bluuebunny/crossref_metadata_2025 huggingface dataset:
42-OR: Effects of Oxidative Phosphorylation Complexes Defects on Beta-Cell Function
Authors: LANG ANNA L. , NISSANKA NADEE , TAMAYO ALEJANDRO M. , MORAES CARLOS T. , CAICEDO ALEJANDRO
Published: June 2021

Background: The pancreatic beta cell is a highly metabolic cell type relying on mitochondrial metabolism for stimulus-secretion coupling. Specifically, the ATP-producing oxidative phosphorylation (OXPHOS) pathway is central to insulin secretion. Although disruptions in ATP production occur in beta cell dysfunction, the exact mechanisms remain unknown. We generated beta cell specific inducible knockout mouse models of OXPHOS Complex I, III, and IV to determine the direct effects of each OXPHOS complex on beta cell function. We hypothesize that individual complexes contribute distinctly to beta cell function.

Methods: Male OXPHOSf/f - MIPcreERT mice were administered tamoxifen (150mg/kg) or vehicle by I.P. injection for 5 days. Glucose and insulin tolerance were assessed 3 weeks after induction. Mice were anesthetized with ketamine/xylazine and perfused with PBS followed by 4% PFA. Pancreata were dissected, embedded in OCT, and cut for islet hormone staining. To determine mitochondrial respiration, Seahorse Bioenergetic Flux analysis was performed on isolated islets from all groups.

Results: Complex III knockout mice developed severe hyperglycemia and glucose intolerance at 3 weeks post-induction, while insulin tolerance remained the same. The other two models showed a trend towards hyperglycemia starting at 5 weeks, but retained their ability to regulate glucose at 3 weeks. Interestingly, no changes in islet cytoarchitecture were observed in any of the groups. Western blot analyses on islet lysates confirmed a marked, and comparable knockdown of the targeted complex in all 3 models. Defects were seen in glucose-stimulated mitochondrial respiration for all knockout models at 3 weeks.

Conclusions: Mice with Complex III deficient beta cells showed a robust diabetic phenotype compared to Complexes I and IV models despite all models having significant knockdown of the targeted complex. This supports the hypothesis that specific OXPHOS complexes contribute differentially to beta cell function.

Disclosure

A. L. Lang: None. N. Nissanka: None. A. M. Tamayo: None. C. T. Moraes: None. A. Caicedo: None.

Funding

National Institute of Environmental Health Sciences (R33ES025673)
428-P: The Association between Monocyte to High-Density Lipoprotein Cholesterol Ratio and Diabetic Retinopathy
Authors: TAN YING , TANG XIXIANG , CHEN YANMING
Published: June 2021

Retinal chronic inflammation plays a pivotal role in the development of diabetic retinopathy (DR). Monocyte to high-density lipoprotein cholesterol (HDL-C) ratio (MHR) is associated with inflammatory and oxidative stress status. Some studies suggest that an elevated MHR can be a biomarker for diabetic complications. However, there are not adequate studies on MHR and DR. A total of 771 patients with T2DM and 607 healthy controls were included in this cross-sectional study. MHR and eye examination were checked. The predictive role of MHR on the development of DR in T2DM patients was analyzed. The MHR in patients with DR was significantly higher than that of both the non-DR diabetic patients (P < 0.05) and the healthy controls (P < 0.01). No significance were observed in the MHR of different DR severity grades. Moreover, MHR was similar between patients with non-macular edema and macular edema. Logistic regression analysis demonstrated that MHR was independently associated with the development of DR in diabetic patients [OR =1.377, 95% CI: 1.176-1.613, P < 0.01]. MHR can be an independent predictor of the development of DR in patients with T2DM.

Disclosure

Y. Tan: None. X. Tang: None. Y. Chen: None.
430-P: Urinary Proteome and Diabetic Retinopathy in the Direct-Protect 1 and 2 Trials
Authors: CUROVIC VIKTOR ROTBAIN , MAGALHÃES PEDRO , HE TIANLIN , HANSEN TINE W. , MISCHAK HARALD , ROSSING PETER
Published: June 2021

Background: Given the association of diabetic retinopathy (DR) to diabetic kidney disease, we investigated the urinary proteome to the presence and deterioration of DR in type 1 and type 2 diabetes in a post-hoc analysis of studies investigating the effect of candesartan on the progression of DR.

