bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifying Barriers of Our Youngsters with Type 1 Diabetes Transitioning to an Adult Unit
Authors: DE VILLAR NOEMI GONZALEZ PEREZ , IGARTUA MARIA COS , HILLMAN NATALIA , GASPAR RUTH , DE IBARRA LOURDES SAEZ , BLANCO ANA COS , HERRANZ LUCRECIA
Published: June 2018

Youngsters with type 1 diabetes feel anxious when transitioning from Pediatric to Adult Care. Loss of attendance and worsening of metabolic control are related to it. Some barriers reported are difficulty in getting appointment, unknown referral health-care provider and work issues.

Objective: To evaluate loss of attendance, metabolic control and satisfaction in a cohort of youngsters with T1D transitioning to Adult Care.

Methods: All Kids with T1D transitioning between 2015-2017 were included. Clinical/demographic data were collected. A1c levels prior and 1 year after Transition were compared. Loss of attendance was defined as “loss of 2 following visits.” An anonymous survey was created ad hoc to evaluate satisfaction. It had 15 questions with a 1-5 scale, being 1 “never” and 5 “always.”

Results: 42 kids transitioned. 31% women, transition age 18(±1.8) years, diabetes duration 11(±4.4) years, 16.7%CSII, 83.9% were students. Delay between Pediatrics and Adults was 2.84(±1.9) months. A1c before and after 1 year were similar: 7.8(±1.5)% vs. 7.9(±1.5)%,p=ns). Loss of attendance occurred in the 2nd year in 3 patients (7.1%). Only worsening of A1c the year before was associated with it. 80.9% of patients answered the survey. Satisfaction degree was “most of the times” or “always” in >80% in questions related to: moment of transition, welcome, time expend on each visit, confidentiality, referral contact name/phone, share decision making or understanding therapy instructions. However, 1 out of 3 patients disagreed in questions about emotional support, feeling comfortable to talk about sex/drugs or feeling free to express their thoughts. Work issues was the most common cause of not compliance to visits.

Conclusion: Although rate of loss of visits is low and maintenance of metabolic control has been observed through Transition, an effort has to be made in our Team to improve satisfaction in terms of freedom to talk about sex or drugs, freedom to express their thoughts and to support their emotional needs.

Disclosure

N. Gonzalez Perez de Villar: None. M. Cos Igartua: None. N. Hillman: None. R. Gaspar: None. L. Saez De Ibarra: None. A. Cos Blanco: None. L. Herranz: None.
2017 Diabetic Food Apps—Are They Useful for the Diabetic Patient?
Authors: WU GLORIA , BILLARD LAURA , MURO ELENA , DOAN AMY , NGO VY-VY
Published: June 2018

Diabetes affects 23 million Americans and additional 7 million of prediabetic patients. Medical health mobile apps has generated 3.2 billion downloads in 2016. Are apps helpful to our diabetic patients seeking food information?

Purpose: Do free diabetic food apps follow the Diabetes Self-management Education and Support (DSME) guidelines?

Methods: Using the search term, “diabetic foods,” we used Google search engine to identify 30 most commonly listed apps by bloggers, websites and web journalists. Then, accessing Google Playstore, we found the 10 most popular diabetic food apps in 2017 based on number of downloads. Inclusion criteria: 1000 downloads or more; ease of web accessibility during multiple downloads over 3 days (no malfunction, no malware). Exclusion criteria: apps which were purely informational. We downloaded the apps and evaluated their adherence to the DSME guidelines.

Results: The most popular diabetic food app is” Fooducate “with 1,000,000 downloads. Fooducate fulfills 8/10 categories, but 3 of them (Hb1AC, TG levels, and BMI) are paid features. Of the 10 food apps, only 3/10 have cal/carb counting feature.

Conclusions: Mobile apps for diabetic foods are still in its preliminary stages of development. More input by interested diabetes health care professionals will improve the quality of future mobile apps for diabetes education and management.

Disclosure

G. Wu: None. L. Billard: None. E. Muro: None. A. Doan: None. V. Ngo: None.
Activation of Browning Adipose Tissues by Placental Growth Factor
Authors: YIN RUILI , ZHOU JING , ZHANG CHUANHAI , YAN CEN , MA WEI , WU NANNAN , ZHAO DONG , FENG YINGMEI
Published: June 2018

Background: Gestational diabetes mellitus (GDM) is a type of metabolic disorders. Browning adipose tissue (BAT) activity is reduced which strengthens insulin resistance in GDM. Placenta growth factor (PlGF) is one of the main factors produced by placenta during pregnancy. Once secreted into circulation, it participates in angiogenesis in peripheral tissues. However, whether and how PlGF modulates BAT function is yet unknown.

Methods: We recruited 91 nondiabetic pregnant participants and 73 GDM patients. Serum levels of PlGF were quantified by ELISA. Skin temperature was measured by Far infrared thermography in the supraclavicular region where classical BAT was located. Primary human preadipocytes isolated from intercapsular BAT were differentiated under different concentrations of PlGF in vitro. Terminally differentiated adipocytes were characterized by qPCR, western blot and oxygen consumption rates by respirometry. Phosphorylation signaling pathways in differentiated cells were dissected using Bio-Plex target assay (Bio-Rad). Cells were exposed with 1 ng PlGF in the presence or absence of 1 nM AMPK inhibitor Compound C to assess UCP-1 expression.

Results: Serum levels of PlGF were lower in GDM patients than non GDM controls, which was accompanied by decreased skin temperature in the supraclavicular region. By qPCR, PlGF dose-dependently induced BAT marker expression in differentiated brown adipocytes (BAC) and peaked at 1 ng as evidenced by the increased mRNA expression of UCP-1 and Oxphos. The increased BAT marker expression was further confirmed by western blot in differentiated BAC exposed to 1 ng PlGF. Accordingly, PlGF-exposed BAC showed higher oxygen consumption rates than control and stimulated AMPK phosphorylation. Blockade of AMPK phosphorylation abrogated UCP-1 and Oxphos expression in BAC induced by PlGF.

