bluuebunny/crossref_metadata_2025 huggingface dataset:
1191-P: Glycemia Does Not Vary in Proximity to Self-Reported Menstrual Cycles in Adolescents with Type 1 Diabetes
Authors: MCDONOUGH RYAN , PRIEBE ANNE-MARIE , HILYARD TENNILLE , DILEEPAN KAVITHA , TSAI SARAH
Published: June 2024

Introduction & Objectives: Menstruation can change the glycemia and insulin needs of individuals living with T1D. Hormonally-induced insulin resistance is thought to play a role in this process. This study evaluates if current treatment methods are associated with differences in CGM-recorded glycemia in relation to the timing of reported last menstrual periods (LMP).

Methods: Adolescent girls with T1D aged 10-18 years connected to a Midwestern Pediatric Diabetes Center Clarity account, were eligible for inclusion. A standard review of systems, which includes a reported LMP, is administered to all ambulatory patients across the organization. All patients reporting any LMP from 11/2018 - 8/2023 were included. CGM data was extracted from Dexcom Clarity and analyzed relative to the date of the LMP.

Results: During the study, 689 unique patients reported a total of 1892 menstrual cycles. Ambulatory Glucose Profile metrics were compared for the 7 days before and 7 days after the start of the self-reported LMP. There were no statistically significant differences in any of the CGM metrics (Table 1).

Conclusions: In this retrospective study, CGM metrics were not statistically or clinically different in the 7 days before to and the 7 days after a self-reported LMP. Prospective future studies are needed to evaluate the effects of advanced insulin delivery systems on glycemia in proximity to menstrual cycles.

Disclosure

R. McDonough: Speaker's Bureau; Provention Bio, Inc. A. Priebe: None. T. Hilyard: None. K. Dileepan: None. S. Tsai: Stock/Shareholder; Dexcom, Inc.
1192-P: Implementation-Effectiveness Trial of a Mindfulness-Based Intervention with Diabetes Education in Adolescents with Type 1 Diabetes
Authors: RAY LAUREN A. , PIKE JULIE M. , MACHUCA LUZ A. , ECKERT GEORGE J. , BRODERICK PATRICIA C. , HANNON TAMARA S.
Published: June 2024

Diabetes control and self-efficacy are related, particularly in adolescents. Mindfulness-based interventions (MBI) are associated with improved mental health outcomes. Our objective was to evaluate acceptability and clinical outcomes of a MBI in adolescents with T1D. We performed a 2-arm implementation-effectiveness trial in adolescents 15-17y with T1D diagnosed for >6 mo. Participants received the evidence-based Learning to BREATHE MBI with diabetes education (MBI+DE) or DE only (DE). DE focused on topics for transitioning to adulthood. For each arm, 12 virtual group sessions were held weekly. Feasibility and acceptability were assessed by enrollment, attendance, and survey completion. Secondary outcomes included HbA1c at appointments and mental health questionnaires. Analyses included independent samples t-test and repeated measures. Sixty adolescents were recruited and 29 enrolled (MBI+DE=20, DE=19, 52% female). Pre (8.3+0.4%) and post-HbA1c (8.3+0.3%) were similar. Session attendance was 7.2+3.3 for MBI+DE and 7.9+3.1 for DE (p=0.57) and 62% completed both survey sets. All reported managing >1 area of life better after the study and 70% reported improved coping with stress. All MBI+DE participants reported practicing >1 MBI skill outside of group sessions. While similar at baseline, MBI+DE reported better coping with stress (3.9+0.6; 6-point Likert scale) compared to DE (3.3+0.5, p=0.03) post-intervention. DE demonstrated a trend for improved scores on the Problem Areas in Diabetes-Teen questionnaire (DE pre 76+12, post 53+8, p=0.06; MBI+DE pre 63+7, post 66+7, p=0.60). In adolescents with T1D, implementation of a MBI is acceptable and associated with improved coping skills. MBI with ongoing diabetes education may improve self-efficacy and coping with T1D. It is yet to be seen whether MBI results in long-term impact on diabetes outcomes.

Disclosure

L.A. Ray: None. J.M. Pike: None. L.A. Machuca: None. G.J. Eckert: None. P.C. Broderick: None. T.S. Hannon: Advisory Panel; Eli Lilly and Company.

Funding

Indiana Clinical and Translational Sciences Institute funded in part by National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award (UL1TR002529)
1193-P: Patterns of Autoimmunity in Youth with New-Onset Diabetes Mellitus during the COVID Era
Authors: MONTGOMERY EMILY L. , WINTERGERST KUPPER A. , WATSON SARA
Published: June 2024

Introduction: The incidence of diabetes mellitus increased globally during the COVID pandemic with changes in autoimmunity patterns reported in Europe. We sought to evaluate these patterns in our US-based patient population.

Methods: Retrospective chart review of patients 1-21 years of age diagnosed with type 1 diabetes at our institution. Patients diagnosed between 1.2017-2.2020 were categorized as pre-pandemic and those diagnosed between 3.2020-12.2022 as pandemic. Chi-square analysis was used to evaluate the difference in autoantibody patterns between these periods.

Results: During the pandemic, 385 patients were diagnosed with T1DM compared with 377 patients in the pre-pandemic period. Compared to the pre-pandemic period, the proportion of patients with positive for IA2A during the pandemic decreased from 72.5% to 63.9% (p <0.001) with associated decrease in GAD+IA2+ from 40.3% to 34.2% (p<0.001), increase in GAD+ only from 12.7% to 18.0% (p = 0.002) and increase in GAD+IAA+ from 4.2% to 6.6% (p=0.019). During the pandemic, the frequency of patients with autoimmune thyroiditis decreased from 17.8% to 13.9% (p=0.045) and the frequency of patients with positive celiac screen increased from 6.0% to 10.1% (p<0.001).

Conclusion: Our study demonstrates a shift in autoimmunity pattern, in a US population that persisted through 2022, with a decrease in IA2 positivity and autoimmune thyroid disease at presentation. Further investigation to evaluate for drivers of this change is important to improve understanding of the risk of comorbidities, particularly in those diagnosed since the onset of the COVID pandemic.

