrants had lower risk of developing ASCVD at 60-80 yr and lower mortality from other causes. This may reflect a ’healthy migrant effect’ or differences in lifestyle or medication.

Disclosure

G.S. Andersen: Stock/Shareholder; Self; Novo Nordisk A/S. S. Byberg: None. A.D. Bjørkman: None. A.A. Isaksen: Research Support; Self; Novo Nordisk Foundation. H. Amadid: None. B. Carstensen: Stock/Shareholder; Self; Novo Nordisk A/S. M.E. Jørgensen: Research Support; Self; Amgen, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi-Aventis. Stock/Shareholder; Self; Novo Nordisk A/S.
1513-P: Severity of Hypertension (HT) as a Predictor of Initiation of Dialysis among Study Participants with and without Diabetes Mellitus (DM)
Authors: OSAWA TAEKO , FUJIHARA KAZUYA , YAMADA MAYUKO H. , SATO TAKKAKI , KITAZAWA MASARU , YAGUCHI YUTA , MATSUBAYASHI YASUHIRO , IWANAGA MIDORI , YAMANAKA NAUTA , SEIDA HIROYASU , SONE HIROHITO
Published: June 2020

Although both hyperglycemia and HT are highly predictive of kidney disease, only a few studies have investigated the associations between the severity of HT and risk of end-stage renal disease especially the initiation of renal replacement therapy in DM+ or DM- in the same cohort at the same time. Thus, we analyzed data from a nationwide claim database involving 258,874 participants during 2008-16. Multivariate Cox regression model was used to identify risks of starting dialysis. HT as a covariate was determined according to systolic blood pressure (SBP)(mmHg) diagnosed by seven different cut-offs (≥110, ≥115, ≥120, ≥125, ≥130, ≥140, ≥150). Hazard ratios (HRs) were compared among 10 groups divided according to combinations of DM+ or DM- and five levels of SBP (mmHg) (≤119, 120-129, 130-139, 140-149, ≥150). Among DM-, baseline age, percent of men, BMI, smoking rate, SBP, and percent of medication for HT were higher in those who started dialysis. In those with DM+, baseline percent of men, SBP, and percent of medication for DM and HT were higher in those who started dialysis. HT was significantly associated with the initiation of dialysis regardless of the presence or absence of DM. The incidence of starting dialysis in those with SBP ≤119 mmHg and DM+ was almost the same as in those with SBP ≥150 mmHg and DM-. In comparison with SBP ≤119 mmHg, SBP ≥150 mmHg significantly increased the risk of the initiation of dialysis about 2.5 times regardless of DM+ or DM-. Compared with DM- and SBP ≤119mmHg, the HR for DM+ and SBP ≥150 mmHg was 6.88 (95% CI 3.66-12.9). Although the risks of HT differed only slightly regardless of the presence or absence of DM, risks for the initiation of dialysis with DM+ and SBP ≤119 mmHg were equivalent to DM- and SBP ≥150 mmHg, indicating stricter blood pressure interventions in DM+ are needed to avoid dialysis. Future studies are needed to clarify the cut-off SBP level to avoid initiation of dialysis considering the risks of strict control of blood pressure.

Disclosure

T. Osawa: None. K. Fujihara: None. M.H. Yamada: None. T. Sato: None. M. Kitazawa: None. Y. Yaguchi: None. Y. Matsubayashi: None. M. Iwanaga: None. N. Yamanaka: None. H. Seida: None. H. Sone: Research Support; Self; Kyowa Hakko Kirin Co., Ltd., Novartis AG, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co.