Conclusions: Physically, PlGF improves preadipocyte differentiation into active BAC. Decreased PlGF levels might contribute to the reduced BAC activity in GDM.

Disclosure

R. Yin: None. J. Zhou: None. C. Zhang: None. C. Yan: None. W. Ma: None. N. Wu: None. D. Zhao: None. Y. Feng: None.
Exercise Improves Sleep and Sleep Improves Glucose Control
Authors: SAKKAL SAAD
Published: June 2018

Background: 77% of people with diabetes have insomnia. Sleep disturbance results in impaired glucose control in healthy individuals or worsens glucose control in people with diabetes. Short-term sleep studies (1-6 weeks) improved glucose control and insulin resistance in obese “healthy” individuals. Few studies have tested the hypothesis that improving sleep quality will improve glucose control. Exercise has been proven to help both sleep and glucose control. We wanted to test, in this abstract, the impact of improving sleep with exercise.

Methods: We recommend aerobic exercise 10 minutes after each meal (HIIT) to all our patients, but not all adhere for a variety of reasons. We also advise balance and stretch.We compared 50 non-adherent type 2 patients to a matched exercise-adherent patients. We quantified feeling of well being, shortening latency of sleep onset, and sleep duration extension. We measured their glucose control with AM insulin/glucose ratio, HgA1c, and in-target glucose when CGMS was available (12 patients). All patients followed our standard diabetes treatment protocol for type 2.

Results: At 12 months, adhering to exercise improved the feeling of well being in 68%, sleep hygiene in 66% of patients; Sleep increased by 28 minutes, and sleep onset latency decreased by 8 minutes. Insulin/glucose ratio was 16/133=0.12, HgA1c 7.1%, HgA1c<7 in 69%, and in-target glucose in 74% on CGMS (7 patients). Non-adherent had feeling of well being in 45%, sleep hygiene in 14%; with sleep increasing by 4 minutes, and sleep onset latency decreased by 2 minutes. Insulin/Glucose ratio was 38/174=0.21, HgA1c 7.9%, HgA1c< 7 in 50%, and in-target-glucose in 54% on CGMS (5 patients.) diabetes medications used were 3 in both groups. Percentage needing basal insulin at the end was 8% in the exercise group, 21% in the non-adherent group.

Conclusion: Exercise Improved sleep and insulin resistance with improved glucose control. However, what is the contribution of each factor will need further study.

Disclosure

S. Sakkal: None.
Free Fatty Acids–Mediated Inflammation and Insulin Resistance/Insulin Production in Healthy and Gestational Diabetes Pregnant Women
Authors: CHEN XINHUA , STEIN THOMAS P. , SCHOLL THERESA O. , STEER ROBERT A.
Published: June 2018

We investigated the relationship of individual free fatty acid (FFA, GCMS), inflammatory biomarkers (multiplex assay) with insulin resistance (HOMA-IR) and production (C-peptide) levels during pregnancy from the Camden Study - a prospective longitudinal cohort (n=1,784, African-American 36%, Hispanic 48%, Caucasian 16%, age 22 ± 5.2 year., BMI 25.6 ± 6.1 kg/m2). Multivariate analyses were performed along with separate analyses for each individual FFA. All of the analyses were adjusted for maternal age, pre-pregnancy BMI, parity, cigarette smoking and ethnicity.

The results obtained at entry to care (16 weeks gestation) are summarized: (i) Elevated HOMA-IR and C-peptide levels were associated with a 50% to 2-fold (p<0.01 to p<0.0001) increased risk for developing gestational diabetes mellitus (GDM); (ii) Specific FFAs (%) (palmitoleic, oleic, linolenic acids) were significantly associated with decreased HOMA-IR and C-peptide levels (p<0.01 to p<0.0001); In contrast, palmitic, stearic, arachidonic acids and dihomo-γ-linolenic acid were associated with increased HOMA-IR and C-peptide (p<0.01 to p<0.0001); (iii) TNF-α, IL-8 and resistin levels were positively and adiponectin was negatively correlated with HOMA-IR and C-peptide (p<0.001 to p<0.0001); and (iv) FFAs predicted cytokine levels. For example, women with elevated palmitic acid were 50% (p<0.01) more likely to have higher IL-8 and TNF-α (highest quartile), whereas women with higher palmitoleic, oleic, linolenic acids levels had a reduced risk (∼2-fold, p<0.01 to p<0.001) of having higher IL-8, IL-6 and TNF-α levels.

Our data suggest that different FFAs are involved in the regulation of insulin resistance and production during pregnancy. The effects are either direct or indirect via modulating inflammatory responses. Thus, recognition and modifying individual FFAs are important in lowering the risk for impaired glucose tolerance and the development of GDM.

Disclosure

X. Chen: None. T.P. Stein: None. T.O. Scholl: None. R.A. Steer: None.
Relationship of Habitual Sedentary Behavior with Glycemic Control in People with Type 2 Diabetes
Authors: ALOTHMAN SHAIMA , ALSHEHRI MOHAMMED , ALENAZI AQEEL M. , KLUDING PATRICIA
Published: June 2018

Objective: Sedentary behavior (SB) has been shown to have an acute negative effect on glucose and insulin metabolism in people who are healthy and those with diabetes. It is unknown whether habitual SB will negatively affect long-term glycemic control as measured by HbA1c. Therefore, the purpose of this study is to examine the relationship between habitual SB and HbA1c in people with type 2 diabetes (T2D).

Methods: Objective assessment of SB and overall daily physical activity was collected in people with T2D in this cross-sectional analysis by asking the participants to wear an activity monitor with accelerometer and inclinometer measures (ActivPAL) for 7 days. The following variables average were included to examine the relationship with HbA1c (measured via disposable blood finger stick test using (A1cNow+) kit): total sitting time (TST), standing time (ST), walking time (WT).

