bluuebunny/crossref_metadata_2025 huggingface dataset:
1097-P: Value of Blood Pressure Measurement Earlier vs. Later in Life to Predict Cardiovascular Mortality
Authors: LEIHERER ANDREAS , ULMER HANNO , MUENDLEIN AXEL , SAELY CHRISTOPH H. , FRAUNBERGER PETER , MADER ARTHUR , SPRENGER LUKAS , MAECHLER MAXIMILIAN , VONBANK ALEXANDER , LARCHER BARBARA , BROZEK WOLFGANG , NAGEL GABRIELE , ZITT EMANUEL , CONCIN HANS , DREXEL HEINZ
Published: May 2022

We here aimed at comparing the value of systolic blood pressure (BP) earlier versus later in life to predict cardiovascular mortality. In a cardiovascular observation study (OS) we prospectively recorded fatal cardiovascular events over up to years in 1282 patients of whom 570 had the Metabolic Syndrome (MetS) at baseline. These patients had participated in a health survey (HS) 15 years prior to the OS baseline. BP was measured both at the HS and at the baseline of the OS. We found that the increase in cardiovascular mortality matched the increase of BP in the HS in a linear way but this is not the case for BP assessed at the OS (figure) . A cox regression analysis revealed that each millimeter of mercury (mm Hg) increased the risk for cardiovascular death by 2% (HR = 1.02 [1.01-1.03], p<0.001) . Applying a stratification for the presence of MetS, we found that in both groups BP was a significant predictor of cardiovascular mortality (HRMetS = 1.02 [1.01-1.02], p<0.0 and HRnoMetS = 1.02 [1.01-1.03], p<0.001) . In contrast, BP as measured at the baseline of the OS was not significantly associated with cardiovascular death during follow-up neither in the total population nor in any subgroup (HR = 1.00 [0.99-1.01], p=0.652; HRMetS = 1.00 [0.99-1.01], p=0.468 and HRnoMetS = 1.00 [0.99-1.01], p=4.66) . We thus conclude that BP assessed earlier in life is a better predictor of cardiovascular mortality than BP assessed later in life.

Disclosure

A.Leiherer: None. B.Larcher: None. W.Brozek: None. G.Nagel: None. E.Zitt: None. H.Concin: None. H.Drexel: None. H.Ulmer: None. A.Muendlein: None. C.H.Saely: None. P.Fraunberger: None. A.Mader: None. L.Sprenger: None. M.Maechler: None. A.Vonbank: None.
1099-P: Truncal Fat–to–Leg Fat Ratio and Carotid Plaque Score in Patients with Type 2 Diabetes
Authors: SHIN JANG YEL
Published: May 2022

High truncal fat is known to be a risk factor for cardiovascular disease (CVD) , but high leg fat has a protective effect on CVD. We investigated the association between truncal fat-to-leg fat ratio (TLR) and carotid plaque score PS) in patients with type 2 diabetes (T2D) . A total of 1966 participants aged over 30 years and having T2D were recruited. Truncal fat, leg fat, and appendicular muscle mass (ASM) were measured using dual-energy X-ray absorptiometry and Carotid intima-media thickness (CIMT) and PS were assessed using high-resolution B-mode ultrasonography. High PS was defined as PS ≥ 3. The prevalence of plaque and high PS were 72.0% and 40.0%, respectively. Patients with high PS were more likely to be old, male, and hypertensive and had higher systplic blood pressure (SBP) , diabetic duration (DD) , serum creatinine (Cr) , and TLR, but lower values of diastolic BP, truncal and leg fat, HDL, and estimated glomerular filtration rate (eGFR) than those without high PS. Participants in the highest TLR tertile group were older and more hypertensive and had higher DD, SBP, waist circumference (WC) , body mass index (BMI) , HOMA-IR, glycated A1c (HbA1c) , triglycerides (TG) , serum Cr, CIMT, and PS, but lower ASM/BMI, HDL, and eGFR than those in the lowest TLR tertile group. The prevalence of high PS progressively increased with increasing TLR tertiles (Lowest vs. Middle vs. Highest = 33.4 vs. 41.0 vs. 45.7%, respectively, p < 0.001) . After adjusting age and sex, the odd ratios (ORs) and 95% confidence intervals (CIs) for high PS were 1.39 (1.- 1.79, p = 0.01) in the middle and 1.65 (1.28 - 2.11, p = < 0.001) in the highest tertile groups. After further adjusting for hypertesnsion, WC, BMI, SBP, DD, HbA1c, HOMA-IR, HDL cholesterol, TG, and eGFR, the ORs and 95% CIs in the middle and highest tertile groups remained significant.

In conclusion, higher TLR was independently associated with carotid PS in patients with T2D. Therefore, we suggest that high TLR may be a risk factor for early atherosclerosis in patients with T2D.

Disclosure

J.Shin: n/a.
1100-P: Endothelial Protein Expression and Its Association with Type 1 Diabetes
Authors: WISE HALEY K. , KESHAWARZ AMENA , MOREAU KERRIE , SNELL-BERGEON JANET K.
Published: May 2022

Introduction: People with type 1 diabetes (T1D) have an increased risk of developing cardiovascular disease. Endothelial cell dysfunction is thought to be a factor in this increased risk but underlying cellular mechanisms related to vasodilation, inflammation and oxidative stress are unknown.

Methods: Participants with T1D (n= 25) and non-T1D (n=20) were categorized into groups of high (≥80) or low (<15 AU) coronary artery calcium (CAC) , measured by computed tomography. Protein expression was assessed for endothelial Nitric Oxide Synthase [eNOS], estrogen receptors (ER) α and ER-β (women only) , nuclear factor [NF]κβ and nicotinamide adenine dinucleotide phosphate [NADPH] using quantitative immunofluorescence in peripheral venous endothelial cells harvested by endovascular biopsy. SphygmoCor Pulse Wave Velocity (PWV) measured arterial stiffness. Linear regression was used to test associations of high vs. low CAC and T1D with proteins of interest. All models included age, sex, CAC and diabetes.

Results: As shown in table 1, eNOS and NADPH were lower and NFκβ and Nitrotyrosine [NT] were higher in T1D compared to non-T1D participants with low CAC. Among T1D, PWV was higher in those with high vs. low CAC. Among non-T1D participants, eNOS was lower and NT and ER-α were lower in those with high vs. low CAC.