Disclosure

E.L. Montgomery: None. K.A. Wintergerst: None. S. Watson: None.
1197-P: Effect of the "Kids in Control of Food" Program on Glycemia in Youth with Type 1 Diabetes—A Retrospective Analysis
Authors: ALMATROOK REEM , ALLAHOU BADREYA , RAHME ZAHRA , TAHA NEHAD , ALSARRAF ALI , ALMAHDI MARIA
Published: June 2024

Introduction: Kuwait has one of the highest global incidence rates of T1D, many of which are poorly controlled. Therefore, the Dasman Diabetes Institute (DDI) has culturally adapted the Kids in Control of Food (KICk-OFF) program, aiming to improve glycemic control. The objective is to investigate the effect of the program on HbA1c in youth with T1D in Kuwait.

Methods: Data were analyzed retrospectively from 138 participants aged 11-16 years (mean age ± SD: 13.6 ± 1.9 years, 49.3% girls) that attended the program since 2019. The 4-day structured program focused on dose adjustment, carb counting, and sick/exercise day rules. Also, participants are required to attend a 1-day refresher course after 6 months. Paired t-tests were conducted using SAS software, with a significance level set at p <0.05.

Results: Six months after completing the program, there was a significant reduction in HbA1c, from 9.3% ± 1.8 to 8.9% ± 1.7 (p-value <0.001). Only 28% of participants attended the refresher course. Attendance was more likely among participants who did not achieve a reduction in HbA1c after 6 months (p-value <0.001) (Table 1).

Conclusion: The culturally adapted KICk-OFF program shows potential for improving HbA1c in youth with T1D. Better strategies are needed to improve attendance to the refresher course, regardless of HbA1c change. Further investigations with a larger sample and longer follow-up are warranted.

Disclosure

R. Almatrook: None. B. Allahou: None. Z. Rahme: None. N. Taha: None. A. Alsarraf: None. M. Almahdi: None.
1203-P: Multiomics Imbalances Are Associated with Glycemic Control in Patients with Type 1 Diabetes
Authors: GU ZHAOHE , TAN HUILING , PAN LANXIN , ZHENG XUEYING , WANG XULIN , WANG JING , WENG JIANPING , DING YU , LUO SIHUI
Published: June 2024

Introduction: Previous studies have indicated associations between the gut microbiota, metabolites, lipids and the onset of type 1 diabetes (T1D). We aimed to further investigate the characteristics of the gut microbiota, metabolites, and lipids in patients with T1D at different glycemic levels.

Methods: We divided 72 patients with T1D into two groups based on hemoglobin A1c (HbA1c) levels : one group with good glycemic control (GC, HbA1c < 7%, n=36) and another with poor glycemic control (PGC, HbA1c ≥ 7%, n=36). We conducted 16S rRNA sequence analysis of their fecal microbiota and analyzed serum metabolites and lipids. Differential expression of microbiota, metabolites, and lipids was identified, and we annotated associated pathways through differential metabolite and lipid analysis.

Results: The two groups with different glycemic control statuses exhibited distinct characteristics in microbiota, metabolites, and lipids. linear discriminant analysis, shapley additive explanations algorithm and machine learning algorithms revealed the enrichment of Bacteroides_nordii, Bacteroides_cellulosilyticus in the GC group, while Bacteroides_coprocola and Sutterella_wadsworthensis enriched in the PGC group. Functionally, several metabolic sets like fatty acid biosynthesis, glycerol phosphate shuttle and glycerolipid metabolism were different between two groups. Correlation analyses were performed between microbiota and metabolites/lipids. Bacteroides. nordii was negatively associated with D-fructose(hit by starch and sucrose metabolism) and MG(16:0)(hit by glycerolipid metabolism) while Bacteroides_coprocola was positively associated with benzoquinone(hit by glycerol phosphate shuttle).

Conclusions: We found evidence from a multi-omics perspective demonstrating the association between the multi-omics profiles of individuals with T1D and their glucose control status.

Disclosure

Z. Gu: None. H. Tan: None. L. Pan: None. X. Zheng: None. X. Wang: None. J. Wang: None. J. Weng: None. Y. Ding: None. S. Luo: None.

Funding

The National Natural Science Foundation (82100822), the Strategic Priority Research Program of Chinese Academy of Sciences (XDB38000000), the Program for Innovative Research Team of The First Affiliated Hospital of USTC (CXGG02), and the Anhui Provincial Natural Science Foundation (2008085MH248, 2008085MH278).
1205-P: Exocrine Function in Individuals at High Risk for Type 1 Diabetes
Authors: MORNEAULT-GILL KAYLA , GUYOT MICHAEL , GESTON JARET , GEORGAS CHRISTOPHER , CAMPBELL-THOMPSON MARTHA , HALLER MICHAEL J. , BRUGGEMAN BRITTANY S.
Published: June 2024

Introduction: The prevalence of exocrine pancreatic insufficiency (EPI) in type 1 diabetes (T1D) is approximately 33%. We are investigating the timing of exocrine pancreatic loss in the pre-T1D period. We hypothesize that fecal elastase (FE-1) will be reduced prior to Stage 1 T1D and its rate of decline used to predict disease onset.

Methods: From two parallel nested case control studies within the TEDDY study, we compare longitudinal FE-1 levels in subjects who develop T1D by age 4 (Cohort A) and who develop persistent multiple islet autoantibodies by age 4 but have not developed dysglycemia or T1D by age 6 (Cohort B) with their respective autoantibody negative euglycemic controls. We included subjects with available sample prior to key endpoints. We excluded subjects with prematurity, pancreatic disease, or medical conditions associated with EPI.

Results: About1187 blinded samples from cases and controls have been evaluated. The median FE-1 level is 958 mcg/g with an interquartile range of 594-1480. 1.8% of samples meet criteria for EPI, defined by FE-1 less than 200 mcg/g.

Conclusion: The low percentage of EPI found, along with the range of FE-1 values, agrees with previous literature (Penno et al). Our study is ongoing as there are about 4700 samples to be run. We hypothesize that future results will demonstrate the efficacy of using FE-1 as a predictive biomarker for T1D progression.