Methods: Baseline urinary proteomic analysis was performed in 783 and 792 randomly chosen subjects from two RCTs: DIRECT-Protect 1 and 2. Endpoints were two-step and three-step change in DR score according to the Early Treatment of Diabetic Retinopathy Study protocol. Peptide levels were correlated to baseline DR score, using Spearman rank correlation (association presented as Rho), in a discovery set of 2/3 of participants in DIRECT-Protect 1. Identified peptide fragments were then tested cross-sectionally in a validation set of the remaining 1/3 in DIRECT-Protect 1. Thereafter, peptides identified in the discovery set were assessed in the entire DIRECT-Protect 1 and 2 cohorts in relation to baseline DR. Finally, peptides validated in the entire cohorts were tested longitudinally. Adjustment included sex, age, diabetes duration, smoking, total cholesterol, HbA1c, SBP, UAER, serum creatinine, and randomization group.

Results: Follow-up ranged from 4.0-4.7 years. 24 out of 427 investigated peptide fragments were associated with baseline DR in the discovery set after adjustment for multiple testing. Two of these (COL3A1 (seq: NTG~) and COL4A1 (seq: DGA~) were also associated to baseline DR in the validation set (Rho: -0.22, p<0.001 and Rho: -0.14, p=0.024). Neither was associated with the development of endpoints. Investigating the discovered fragments in the full cohorts, several collagen fragments were associated with baseline DR and endpoints, in both type 1 and type 2 diabetes, however without overlap.

Conclusions: Several urinary peptide fragments (mainly collagen) were associated with the presence of DR, however, they were not conclusively associated with worsening of DR.

Disclosure

V. Rotbain curovic: None. P. Magalhães: None. T. He: Employee; Self; Mosaiques Diagnostics GmbH. T. W. Hansen: Stock/Shareholder; Self; Novo Nordisk A/S. H. Mischak: Stock/Shareholder; Self; Mosaiques Diagnostics. P. Rossing: Advisory Panel; Self; Astellas Pharma Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Gilead Sciences, Inc., Merck KGaA, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Vifor Pharma Management Ltd.
432-P: Sodium Intake and Incidence of Diabetes Retinopathy in Elderly Patients with Type 2 Diabetes: Analysis of Data from the Japanese Elderly Diabetes Intervention Study (J-EDIT)
Authors: HORIKAWA CHIKA , AIDA REI , TANAKA SHIRO , KAMADA CHIEMI , TANAKA SACHIKO , YOSHIMURA YUKIO , KODERA REMI , FUJIHARA KAZUYA , KAWASAKI RYO , MORIYA TATSUMI , SONE HIROHITO , ARAKI ATSUSHI
Published: June 2021

Though excessive sodium intake is regarded as a crucial factor related to developing and worsening of diabetes complications, data on this topic in elderly patients with diabetes are sparse. We investigated the associations between sodium intake and diabetes complications in a nationwide cohort of elderly Japanese patients with type 2 diabetes aged 65 - 85 years. The present analysis was conducted among Japanese patients with type 2 diabetes from outpatient clinics in 39 university and general hospitals in Japan. Data were analyzed on 912 individuals whose dietary intake at baseline was assessed by the Food Frequency Questionnaire based on food groups. Primary outcomes were times to diabetic retinopathy, overt nephropathy, cardiovascular disease, and all-cause mortality during 6 years. Cox regression analyses estimated hazard ratios (HRs) for dietary intake adjusted for age, gender, body mass index, HbA1c, smoking, energy intake, and other confounders Mean sodium intake in quartiles ranged from 2498 mg to 5910 mg/day and more than three-quarters of participants had sodium intake more than the recommended dietary allowance by American Diabetes Association (< 2300 mg/day). After adjustment for confounders, HRs for complications in patients with sodium intake in the 2nd, 3rd, and 4th quartiles compared with sodium intake in the 1st quartile were analyzed, and no significant differences were shown between sodium intake and complications. Among patients whose vegetable intake was less than the average of 268.7 g, HRs for diabetic retinopathy in patients in the 2nd, 3rd, and 4th quartiles of sodium intake compared with the 1st quartile were 0.87 (95% CI, 0.31-2.41), 2.61 (1.00-6.83), and 3.70 (1.37-10.02), respectively. Findings indicated that high sodium intake under conditions of low vegetable intake is associated with elevated incidence of diabetic retinopathy in elderly patients with type 2 diabetes.

Disclosure

C. Horikawa: None. T. Moriya: None. H. Sone: Research Support; Self; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co. A. Araki: None. R. Aida: None. S. Tanaka: None. C. Kamada: None. S. Tanaka: None. Y. Yoshimura: None. R. Kodera: None. K. Fujihara: None. R. Kawasaki: None.