Results: Total of 31 participants (65 ± 7.64 years, 10 males) were included in the analysis. The main outcomes averages were as follow: HbA1c 7.33 ± 1.41, TST 11.43 hr. ± 2.21, ST 3.86 hr. ± 1.65, WT 1.49 hr. ± 0.7. Person correlation coefficients test showed that HbA1c was positively correlated with TST (r= 0.365, p<0.05) but not with ST (r= - 0.293, p=0.11) or WT (r= - 0.291, p=0.11).

Conclusion: The results of this study indicates that SB level is an important modifiable factor in glycemic control in people with T2D. This effect appears to be independent of daily physical activity level. Future studies should focus on establishing causality between SB and long-term glycemic control. As many people with T2D struggle to meet recommended physical activity levels, targeting SB may be an important step in the process of reaching a healthy lifestyle.

Disclosure

S. Alothman: None. M. Alshehri: None. A.M. Alenazi: None. P. Kluding: None.
Searching for the High-Risk Group in Type 2 Diabetes by Anchoring of Distress
Authors: LIAO YIN-KAI , YANG YI-SUN , HUANG CHIEN-NING , PENG HSIU-LING
Published: June 2018

Objective: This is a cross-sectional study aimed to explore the risk factors associated with diabetes distress in type 2 diabetes.

Research Design and Methods: Patients with type 2 diabetes were recruited from tertiary hospital in central Taiwan for a diabetes distress evaluation. Diabetes distress was assessed both at baseline using a 17-item Diabetes Distress Scale (DDS-17) in Chinese version. Baseline demographic characteristics and biochemistry data were collected. Linear regression models were used to examine the relationship between baseline variables and the scores in DDS-17.

Results: Three hundred and sixty participants completed DDS-17 scale, their mean (SD) age and diabetes duration were 59.9 (11.6) years and 9.8 (7.4) years, respectively, and 49.1% were women.The correlation between glycaemia and distress was significantly positive (r=.472, p<.01) and distress can predict glycaemia significantly (R2=.223, p<.01). The correlation between HbA1C and diabetes duration, diabetes distress were significantly positive (r = .142, .294, p<.01). Furthermore, when diabetes distress predicted HbA1C, diabetes duration and age were mediators (βd = -.121, δR2 = .102, p<.05; βa = -.128, δR2 = .091, p<.05). Linear regression models, diabetes duration less than 4 years group were 3.26 times than the others (OR = 3.26, 95% CI 1.22-8.71). Younger age less than 50 years old were 5.53 times than the older aged (OR = 5.53, 95% CI 5.23-5.83). If considering age and duration simultaneously, the odds ratio of younger age and shorter disease duration were 10.71 times (OR = 10.71, 95% CI 2.28-50.36).

Conclusions: The high-risk group for diabetes distress was younger than 50 years old and shorter duration less than 4 years. HbA1C was easily raised in shorter duration of disease and in younger age patients when their diabetes distress increased. The findings can help clinicians to select in education or psychotherapy, and improve their distress and stabilize their glycemic control.

Disclosure

Y. Liao: None. Y. Yang: None. C. Huang: None. H. Peng: None.
Prevalence of Depression among Nepalese Patients with Type 2 Diabetes Attending Endocrine Clinic in Kathmandu, Nepal
Authors: YONZON PRIYADARSHINI , JOSHI ANSUMALI , GHIMIRE MONIKA
Published: June 2018

Background: Diabetes mellitus is a common chronic metabolic disorder in Nepal.Stressful living conditions and chronic illnesses make Nepalese people psychologically vulnerable. In a meta-analysis review the prevalence of major depression in people with diabetes was 11%.Limited studies have investigated the prevalence of depression in Nepalese population with diabetes.

Objective: To identify the prevalence of depression among Nepalese patients with type 2 diabetes and to examine the relationship between depression and socio-demographic factors, clinical factors and glycemic level.

Methods: This was a descriptive cross sectional study conducted at Kathmandu Diabetes and Thyroid Center Pvt Ltd, Nepal. Hundred thirty patients diagnosed with type 2 diabetes without prior history of depression were enrolled in the study. The translated Nepali version of Beck Depression Inventary (Ι a) was used to identify prevalence of depression. Data was analyzed with SPSS 16.

Results: The proportion of respondents with depression was 29.2%. Using chi-square test, the result showed significant association of gender (p=0.010), occupation (p=0.057) and complications of diabetes (p=0.001) with depression (Table).

Conclusion: Among the respondents, 29.2% were potential cases of depression. Psychological assessment should be included as a routine clinical evaluation for patients with diabetes.Total (n)DepressedNot depressedp- valueAge <55 yrs>55 yrs626829.03% (n 18)29.41%(n 20)70.96% (n 44)70.58% (n 48)0.962GenderMaleFemale646618.75% (n 12)39.39% (n 26)81.25% (n 52)60.60% (n 40)0.010Marital statusMarriedUnmarried1201027.5%(n 33)20% (n 5)72.5% (n 87)50% (n 5)0.133Family typeNuclearJoint745627.02% (n 20)32.14% (n 18)72.97% (n 54)67.85% (n 38)0.525Duration of illness< 5 years>5 years607026.67% (n 16)31.43% (n 22)73.33% (n 44)68.57% (n 48)0.552Complication of DiabetesPresentAbsent458546.66% (n 21)20% (n 17)53.33% (n 24)80% (n 68)0.001Fasting glucose level80-110 mg/dL>110 mg/dL508024% (n 12)32.5% (n 26)76% (n 38)67.5% (n 54)0.300

Disclosure

P. Yonzon: None. A. Joshi: None. M. Ghimire: None.
The Mitochondrial Cholesterol Transporter TSPO—Gatekeeper of Gestational Progesterone Production
Authors: HAGHIAC MARICELA , MINIUM JUDI , SKOMOROVSKA-PROKVOLIT YELENNA , CATALANO PATRICK , DE MOUZON SYLVIE HAUGUEL
Published: June 2018

During pregnancy, progesterone is exclusively produced by the placenta. As in all steroidogenic tissues, the first and rate-limiting step for the biosynthesis of placental progesterone is the import of cholesterol into the mitochondria via specific transporters. Plasma progesterone is 20% lower in pregnant obese women despite increased cholesterol availability suggesting an impairment in cholesterol import mechanisms. We investigated the role of the outer mitochondrial translocator protein (TSPO), the placental analog of StAR, as a potential regulator of placental progesterone production.