Conclusions: T1D is associated with adverse endothelial proteins that may contribute to endothelial dysfunction and vascular disease.

Disclosure

H.K.Wise: None. A.Keshawarz: None. K.Moreau: None. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc.
1109-P: Performance of 2021 U.S. Preventative Services Task Force Screening Criteria for Prediabetes and Diabetes
Authors: O'BRIEN MATTHEW J. , ZHANG YAN , BAILEY STACY , KHAN SADIYA , ACKERMANN RONALD T. , ALI MOHAMMED K. , BENOIT STEPHEN R. , IMPERATORE GIUSEPPINA , HOLLIDAY CHRISTOPHER S. , BULLARD KAI M.
Published: May 2022

In 2021, the US Preventive Services Task Force (USPSTF) expanded the recommended age range for prediabetes and diabetes screening among those with overweight/obesity to 35-70 years. Using 2017 to pre-pandemic March 2020 National Health and Nutrition Examination Survey data, we applied these screening criteria to assess their performance in a nationally representative sample. We included 3243 non-pregnant adults aged ≥18 years without diagnosed diabetes. Screening eligibility was determined based on participants' age and measured body mass index (BMI) [≥23kg/m2 for non-Hispanic (NH) Asian adults and ≥25kg/m2 for other ethnic groups]. Dysglycemia was defined based on A1c ≥5.7% or fasting plasma glucose ≥100mg/dL. We compared participant characteristics by USPSTF eligibility. We also assessed performance [sensitivity, specificity, positive predictive value (PPV) , and negative predictive value (NPV) ] of the screening criteria for detecting dysglycemia overall and by ethnicity. During 2017-2020, 44.4% of US adults aged 35-70 years were eligible for screening, representing 95.9 million US adults. Relative to adults who were ineligible, those who were eligible had a higher burden of diabetes risk factors, as well as greater proportions of some racial ethnic groups, higher proportion of those with less than a high school education, and more likely to be living in poverty. The performance characteristics of the USPSTF screening criteria were: sensitivity 59.4% (95% CI: 56.4-62.4) ; specificity 68.6% (65.1-71.9) ; PPV 62.4% (59.2-65.6) ; and NPV 65.8% (61.9-69.5) . The sensitivity by ethnicity was as follows: NH White adults 59.1% (55.4-62.7) ; NH Black adults 63.6% (57.8-68.9) ; Hispanic adults 62.0% (55.0-68.5) ; and NH Asian adults 57.3% (46.6-67.3) . Screening based on the 2021 USPSTF criteria will detect approximately 60% of US adults with dysglycemia, which was similar across ethnic groups.

Disclosure

M.J.O'brien: None. K.M.Bullard: None. Y.Zhang: n/a. S.Bailey: Consultant; Lundbeck, Luto, Pfizer Inc., Sanofi, Research Support; Eli Lilly and Company, Gordon and Betty Moore Foundation, Lundbeck, Merck & Co., Inc., Pfizer Inc., Retirement Research Foundation for Aging. S.Khan: None. R.T.Ackermann: Consultant; UnitedHealth Group. M.K.Ali: Advisory Panel; Bayer AG, Research Support; Merck & Co., Inc. S.R.Benoit: None. G.Imperatore: None. C.S.Holliday: None.
1116-P: Enrollment of Racial/Ethnic Minorities in the Rare and Atypical Diabetes Network (RADIANT)
Authors: TOSUR MUSTAFA , GANDOLFO LAURA , BALASUBRAMANYAM ASHOK , NAYLOR ROCHELLE N. , POLLIN TONI I. , RASOULI NEDA , BUSE JOHN B. , REDONDO MARIA J. ,   RADIANT STUDY GROUP
Published: May 2022

RADIANT is an NIH study of people with uncharacterized forms of atypical diabetes mellitus (DM) in the US. RADIANT participants consent online and progress through three sequential stages of study procedures, as eligible. DM in underrepresented minorities (URM) is rapidly increasing in incidence and has worse outcomes than DM in non-Hispanic whites. RADIANT pre-set targets proportionate to ethnic/racial distribution in the US to enroll individuals from a wide racial/ethnic spectrum. We aimed to study the URM participation in RADIANT across study stages. Enrollment rate for URM was significantly below pre-set targets at consent and across most stages (Table 1) . Referral sources significantly differed by races (p=0.003) but not ethnicities (p=0.16) . Most African-Americans (54%) were referred by RADIANT investigators but flyers, news, social media and family or friend were the major sources of referral for whites (30%) . Some of the initiatives to increase URM in RADIANT include engaging with clinics serving URM, working with local clinics/hospitals, electronic medical record screening approaches, increased focus on DM types more frequent in URM, providing culturally competent study coordination and targeted advertisement. In sum, enrollment rate of URM in RADIANT is suboptimal. Investigating barriers and facilitators for minority recruitment in RADIANT, with implications for other studies, is warranted.

Disclosure

M. Tosur: Advisory Panel; Provention Bio, Inc. A. Balasubramanyam: None. R.N. Naylor: None. T.I. Pollin: Research Support; Regeneron Genetics Center, Regeneron Pharmaceuticals Inc. N. Rasouli: Advisory Panel; Eli Lilly and Company, Novo Nordisk, Sanofi. Research Support; Allergan, Eli Lilly and Company, Novo Nordisk. J.B. Buse: Consultant; Alkahest, Anji, AstraZeneca, Boehringer Ingelheim International GmbH, Cirius Therapeutics, Inc., Eli Lilly and Company, Fortress biotech, GentiBio, Glycadia, Glyscend, Janssen Pharmaceuticals, Inc., Mellitus Health, Moderna, Inc., Pendulum Therapeutics, Praetego, LLC, Stability Health, Valo, Zealand Pharma A/S. Research Support; AstraZeneca, Dexcom, Inc., Eli Lilly and Company, Novo Nordisk, vTv Therapeutics. Stock/Shareholder; Glyscend, Mellitus Health, Pendulum Therapeutics, PhaseBio Pharmaceuticals, Inc., Praetego, LLC, Stability Health. Other Relationship; Adocia, AstraZeneca, Eli Lilly and Company, Intarcia Therapeutics, Inc., MannKind Corporation, Novo Nordisk, Sanofi, Senseonics, vTv Therapeutics. M.J. Redondo: Advisory Panel; Provention Bio, Inc.