Funding

Japan Society for the Promotion of Science (19H04028)
434-P: Large Quantity of Alcohol Intake per Occasion was Positively Associated with Vision-Threatening Eye Diseases in Japanese Men with Type 2 Diabetes
Authors: YAMAMOTO MASAHIKO , FUJIHARA KAZUYA , YAGUCHI YUTA , OSAWA TAEKO , KANEKO MASANORI , KITAZAWA MASARU , SATO TAKAAKI , YAMADA MAYUKO H. , MATSUBAYASHI YASUHIRO , YAMADA TAKAHO , KODAMA SATORU , SONE HIROHITO
Published: June 2021

Heavy total alcohol consumption was reported to increase the risk of development and progression of diabetic retinopathy. However, differing from total alcohol consumption, whether the quantity of alcohol intake per occasion had harmful or beneficial effects related to severe eye diseases caused by diabetes remains unknown. To clarify this, we utilized ICD-10 and medical treatment codes from a nationwide claims database that finally included 21,392 men with type 2 diabetes (mean age 53 y, HbA1c 7.0%, mean follow-up period 4.3 y). During the study period, 425 patients developed vision-threatening treatment-required diabetic eye diseases (TRDED) (4.6/1000 person-years). Multivariate Cox analysis demonstrated that a large quantity of alcohol per occasion defined as ≥3 drinks per occasion was positively associated with future occurrence of TRDED. One drink was defined as a standard Japanese drink with a volume equivalent to 23 g ethanol. Hazard ratio in patients drinking large amounts of alcohol per occasion for incident TRDED was 4.49 (95% confidence interval, 1.98-10.19) compared with the reference group (≤1 drink per occasion) after adjusting for covariates including total alcohol consumption. This finding demonstrated that a large quantity of alcohol per occasion had a significant association with future vision-threatening retinopathy in men with type 2 diabetes. The mechanism of this finding with regard to severe retinopathy awaits further research.

Disclosure

M. Yamamoto: None. T. Yamada: None. S. Kodama: None. H. Sone: Research Support; Self; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co. K. Fujihara: None. Y. Yaguchi: None. T. Osawa: None. M. Kaneko: None. M. Kitazawa: None. T. Sato: None. M. H. Yamada: None. Y. Matsubayashi: None.
436-P: Low Prevalence of Diabetic Retinopathy in Type 1 Diabetes Patients with a Long-Term Modernly Treated Disease and Very Good Glycaemic Control: A Retrospective Single-Center Analysis
Authors: SUROWIEC PAULINA , MATEJKO BARTłOMIEJ , KOPKA MARIANNA , FILEMONOWICZ-SKOCZEK AGNIESZKA , KLUPA TOMASZ , ROMANOWSKA-DIXON BOZENA A. , CYGANEK KATARZYNA , MALECKI MACIEJ
Published: June 2021

Despite continuous progress in the therapy of type 1 diabetes (T1DM), diabetic retinopathy (DR) is still a common chronic complication. We aimed to analyse DR prevalence and its predictors in patients with T1DM lasting 10 years or more, treated with modern methods, and with excellent glycaemic control. The analysis included data from 384 (80.7% women) patients taking part in the Polish National Health Fund’s Program of Comprehensive Outpatient Specialist Care at the University Hospital in Krakow between 2014-2020. A retrospective analysis of data from medical records was applied. T1DM patients of average 34 ± 9.2 years, mean BMI of 25.0 ± 3.9 and diabetes duration of 20.5 ± 7.9 years was included. The mean HbA1c of all patients throughout the follow-up period was 6.9 ± 1 % [52 mmol/l]. The analysed group consisted of 238 (62,0%) patients treated with CSII, 99 (25.8%) treated with MDI; and 47 (12.2%) who used both methods during the observation period. All patients used short-acting analogues, 144 (98.6%) MDI users were treated with long-acting analogues. DR was confirmed in 150 (39.1%) patients, 109 (72.2 %) of them were diagnosed de novo in the analysed period. Severe DR, defined as an advanced non-proliferative DR or proliferative DR, was observed in 31 persons (8.07% of the entire study group and 20.7% of the DR group).In the multivariate logistic regression model, T1DM duration (OR 1.13; 95% CI, 1.09-1.19), HbA1c level (OR 1.41; 95% CI, 1.08-1.84), LDL level (OR 1.79; 95% CI, 1.16-2.87), and combined incidence of non-DR micro- and macrovascular chronic complications (OR 1.86; 95% CI, 1.16-3.03) were independent risk factors for DR presence. In our long-term retrospective study, the prevalences of both any stage of DR and severe DR were lower than reported in other cohorts from earlier periods. Independent risk factors for DR in this highly selected cohort did not differ from the previously reported.