Study design: Villous fragments of placentas were collected at term scheduled Cesarean delivery of lean and obese women with normal glucose tolerance. Trophoblast cells were isolated and plated for primary culture. In vitro silencing of TSPO was performed by transfecting primary trophoblast cells with siRNA. Progesterone production was measured in lysates of trophoblast cells before and after TSPO silencing.

Results and Discussion: TSPO mRNA and protein expression were 2 to 3-fold lower in placentas of obese vs. lean women. TSPO siRNA silencing in trophoblast cells induced a 90% (p<0.001) decrease in TSPO protein expression, with no change in other proximal translocators: the voltage anion dependent channel (VDAC) and the adenine nucleotide translocator (ANT). Progesterone concentration dropped by 85% (p< 0.001) upon TSPO silencing. These results demonstrate that the cholesterol translocator TSPO directly regulates the production of placental progesterone. Together, our data point to mitochondrial dysfunction as a component of progesterone deficiency in obese pregnant women.

Disclosure

M. Haghiac: None. J. Minium: None. Y. Skomorovska-Prokvolit: None. P. Catalano: None. S. Hauguel de Mouzon: None.
Evaluation of the GLUCOCARD® W Blood Glucose Monitoring System’s Ease of Use
Authors: WALKER JULIE , GILL PATRICIA , MAHER DANIELLE , GLEISNER JOHN M.
Published: June 2018

Background: It is critical that Blood Glucose Monitoring System’s (BGMS) are easy to use since they are an important tool in the management of diabetes mellitus, including the prevention of micro and macrovascular complications. The GLUCOCARD® W BGMS is intended for consumer use and is an aid in monitoring the effectiveness of diabetes management. The “Ease of Use” consumer study is typically evaluated as part of the FDA 510(k) approval process for BGMS.

Purpose: The objective of this study was to evaluate the Ease of Use for the GLUCOCARD® W BGMS.

Methods: A total of 148 untrained consumers with diabetes performed a fingerstick self-test and answered a questionnaire directed at Ease of Use of the device and test strip. The topics in the questionnaire included, “Inserting a Test Strip into Meter to Turn it On”; “Blood Draw into Test Strip (Capillary Action)”; “Reading the Meter Display”; “Removing Test Strip from Meter” and “Performing a Blood Glucose Test from your Fingertip.” The subjects were asked to rate the topics as Very Easy, Easy, Ok, Difficult or Very Difficult. For evaluation purposes, these topics were grouped as Positive (Very Easy/Ease/Ok) and Negative (Difficult/Very Difficult).

Results: The topics in the questionnaire received the following positive ratings (%): “Inserting a Test Strip into Meter to Turn it On”, 97.3% (144/148); “Blood Draw into Test Strip (Capillary Action)”, 100.0% (147/147, one subject did not rate this topic); “Reading the Meter Display” received a 99.3% (147/148); “Removing Test Strip from Meter”, 100.0% (148/148) and “Performing a Blood Glucose Test from your Fingertip”, 100.0% (148/148).

Conclusion: The GLUCOCARD® W BGMS scored an overall positive rating of 99.3% (average of the ratings) from the untrained consumers with diabetes evaluating the BGMS as Very Easy to Ok to use.

Disclosure

J. Walker: Employee; Self; Arkray, Inc. P. Gill: Employee; Self; Arkray, Inc. D. Maher: Employee; Self; Arkray, Inc. J.M. Gleisner: Employee; Self; Arkray, Inc..
The New Paradigm of Diabetes Care
Authors: SAKKAL SAAD
Published: June 2018

Background: Achieving targets in diabetes care is still an elusive dream since < 54% reach HgA1c<7%. Is there a better paradigm? CGMS has proven its excellent data and analytics value.The Virtual Pancreas System (VPS) has proven its therapeutic value, by reaching Targets in >% 80, to achieve the triple aim of optimum HgA1c/glucose variability, zero hypoglycemia or weight gain,it is now cloud-based, reachable by any mobile or internet as a VPS/metabolic simulator. The value index is how much money ($) is spent on improving HgA1c 1% in three months

Methods and Design: We compared, using the value index, in 10 matched patients the standard paradigm (SP) and the new CGMS/VPS paradigm. We projected savings on total diabetes care for 10 million people with diabetes. We present data for both paradigms and consider the better option.

Results: CGMS/VPS lowered HgA1c by the absolute value of 2.4% and the relative value of 2.7% when compared to standard paradigm(SP), which is better than many newer standard medications (DPP-4 lowers HgA1c by an average of 0.5%, SLGT2: 0.8-1, Dulaglutide: 1.08). With CGMS/VPS the glucose in targets was 82%, FBS was 123, PPG 154, hypoglycemia 0.8%, and weight -5 lbs, the value index was $236 per quarter.In standard care, the glucose in the target was 66%, FBS 148, PPG 186, and weight +6 lbs, and the value index was $1400 per quarter.

Conclusion: CGMS/VPS is a superior new paradigm.Here is how I envision the new brave world of diabetes care in the future: 1) each patient registers through their medical home, to the cloud-based VPS with secure password, with CGMS daily data transmission 2) Patients and providers receive instant feedback to act. 3)diabetologists supervise the process, consult and advice when necessary. 4) The goal of optimum diabetes care is reached with optimal HgA1C, optimal weight, and no hypoglycemia with quarterly CGMS. 5) This new paradigm will cut the burden of the diabetic epidemic scourge by 30 Billion/year; we could prove it by initiating real-life large multi-center studies. This should be the new paradigm: promising and achievable.