Funding

Japan Society for the Promotion of Science
1546-P: Complex Relationships between Income, Food Insecurity, Dietary Behaviors, and A1C in U.S. Adults with Diagnosed Diabetes: NHANES, 2007-2014
Authors: MERCADO CARLA , SAYDAH SHARON , BULLARD KAI M. , SIEGEL KAREN R. , IMPERATORE GIUSEPPINA
Published: June 2020

In people with diagnosed diabetes (DM), pathways between income, diet, and glycated hemoglobin levels (A1c) are unclear. Performing mediation analysis using structural equation modeling, we investigated cross-sectional total effects (direct + indirect effects), shown as standardized coefficients in this conceptual model of household poverty-to-income ratio (PIR), household food insecurity (FI), and individual consumer-related dietary behavior [# of meals prepared away from home (#meals) and % of #meals from fast food/pizza place (%FFpizza) in last 7 days] associated with A1c (Figure). Data from 2,343 participants aged ≥21 years with DM in 2007-2014 National Health and Nutrition Examination Survey were used. Among U.S. adults with DM; 43% had PIR<200%, 16% were FI, and 42% and 37%, respectively, reported ≥3 #meals and more than 50% %FFpizza. Greatest absolute magnitude of association was PIR with FI (-0.41), which was more than 1.5 times greater than next largest, PIR with #meals (0.25). Only FI (0.11) and #meals (0.07) had significant total effect with A1c. Though #meals had a positive total effect on %FFpizza, %FFpizza had no significant total effect on A1c. Complex relationships between PIR, FI, #meals, and %FFpizza in adults with DM suggest the need for a better understanding of dietary behaviors that can influence healthier options for better DM management.

Disclosure

C. Mercado: None. S. Saydah: None. K.M. Bullard: None. K.R. Siegel: None. G. Imperatore: None.
1556-P: Trend and Prevalence of Underweight, Overweight, Obesity in Chinese Patients with Type 2 Diabetes, Aged 20-89 Years
Authors: LV FANG , CAI XIAOLING , JI LINONG
Published: June 2020

Background: Both underweight and obesity are associated with highly elevated risks of adverse health outcomes. Gender, and age differences of overweight and obesity prevalence had been identified in overall population. However, less data was specialized evaluate the body mass index (BMI) characteristics, gender and age differences in patients with type 2 diabetes (T2D).

Methods: We analyzed six hospital-based studies that had recorded height and weight in adults with T2D aged between 20 and 89 years. We calculated the trends of mean BMI and the prevalence of BMI categories defined by World Health Organization (WHO) and Working Group on Obesity in China (WGOC) criteria stratified by sex, age and provinces.

Results: According to WGOC standard, the crude prevalence of general obesity (BMI ≥28 kg/m2) and overweight (24 kg/m2 ≤ BMI < 28 kg/m2) ranged from 10.3% to 16.4%, and 42.0% to 45.2%, respectively. According to WHO standard, the prevalence of general obesity (BMI ≥ 30 kg/m2) and overweight (25 kg/m2 ≤ BMI <30 kg/m2) ranged from 3.9% to 7.0%, and 34.3% to 37.8%, respectively. The crude prevalence of underweight (BMI <18.5 kg/m2) ranged from 1.7% to 2.4%. Age-stratified analysis revealed BMI and prevalence of obesity peaked in men aged 20 to 29 years, thereafter gradually declined. However, in women, BMI and trends of obesity were not consistent. The prevalence of underweight was higher in younger and older patients in both men and women. Geographic heterogeneity of obesity, overweight and underweight were observed across different provinces in mainland China.

Conclusion: Gender, age and regional differences of BMI and prevalence of underweight, overweight, obesity were observed in Chinese patients with T2D, aged 20-89 years. Further studies are warranted to investigate the better BMI cutoff value in T2DM of different gender and age to plan health services and promote scientific decision-making in T2D.

Disclosure

F. Lv: None. X. Cai: None. L. Ji: None.

Funding

National Natural Science Foundation of China (81970698, 81900805), National Key Research and Development Program of China (2016YFC1304901)
1563-P: Neighborhood Drivability and Diabetes Incidence in Toronto, Canada
Authors: BRAVER NICOLE DEN , BEULENS JOLINE , LAKERVELD JEROEN , GOZDYRA PETER , WU FANGYUN , RUTTERS FEMKE , FAZLI GHAZAL S. , MOINEDDIN RAHIM , BOOTH GILLIAN
Published: June 2020

Background: Reliance on cars contributes to physical inactivity, and therefore may be a risk factor for type 2 diabetes. We investigated whether living in neighborhoods that are highly conducive to driving is associated with an increased incidence of diabetes.