Disclosure

K. Morneault-Gill: None. M. Guyot: None. J. Geston: None. C. Georgas: None. M. Campbell-Thompson: None. M.J. Haller: Consultant; Sanofi. Advisory Panel; SAB Biotherapeutics, Inc. Consultant; MannKind Corporation. B.S. Bruggeman: Research Support; Tandem Diabetes Care, Inc.

Funding

National Institute of Health (NIH NIDDK R03DK129971 and NIH K23DK131363), Pediatric Endocrine Society Clinical Scholar Award
1213-P: The Effect of Bile Acid–RNA Methylation on Intergenerational Inheritance of Diabetes Mellitus by Microbiota Vertical Transmission
Authors: XIE QINYUAN , YUAN HUIJUAN
Published: June 2024

Introduction & Objective: Maternal hyperglycemia during pregnancy (HIP) poses health risks to mothers and offspring, with unclear mechanisms. Our previous studies have confirmed that dysregulated vertical transmission of microbiota is one of the causes of abnormal glucose metabolism in offspring. This study further explored the effect of microbiota transmission on progeny glucose metabolism and elucidate the mechanism.

Methods: The feces of HIP mother mice in the previous study were colonized into germ-free mice, and after the difference in glucose metabolism, they were impregnated to produce offspring. OGTT were used to evaluate progeny glucose metabolism, 16S rRNA sequencing was used to detect fecal microbiota, and bile acid profiles of fecal metabolites were detected by targeting bile acid metabolites. To screen possible pathways using transcriptomic sequencing of the mouse liver for further validation at the protein and gene levels.

Results: The colonization of germ-free maternal mice with HIP’s microbiota adversely affected glucose metabolism, liver development, and RNA methylation levels in offspring. The vertical transmission of key bacteria such as Bifidobacterium choerinum is consistent with the intergenerational inheritance of abnormal glucose metabolism. Also, a significant descending of bile acid HDCA in maternal and offspring mice was observed, leading to an impaired bile acid gut-liver axis and aberrent gene expression in bile acid metabolism. Validation experiments showed the impact of varying HDCA levels on RNA methylation levels and key metabolic factors in liver cells. HDCA concentration was significantly positively correlated with the expression of SOCS3, INSR, etc. in hepatocytes.

Conclusion: Abnormal microbiota transmission caused dysregulated microbiota and reduced HDCA in HIP’s offspring, while HDCA induced elevated RNA methylation, improving metabolic gene expression.

Disclosure

Q. Xie: None. H. Yuan: None.
122-OR: ADA Presidents' Select Abstract: Lower Plasma Levels of Truncated Apolipoprotein C-I Are Associated with Increased Risk of Diabetes—Multiethnic Study of Atherosclerosis
Authors: KOSKA JURAJ , HU YUEMING , BILLHEIMER DEAN , NEDELKOV DOBRIN , BUDOFF MATTHEW , BERTONI ALAIN , MCCLELLAND ROBYN , REAVEN PETER
Published: June 2024

Apolipoprotein C-I (apoC-I) is a key regulator of triglyceride and HDL metabolism. Preclinical data also indicate a role of apoC-I in insulin resistance (IR) and hyperglycemia. In circulation, apoC-I appears as native (C-I) and truncated (C-I’) proteoform. Higher ratio of C-I’ to C-I (C-I’/C-I) is associated with more favorable cardiometabolic risk profiles. We now tested if C-I’/C-I is associated with longitudinal changes in fasting glucose (FG) and IR, and incident diabetes. ApoC-I proteoforms were measured by mass spectrometry immunoassay in plasma from 4,747 participants of the Multi-Ethnic Study of Atherosclerosis that were without diabetes at baseline. IR estimated by HOMA-IR was measured at baseline and at ~10-year follow-up. FG and incident diabetes (FG > 6.99 mmol/l or on diabetes medications) were evaluated for up to 16 years. Lower baseline C-I’/C-I was associated with greater longitudinal increases in FG and IR (by 2.7% [95%CI: 1.5, 3.9] and 4.3% [1.1, 7.3] per 1 SD decrease in C-I’/C-I), and increased risk of diabetes (n=768 events) after adjusting for baseline age, sex, race & ethnicity, income, education, BMI, systolic BP, FG, fasting insulin, antihypertensives and statins use, eGFR and plasma lipids (Hazard ratio: 1.19 [95% CI: 1.10, 1.28]). The association with diabetes was stronger in those with normal than impaired FG (1.20 [1.08, 1.33] vs. 1.09 [0.96, 1.23], p-interaction 0.023). Total apoC-I concentrations were not associated with changes in FG and IR in all models, and with incident diabetes upon adjusting for risk factors.

In conclusion, lower posttranslational apoC-I truncation was associated, independently of typical diabetes risk factors, with greater worsening of IR, greater increase in FG and higher risk of diabetes. The relationship of lower C-I’/C-I with diabetes risk appeared present prior to development of impaired FG. In contrast, total apoC-I concentrations were not related to worsening of glucose metabolism.

Disclosure

J. Koska: None. Y. Hu: None. D. Billheimer: None. D. Nedelkov: None. M. Budoff: Speaker's Bureau; Boehringer-Ingelheim, Lilly Diabetes, AstraZeneca. A. Bertoni: None. R. McClelland: None. P. Reaven: Research Support; Dexcom, Inc.

Funding

National Heart, Lung, and Blood Institute (R01-HL-138969)
1222-P: The Association between Perioperative Continuous Glucose Monitoring Metric and Post–Cesarean Section Infection in Pregnancy—A Prospective, Observational Cohort Study
Authors: LIU YUJIE , DING YU , GONG YIXIN , WEI TIAN , CHEN SUYU , ZHENG XUEYING , LUO SIHUI , WENG JIANPING
Published: June 2024

Background and Aims: Hyperglycemia has been identified as a risk factor for infection after operation. However, the association between maternal peri-operative glucose level and post-cesarean section infection has yet to be elucidated. We used CGM to profile maternal peri-operative glucose characteristics and determine the effect on post-cesarean section infection.