Disclosure

S. Sakkal: None.
Photoactivation of Autologous Transplantation of Subcutaneous Adipose Tissue Improves Glucose Homeostasis
Authors: WU JIANBO
Published: June 2018

Photoactivation of autologous transplantation of subcutaneous adipose tissue improves glucose homeostasis Increasing evidences indicated that normal adipose tissue transplantation improves whole-body energy metabolism and glucose homeostasis in a high-fat diet (HFD)-induced obese mice model. Adipose tissue macrophage is associated with glucose homeostasis and insulin resistance in type 2 diabetes and obese humans, offering a potential target for therapeutics. However, whether transplantation of autologous AT that changed macrophage phenotype directly contribute to systemic glucose intolerance has not been determined. Here we specifically developed our device, with more specific wavelengths of light, to activate macrophage phenotype in isolated sWAT from HFD mice. We found that the macrophage polarization, M1 marker genes expression, such as CD11c, IL-6 and monocyte chemoattractant protein-1, but also the M1-to-M2 ratio were increased by an HFD and decreased by photoactivation treatment. Furthermore, autologous transplantation of photoactivated sWAT into a HFD mice reduced blood glucose level and caused significant improvement in glucose tolerance, which was not shown in a sham-operated or non-photoactivated sWAT HFD mice. Moreover, Positron emission/computed tomography scans indicated higher glucose uptake in heart, but not liver, hindlimb muscles, and abdominal subcutaneous white adipose tissue. These data suggested that the correlation with photoactivation to shift ATMs polarization of HFD mice caused significant improvement in glucose homeostasis, and that autologous transplantation might be a promising therapeutic option for the treatment of diabetes.

Disclosure

J. Wu: None.
A Comparative Study of Hybrid Artificial Pancreas and Virtual Pancreas System
Authors: SAKKAL SAAD
Published: June 2018

Introduction: Advances in the last decade in Artificial Pancreas system (APS) have been promising and accelerating with the introduction of Hybrid CGMS/Pump infusion technology as a major step toward long-term Artificial durable pancreas. Also, there exist virtual system termed the Virtual Pancreas System (VPS) that makes treatment effective, and cut cost to achieve the triple aim of optimum HgA1c/glucose variability, averting hypoglycemia or weight gain. The system also adjusts insulin pump setting and recently used the data from CGMS to direct therapy. However, what is the cost-effectiveness of such system compared to Hybrid Artificial Pancreas?

Methods: We compared the features of both systems from the literature review. We wanted to determine how much money ($) is spent on improving HgA1c by 1% in three months, reaching glucose within target (70-170) range, and hypoglycemia rate < 70 for both.

Results: 1.) VPS/CGMS lowered HgA1c by the absolute value of 2.4 in more than 90%. APS reported improvement in HgA1C of 1% recently.The Longest study is three months.

2.) VPS needs 14 glucose tests per month to get the optimum control or may use CGMS. APS needs CGMS.

3.) The diabetes care value index was: $236 per 1% HgA1C drop for VPS/CGMS, APS Value index still pending long-term study but short term it is $4000.

4.) VPS gets 90% glucose within target, APS 76% at this time, hypoglycemia 0 per patient in the VPS (or <0.2%), 1.1 per patient in APS (or <2%).

5.) VPS/CGMS costs $ 600/ year. APS as technology is still expensive. Our estimate it will be $12000/year for the next ten years

6.) VPS technology is available now. APS is still in early stage II or III clinical testing and will need ten years of clinical practice.

Conclusion: Virtual Pancreas System has superior Diabetes Care Value Index compared to any form of artificial pancreas system including the recently approved hybrid model intensive care. VPS will save more than $12000 yearly per patient, and $ 6 Billion nationally when compared to APS if applied only to <10% of people with diabetes.

Disclosure

S. Sakkal: None.
Characteristics of Patients Newly Prescribed IDegLira in U.S. Real-World Practice
Authors: MOCARSKI MICHELLE , DA ROCHA FERNANDES JOAO DIOGO , KALLENBACH LEE , VASEY JOE , KEN JESSICA , BOGDANOV ALINA N. , RADIN MICHAEL , EGEDE LEONARD E.
Published: June 2018

Background: IDegLira, a fixed-ratio combination of a basal insulin (BI), insulin degludec, and liraglutide, a glucagon-like peptide-1 receptor agonist (GLP-1), was approved by the FDA in Q4 2016 for the treatment of type 2 diabetes Mellitus (T2DM). This study describes characteristics of adult patients (pts) who initiated IDegLira in a real-world setting.

Methods: Demographic and clinical data for pts prescribed IDegLira between May and November 2017 were extracted from the Practice Fusion ambulatory care database. Pt characteristics were described for the 6-months prior to initiation. Pts were grouped by most recent antidiabetic therapy regimen in the prior 6-months.

Results: Pts prescribed IDegLira (n=388) received one of five prior therapy regimens: BI as only injectable (BI-INJ, N=88), GLP-1 as only injectable (GLP-INJ, N=47), GLP-1+insulin (GLP-INS, N=65), multiple daily insulin injections (MDI, N=35), and no injectable therapy (N-INJ, N=153). On average, IDegLira pts were 58 years old (SD 11.5); the majority (66%) between 40 and 64 years of age. Pts’ mean BMI was 35 (7.6). Mean A1C was 9.0 (1.82), with 12% below <7%, 19% between 7-7.9%, 25% between 8-8.9%, and 44% >9%. The N-INJ group had the highest mean A1C prior to initiating IDegLira (9.6), BI-INJ and GLP-INJ had intermediate means (both 9.0), and the GLP-INS and MDI groups had the lowest (8.4, 8.3). IDegLira patients previously treated with GLP-INS, MDI, and N-INJ had higher Charlson Comorbidity and Diabetes Complication Severity scores compared to patients previously treated with BI-INJ or GLP-INJ. Most prescriptions were written by PCPs (53%).