Funding

National Institutes of Health (U54, DK118638-01)
1131-P: Progression to Diabetes Despite a Baseline Fasting Plasma Glucose = 80mg/dL: A Population-Based Case-Control Study
Authors: MOHAN SNEHA , VELLA ADRIAN , EGAN AOIFE M.
Published: May 2022

While elevations in baseline fasting plasma glucose (FPG) are associated with risk of type 2 diabetes mellitus (DM) , some individuals with lower FPG will also develop DM. The aim of this study was to identify factors associated with DM in people with a baseline FPG of ≤ 80mg/dL. Using the population-based Rochester Epidemiology Project medical records linkage system, we identified subjects with ≥ 2 FPG tests from 2005-17, and a baseline FPG of ≤ 80mg/dL. Subjects who developed DM (FPG > 125mg/dL) were assigned an event date as the date of the 1st diagnostic value. Those who did not develop DM were censored at their last FPG. The median duration of follow-up was 7 years. The entire cohort consisted of 2315 subjects, of whom 130 (5.6%) developed DM. Using a nested case-control design we compared all 130 who progressed to diabetes (cases) to 491 randomly selected controls. Among the cases, 121 (93%) developed type 2 DM, 4 (3%) had type 1 DM, and 5 (4%) reverted to normal FPG on repeat. Cases were older, more commonly male, and had a higher BMI (see table) . Cases were more likely to have experienced a critical health event such as a malignancy diagnosis or exposure to high dose glucocorticoids. On extended follow up, 15% of cases were deceased.

In summary, progression to DM in individuals with a low-normal FPG at baseline typically occurs in the context of significant medical comorbidity and portends a poor prognosis.

Disclosure

S.Mohan: None. A.Vella: Advisory Panel; Crinetics Pharmaceuticals, Inc., Rezolute, Inc., vTv Therapeutics, Zealand Pharma A/S, Other Relationship; Novo Nordisk. A.M.Egan: None.
1133-P: High Prediabetes Risk and Associated Risk Factors in Indian Population Based on Online Prediabetes Risk Test
Authors: VERMA RITIKA , SAHAY RAKESH , BANTWAL GANAPATHI , KALRA SANJAY , AGNIHOTRI AKSHATA D. , TIWASKAR MANGESH H. , ADE SURESH F. , JUNEJA ARCHANA M. , LAKHANI OM J. , SINGAL ARBINDER K.
Published: May 2022

Background: In India, a significant number of people are still diagnosed with diabetes at a later stage or after the complications have started. The unawareness about the disease and financial burden associated with the diagnostic testing remains a challenge. The study was aimed at the digital administration of a prediabetes risk test questionnaire to understand the people who are at high risk and more prone to developing prediabetes and eventually diabetes.

Methods: A prediabetes risk questionnaire was developed based on the American Diabetes association risk score test. The test was completed by 1722 participants across India. The test was based on risk factors like age, gender, race, BMI, family history of diabetes, history of high blood pressure, and physical activity status. The scoring was done for three groups including high risk (score >5) , medium risk (score 3-5) , and low risk (score <3) . Binomial logistic regression was used for risk factor analysis among groups with low score and high-medium score.

Results: The risk of prediabetes was low in 21 %, medium in 65 % and high in 12 % of participants. Out of all the participants 44 % had age ≥ 40 years, 71% were male, 96 % were asian, 74 % had BMI ≥ 23 kg/m2, 59 % of total participants have a family history of diabetes (first-degree relatives) , 17 % had high blood pressure, and 44 % were performing physical activity below recommended level of 150 mins per week. Among people with BMI ≥ 23 kg/m2, 89 % were having either high or medium risk scores. Among young people (age < 40 years) , 67 % were having high or medium scores. The odds ratio for score in high or medium range for people with BMI ≥ 23 kg/m2 and age ≥ 40 years was 38.51 (95% CI: 24.19-61.30, P<0.001) and 78.89 (95% CI: 41.21-136.06, P<0.001) respectively.

Conclusion: The study showed that out of all the participants, 77% had a high or medium risk score. The study highlights the importance of using a prediabetes risk calculator as a tool for improving awareness about the risk of developing prediabetes.

Disclosure

R.Verma: Employee; Fitterfly Healthtech Pvt Ltd, Wellthy Therapeutics Pvt Ltd. A.K.Singal: Other Relationship; Fitterfly Healthtech Pvt Ltd. R.Sahay: Advisory Panel; Torrent Pharmaceuticals , Speaker's Bureau; Dr. Reddy’s Laboratories Ltd., Eli Lilly and Company, Eris Lifesciences Ltd., Intas Pharmaceuticals Ltd., Novo Nordisk, USV Private Limited. G.Bantwal: None. S.Kalra: Speaker's Bureau; Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi. A.D.Agnihotri: None. M.H.Tiwaskar: None. S.F.Ade: None. A.M.Juneja: None. O.J.Lakhani: Advisory Panel; FITTERFLY, Speaker's Bureau; Eli Lilly and Company, Novo Nordisk Global Business Services, Sanofi, Stock/Shareholder; Zydus Cadilla.
1138-P: Impact of Continuous Glucose Monitoring (CGM) on Glycemic Control and Acute Complications in Type 2 Diabetes (T2D) in the Veterans Health Administration (VHA)
Authors: REAVEN PETER , NEWELL MICHELLE , RIVAS SALVADOR , ZHOU XINKAI , NORMAN GREGORY J. , ZHOU JIN
Published: May 2022

Use of CGM in T2D is rising rapidly, yet little is known regarding its effects on glucose management in the VHA. We thus identified new CGM users (new CGM sensor prescriptions for T2D on insulin) and non-users (T2D receiving glucose strips) during the years 2015-2020 and used national VHA healthcare data from visit encounters to compare change over 12 months in glucose control and new emergency room (ER) or hospital admissions. Changes in HbA1c and acute admissions were compared by linear mixed models and generalized linear models, respectively. Compared with 36,082 non-users, CGM users (n=16,013) differed in many ways but were well-balanced with overlap weighting from propensity score modeling. CGM users had a greater reduction in HbA1c over 12 months (-0.25%; 95% CI -0.21-0.29, p<0.0001) and a decline in hypoglycemia related ER visits/hospitalizations (OR = 0.78; CI 0.62-0.97) . Among CGM users, those < 65 years old or with initial HbA1c > 8. 4% (median) had greater reductions in HbA1c, while those at higher hypoglycemia risk had reduced hypoglycemia and hyperglycemia related ER visits/hospitalizations and all-cause hospitalizations (Table) . In this large national study in T2D, CGM initiation was linked with better glucose control and reduced ER and/or hospital admissions for hypoglycemia and showed even greater benefits in subsets of CGM users.