Disclosure

P. Surowiec: None. B. Matejko: Other Relationship; Self; Ascensia Diabetes Care, Roche Diabetes Care. M. Kopka: None. A. Filemonowicz-skoczek: None. T. Klupa: Advisory Panel; Self; Dexcom, Inc., Ypsomed Group, Employee; Spouse/Partner; Ascensia Diabetes Care, Research Support; Self; Abbott Diabetes, Speaker’s Bureau; Self; Bioton S. A., Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Novo Nordisk Inc., Sanofi-Aventis. B. A. Romanowska-dixon: None. K. Cyganek: Advisory Panel; Self; Medtronic, Speaker’s Bureau; Self; Lilly Diabetes, Novo Nordisk. M. Malecki: Advisory Panel; Self; Abbott Diabetes, Medtronic, Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly Diabetes, Merck & Co., Inc., Mundipharma International, Novo Nordisk, Sanofi-Aventis, Servier Laboratories.
437-P: MicroRNA-223 Expression Is Upregulated in Type 2 Diabetes and Associated with Diabetic Retinopathy in Cohort of Qatar Biobank: Functional Validation in Zebrafish Model
Authors: AKIL AMMIRA S. , DA’AS SAHAR , JERMAN LAILA A. , ABDELRAHMAN DOUA , HASAN WASEEM , FAKHRO KHALID
Published: June 2021

MicroRNAs (miRNAs/miRs) are implicated in the pathogenesis of type 2 diabetes (T2D) and its long-term complications such as retinopathy. miRNAs circulating levels have explored as possible biomarkers for the advancement of T2D. We examined the expression of customized set of miRNAs in T2D Qatari nationals with and without diabetic retinopathy (DR) from Qatar Biobank 1000 Qatar omics cohort. MiR-223 appeared to be significantly upregulated in T2D in comparison to the healthy controls. MiR-223 previously found to play a role in insulin resistant human adipose tissues, human and murine obesity and potential regulators of optic nerve regeneration. To further investigate the potential role of miR-223 in the development of DR, we established a zebrafish (ZF) model to functionally validate this potential correlation. Our aim is to investigate the miR-223 with hyperglycemia on the developing retina in the ZF as a vertebrate model. Mimic miR-223 was injected into single cell ZF embryos and incubated in normal and induced hyperglycemia conditions. We have examined the glucose ratios, eye morphology and vasculature structure in the developing model in comparison to the control groups. To understand the cellular mechanisms involved in DR; histological examination, cell apoptosis and proliferation have been performed and to be evaluated. miR-223 over expression resulted in an alteration of the glucose metabolism within the ZF model. Glucose ratio was significantly increased in ZF embryos injected with mimic miR-223. Increased miR-223 in the developing ZF larvae together with hyperglycemia affected the retinal development. The eye size was significantly reduced with degenerated vasculature and altered eye morphology.

In conclusion, we have identified a novel correlation between DR development and miR-223. Targeting miR-223 in T2D patients may serve as promising therapeutic strategy to control DR in at risk T2D patients.

Disclosure

A. S. Akil: None. S. Da’as: None. L. A. Jerman: None. D. Abdelrahman: None. W. Hasan: None. K. Fakhro: None.

Funding

Qatar National Research Fund (NPRP9-229-3-041)
438-P: Contribution of Hypertriglyceridemia to Cardiovascular Disease in Korean Women: A Nationwide Population-Based Study
Authors: CHOE HUN JEE , MOON MIN KYONG , KOO BO KYUNG
Published: June 2021

Introduction: The independent effect of serum triglyceride (TG) level on the development of cardiovascular disease (CVD) has been inconclusive, which might be due to heterogeneity of study populations. We aimed to evaluate the effect of TG level on CVD and mortality in Korean women with stratification according to the menopausal status, diabetes mellitus (DM) or LDL cholesterol level (LDL-C).

Method: We investigated Korean women aged 40-69 years who underwent health examination in 2009 and were followed up until 2018 using nationwide claim data covering 97.0% of the Korean population. The subjects were divided into four groups according to TG quartiles (Q): Q1 <70 mg/dL, Q2 71-99 mg/dL, Q3 100-142 mg/dL, Q4 ≥143 mg/dL. The primary outcome was the incidence of CVD defined as composite of myocardial infarction and ischemic stroke.

Results: Among 2,208,347 women, primary outcome occurred in 62,255 (2.8%) subjects. As TG levels increased, the event rate of primary outcome increased in both premenopausal and postmenopausal women in the fully adjusted model (hazard ration [HR] per 1 Q, 1.10 [95% confidence interval (CI), 1.08-1.12] and 1.08 [95% CI, 1.07-1.09], respectively), which was maintained on further stratification according to DM or LDL-C (p<0.05 in all). In premenopausal women without diabetes and LDL-C of less than 130 mg/dL, even those in Q2 had a significantly higher CVD risk compared to subjects in Q1 (p<0.05), which was not found in the in subjects with diabetes or in the higher range of LDL-C.

Conclusion: TG is an independent prognosticator in the development of CVD in the Korean women aged 40-69 years. The dose-response relationship is more significant in patients without diabetes when LDL-C<130mg/dL. These results imply that more emphasis should be set on TG when assessing women with elevated TG levels with otherwise few established risk factors.