Materials and Methods: This is a prospective, observational cohort study with 227 pregnant women who wore CGM before cesarean section during 2020-2022 in China. The primary outcome was maternal infection within 6 weeks after cesarean section. The definition of maternal infection was one or more than one of the following: surgical site infection (SSI), endometritis, urinary tract infection, and febrile morbidity. Logistic regression models were used to evaluate the association between CGM metrics and maternal infection with estimated risk ratios (RRs) and 95% CIs.

Results: Of the 227 studied women, 110 (48.25%) were categorized into the hyperglycemia in pregnancy (HIP) group, and 118 (51.75%) were in the non-HIP group. The incidence of post-cesarean section infection was significantly higher in the HIP group (17.43%) compared with the non-HIP group (7.63%, RR2.46, 95%CI(1.307-4.651)). Women who had post-operative infection had a significantly higher level of 3 post-operation-days(PODS) mean glucose (5.20 vs. 4.79, adjusted RR 1.03,P=0.017), glucose management indicator (5.54 vs. 5.37, adjusted RR 1.29,95% CI(1.22-10.85)), estimated HbA1c (4.89 vs. 4.63, adjusted RR 1.93,P=0.016), TAR10.0 (3.68 vs. 1.84, adjusted RR 1.17, 95% CI(1.01-1.39)), and TAR7.0 (15.68 vs. 9.98, adjusted RR 1.04, 95% CI(1.00-1.09)).

Conclusion: Women with HIP had higher incidence of post-cesarean section infection. Post-operative glucose hyperglycemia, estimated by CGM metrics, was significantly associated with post-cesarean section infection.

Disclosure

Y. Liu: None. Y. Ding: None. Y. Gong: None. T. Wei: None. S. Chen: None. X. Zheng: None. S. Luo: None. J. Weng: None.
1235-P: Gestational Diabetes Mellitus in Georgia, United States—Agreement between Maternal Self-Report and Birth Certificate Documentation
Authors: VUNCANNON DANIELLE M. , CHANDRASEKARAN SUCHITRA , LUONG JACKIE , STEVENSON INDIA C. , JOHNSON LESLIE C.M.
Published: June 2024

Introduction: The true prevalence of gestational diabetes mellitus (GDM) in Georgia is unknown. This study aimed to report rates of GDM using two existent data sources, and to examine concordance between data that was self-reported versus abstracted from medical records.

Methods: For this mixed methods study, interviews with healthcare professionals (n=12) and 2017-2020 data from the Pregnancy Risk Assessment Monitoring System (PRAMS) for Georgia were triangulated to explain concordance in GDM diagnosis observed between PRAMS self-report and birth certificate data. Self-reported clinical outcomes, including attendance at the postpartum visit and completion of the postpartum glucose tolerance test (GTT), were compared between groups using Chi-squared tests. A content analysis of the interview data was conducted to provide context for the quantitative findings.

Results: The PRAMS sample included 3,164 individuals. 392 self-reported GDM (n=392/3,164, 12.4%) while 209 had GDM based on birth certificate data (n=209/3,164, 6.6%). 34.6% had concordant diagnoses. There was no difference in postpartum visit attendance for those who were concordant (n=137/154, 89.0%) vs. discordant (n=252/291, 86.6%). GTT completion was also similar for concordant (n=76/154, 49.4%) vs. discordant (n=137/291, 47.1%). Interview data emphasized that many patients with GDM are not well educated about the condition, with patients commonly not reporting having experienced GDM during postpartum encounters. These findings suggest that data discordance may result from recall bias, misunderstanding around GDM, and data quality issues.

Conclusion: In Georgia, rates of GDM range from 6.6-12.4% with higher rates reflecting self-reported diagnoses. Rates of concordance were low, but clinical outcomes were not notably different between groups. High rates of discordance indicate a need to improve methods for tracking and reporting GDM data.

Disclosure

D.M. Vuncannon: None. S. Chandrasekaran: None. J. Luong: None. I.C. Stevenson: None. L.C.M. Johnson: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (P30DK111024)
1256-P: Studying Mortality in Patients with Diabetes over 75 Years
Authors: KOIDE SAKIHO , ITOU TAKAYA , KOJIMA HIDEOMI , MUKAI TOMOMI , NAKASONE YASUTO , MIYAKOSHI TAKAHIRO , YAMASHITA KOH , AIZAWA TORU
Published: June 2024

Introduction & Objective: In general, less stringent glucose management is recommended for elderly patients with diabetes. Yet, little has been known regarding actual incidence of adverse events as a function of glucose for patients over 75 years (the old-old). Aim of this study was to clarify total mortality rate (MR) and the MR related to diabetes as a function of glucose in the old-old patients with diabetes.

Methods: Consecutive 3172 patients with diabetes over 75 years who visited A hospital as new patients during 2012 and 2020 were retrospectively analysed. Of these, 1459 have been followed up for the mean of 4.1 years or until death whichever comes first. The average HbA1c obtained from the initial and the last sample was taken as the mean HbA1c of each patient. The use of oral hypoglycemic agents (OHA) and insulin, one year after the initial visit were registered in which SU, DPP4i, biguanide and SGLT2i were differentiated. Cox proportional hazards model was used to calculate hazard ratio (HR) for total or diabetes-related (stroke, coronary events and renal failure) death associated with Quartile (Q) of HbA1c. The rest (N=1703) dropped out during the study.

Results: The drop-outs and the study subjects were not significantly different. HR was J-shaped for total death and skewed U-shaped for diabetes-related death (Fig. 1).

Conclusion: Mild hyperglycemia is not associated with increased mortality in the old-old.

Disclosure

S. Koide: None. T. Itou: None. H. Kojima: None. T. Mukai: None. Y. Nakasone: None. T. Miyakoshi: None. K. Yamashita: None. T. AIzawa: None.
1258-P: Racial/Ethnic Disparities in Life Years Lost (LYL) to Type 2 Diabetes (T2D) in Medicare Beneficiaries in the United States
Authors: WANG YU , SHAO YIXUE , CHENG YILING , IMPERATORE GIUSEPPINA , LUMAN ELIZABETH , HOLLIDAY CHRISTOPHER S. , ZHANG PING
Published: June 2024

Introduction & Objective: Racial/ethnic variation in LYL due to T2D is unclear. We estimated LYL due to T2D by race/ethnicity among Medicare beneficiaries.