Disclosure

P.Reaven: Research Support; AstraZeneca, Dexcom, Inc. M.Newell: Research Support; Dexcom, Inc. S.Rivas: None. X.Zhou: None. G.J.Norman: Employee; Dexcom, Inc. J.Zhou: Research Support; Dexcom, Inc.

Funding

DexCom, Inc
1140-P: Twenty-Year Trends in Vision Impairment among U.S. Adults with Diabetes
Authors: LUNDEEN ELIZABETH A. , KIM MINCHUL , EHRLICH JOSHUA R.
Published: May 2022

Previous research found a decline in vision impairment (VI) prevalence among US adults with diabetes mellitus (DM) from 1997-2010. However, from 2007-20to 2015-2018, there was a decrease in glycemic control in US adults with DM, potentially leading to a worsening of ocular complications that can result in VI. We examined 20-year trends (1999-2018) in VI prevalence among adults ≥18 years with diagnosed DM, using self-reported data from the U.S. National Health Interview Survey. Annual prevalence is presented as single years and a 3-year moving average, age-standardized to the 20U.S. Census. Trends were analyzed using Joinpoint regression with single years of data. Annual Percent Change (APC) is presented. Using the 3-year moving average, the prevalence of adults with DM who reported VI decreased from 21.5% in 1999 to 20.7% in 2018. This trend was not statistically significant (APC: -0.47; p=0.2) . However, Joinpoint regression found distinct trends, with VI prevalence decreasing significantly from 1999-2012 (APC: -1.93; p<0.001) followed by an inflection point at 2012, resulting in an increase in prevalence from 2012-2018 that was not statistically significant (APC: 2.86; p=0.1) . These results suggest that declines in VI among adults with DM seen in the first decade of the century may have plateaued in 2012. Future research could identify determinants, including glycemic management, vision screening, and healthcare utilization.

Disclosure

E.A.Lundeen: None. M.Kim: None. J.R.Ehrlich: Consultant; MetLife.
1147-P: Trends in Diabetes-Related Foot Disease Hospitalization, Revascularization, and Amputations in Australia 20to 2019
Authors: QUIGLEY MATTHEW , MORTON JEDIDIAH I. , LAZZARINI PETER A. , SHAW JONATHAN E. , MAGLIANO DIANNA J.
Published: May 2022

Hospitalization for diabetes-related foot disease adds considerable burden for people living with diabetes and often leads to lower extremity amputation. We evaluated trends in the incidence of foot disease related hospital admission, revascularization and amputation procedures among people with type 1 and type 2 diabetes in Australia from 2010-2019. We included 70,766 people with type 1, and 1.1 million people with type 2 diabetes from the Australian diabetes registry (55% male) . We linked the diabetes registry to hospital admissions data to obtain the number of hospital admissions for foot disease, revascularization and amputation procedures. We estimated the annual incidence rates, using people with diabetes as the denominator, and evaluated trends over time with Joinpoint regression. In type 1 diabetes, rates of admission for foot disease and revascularization increased, while amputation rates were relatively stable (Table) . In type 2 diabetes, rates of foot disease admission and revascularization increased. While above the knee amputations decreased, below the knee amputations were stable, and foot and toe amputations increased. Average annual percent changes were generally higher for men than women (i.e. men showed greater increases or less of a decrease over time) . These findings highlight the importance of improving management of diabetes-related foot disease.

Disclosure

M.Quigley: None. J.I.Morton: None. P.A.Lazzarini: None. J.E.Shaw: Advisory Panel; Abbott Diagnostics, AstraZeneca, Eli Lilly and Company, Pfizer Inc., Roche Diagnostics, Research Support; AstraZeneca, Boehringer Ingelheim International GmbH, Speaker's Bureau; AstraZeneca, Eli Lilly and Company, Novo Nordisk, Sanofi. D.J.Magliano: None.

Funding

MQ is supported by an Australian Government Research Training Program (RTP) Scholarship. JIM is supported by an Australian Government Research Training Program (RTP) Scholarship and Monash Graduate Excellence Scholarship. PAL is supported by a National Health and Medical Research Council Early Career Fellowship. JES is supported by a National Health and Medical Research Council Investigator Grant. DJM is supported by a National Health and Medical Research Council Senior Research Fellowship. This work is partially supported by the Victorian Government’s Operational Infrastructure Support Program.
1152-P: Achieving Diabetic Management Targets in People with Type 1 Diabetes
Authors: VARKEVISSER RITA D.M. , BIRNIE ERWIN , VOLLENBROCK CHARLOTTE E. , MUL DICK , VAN DIJK PR , VAN DER KLAUW MELANIE M. , VEEZE HENDRIK J. , AANSTOOT HENK-JAN , WOLFFENBUTTEL BRUCE H.
Published: May 2022

Background: Optimal diabetes care and risk factor management are important to delay micro- and macrovascular complications in individuals with type 1 diabetes (T1D) . Ongoing improvement of management strategies requires the evaluation of target achievement and identification of determinants in individuals who do (or do not) achieve these targets.

Methods: Cross-sectional data were collected from individuals with T1D visiting Diabeter and the University Medical Center Groningen, the Netherlands, in 2018. Targets were defined as HbA1c <7%, LDL-c <2.6mmol/l (no CVD present) or <1.8mmol/l (CVD present) , or blood pressure (BP) <140/90mmHg. Determinants between individuals who did (or did not) achieve targets were compared by presence of CVD.