Disclosure

H. Choe: None. M. Moon: None. B. Koo: None.
44-LB: Insulin Treatment Satisfaction Questionnaire Results for PRONTO-Pump-2 Study
Authors: PIRAS DE OLIVEIRA CAROLINA , PACZKOWSKI ROSIRENE , CHO JANG IK , JUNEJA RATTAN , POON JIAT LING , HANKOSKY EMILY R. , IGNAUT DEBRA A.
Published: June 2021

Background: In PRONTO-Pump-2, a Phase 3, 16-week, randomized, double-blind clinical trial in patients with type 1 diabetes on continuous subcutaneous insulin infusion (CSII), ultra rapid lispro (URLi; a novel mealtime insulin), showed superior postprandial glucose control and noninferior HbA1c reduction, with less hypoglycemia compared to Humalog® (Lispro). We assessed treatment satisfaction in patients enrolled in this trial (URLi, N=215; Humalog, N=217), using the Insulin Treatment Satisfaction Questionnaire (ITSQ).

Methods: The ITSQ was administered to patients at baseline and endpoint (week 16 or early discontinuation). The 5 domains assessed were glycemic control, hypoglycemic control, insulin delivery device, inconvenience of regimen, and lifestyle flexibility. Domain scores were transformed to a scale of 0-100 for analysis, with higher scores indicating better treatment satisfaction. The change in each domain-specific and overall transformed score from baseline to endpoint (last observation carried forward) was analyzed using an ANCOVA model.

Results: At endpoint, for patients treated with URLi, glycemic control scores had increased from a baseline of 66.9 by +7.0 (standard error [SE] 1.59; p<0.001), and scores for all other domains, except hypoglycemic control, had numerically increased. For patients treated with Humalog, glycemic control scores increased from a baseline of 61.3 by +3.9 (SE 1.51; p=0.010) while inconvenience of regimen scores decreased from a baseline of 80.0 by -2.5 (SE 1.13; p=0.029). At endpoint, the inconvenience of regimen score was significantly higher with URLi treatment compared to Humalog (between-treatment difference: 2.9 [95% CI 0.2, 5.6]; p= 0.034). No significant differences were observed in the overall ITSQ score between treatments.

Conclusion: Patients with type 1 diabetes treated with URLi using CSII reported to be satisfied with the glycemic control they experienced and perceived URLi treatment to be more convenient than Humalog.

Disclosure

C. Piras de oliveira: Employee; Self; Eli Lilly and Company, Stock/Shareholder; Self; Eli Lilly and Company. R. Paczkowski: Employee; Self; Eli Lilly and Company, Employee; Spouse/Partner; Amgen Inc., Stock/Shareholder; Self; Eli Lilly and Company, Stock/Shareholder; Spouse/Partner; Amgen Inc. J. Cho: None. R. Juneja: Employee; Self; Eli Lilly and Company. J. Poon: Employee; Self; Eli Lilly and Company. E. R. Hankosky: Employee; Self; Eli Lilly and Company, Stock/Shareholder; Self; Eli Lilly and Company. D. A. Ignaut: Employee; Self; Eli Lilly and Company.

Funding

Eli Lilly and Company
444-P: Rates and Reasons for 30-Day Readmissions in Hospitalizations among Patients with Diabetes Mellitus Who Underwent Below-Knee Amputation: Analysis of the Nationwide Readmissions Database
Authors: CORPUZ CARLOS GABRIEL D. , SHAKA HAFEEZ , RAMIREZ MARCELO , AGUILERA MARIA C. , YAP SARA ELIZABETH T. , KICHLOO ASIM , MURTHI MUKUNTHAN , ATLURI RAMTEJ , GONAKOTI SRIRAM
Published: June 2021

Introduction: Diabetes mellitus (DM) is the commonest cause of nontraumatic amputation worldwide. With increasing prevalence of DM, there has been an increase in the rate of below the knee amputations (BKA), usually in the setting of severe soft tissue infections and osteomyelitis. Readmissions are often related to prior admissions and account for significant and usually preventable healthcare cost burden. This study assessed the rate and reasons for 30-day readmissions (30DR) in DM patients with BKA with the aim of identifying preventable factors for readmissions.

Methods: The National Readmission Database for 2018 was queried for hospitalizations involving adult patients with DM who had BKA from January 1 to November 30, 2018. Elective and traumatic admissions were excluded. Outcomes assessed were 30DR rates, mortality, length of stay (LOS), hospitalization costs (THC) and top principal diagnosis for readmitted patients following BKA.