Methods: Working age adults (20-64 yrs) who were living in Toronto, Canada on April 1st 2011, were followed over 6 yrs for incident diabetes using a validated algorithm based on hospital records and physicians’ services claims. For neighborhood drivability, we used a novel index capturing three factors of the built environment: urban sprawl, pedestrian unfriendliness and parking options. Cox regression was used to examine the association between neighborhood drivability quintiles (Q) and diabetes incidence, adjusting for age, sex, income, ethnicity, immigration status and comorbidity, and censoring for death.

Results: Among 1,473,994 individuals in our sample (mean age 40.9±12.2, 48.5% male), 77,835 developed diabetes. Overall, there was a direct relationship between drivability and diabetes incidence, however the magnitude of this effect varied by age and income. Among young adults (20-34 yrs), those living in the most drivable neighborhoods (Q5) had a 58% higher incidence of diabetes (adjusted HR: 1.58 (95%CI: 1.47-1.69)) relative to those in the least drivable neighborhoods (Q1), whereas the same comparison in older adults (55-64 yrs) yielded smaller differences (HR: 1.31 (95%CI: 1.26-1.36)). High drivability was most strongly associated with diabetes risk in the middle income neighborhoods with 96% increased risk for young residents (HR:1.96 (95%CI: 1.64-2.33) and a 46% increased risk for older residents (HR: 1.46 (95%CI:1.32-1.62). Associations between drivability and diabetes incidence were significant but of a lesser magnitude in low- and high-income neighborhoods.

Conclusion: In our setting, neighborhood drivability is a risk factor for the diabetes incidence among working age adults, especially younger, middle-income populations.

Disclosure

N. den Braver: None. J. Beulens: None. J. Lakerveld: None. P. Gozdyra: None. F. Wu: None. F. Rutters: None. G.S. Fazli: None. R. Moineddin: None. G. Booth: None.
1566-P: Association of Demographic Factors with Emergency Department Use among Adults with Diabetes, 2009-2017
Authors: UPPAL TEG S. , FERNANDES GAIL , HAW JEEHEA SONYA , SHAH MEGHA K. , TURBOW SARA , RAJPATHAK SWAPNIL , VENKAT NARAYAN K.M. , ALI MOHAMMED K.
Published: June 2020

There are limited data which examine the current trends in emergency department (ED) use among adults with all-type diabetes by demographic characteristics. We analyzed data from the nationally representative Medical Expenditure Panel Survey (MEPS), which uses a rotating panel design—a new cohort is initiated annually, and health care use is recorded over the course of 2 years. We pooled panels, each with 2-year follow-up into years 2009-2012 and 2014-2017 to improve precision. We identified adults with diabetes by self-report, presence of diabetes-specific ICD-codes, or prescriptions of antidiabetic agents and used all-cause event-level ED data to estimate weighted counts and age-adjusted rates of average annual ED visits per 1000 persons with diabetes. We then compared rates of ED use between the two time periods by calculating absolute and percent change. Increases in use were greatest among the groups: 65-74 yrs (38.1%), 75+ yrs (28.6%), West (27.3%), Midwest (16.5 %), Female (19.4%), and White (15.9%). The share of visits by the uninsured dropped (10.1% to 5.3%), while share of visits increased (29% to 36.3%) for those covered by Medicaid (data not shown). Further analysis will be conducted to analyze the trend over time from earlier time periods (2004-2007), understand the type of event (nondiabetes vs. diabetes-related) and stratify by potentially preventable visit and insurance type.

Disclosure

T.S. Uppal: None. G. Fernandes: Employee; Spouse/Partner; Janssen Pharmaceuticals, Inc. Employee; Self; Merck Sharp & Dohme Corp. J. Haw: None. M.K. Shah: None. S. Turbow: Research Support; Self; Gilead Sciences, Inc. S. Rajpathak: Employee; Self; Menarini Group. K. Narayan: None. M.K. Ali: Research Support; Self; Merck & Co., Inc.