Results: Data from 1,737 individuals were available. Mean age was 27 [IQR 22-43] years and 50% female. Mean HbA1c was 63 mmol/mol (7.9%) , LDL-c was 2.67mmol/l, and BP 131/76mmHg. In individuals with CVD, 24%, 33%, and 46% achieved HbA1c, LDL-c, and BP targets respectively. In individuals without CVD these percentages were, 29%, 54%, and 77%, respectively. Individuals with CVD who did or did not achieve HbA1c targets did not differ significantly. Individuals who achieved LDL-c targets had a longer diabetes duration (42 vs. 37 years, p=0.03) , lower eGFR (eGFR 56 vs. 70 ml/min/kg2) and were prescribed more lipid lowering medication (94% vs. 77%, p=0.05) . Individuals who achieved BP targets were younger (58 vs. 62 years, p=0.05) . In comparison, individuals without CVD who achieved HbA1c targets differed in age (28 vs. 25 years, p=<.001) , sex (45% vs. 53% female, p=0.02) , and insulin pump use (60% vs 52%, p=0.01) amongst others. Those who achieved LDL-c targets had lower BMI (24.1 vs. 26.1kg/m2, p=<.001) . BP targets were achieved by younger individuals with less microvascular complications (14% vs. 33%, p=<.001) .

Conclusions: Opportunities for improvement diabetes management exist for the achievement of glycaemic, lipid and BP targets but differ between individuals with and without CVD.

Disclosure

R.D.M.Varkevisser: None. E.Birnie: None. C.E.Vollenbrock: None. D.Mul: None. P.Van dijk: None. M.M.Van der klauw: Advisory Panel; Pfizer Inc. H.J.Veeze: Employee; Medtronic. H.Aanstoot: Consultant; Lilly Diabetes, Medtronic. B.H.Wolffenbuttel: Advisory Panel; Novo Nordisk A/S, Other Relationship; Novo Nordisk.
1164-P: The Prevalence of Comorbidities among People with Obesity with and without Prediabetes
Authors: FORD JANET , LAGE MAUREEN J. , BOYE KRISTINA , BAE JAY P. , TERRELL KENDRA A. , BUNCK MATHIJS C.
Published: May 2022

Objective: Obesity and prediabetes are widespread in the U.S., with an estimated 42% of adults living with obesity and 35% living with prediabetes. This research examines the prevalence of comorbidities among people with obesity with or without prediabetes over a 5-year period.

Methods: This observational study uses Optum® Market Clarity deidentified data from 2007-2020. For adults with obesity and prediabetes, the index date was defined as the first date where the person was identified with both obesity (BMI ≥ 30 kg/m2) and prediabetes (5.7% ≤ A1c < 6.5%) while for adults with obesity without prediabetes (obesity only) , the index date was defined as the first date with BMI ≥ 30 kg/m2. All patients were required to be continuously insured from 1 year prior through 5 years post index date. For both cohorts, patients were excluded if there was any prior evidence of diabetes and in the obesity only cohort individuals were excluded if identified with prediabetes in the pre-period. Prevalence rates and 95% CIs were calculated for comorbidities for each 365-day period post index date and over the entire 5-year post-period.

Results: There were 22,423 individuals with obesity and prediabetes (mean age = 58.5 years; 42.2% male) and 902,975 individuals with obesity only (mean age = 51.7 years; 46.1% male) . The mortality rate after 5 years was 16.7% for adults with obesity and prediabetes and 9.9% for adults with obesity only (p<0.05) . Five years post index date, the prevalence of T2D was 28.8% for people with obesity and prediabetes and 11.9% for people with obesity only (p<0.05) . Prevalence rates for heart failure (4.3% v 2.2%) , atherosclerotic cardiovascular disease (16.2% v 6.9%) , and obstructive sleep apnea (2.2% v 1.0%) were significantly higher for adults with obesity and prediabetes compared to adults with obesity without prediabetes (all p<0.05) .

Conclusion: Findings indicate that the presence of prediabetes contributes to the development of additional morbidity and mortality in adults with obesity over time.

Disclosure

J.Ford: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. M.J.Lage: Consultant; Eli Lilly and Company. K.Boye: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. J.P.Bae: None. K.A.Terrell: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. M.C.Bunck: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company.
1166-P: Distinct Phenotypes of Multiorgan Abnormalities in Long COVID and Type 2 Diabetes Identified by Multiparametric Magnetic Resonance Imaging
Authors: EICHERT NICOLE , TELFORD ALISON , ROCA-FERNANDEZ ADRIANA , HAMID AZLINDA , THOMAIDES-BREARS HELENA B. , DENNIS ANDREA , BANERJEE RAJARSHI , ALI SARAH , THANABALASINGHAM GAYA , KEMP GRAHAM , CUTHBERTSON DANIEL , BANERJEE AMITAVA
Published: May 2022

Introduction: Both long COVID and Type 2 Diabetes (T2D) are multi-system conditions requiring multi-organ assessment to monitor organ health and detect co-morbidities earlier. Here, we defined multi-organ abnormalities in both patient groups with a rapid, non-contrast MRI scan.

Methods: We recruited 135 long COVID patients (NCT04369807) and 135 T2D patients (NCT04114682) . MRI data were acquired for organ-specific measures of size, fat deposition and fibroinflammation (CoverScan®, Perspectum Ltd.) . Reference values were based on 92 controls and published literature.

Results: There was a high prevalence of organ abnormality in both patient groups (Figure, left) , including increased fat deposition (steatosis) in liver, pancreas, and kidney (Figure, right) . 35% of T2D patients had clustering of abnormalities involving at least 2 organs, compared to 23% in long COVID. Abnormalities affecting the liver and renomegaly were more common in T2D than in long COVID. Considering only obese patients, liver fibroinflammation, hepatomegaly, and renomegaly remained significantly more prevalent in T2D than in long COVID.

Conclusion: Multi-organ MRI assessment can enrich the current blunt assessment of multi-system abnormalities in diverse disease states to inform earlier intervention and treatments.

Disclosure

N.Eichert: Employee; Perspectum Ltd. G.Kemp: None. D.Cuthbertson: Other Relationship; AstraZeneca, Novo Nordisk. A.Banerjee: Research Support; AstraZeneca. A.Telford: Employee; Perspectum Ltd. A.Roca-fernandez: Employee; Perspectum Ltd. A.Hamid: None. H.B.Thomaides-brears: Employee; Perspectum Ltd, Stock/Shareholder; Perspectum Ltd. A.Dennis: Employee; Perspectum Ltd. R.Banerjee: Employee; Perspectum Ltd., Other Relationship; Perspectum Ltd., Stock/Shareholder; Perspectum Ltd. S.Ali: Other Relationship; NICE committee for diabetes. G.Thanabalasingham: Speaker's Bureau; Boehringer Ingelheim International GmbH.