Methods: Using 100% 2001-2021 Medicare claims, we identified 3,040,965 people with incident T2D using International Classification of Diseases codes and matched them with people without diabetes by race/ethnicity (White, Black, Hispanic, Asian/Pacific Islander, American Indian /Alaska Native), age, sex, and comorbidities. We followed them until death, disenrollment, or 12/31/2021. We modeled the survival rate with polynomial regression. LYL due to T2D was calculated as the difference between the aggregated annual survival rates of the two cohorts. Race/ethnic differences in LYL were compared by each sex (men and women)-age (70, 75, 80 and 85 years) group.

Results: LYL due to T2D decrease by age of diagnosis (Figure). Race/ethnic disparity in LYL vary by sex and age of diagnosis. White or American Indian /Alaska Native women had the most LYL. In men, group with the most LYL depended on the age of diagnosis.

Conclusion: T2D reduces life years differently across racial/ethnic groups. Our results could help estimate potential life years gained for Medicare programs that target various racial/ethnic groups.

Disclosure

Y. Wang: None. Y. Shao: Employee; Biogen. Y. Cheng: None. G. Imperatore: None. E. Luman: None. C.S. Holliday: None. P. Zhang: None.
1262-P: Effect of Cardiovascular Risk Factor Control on Mortality in Older Adults—Findings from the Costa Rican Longevity and Healthy Aging Study
Authors: CALVO MARIN JAVIER , TORREALBA-ACOSTA GABRIEL , ERNEST-SUAREZ KENNETH
Published: June 2024

Introduction: The Costa Rican Longevity and Healthy Aging Study prospective cohort examined older adults' health status in Costa Rica. We investigated the influence of goal attainment on controlling cardiovascular risk factors (CVRFs): BMI, A1C, exercise, blood pressure, and smoking, along with their correlation with all-cause mortality.

Methodology: Survival data from the initial 2005 visit to 2019 included 1943 participants. Categorization was based on meeting targets for five CVRFs. Hazard ratios for all-cause mortality were estimated, adjusting for age, sex, C-reactive protein category, and history of previous cardiovascular events.

Results: The mean age for the cohort was 73.3 years, with 54.0% females. More than 2 hours of weekly exercise, controlled BMI, and A1C reduced all-cause mortality (aHR 0.77, 0.78, 0.72, respectively, p<0.001) (Figure 1a). Additionally, having 4 (aHR 0.50, p=0.035) or 5 (aHR 0.34, p=0.007) controlled CVRFs reduced overall mortality within the cohort.

Conclusions: A controlled A1C and BMI and engaging in exercise correlated with reduced mortality in the Costa Rican elderly population. Additionally, aHRs for all-cause mortality decreased as more CVRFs were controlled, emphasizing the crucial role of managing these multiple factors in this population.

Disclosure

J. Calvo Marin: Speaker's Bureau; Novo Nordisk, AstraZeneca. G. Torrealba-Acosta: None. K. Ernest-Suarez: Advisory Panel; Janssen Pharmaceuticals, Inc. Consultant; Janssen Pharmaceuticals, Inc. Speaker's Bureau; Janssen Pharmaceuticals, Inc. Advisory Panel; Pfizer Inc. Speaker's Bureau; Pfizer Inc. Advisory Panel; AstraZeneca. Consultant; AstraZeneca. Speaker's Bureau; AstraZeneca. Advisory Panel; Takeda Canada. Speaker's Bureau; Sandoz.
1263-P: Determinants of Cardiovascular Risk Factors in the Aging Costa Rican Population—Insights from an Ordered Logistic Regression Model in the Costa Rican Longevity and Healthy Aging Study
Authors: CALVO MARIN JAVIER , TORREALBA-ACOSTA GABRIEL , ERNEST-SUAREZ KENNETH
Published: June 2024

Introduction: The Costa Rican Longevity and Healthy Aging Study (CRELES), initiated in 2005, captures the health and lifestyle of elderly Costa Ricans with survival data up to 2019. We explored the association between sociodemographic and clinical variables and the number of controlled cardiovascular risk factors (CVRFs).

Methodology: From CRELES, 1943 participants were categorized for meeting targets for none to 5 CVRFs, which included A1c, blood pressure, exercise, BMI, and smoking. We modeled the association between sociodemographic and clinical variables and the number of controlled CVRFs through ordered logistic regression.

Results: Participants with 0, 1, 2, 3, 4, and 5 controlled CVRFs constituted 0.8%, 13.3%, 32.1%, 35.8%, 15.0%, and 3.0%, respectively. Males were less likely to have more controlled CVRFs (OR: 0.479, 95% CI: 0.359-0.638, p<0.001). Conversely, a never-smoker status (OR: 10.2, 95% CI: 7.5-14.0, p<0.001) and not having diabetes (OR: 3.1, 95% CI: 2.1-4.5, p<0.001), had a higher likelihood of having more controlled CVRFs (see Table 1).

Conclusions: Female sex, increased education, living without diabetes, and non-smoking status were associated with a greater likelihood of having more controlled CVRFs.

Disclosure

J. Calvo Marin: Speaker's Bureau; Novo Nordisk, AstraZeneca. G. Torrealba-Acosta: None. K. Ernest-Suarez: Advisory Panel; Janssen Pharmaceuticals, Inc. Consultant; Janssen Pharmaceuticals, Inc. Speaker's Bureau; Janssen Pharmaceuticals, Inc. Advisory Panel; Pfizer Inc. Speaker's Bureau; Pfizer Inc. Advisory Panel; AstraZeneca. Consultant; AstraZeneca. Speaker's Bureau; AstraZeneca. Advisory Panel; Takeda Canada. Speaker's Bureau; Sandoz.
1266-P: The Risk of Major CV Events after Initiation of SGLT2i, GLP-1RA, DPP-4i, or SUs in Patients with Type 2 Diabetes and Low-to-Moderate CV Risk
Authors: PATORNO ELISABETTA , TESFAYE HELEN , ALIX CAROLINE , DICESARE ELYSE C. , JANE CROMER SARA , EVERETT BRENDAN M. , GLYNN ROBERT , WEXLER DEBORAH J. , PAIK JULIE M.
Published: June 2024

Introduction & Objective: We assessed the risk of major CV events (MACE) after initiation of SGLT2 inhibitors (SGLT2i), GLP1 receptor agonists (GLP-1RA), DPP-4 inhibitors (DPP-4i), or sulfonylurea (SU) in patients with T2D and low-to-moderate CV risk, for whom limited guidance exists on which diabetes medications clinicians should prescribe.