Conclusion: This analysis shows that initial use of IDegLira has been across a range of practices and clinical profiles. Most IDegLira prescribing occurred among pts on a previous injectable therapy, with those on single injectable therapy having higher A1Cs than those on multiple injectable therapies. Pts prescribed IDegLira with no injectable therapy in the prior 6 months had the highest A1C values.

Disclosure

M. Mocarski: Employee; Self; Novo Nordisk Inc.. Stock/Shareholder; Self; Novo Nordisk A/S. J. da Rocha Fernandes: Employee; Self; Novo Nordisk A/S, International Diabetes Federation. L. Kallenbach: None. J. Vasey: None. J. Ken: None. A.N. Bogdanov: None. M. Radin: Employee; Self; Novo Nordisk Inc. L.E. Egede: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Advisory Panel; Self; Novo Nordisk Inc..
Preferable Conversion Rate from Intravenous to Subcutaneous Insulin in Hyperglycemic Emergencies in Diabetic Patients
Authors: TAKAMINE HIKARU , NAMIKI YULIA , HIIRAGI HIROKO , YAMADA TAKU , TAKANO YUYA , OSADA URU N.
Published: June 2018

To clarify the safe and effective conversion ratio from continuous intravenous insulin infusion (II) to subcutaneous long-acting insulin injection (SI) in diabetic ketoacidosis (DKA) or hyperosmolar hyper glycemic state (HHS), we conducted single center, retrospective, cohort study. Based on electronic medical records at our hospital from inception through September 2017, we extracted the subjects with DKA/HHS diagnosis. Other inclusion criteria were 1) no intermission between II and SI, 2) co-administered II and SI within 3 hours, and 3) aged ≥18 years old. We defined II requirement (IR) as the total II dose within 24 hours before conversion to SI. Then we divided subjects into 4 groups according to the percentage of SI to IR [group stratification: 0-39% (Q1), 40-69% (Q2), 70-89% (Q3), ≥90% (Q4)], and compared primary outcome which was the percentage achieving glycemic target of 80-180 mg/dl within 24 hours after the conversion. As the result, 44 subjects were included (male 52%, mean age 59 years old, mean HbA1c 11.6%, DKA 75%, median serous-CPR (CPR) 0.17 ng/ml). Median IR and the percentage of SI to IR were in inverse correlation; Q1=51 units (U), Q2=25.2U, Q3=27.2U, and Q4=7.1U (p=0.0001). In primary analysis, the median percentage achieving the glycemic target was highest with 67.5% in Q4, and was comparatively lower in the other groups; Q1=13.4% (p=0.01), Q2=16.7% (p=0.01), Q3=40% (p=0.089). In multivariate analysis adjusted with age, BMI, CPR and IR, ≥90% (β=14.6, SE=5.7, p=0.01) and ≥70% (β=9.1, SE=4.4, p=0.04) but not ≥40% were the significant factor to achieve the glycemic target. Hypoglycemia ≤70 mg/dl occurred only in 2% of entire subjects, and the incident rate were not different between the groups.

In summary, our result indicated that at least 70% of the conversion ratio was required for the safe and effective conversion from SI to II in DKA/HHS.

Disclosure

H. Takamine: None. Y. Namiki: None. H. Hiiragi: None. T. Yamada: None. Y. Takano: None. U.N. Osada: None.
Antidiabetic Effect of JP-2266, a Novel SGLT1/2 Dual Inhibitor, for the Treatment of Type 1 Diabetes
Authors: PARK YOUNGJUN
Published: June 2018

JP-2266, a potent, a new synthetic small molecule, is highly selective sodium glucose cotransporter (SGLT) 1 and 2 inhibitor, and offers new therapeutic regimen by improving glycemic control for type 1 diabetes mellitus (T1DM). Insulin used for blood glucose lowering, which is an important agent in controlling blood glucose in T1DM patients, however, it is not easy to be administrated due to inconvenience of injection and hypoglycemic risk. JP-2266, as adjunct therapy to insulin, is expected to overcome the shortcomings of insulin monotherapy in T1DM.

We discovered JP-2266, a preclinical candidate to develop as an agent for the treatment of type 1 diabetes. IC50 values of JP-2266 were 10.1 nM and 1.3 nM, respectively, for SGLT1 and SGLT2 in vitro glucose uptake assay. Sotagliflozin which is known as a SGLT1 and 2 dual inhibitor was 36 nM and 1.8 nM, respectively, in vitro glucose uptake assay.

Also JP-2266 showed a significant decrease postprandial blood glucose level in type 1 diabetes rat models. When JP-2266 was treated with 1, 2, or 5 mg/kg by single oral administration in streptozotocin (STZ)-induced T1DM rat model, AUC0-4h (mg·h/dL) for 4 hours in OGTT was 38.4%, 48.1% and 56.4%, respectively, compared to vehicle treated group. Moreover, STZ rats treated with 5mg/kg of JP-2266 showed the same AUC0-4h reduction rate as the high-dose insulin treated group (1.8U/kg), and blood glucose reduction rate of JP-2266 and Sotagliflozin at 10 mg/kg was 49.4% and 39.1%, respectively, compared to vehicle treated group in oral repeated administration for 28 days. Additionally, HbA1c of JP-2266 treated group was 6.4%, while Sotagliflozin treated group was 7.2% at 10 mg/kg.

We suggest that JP-2266 will be a potent candidate agent for the treatment of T1DM, since JP-2266 has a more potent reducing effect on hyperglycemia in OGTT and showed comparable effect by oral repeated dose administration than those of Sotagliflozin.