Funding

EU RADIcAL grant, Innovate UK
117-LB: Glucokinase Activator Restores Glucose Sensitivity and Early-Phase Insulin Secretion in T2DM Patient—A Post Hoc Analysis of Dorzagliatin
Authors: FENG LINGGE , GUO QUANLE , CHEN CHUNXIANG , LIU XIANG , CHEN LI , YANG WENYING
Published: May 2022

Background: Insulinogenic index (IGI) and disposition index (DI) measures patient’s early phase insulin secretion ability and glucose sensitivity. Pervious clinical trials of dorzagliatin have showed excellent effect on glycemic control and good safety profile in Chinese T2DM patients. This post-hoc analysis was focused on evaluating the correlation between glycemic control and the restoration effect of glucokinase activator on β-cell function.

Method: The analysis has involved two phase III clinical trials of dorzagliatin, monotherapy (SEED) (NCT03173391) and metformin add-on (DAWN) (NCT03141073) , respectively. The change of HOMA2-IR, IGI and DI from baseline to 24 weeks were analyzed. Correlation between glycemic control status and patient’s early phase insulin secretion ability as well as glucose sensitivity were further demonstrated by logistic regression analysis with IGI, DI, HOMA2-IR and other characteristics.

Results: Totally 726 patients were included in the final analysis set, with 241 patients from SEED cohort and 485 patients from DAWN. After 24 weeks treatment, two cohorts showed the consistent result of IGI and DI improvement. Nevertheless, The improvement of IGI and DI for HbA1c controlled group (HbA1c <7%) were significantly higher than HbA1c uncontrolled group (HbA1c ≥ 7%) . The result was also consistent across different disease course groups in DAWN cohort considering the relatively longer disease course. Logistic regression analysis revealed that both the improvement of IGI and DI were independent influential factor of patient’s HbA1c controlled status after treatment of dorzagliatin.

Conclusion: The post hoc analysis demonstrated the beneficial effect of dorzagliatin on early insulin secretion ability and glucose sensitivity on T2DM patients. The HbA1c control status were significantly affected by improvement of early insulin secretion ability and glucose sensitivity both for drug naïve patients and metformin tolerated patient.

Disclosure

L. Feng: Employee; Hua Medicine. Q. Guo: None. C. Chen: Employee; Hua Medicine. X. Liu: Employee; Hua Medicine. L. Chen: Employee; Hua Medicine. W. Yang: Advisory Panel; Hua Medicine.

Funding

Hua Medicine
1183-P: Effects of an Early Postpartum Lifestyle Intervention on Long-Term Risk of Diabetes in Women with Gestational Diabetes Mellitus
Authors: HU GANG , LIU HUIKUN , LENG JUNHONG , WANG LEISHEN , ZHANG SHUANG , LI WEIQIN , LI WEI , QI LU , YU ZHIJIE , YANG XILIN , TUOMILEHTO JAAKKO
Published: May 2022

Few randomized controlled trials (RCT) that have thus far been published have not unequivocally found that early postpartum lifestyle intervention can prevent or delay the onset of type 2 diabetes in women with prior gestational diabetes mellitus (GDM) . The aim of the present large-scale, long-term RCT was to assess whether an early postpartum lifestyle intervention can reduce or delay type 2 diabetes risk in women with prior GDM in the Tianjin Gestational Diabetes Mellitus Prevention Program in China. A total of 1180 women who were diagnosed with GDM from 20to 20were randomly assigned to either a 4-year lifestyle intervention (n = 586) or a control group (n = 594) . Major elements of the intervention included six face-to-face meetings with study dietitians in the first year, and two additional sessions and two telephone calls in each subsequent year. The mean follow-up was 4.5 years. During the trial, overweight women with GDM in the intervention group compared with the control group were more likely to lose weight. The incidence of diabetes was 0.87 and 1.46 per 100 person-years in the lifestyle intervention and control groups, respectively; the lifestyle intervention reduced the incidence by 45 percent (P = 0.023) . An early postpartum healthy lifestyle management markedly reduced the incidence of diabetes among women with prior GDM.

Disclosure

G.Hu: None. X.Yang: None. J.Tuomilehto: Stock/Shareholder; Orion Pharma. H.Liu: None. J.Leng: None. L.Wang: None. S.Zhang: None. W.Li: None. W.Li: None. L.Qi: None. Z.Yu: None.

Funding

This study is supported by the grant from European Foundation for the Study of Diabetes (EFSD) /Chinese Diabetes Society (CDS) /Lilly program for Collaborative Research between China and Europe. Dr. Hu is partly supported by the grant from the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100790) and the National Institute of General Medical Sciences (U54GM104940) of the National Institutes of Health.
1187-P: Distinct Islet Autoantibody Profiles in Hispanic Youth at Type 1 Diabetes Onset
Authors: SIMMONS KIMBER M. , VIGERS TIMOTHY B. , PYLE LAURA , YOUNGKIN ERIN M. , BASCHAL ERIN E. , MCDANIEL KRISTEN , YU LIPING , MICHELS AARON W.
Published: May 2022

The incidence of type 1 diabetes continues to increase, most notably in American Hispanic (HIS) youth. Type 1 diabetes autoimmunity has not been fully characterized in HIS youth. Determining the prevalence of islet autoantibody positivity in HIS youth may improve understanding of T1D immunopathogenesis and potentially impact treatment. We determined the prevalence of islet autoantibodies directed against glutamic acid decarboxylase 65 (GADA) , insulinoma antigen-2 (IA-2A) , insulin (IAA) and zinc transporter 8 (ZnT8A) using fluid-phase radiobinding assays from stored sera in HIS youth (n=378) and in age/sex matched (9.4±4.0y, 48% male) non-Hispanic white (NHW) youth (n=378) with recent onset diabetes from our large diabetes center in Colorado. Of note, BMI was significantly lower in HIS youth (17±3.6 kg/m2) compared to NHW youth (20.0±7.1) (p=0.01) . HIS youth with type 1 diabetes had a higher rate of positivity for GADA and IA-2A when compared to NHW youth with type 1 diabetes (p<0.01, Figure) . HIS youth were also more likely to have 3 or more islet autoantibodies present at diagnosis compared to NHW youth (p=0.01) . Investigating the phenotype of diabetes in diverse racial and ethnic groups with type 1 diabetes provides an opportunity to further dissect the heterogeneity that exists within diabetes in youth.