Results: A total of 15,090 hospitalizations involved adults with DM who had DKA as index admissions. The 30DR rate was 13.79%. The most common reasons for readmission were sepsis unspecified (18.4%), hypertension with CKD and heart failure (7.0%), DM angiopathy with gangrene (4.2%), acute renal failure (3.0%), and hypertension with heart failure (2.1%). Readmission was associated with higher odds of mortality (6.1% vs. 4.3%, OR: 1.45, 95% CI: 1.11 - 1.89, p=0.007) compared to the index admission. In patients with DM with BKA, readmissions accounted for a cumulative 18,078 days of hospitalization, which cost patients over $40 million within the period.

Conclusion: A significant proportion of patients with DM with BKA are readmitted for various complications. 30DR is associated with higher mortality and result in a significant cost burden to the patient and healthcare system. Mitigating the rate or readmissions would significantly improve patient outcomes.

Disclosure

C. D. Corpuz: None. H. Shaka: None. M. Ramirez: None. M. C. Aguilera: None. S. T. Yap: None. A. Kichloo: None. M. Murthi: None. R. Atluri: None. S. Gonakoti: None.
456-P: Ongoing Knowledge Gaps in Antiplatelet Therapy for High-Risk Diabetes Patients with CAD
Authors: KARANDREA SHPETIM , AGARWAL NEHA , JAMROGIEWICZ AMANDA
Published: June 2021

Patients with diabetes and coronary artery disease (CAD) are at increased risk for atherothrombotic events compared to CAD patients without diabetes. Current antiplatelet therapy may not be adequate in these high-risk patients, and several recent clinical trials have evaluated the use of more potent agents in this setting. Therefore, it is crucial to educate clinicians about their results and clinical practical implications. CMHC organized a CME virtual symposium to educate multi-disciplinary clinicians and assessed the changes in knowledge and competence using pre-/post assessment questions. A Chi-Square test was used to analyze the percentage of correct responses and determine statistical significance (p <0.05). The activity took place on Oct. 23, 2020, with participation of 263 healthcare professionals (MD/DO, PAs, RNs, NPs, PharmDs) representing specialties that treat high-risk diabetes patients with CAD (including 48% PCPs, 24% cardiologists, 23% endocrinologists). A slight increase in knowledge about recent clinical trial results was observed, though not statistically significant (9.2% relative increase in knowledge compared to baseline, p = 0.5). Conversely, a significant increase in competency in selecting correct treatment regimens to prevent adverse CVD events in high-risk diabetes patients with CAD was demonstrated (58% relative increased to baseline, p=.0002); however, only ~60% of participants opted for the correct option. According to post-activity evaluation (n=208), 29% identified insurance and financial issues, 28% identified formulary restriction, and 9% not knowing treatment-related adverse events as the primary barriers to implementing change in their practices. It is evident from the outcomes of this educational activity that there was a noticeable gap in attendee’s knowledge about advances in antiplatelet therapy in patients with diabetes and CAD. A series of educational activities is imperative to increase awareness and improve patient outcomes.

Disclosure

S. Karandrea: None. N. Agarwal: None. A. Jamrogiewicz: None.

Funding

AstraZeneca (62051961)
46-LB: Humor and A1C: The Interaction between Humor and Diabetes Control
Authors: GREENE DAVID S.
Published: June 2021

Humor and A1C: The Interaction Between Humor and Diabetes Control There is increasing evidence of specific medical and psychological benefits associated with humor within diabetes populations. The benefits of maintaining good diabetes control are also well established. The more general relationship between humor and diabetes control however remains unexplored. The purpose of this study was to examine if there was a difference between people with diabetes with an A1C ≤ 6.99% versus those ≥ 7.0% on four disparate types of humor. The sample consisted of 284 participants, 65.5% with type 1 diabetes, 68.3% female, 89.1% Caucasian, and 68.7% college educated. Participants completed the Humor Styles Questionnaire (HSQ) and were divided into two groups, A1C ≤ 6.99% and A1C ≥ 7.0%. The A1C ≤ 6.99% group scored significantly higher on both types of positive humor, affiliative humor (P < 0.01) and self-enhancing humor (P < 0.05). There was no significant difference between participants on either type of negative humor, aggressive humor (P > 0.05) or self-defeating humor (P > 0.05). Results indicate that good control (A1C ≤ 6.99%) is associated with positive humor. These findings provide evidence that there is an association between American Diabetes Association recommended levels of control and positive humor styles. Implications are extensive and important. Regardless of if humor contributes to better control, or better control leads to a better sense of humor, humor is the common denominator. In either case the existence of positive humor is connected to reduced medical complications, psychological complications, and successful diabetes management. Since humor is free, readily available, and can be developed and strengthened, it is suggested as a viable treatment component. Furthermore, results confirm and add support to the evidence that including humor in diabetes education leads to improved diabetes education outcomes.