Disclosure

Y. Park: None.
Comparison of Novel MicroRNA and Cell-Free DNA Biomarkers of Beta-Cell Death and Diabetes Progression
Authors: JOGLEKAR MUGDHA , FARR RYAN , WONG WILSON , ROTHER KRISTINA , JENKINS ALICIA , YAJNIK CHITTARANJAN S. , MA RONALD C. , CRAIG MARIA E. , JONES TIM , HARDIKAR ANAND ,   PREDICT T1D STUDY GROUP
Published: June 2018

Type 1 diabetes (T1D) is characterized by the loss of insulin-producing beta-cells. We currently lack diagnostic tools to measure T1D progression. Using systematic approaches involving unprejudiced discovery analyses in human tissues and clinical samples, we identify microRNAs that are: i) associated with insulin expression during embryonic development (N>60); ii) predictive of and necessary for insulin transcription (N=698); and iii) dysregulated in individuals with (vs. without) T1D (N=200). Insulin cfDNA (assessed by ddPCR) and microRNA (assessed by TaqMan qPCR) biomarkers were measured in around; i) N=400 Australian T1D individuals; ii) N=30 longitudinal samples from children at risk of T1D; iii) N=100 clinical trial samples from individuals receiving IFN-a or Exenatide vs. placebo; iv) N=400 Hong Kong Chinese individuals with T1D; v) N=700 Danish individuals at diagnosis of T1D and vi) N=400 Asian Indian T1D subjects. Among N=600 Australian samples, we identified miRNAs (N=5) that were significantly increased in the circulation of T1D individuals (vs. controls), decreased (at least 2 Fold Change/FC, P<0.05, N=7miRNAs) in T1DCx+ vs. T1DCx- (no T1D complications) or significantly increased (2 FC, P<0.05, N=5) in T1D individuals with detectable C-peptide vs. non-detectable C-peptide. Our studies highlight the potential of circulating microRNAs and cfDNA in quantifying beta cell death before clinical diagnosis of T1D. These data demonstrate that microRNA/cfDNA signatures not only facilitate the potential prediction of diabetes progression, but can also help in stratifying individuals at risk of T1D as well as assess treatment efficacies in trials aiming to retard beta-cell death. We also present our preliminary analysis of cross-ethnic variation in these cfDNA/miRNA biomarkers and present ongoing/future studies to develop a diagnostic test for T1D prediction.

Disclosure

M. Joglekar: None. R. Farr: None. W. Wong: None. K. Rother: None. A. Jenkins: Research Support; Self; Medtronic, Mylan, Sanofi-Aventis. C.S. Yajnik: None. R.C. Ma: Research Support; Self; AstraZeneca, Bayer AG, Merck Sharp & Dohme Corp., Pfizer Inc.. Advisory Panel; Self; Boehringer Ingelheim GmbH, Nippon Boehringer Ingelheim Co. Ltd.. M.E. Craig: None. T. Jones: None. A. Hardikar: None.
Nonglycaemic Effects of Sitagliptin—Systematic Review and Meta-analysis of Six Published Randomised Controlled Clinical Trials
Authors: KHURANA GIRISH , GUPTA VIPUL , MAKKAR BRIJ M. , SHARMA JUGAL K. , KHURANA HARDIK , WADHWA NAVNEET
Published: June 2018

We explorde the evidence for contemporary role of sitagliptin and evaluate for the non-glycemic effects of sitagliptin, through analysing the quantity and quality of the published evidences through the highest level of evidences ie: Randomised Controlled Clinical Trials (RCCTs). We searched Cochrane Library, pubmed- MEDLINE, IndMED databases to conduct a systematic review of published Randomised Controlled Clinical Trials (RCCTs) evaluating the contemporary role of sitaglitin for the non-glycemic effects. Only the trials with the comparator arms were included, studies evaluating glycemic effects of sitaglitin were excluded by appropriate Boolean operators. Only the RCCTs with healthy subjects and nondiabetics were included. Graph pad prism 7.0 version software and t-test was utilised for statistical analysis. 295 clinical trials published in last 10 years (20to 2017) were screened which yielded eight RCCTs, of which six met inclusion criteria, were compared for study design, patient characteristics, geography, impact factor of journals, intervention, duration and outcomes by using the appropriate statistical methods. Cumulatively, 269 patients (mean 45 patients, SD ± 64, SEM ± 26, minimum 6 patients, maximum 174 patients, 95% CI -23 to 112, p=0.147) have been evaluated across 6 RCCTs. Duration of RCCTs varies from 1 day to 1 year (n=2). Based on the impact factor of journals (mean 3.5, min 1.5, max 5.5, SD ± 1.4, SEM ± 0.59, 95% CI 2 to 5.1; p=0.0019), we formulated an indexed weightage score (mean 100, min 43.34, max 156.4, SD ± 40.9, SEM ± 16.7, 95% CI 57.to 142.9). Sitagliptin has systemic and adipose anti-inflammatory effects in cART-treated HIV+ adults with impaired glucose tolerance, improvement in the left and right ventricular ejection fraction changes from baseline to 6 months of follow-up is evident. Sitagliptin is useful in varied clinical conditions with non-glycemic effects which needs validation across global multicentric trials.

Disclosure

G. Khurana: None. V. Gupta: None. B.M. Makkar: None. J.K. Sharma: None. H. Khurana: None. N. Wadhwa: None.
Continued Follow-Up by a Hospital Diabetes Care Team Improves HbA1c at 1 Year after Elective Orthopedic Surgery
Authors: GARG RAJESH , BHANDARI SHREYA , REIN RAQUEL , MCDONNELL MARIE E.
Published: June 2018