Methods: Using Medicare and 2 U.S. private health plans (2013-2023), we identified six pairwise cohorts of 1:1 propensity score-matched patients aged ≥18 years (≥66 years in Medicare) with T2D and no established CV disease, initiating SGLT2i, GLP-1RA, DPP-4i, or SU (Table). Our primary outcome was MACE, i.e., myocardial infarction (MI), stroke, or mortality. We estimated HRs and 95% CIs, adjusting for 156 covariates.

Results: Compared to DPP-4i or SUs, SGLT2i and GLP-1RA were associated with 15-28% reductions in the risk of MACE (Table), over a mean follow-up of ~11 months. Compared with GLP-1RA, SGLT2i were associated with a small increase in the risk of MACE (HR=1.06; 95% CI=1.01-1.11), driven by a 13% increase in risk of MI. Compared with SUs, DPP-4i had a 10% decrease in the risk of MACE.

Conclusion: This study suggests robust reductions in rates of MACE with SGLT2i and GLP-1RA compared to DPP-4i or SUs in patients with T2D and no CV disease. Although differences were not large, the risk of MACE was lower with GLP-1RA (vs SGLT2i) and DPP-4i (vs SUs).

Disclosure

E. Patorno: Research Support; Boehringer-Ingelheim, Food and Drug Administration (FDA), National Institutes of Health, Patient-Centered Outcomes Research Institute. H. Tesfaye: None. C. Alix: None. E.C. DiCesare: None. S. Cromer: Other Relationship; Johnson & Johnson Medical Devices Companies. Advisory Panel; Alexion Pharmaceuticals, Inc. Other Relationship; Wolters Kluwer Health. B.M. Everett: Consultant; Novo Nordisk. Research Support; Novo Nordisk. Consultant; Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Ipsen Pharmaceuticals, Provention Bio, Inc. R. Glynn: Research Support; Amarin Corporation, Kowa Pharmaceuticals America, Inc., Novartis AG, Pfizer Inc. D.J. Wexler: Other Relationship; Novo Nordisk. J.M. Paik: None.

Funding

Patient Centered Outcomes Research Institute (DB-2020C2-20326)
1274-P: Evolving Burden of Stroke Attributable to High Fasting Plasma Glucose in the United States from 1990–2019—A Benchmarking Systematic Analysis
Authors: MADDINENI KAVYA , PARISAPOGU ANUSHA , TEJA CHINTHAPALLI MRUNAL , POTLURI GEETHIKA , MARKANDU KEETHANSHAN , ISLAM HAMZA , ISLAM RABIA , DEKHNE ANUSHKA , DINESHBHAI DESAI HARDIK
Published: June 2024

Introduction: Stroke remains a leading cause of mortality and disability in the United States, presenting significant public health and economic challenges. Among the various risk factors contributing to the incidence of stroke, high fasting plasma glucose levels (FPG) have emerged as a critical element.

Method: Using Global Burden of Disease tool, deaths and disability adjusted life years (DALYs) due to stroke attributable to FPG were estimated by age, sex, year across the US from 1990-2019.

Results: From 1990-2019, the annual percentage change (APC) in deaths rose by 77% (95% UI: 52-107%), and DALYs increased by 78% (56-106%). However, the age-standardized APC saw a 3% decrease in death rates, while DALY rates increased by 3%. Nevada experienced the highest increase in death APC at 338%, followed by Alaska at 312%, whereas Pennsylvania had the lowest at 18%. The highest death toll was in the 85-89 age group, and the most DALYs were seen in the 70-74 age group in 2019. Females showed a higher APC in both deaths (83% vs 70%) and DALYs (81% vs 74%) compared to males during this period.

Conclusion: Stroke related to FPG represented 28.68% of all stroke-related deaths. This significant proportion underscores the need for public health policymakers to take decisive action to address and mitigate this growing burden.

Disclosure

K. Maddineni: None. A. Parisapogu: None. M. Chinthapalli: None. G. Potluri: None. K. Markandu: None. H. Islam: None. R. Islam: None. A. Dekhne: None. H. Desai: None.
128-OR: Investigating C-Fiber Activity Using Depolarizing Stimuli Provides Insight into the Natural Course of Diabetic Polyneuropathy
Authors: ELDESOUKY OMAR , SEEBAUER LUKAS , RUKWIED ROMAN , CARR RICHARD , ROSHAN MANI , SULAJ ALBA , TSILINGIRIS DIMITRIOS , KOPF STEFAN , FLEMING THOMAS H. , SCHMELZ MARTIN , SZENDROEDI JULIA , KENDER ZOLTAN
Published: June 2024

Introduction: Based on quantitative sensory testing (QST) we described the progression of diabetic sensorimotor polyneuropathy (DSPN) from healthy to thermal hyperalgesia, to mechanical hyperalgesia, to sensory loss. While QST provides valuable insights, it gives less information about the level of sensory impairment (transductional vs axonal). Therefore, we performed an electrical stimulation protocol to evaluate C-nociceptor excitability in individuals with DSPN.

Methods: We examined 66 individuals with diabetes mellitus, 51 having varying stages of DSPN. Slow depolarizing transcutaneous currents of low-intensity with 4 Hz sinusoidal stimulation profile and single 500 ms half sine wave pulses were used to stimulate C-fibers. Pain perception was quantified using (0-10)-Numeric-Rating-Scale. Findings were cross-referenced with QST Z-scores and correlated to serum levels of the axonal marker neurofilament light chain (NfL).