Disclosure

D. S. Greene: None.
465-P: Applying the Ancestral Knowledge System Framework to Interviews with Key Stakeholders Regarding a Gestational Diabetes Mellitus Risk Reduction and Reproductive Health Planning Program for American Indian Adolescent Females
Authors: CHARRON-PROCHOWNIK DENISE , SOON RENI , STOTZ SARAH A. , FISCHL ANDREA F. , GONZALES KELLY L. , MAU MARJORIE , MOORE KELLY R.
Published: June 2021

Gestational Diabetes Mellitus (GDM) is the most common complication of pregnancy and potentially causes problemsfor both mother and baby, including risks of developing type 2 diabetes (T2D). Compared to other Americans, Indigenous youth have more risk factors and higher rates of GDM. We developed Stopping GDM a GDM risk reduction and reproductive health program for American Indian adolescent females. To further deepen the cultural strengths of the program we draw on constructs from Indigenous ways of knowing, such as Ancestral Knowledge System (AKS). We conducted a secondary analysis on an existing qualitative dataset collected during the Stopping GDM study using AKS as a secondary framework. Key constructs from AKS include: relationships, place-based knowledge, generational networks, holistic approaches, language, cultural heritage, and critical reflection. This dataset includes focus groups with AI adolescent girls (age 12-20) (n=13); their adult female caregivers (n=9); and AI women with a history of GDM or T2D (n=5) from two urban sites. All focus groups were moderated by a trained qualitative researcher with a notetaker and semi-structured moderator guide and analyzed using Atlas.ti. Four primary themes supported by the AKS framework constructs emerged: 1) the important and unique role of women in Native communities; 2) traditional ways as they relate to women, reproductive health, and wellness; 3) support for women’s wellness and reproduction; 4) social determinants as challenges for Indigenous communities in promoting healthy behaviors. These findings will be used to support expansion of Stopping GDM to increase its cultural relevance for a broader Indigenous priority audience which includes Native Hawaiian and Alaska Native communities.

Disclosure

D. Charron-prochownik: None. R. Soon: None. S. A. Stotz: None. A. F. Fischl: None. K. L. Gonzales: None. M. Mau: None. K. R. Moore: None.

Funding

National Institutes of Health (UL1TR001857 to D.C-P.); National Institute of Nursing Research (1R01NR014831-01A1 to D.C-P., K.R.M.)
466-P: Cultural Adaptation of a Diabetes Self-Management Education and Support Telehealth Intervention for Rural Colorado
Authors: OSER TAMARA , LITCHMAN MICHELLE L. , KWAN BETHANY , NEUBERGER JULIE , CURCIJA KRISTEN , BURKE SHAWNECCA , ZITTLEMAN LINDA K. , SIMONETTI JULIANA S.
Published: June 2021

Diabetes impacts rural populations at higher rates compared to their urban counterparts. Diabetes self-management education and support (DSMES) is an evidence-based standard of care for people with diabetes. Yet, in rural areas, DSMES is often not available, culturally relevant, or integrated into primary care practices where many people receive diabetes care. This study uses a community-based participatory research (CBPR) approach to adapt the language, tools, and delivery of a DSMES program for use in Spanish and English-speaking populations in the High Plains Research Network in rural eastern Colorado. Boot Camp Translation (BCT) is a CBPR method that combines medical, research, and local community member expertise to create locally relevant language, messages and materials to promote discussion and action around a medical condition. For this study, community partners included 13 diverse community members (including bilingual Spanish-speakers, patients, caregivers, and healthcare providers). The group identified a particular need to increase awareness of the connection between diabetes and mental health, specifically depression, and diabetes burnout. Language and tools to address stigma and normalize the connection, talking points to initiate discussions with care teams, and calls for practices to increase screening for depression among patients with diabetes, are under development. Additional themes identified include incorporating nutrition information for food that is culturally appropriate and locally available, and integrating DSMES within the primary care practices where people with diabetes receive their care. Community engagement is crucial to support DSMES program adoption in rural communities.

Disclosure

T. Oser: Advisory Panel; Self; Cecelia Health, Dexcom, Inc., Advisory Panel; Spouse/Partner; Cecelia Health, Dexcom, Inc. M. L. Litchman: Research Support; Self; Abbott Diabetes. B. Kwan: None. J. Neuberger: None. K. Curcija: None. S. Burke: None. L. K. Zittleman: None. J. S. Simonetti: Consultant; Self; Rhythm Pharmaceuticals, Research Support; Self; Rhythm Pharmaceuticals .

Funding

National Institute of Nursing Research; National Institutes of Health (1R56NR019466-01)
470-P: Usability and Satisfaction of a Mobile Application to Support Individuals with Insulin Therapy Management
Authors: SIMINERIO LINDA M. , BEDNARZ LORI L. , DEJESUS CARLA , NG JASON , REYNOLDS SHARI L. , KRALL JODI S.
Published: June 2021

People with type 2 diabetes mellitus (T2DM) continue to be reluctant to begin insulin therapy. Methods to assure education access and support are critically important. To supplement health care provider efforts, the BD Diabetes Care App was developed to offer information on injection administration and self-management strategies. Ongoing support is built into the app in the form of articles and videos related to starting and using insulin. The purpose of this study was to evaluate patient and educator usability of and satisfaction with the app.