Disclosure

K.M.Simmons: Advisory Panel; Provention Bio, Inc., Consultant; Dexcom, Inc. T.B.Vigers: None. L.Pyle: None. E.M.Youngkin: None. E.E.Baschal: None. K.Mcdaniel: None. L.Yu: None. A.W.Michels: Employee; ImmunoMolecular Therapeutics, Stock/Shareholder; ImmunoMolecular Therapeutics.

Funding

National Institutes of Health (K12DK094712)
1193-P: Natural History of Type 2 Diabetes in South Asians: Arrow of Time
Authors: NARAYAN K.M. VENKAT , KONDAL DIMPLE , STAIMEZ LISA R. , ANJANA RANJIT MOHAN , GUJRAL UNJALI , DEEPA MOHAN , PATEL SHIVANI A. , ALI MOHAMMED K. , PRABHAKARAN DORAIRAJ , CHANG HOWARD H. , TANDON NIKHIL , MOHAN VISWANATHAN
Published: May 2022

Background: People of South Asian ancestry are at high risk for type 2 diabetes, but the time to disease progression in this population is not fully understood.

Methods: We analyzed data from 2714 adults aged ≥20 years, enrolled in the Chennai site of the prospective Cardiometabolic risk reduction in South Asia (CARRS) study. Participants had 75g OGTT and HbA1c measurements. We defined normal glucose tolerance (NGT) , isolated impaired fasting glucose (iIFG) , impaired glucose tolerance (IGT) , and diabetes based on ADA criteria. We constructed continuous chain Markov models to estimate the transition through multiple states (NGT -> iIFG -> diabetes; NGT -> IGT -> diabetes) . The annual and five-year transition probability among states was estimated based on transition intensity.

Results: Participants were, on average, 38.4 (range 20-89) years old, and 40.1% were male. Prevalence of iIFG and IGT was 16.9% and 7.3%, respectively. Over 5 years of follow up, the progression rates were: NGT to iIFG, 36.3 (95% CI: 32.5, 40.5) per 1,000 person-years (PYR) , NGT to IGT, 27.4 (95% CI: 24.1, 31.1) per 1,000 PYR, iIFG to diabetes 47.3 (95% CI: 40.4, 55.4) per 1,000 PYR, and IGT to diabetes 77.1 (95% CI: 65.1, 91.3) per 1,000 PYR. The estimated annual probability of remaining as NGT, iIFG, and IGT were 95.2% (94.7%, 95.8%) , 87.3% (85.5%, 89.0%) ;%) , and 81.9% (79.6%, 84.3%) %) , respectively. Assuming unidirectional transition, the annual probability of conversion from NGT to iIFG, and iIFG to diabetes were 4.5% (3.9%, 4.9%) , and 12.7% (10.9%, 14.5%) , respectively; and NGT to IGT, and IGT to diabetes were 3.8% (3.3%, 4.2%) and 18.1% (15.7%, 20.3%) . The estimated mean sojourn time (years) in each state were: NGT 20.5 (18.2, 23.2) , iIFG 7.4 (6.4, 8.6) , and IGT 5.0 (4.4, 5.8) , respectively.

Conclusion: The course to diabetes in South Asians is rapid once prediabetes sets in, allowing a window of only 5-7.4 years to implement proven prevention. Innovative prevention efforts in normoglycemic people may be needed to prevent prediabetes in the first place.

Disclosure

K.Narayan: n/a. H.H.Chang: None. N.Tandon: None. V.Mohan: None. D.Kondal: None. L.R.Staimez: None. R.Anjana: None. U.Gujral: None. M.Deepa: None. S.A.Patel: Research Support; Johnson & Johnson. M.K.Ali: Advisory Panel; Bayer AG, Research Support; Merck & Co., Inc. D.Prabhakaran: None.

Funding

The National Heart, Lung, and Blood Institute (NHLBI) , National Institutes of Health (HHSN268200900026C)
12-LB: A Prediction Model on Incident End-Stage Kidney Disease (ESKD) among Individuals with Type 2 Diabetes (T2D) and Chronic Kidney Disease (CKD)
Authors: LIN YILU , SHAO HUI , ANDERSON AMANDA H. , FONSECA VIVIAN , BATUMAN VECIHI , SHI LIZHENG
Published: May 2022

Diabetes is the leading cause of ESKD, a costly and disabling condition that often results in premature death. This study aimed to predict incident ESKD among individuals with T2D comorbid with CKD. The ACCORD clinical trial data were split into a training set and a validation set by a ratio of 7:3. A dynamic time-varying Cox model was fit to predict the development of incident ESKD. Significant predictors were identified from a list of candidate variables, including demographic characteristics, physical exam results, laboratory results, medical history, drug information, and healthcare utilization. Model performance was evaluated by Brier score and C statistics. Confidence intervals (CI) were calculated using a bootstrap method. Decomposition analysis was conducted to assess the variable importance. Patient-level data of HARMONY Outcome clinical trial was used for external validation. A total of 6,982 diabetes patients with CKD at baseline were used for model development, with a median follow-up of 4 years and 312 ESKD events. The significant predictors for the ESKD risk model were female, race, smoking status, age at T2D diagnosis, SBP, HR, HbA1c, estimated glomerular filtration rate (eGFR) , urine albumin-creatinine ratio (UACR) , retinopathy event happened in last year, antihypertensive drug use, and an interaction term between SBP and female. The model demonstrated good performance in discrimination (C-statistics 0.764 [95% CI 0.763-0.811]) and calibration (Brier Score 0.0083 [95% CI 0.0063-0.0108]) . The top 3 most important predictors in the prediction model were eGFR, retinopathy event, and UACR. There were 2,954 patients with CKD extracted from HARMONY Outcome with 545 ESKD events and a median follow-up of 2 years. Acceptable discrimination (C-statistics: 0.701 [95% CI 0.665-0.716]) and calibration (Brier Score: 0.0794 [95% CI 0.0733-0.1022]) were demonstrated in the external data. The dynamic risk prediction of incident ESKD among individuals with T2D can be used to support better disease management to lower the risk of developing ESKD.