Results: Mechanical pain scores positively correlated with electrically induced pain (r=0.757, P<0.001) whereas only a weak positive correlation was found between electrical pain and thermal pain Z-scores at high stimulation intensities (r=0.403, P<0.01). Increased electrical pain ratings were found in individuals with reduced heat pain but not in participants with reduced mechanical pain indicating a possible axonal degeneration in the latter. In most of our subjective sensory tests, higher NfL levels correlated with impaired sensory function (r>-0.3, P<0.05).

Conclusion: Loss of mechanical pain indicated axonal degeneration, while absent heat sensation with normal electrically induced pain suggested a progression involving impaired transduction or superficial degeneration of sensory endings. Hypersensitivity to weak depolarizing stimuli may offer insights into DSPN's natural course, aiding high-risk patient identification and guiding interventions.

Disclosure

O. Eldesouky: None. L. Seebauer: Other Relationship; Springer Medizin Verlag GmbH. R. Rukwied: None. R. Carr: None. M. Roshan: None. A. Sulaj: None. D. Tsilingiris: None. S. Kopf: Speaker's Bureau; Lilly Diabetes, Bayer Inc. T.H. Fleming: None. M. Schmelz: Consultant; Lilly GmbH, Merz Therapeutics, Bayer Inc., Medtronic GmbH. J. Szendroedi: None. Z. Kender: None.
1286-P: Impact of Changes in Glucose Tolerance Status on Incidence of Cardiovascular Disease in Japan—Historical Cohort Study Using a Nationwide Claims Database
Authors: SHIMAYAMA CHIHIRO , FUJIHARA KAZUYA , OE MOMOKO , UEGAMI YOHEI , TAKIZAWA HIROKI , SATO TAKAAKI , SUZUKI HIROSHI , KITAZAWA MASARU , MATSUBAYASHI YASUHIRO , YAMADA TAKAHO , KODAMA SATORU , SONE HIROHITO
Published: June 2024

Although both glucose abnormalities and a history of cardiovascular disease such as coronary artery disease (CAD) or cerebrovascular disease (CVD) are risk factors for cardiovascular disease, few studies have examined the association of changes in glucose tolerance and subsequent CAD and CVD in those with and without a history of cardiovascular disease in the same cohort. Thus, we studied the impact of changes in glucose tolerance status over 2 years on subsequent CAD and CVD in those with and without a history of either. During a 2-year baseline period in which there was worsening, no change, or improvement in glucose tolerance according to a history or no history of CAD/CVD, 363,856 people were classified as having either normoglycemia (NGT), prediabetes (preDM), or diabetes (DM). After baseline, incident CAD and CVD were followed up. The association between changes in glucose tolerance and the incidence of CAD/CVD was analyzed by a multivariate Cox regression model. In the absence of prior CAD/CVD, hazard ratios (HR) for CAD/CVD and CAD were 0.6 to 0.7 for those with ‘DM to preDM’ compared with ‘DM to DM’. In the presence of prior CAD/CVD, the HRs for CAD/CVD, CAD, and CVD were 1.3 to 1.6 in ‘preDM to DM’ compared with ‘preDM to preDM’ (Table). Individualized treatment strategies should consider changes in glucose tolerance status and prior cardiovascular disease.

Disclosure

C. Shimayama: Employee; Kowa Company, Ltd. K. Fujihara: None. M. Oe: Employee; Kowa Company, Ltd. Y. Uegami: None. H. Takizawa: None. T. Sato: None. H. Suzuki: None. M. Kitazawa: None. Y. Matsubayashi: None. T. Yamada: 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.
1288-P: Comparison of Moderate Intensity Atorvastatin and Ezetimibe with High Intensity Atorvastatin on Cardiovascular Events and Diabetes in Patients with Angina Pectoris Undergoing Percutaneous Coronary Intervention
Authors: YOUNG SOHN SEO , WOO CHO SUNG
Published: June 2024

Objective: This real-world large cohort study was aimed to compare effect of moderate intensity atorvastatin and ezetimibe combination therapy and high intensity atorvastatin therapy on cardiovascular events and diabetes in patients with angina pectoris undergoing percutaneous coronary intervention (PCI).

Methods: This retrospective cohort study used Korean National Health Insurance Data. Study participants underwent PCI between 2015 and 2018, and received high-intensity atorvastatin (atorvastatin 40-80 mg; n = 2,102) or moderate-intensity atorvastatin (atorvastatin 10-20 mg) plus ezetimibe (n = 4,682). The primary outcome was each cardiovascular outcome; incidence of cardiovascular death, myocardial infarction (MI) and stroke. The secondary outcome was newly developed diabetes.

Results: During a mean follow up of 4 years, there were no significant differences in the cardiovascular outcomes between high-intensity atorvastatin monotherapy and moderate-intensity atorvastatin and ezetimibe combination therapy. The adjusted hazard ratio (aHR) for cardiovascular death was 1.18 [95% confidence interval (CI): 0.87-1.61, p=0.285], MI was 0.82 (95% CI 0.67-1.01; p = 0.066). and stroke was 1.10 (95% CI: 0.86-1.39, p=0.453), respectively. The risk of new onset diabetes was not different between the two-treatment group (aHR: 0.99, 95% CI: 0.88-1.13, p=0.94).

Conclusions: There was no significant difference in the cardiovascular outcome and risk of new onset diabetes between high-intensity atorvastatin monotherapy and moderate-intensity atorvastatin and ezetimibe combination therapy, in real-world large cohort study.