Hospitalization is considered an opportunity to improve long-term glycemic control in patients with poor glycemic control at the time of admission. Previous studies have shown an improvement in HbA1c at 3 months, followed by deterioration at 1 year after discharge. In a randomized controlled trial of patients with high HbA1c (≥8%) undergoing an elective surgery, we found that continued care (CC) by a hospital diabetes care team as compared to the usual care (UC) had no significant effect on HbA1c at 1 year after discharge. Here, we present a secondary analysis of these data to evaluate the effect of type of surgery on our outcomes. We hypothesized that patients undergoing an orthopedic surgery may have a higher reduction in HbA1c in response to our intervention. Out of 151 patients, 35 patients had undergone an orthopedic surgery, 18 in the CC group and 17 in the UC group. Baseline characteristics and clinical outcomes are shown in Table 1. Patients undergoing an orthopedic surgery had a significant reduction in HbA1c in the CC group while those in the UC group had no change at one year. In contrast, patients undergoing a non-orthopedic elective surgery had similar reduction in HbA1c in the CC and UC groups. These data suggest that the effect of intervention to improve long-term glycemic control after discharge from the hospital is affected by the hospital diagnosis.Table 1. Patient characteristics and clinical outcomes.Orthopedic SurgeryNon-orthopedic SurgeryVariableCC groupN=18UC groupN=17P valueCC groupN=59UC groupN=57P valueAge, years67±764±110.3764±1062±100.28Female Gender6 (33)4 (23)0.5129 (49)21 (37)0.18White Race18 (100)15 (88)0.1355 (93)55 (96)0.40Duration of diabetes, years12.4±10.612.8±6.70.9111.2±8.212.2±9.80.55BMI, kg/m234.7±8.638.0±13.00.3935.2±8.533.5±8.10.31Serum Creatinine, mg/dL0.86±0.150.88±0.240.851.1±0.61.1±0.50.90eGFR, mL/min58.5±3.459.3±5.40.8855.0±11.055.5±9.70.82Baseline HbA1c8.5±0.48.9±0.70.039.0±1.19.2±1.20.25HbA1c at 1-year after discharge7.8±1.08.9±1.30.018.3±1.48.4±1.50.76Change in HbA1c at 1-year from baseline0.7±0.90.0±1.20.050.7±1.50.9±1.60.56Data are presented as mean with SD for continuous variables and N with % for categorical variables.

Disclosure

R. Garg: None. S. Bhandari: None. R. Rein: None. M.E. McDonnell: None.
Emergency Department Access in Diabetic Patients
Authors: PIFFER SILVANO
Published: June 2018

Introduction: Access of diabetic patients to Emergency Departments (ED) is an indicator of the filtering capabilities of territorial services.

Aims: To analyze the access to ED of the Trento province (540.000 inhabitants-north-east Italy) by diabetic patients in the period 2012-2016.

Methods: Accesses of diabetics patients (ICDIXCM 250-251), were analyzed from the Database of ED considering year, gender, age class, month and week day, citizenship, way of arrival, triage score, area (urban/rural) of the residents cases, the proportion of hypoglycemia accesses, hospitalization.

Results: A total of 2839 diabetic patients accessed to the ED in the study period (567/year), 70% were type 2. The time trend is slightly decreasing. Males are 54%; the age group 0-14:6%, 15-29 5%, 30+years 89%. Males median age is 61 y, Females median age 66 y. Foreigners represent 10% of the cases. Most subjects arrived by ambulance/helicopter (44%); 2,7% were in red code. There were no differences in relation to the month or day of the week; 52.7% are hospitalized. The ED access rate is 7.7/10.000/year for urban and 10/10.000/year for rural area residents (p<0,01). Hypoglycemia occur in 28% of total access of diabetics without any change over time; 60% were in type 1. There were no differences in relation to gender and age-class, compared to general cases and no change in relation to the month or day of the week or geographical area for resident cases as well. Patients with hypoglycemia at access are more serious considering that 76% accessed by ambulance or helicopter and 4.2% were in red code (p<0,001). The proportion of hospitalized cases is 30,2%, lower than the general case series.

Conclusions: The access of diabetic patients to the ED of the province of Trento does not change over time. The proportion of patients with hypoglycemia is considerable, with a higher prevalence in case of type 1 diabetes. It does not change over time and requires substantial costs for the transfer to health structures.

Disclosure

S. Piffer: None.
Evaluating T1DM Patient Experience Using the Patient Assessment of Chronic Illness Care Survey
Authors: MORRISEY ROBIN , KACZMAR ELIZABETH , TSIMIKAS ALEXIA , ARNOLD FRANCES M. , CLARK TAYLOR , MCCALLUM JAMES , FORTMANN ADDIE L.
Published: June 2018

Aligning diabetes care with components of the Chronic Care Model (CCM) facilitates productive interactions between a proactive care team and an informed, activated patient, allows the care plan to be individualized, and can improve care and outcomes. The Patient Assessment of Chronic Illness Care (PACIC) survey assesses patient experience with CCM-based healthcare delivery components. In the Division of Diabetes and Endocrinology at Scripps Health, a large integrated health system in San Diego, CA, patients with T1DM have access to an interdisciplinary team of clinicians who provide care, education, and ongoing support. Guided by the CCM, an interactive care delivery system involving the endocrinologist, PCP, diabetes educator, RD, behavioral specialist and the patient was implemented to facilitate proactive and productive care but some interactions remained isolated. Between June and August 2017, the PACIC survey was administered by research assistants to N=47 adults with T1DM who have received care in the Division for at least 6 months. Overall, patients reported high satisfaction with care (M=4.77 out of 5; SD=0.56). Results also indicated high ratings for specific CCM elements, including Patient Activation, Delivery System Design/Decision Support, and Self-Management Support (M=4.29-4.55). Lower ratings were observed for Follow-Up/Coordination (M=3.81; SD=1.01), suggesting a need for enhanced post-visit contact with patients, referrals to community programs, dietitians, and counselors, and discussion of specialist appointments. In line with the Institute for Healthcare Improvement’s Triple Aim focused on improving the health of populations through optimization of health system performance, an RN with specialized experience in T1DM was added to the team as the Diabetes Care Manager to assist with follow-up and care coordination. The PACIC will be re-administered after 6 months to determine the impact on patient perceptions of follow-up/coordination between visits.

Disclosure

R. Morrisey: None. E. Kaczmar: None. A. Tsimikas: None. F.M. Arnold: None. T. Clark: None. J. McCallum: None. A.L. Fortmann: None.