Disclosure

Y. Lin: None. H. Shao: Board Member; BRAVO4HEALTH, LLC. A. H. Anderson: None. V. Fonseca: Consultant; Abbott, Asahi Kasei Corporation, Bayer AG, Novo Nordisk, Sanofi, Research Support; Fractyl Health, Inc., Jaguar Gene Therapy, Stock/Shareholder; Abbott, Amgen Inc., BRAVO4Health, Mellitus Health. V. Batuman: None. L. Shi: None.
1200-P: The Prevalence of Obesity-Associated Loss of Lean Muscle Mass
Authors: MURDOCK DANA J. , WU NING , GLASS DAVID J. , GRIMSBY JOSEPH S. , CALLE ROBERTO A. , DONAHUE STEPHEN , SLEEMAN MARK , SANCHEZ ROBERT J.
Published: May 2022

Sarcopenia, originally defined as age-related low muscle mass and function, has also been used to describe the loss of muscle mass and quality among certain populations, such as sarcopenic obesity (SO) . SO refers to loss of muscle and function in obese subjects; however, given age is not a factor in SO, we classified SO as obesity with low lean muscle mass (OLLMM) . Given the paucity of data in OLLMM, the purpose was to describe the prevalence of OLLMM in the US. Data from NHANES 2017-2018 were used to estimate the prevalence of OLLMM in adults ≥20 yrs of age. OLLMM was defined as DEXA-assessed low appendicular lean mass, adjusted for BMI (men <0.789, women <0.512) and obesity (body fat%: men >25%, women >35%) . Since DEXA was only measured in those aged 20-59 in NHANES 2017-2018, we utilized logistic regression models to predict OLLMM from NHANES 1999-20for those ≥60 yrs. The prevalence of OLLMM was estimated overall, by sex, age group, and diabetes status (prediabetes and T2DM) . We extrapolated results to the US using NHANES sampling weights. Of the 4174 adults (representing 181M US adults) , we identified 827 (28.8M, 15.9% of the US pop.) with OLLMM. Older adults had higher prevalence of OLLMM as did those with prediabetes and T2DM (Figure 1) . The prevalence of OLLMM in the US is high. While the prevalence of OLLMM was higher with age, its prevalence was also high in diabetics, regardless of age. Clinicians should monitor for OLLMM among obese T2DM patients.

Disclosure

D.J. Murdock: Employee; Regeneron Pharmaceuticals Inc. Stock/Shareholder; Regeneron Pharmaceuticals Inc. N. Wu: Employee; Regeneron Pharmaceuticals Inc. Stock/Shareholder; Regeneron Pharmaceuticals Inc. D.J. Glass: Employee; Regeneron Pharmaceuticals Inc. Stock/Shareholder; Regeneron Pharmaceuticals Inc. J.S. Grimsby: Employee; Regeneron Pharmaceuticals Inc. Stock/Shareholder; Regeneron Pharmaceuticals Inc. R.A. Calle: Employee; Regeneron Pharmaceuticals Inc. Stock/Shareholder; Regeneron Pharmaceuticals Inc. S. Donahue: Employee; Regeneron Pharmaceuticals Inc. Stock/Shareholder; Regeneron Pharmaceuticals Inc. M. Sleeman: Employee; Regeneron Pharmaceuticals Inc. Stock/Shareholder; Regeneron Pharmaceuticals Inc. R.J. Sanchez: Employee; Regeneron Pharmaceuticals Inc. Stock/Shareholder; Regeneron Pharmaceuticals Inc.

Funding

Supported by Regeneron Pharmaceuticals, Inc.
1209-P: Genetic Subtypes of Prediabetes, Healthy Lifestyle, and Risk of Type 2 Diabetes in U.S. Hispanics
Authors: LI YANG , CHEN GUOCHONG , MOON JEE-YOUNG , SOTRES-ALVAREZ DANIELA , DAVIGLUS MARTHA L. , PIRZADA AMBER , MATTEI JOSIEMER , PERREIRA KRISTA M. , WASSERTHEI-SMOLLER SYLVIA , WANG TAO , KAUFMAN JOEL D. , KAPLAN ROBERT , QI QIBIN
Published: May 2022

Prediabetes is a heterogenous metabolic condition. We calculated 5 pathway-based partitioned polygenetic risk scores (pPRS: beta-cell, proinsulin, obesity, lipodystrophy and liver/lipid scores) based on 94 type 2 diabetes (T2D) -associated variants in 3677 individuals with prediabetes from the Hispanic Community Health Study/Study of Latinos. Based on these 5 pPRS, we identified 6 subtypes of prediabetes (n=488∼742 in each cluster) with different pPRS patterns by consensus clustering (Fig 1A) . Phenotypic patterns were consistent with pPRS patterns in these subtypes (Fig 1B; e.g., Cluster 1 had much lower beta-cell score, higher obesity and liver/lipid scores, and higher HOMA-B, BMI and HOMA-IR compared to other clusters) . These subtypes had similar levels of fasting glucose, HbA1c and 2h glucose at baseline but different risk of incident T2D over 6 years (Fig 1C) . Individuals in Cluster 6 featured with a very low proinsulin score had the highest risk of T2D (RR=1.42 [95% CI 1.13, 1.80] compared to Cluster 1) . We examined the association between a lifestyle score, using BMI, alcohol intake, smoking, physical activity and diet, and risk of T2D across 6 subtypes and found significant associations only in Cluster 1 (RR=0.76 [0.62, 0.93]) and Cluster 5 (RR=0.79 [0.67, 0.92]) . In US Hispanics, we identified 6 genetic subtypes of prediabetes which may differ in the development of T2D and benefits from healthy lifestyle.

Disclosure

Y.Li: None. T.Wang: None. J.D.Kaufman: None. R.Kaplan: None. Q.Qi: None. G.Chen: None. J.Moon: None. D.Sotres-alvarez: None. M.L.Daviglus: None. A.Pirzada: n/a. J.Mattei: None. K.M.Perreira: None. S.Wasserthei-smoller: None.