Disclosure

S. Sohn: None. S. Cho: None.
1295-P: Fasting Plasma Glucose and A1C Underperform as Diagnostic Tests for Africans with Diabetes—Insight from the Africans in America Study
Authors: WORTHY CHARLITA , SAYED MARIAM , HUEFNER ELIZA A. , HURSTON JAMAIICA , DUBOSE CHRISTOPHER , SUMNER ANNE E.
Published: June 2024

According to the International Diabetes Federation, the prevalence of type 2 diabetes (DM) in sub-Saharan Africa will increase by 134% in the next 25 years. Furthermore, recent data suggests that the most widely used diagnostic tests, fasting blood glucose (FPG) (≥126 mg/dL) and A1C (≥6.5%) underperform in Africans. Thus, rigorous testing by the OGTT for the detection of DM in Africans is critical. The OGTT allows for assessment of 2h glucose, a postprandial equivalent. Therefore, OGTT were performed in 601 African-born Blacks enrolled in the Africans in America cohort (male: 63% (377/601), age: 39±11, (mean±SD) range 20-69, BMI: 27.7±4.5, range (18.2-42.0)). DM diagnosis was based on ADA glucose criteria for the OGTT. To determine if confounding factors were present, tests were done to assess hemoglobin, hemoglobin type, nutritional status and renal and hepatic function. Assays for G6PD deficiency were performed in 228 consecutively enrolled participants. DM occurred in 7% (42/601) of participants. Sickle cell trait (SCT) or HbC Trait occurred in 17% (100/601) of participants overall and 33% (14/42) of individuals with DM. No participants (0/601) had anemia (Hgb<11 g/dL), nutritional deficiencies or renal or hepatic dysfunction. G6PD deficiency was identified in 10% (22/228) of participants overall, and no one with DM (0/18). Diagnostic sensitivity of FPG for the detection of DM was 16% (7/42). Sensitivity of A1C was 28% (12/42). Sensitivity of both tests combined was 33% (14/42). When the Africans with SCT or HbC trait were excluded, sensitivity of FPG was 21% (6/28) and A1C was 29% (8/28). For both tests combined, the sensitivity increased to only 36% (10/28). In short, FPG and A1C underperform in the detection of DM in Africans even in the absence of SCT, HbC trait and metabolic disorders and nutritional deficiencies. This data raises concern that the DM epidemic in Africa may be worse than predicted.

Disclosure

C. Worthy: None. M. Sayed: None. E.A. Huefner: None. J. Hurston: None. C. DuBose: None. A.E. Sumner: None.
13-OR: Relationship between Visit-to-Visit Variability of HbA1c and Development/Progression of Diabetic Retinopathy
Authors: YUKI MASAHIRO , YAMAZAKI TSUTOMU , TOKI RYOTA , SAKAMOTO MASAYA
Published: June 2024

Introduction: Our study is aimed to examine the relationship between visit-to-visit variability (VVV) of HbA1c and development/ progression of diabetic retinopathy (DR).

Methods: This retrospective study analyzed data on 5,898 T2DM patients that had ophthalmic follow data. The VVV of HbA1c was evaluated using the intrapersonal coefficient of variation (CV) of HbA1c during a 7-year period from 2014-2020. We divided patients as (1) diagnosed with non-DR and (2) diagnosed with DR at start of this study. DR was assessed by Davis classification. Data analyses were performed using SPSS version 29.0 software.

Results: The number of patients is as follows; (1) patients with non-DR(n=4,197), (2) patients with DR(n=1,701). Multivariate logistic regression analyses indicated there is no significant association with CV of HbA1c and development of DR. There are, however, significant increase risks of development of DR with HbA1c level (OR=1.37), pulse pressure (OR=1.04) and diabetic duration (OR=1.02). Interestingly, there is significant association with CV of HbA1c and progression of DR (OR=1.04, Figure).

Conclusion: This study suggests that development of DR was associated with HbA1c level, pulse pressure and diabetic duration, but not with VVV of HbA1c. Progression of DR was associated with VVV of HbA1c. Thus, the VVV of HbA1c might be a new marker of progression of diabetic retinopathy.

Disclosure

M. Yuki: None. T. Yamazaki: None. R. Toki: None. M. Sakamoto: None.
1317-P: Novel Clusters of Prediabetes Help to Better Identify People at Risk for Diabetes-Associated Complications
Authors: ANSMANN MALIN , KLIEMANK ELISABETH , RAUCHHAUPT EKATERINA V. , SCHIMPFLE LUKAS , SEEBAUER LUKAS , ROSHAN MANI , KENDER ZOLTAN , KOPF STEFAN , SZENDROEDI JULIA , SULAJ ALBA
Published: June 2024

Introduction & Objective:The description of prediabetes subphenotypes could improve the detection of individuals at increased risk for the onset of diabetes and/or related complications. The aim of this study was to assess the prevalence of diabetes-associated complications in newly established clusters of prediabetes and to compare them with the current classification of prediabetes.

Methods: People with prediabetes (n=118: 57/61 women/men, HbA1c 5.6±0.3%, age 57.4±9.8 y, BMI 29.7±5.7 kg/m2) were identified either using classical clinical parameters (increased HbA1c levels: HbA1c, impaired fasting glucose: IFG, impaired glucose tolerance: IGT) or using a novel pathophysiology-based subphenotyping of prediabetes (cluster 1-6, according to Wagner et al., Nature medicine 2021 ). Study participants were screened for diabetes-associated complications such as nephropathy, neuropathy, retinopathy, and pneumopathy, with a focus on liver steatosis and fibrosis according to liver stiffness measurement.

Results: Individuals allocated to the new prediabetes clusters 5 and 6 showed more often at least 2 diabetes-associated complications (70.6% vs. 52.2%) compared to prediabetes individuals identified using the classical parameters HbA1c, IFG and IGT (44.3% vs. 37.3% vs. 16.7%), all p=0.026. Elevated markers for liver steatosis were more common in cluster 3, 4, 5 and 6 (76% vs. 91% vs. 100% vs. 83%) compared to classical cluster HbA1c (74%), whereas for liver fibrosis in cluster 5 and 6 (50% vs. 41%) compared to 26% in the IFG cluster. Further analyses showed that 83% and 73% of people in cluster 5 and 6 with liver steatosis had at least one additional diabetes-associated complication compared to 63%/56% in cluster HbA1c/IFG.

Conclusion: The novel pathophysiology-based clusters of prediabetes help to better identify people with increased risk of diabetes-associated complications, allowing the design of early targeted preventive measures.

Disclosure

M. Ansmann: None. E. Kliemank: None. E.V. Rauchhaupt: None. L. Schimpfle: None. L. Seebauer: Other Relationship; Springer Medizin Verlag GmbH. M. Roshan: None. Z. Kender: None. S. Kopf: Speaker's Bureau; Lilly Diabetes, Bayer Inc. J. Szendroedi: None. A. Sulaj: None.