Methods: Patients >18 years with T2DM, new to or identified as having issues with insulin therapy were recruited from in- and outpatient settings. Participants received insulin education according to standard practice and were then introduced to the app. Over the study period, participants were able to use the app as much or as little as preferred; use was tracked with app analytics. HbA1c was measured at baseline and 3 months and satisfaction surveys were administered.

Results: Participants (n=22) were 27% female, 73% White Non-Hispanic, mean age 55 years, with baseline mean HbA1c of 11%. Glycemic control significantly improved during the study period, with an average reduction in HbA1c of 3.2±2.9%. All participants used the app; 86% launched it within one day of enrollment. Average use was 11 times over the course of the study, 55% were considered highly engaged (consistently used app over the course of study). Participants were most likely to access curriculum (articles and videos) about insulin pen therapy followed by living with diabetes. Most participants found the app easy to use (75%), visually appealing (81%), to contain helpful content, especially articles (77%); 73% said that they would recommend the app to another person with diabetes. Educators reported high satisfaction and a positive experience in using the app.

Conclusion: The BD Diabetes Care App offers a promising approach to support patients starting and using insulin.

Disclosure

L. M. Siminerio: Advisory Panel; Self; Abbott Diabetes, Bayer U. S., Research Support; Self; Becton, Dickinson and Company. L. L. Bednarz: Other Relationship; Self; Medtronic, Tandem Diabetes Care. C. Dejesus: None. J. Ng: Research Support; Self; Sanofi-Aventis. S. L. Reynolds: None. J. S. Krall: Research Support; Self; Becton, Dickinson and Company, Sanofi.

Funding

BD
5-OR: Health Disparities in People with and without Diabetes during the COVID-19 Pandemic
Authors: MYERS BARBARA A. , KLINGENSMITH RACHEL , DE GROOT MARY
Published: June 2021

Purpose: To characterize the psychosocial experiences of adults with (PWD) and without diabetes (ND) during the COVID-19 pandemic. US adults (2176) completed a web-based survey in May-June, 2020 and November-December, 2020, including demographics, COVID-19 exposure, diabetes-related distress (DDS-17), depressive symptoms (PHQ-8) and anxiety (GAD-7). At baseline, mean age was 49.6 years (S.D. = 16.9), 80% female, 88.3% White, with an annual household income of ≥ $60,000 (57.6%), type 2 diabetes (T2D; 301,13.9%), 145 prediabetes (145, 6.6%) and type 1 (T1D, 100, 4.6%). One-third (29.7%) reported decreased income due to the pandemic. T2Ds had more medical comorbidities and COVID risk factors than T1Ds and NDs (all p < 0.01). Mean PHQ-8 scores were 7.1 (S.D. = 5.8; mild), with the T2Ds (M = 7.7; S.D. = 5.9) exceeding NDs (M = 6.9; S.D. = 5.7; p<.001). Mean DDS-17 and GAD-7 scores were comparable for T1Ds and T2Ds (moderate level; p=NS). At 6 months (6MFU), 1,345 (62.6%) completed follow up surveys. Completers were more likely to be older, male, White, married, with higher education levels, and homeowners, with a greater proportion of medical comorbidities and lower A1cs at baseline than non-completers (all p<.05). 6MFU completers had lower baseline depressive symptoms and diabetes distress, lower household COVID-19 rates and less difficulty paying bills than non-completers (all p<.05). At 6MFU for all groups, depressive symptoms decreased (p<.0001) and financial strain improved (p<.001), while COVID exposure increased (personal and household, p<.001). Diabetes distress remained at a moderate level for T1Ds and T2Ds. T1Ds and T2Ds showed comparable levels of depressive symptoms to NDs but were more likely to report financial hardship (p<.05) and difficulty paying bills than NDs (p<.001).

Health outcomes were worse for PWDs compared to NDs during the COVID-19 pandemic despite high SES protective factors. Persistent financial strain and diabetes distress increase the risk for future poor health outcomes.

Disclosure

B. A. Myers: None. R. Klingensmith: None. M. De groot: Consultant; Self; Johnson & Johnson.
500-P: Determinants of Exercise-Induced Increase in Insulin Sensitivity
Authors: KUMAR ARATHI PRABHA , DASARI SURENDRA , PATAKY MARK W. , CROOK JULIA , BALL COLLEEN T. , KLAUS KATHERINE , LANZA IAN R. , ROBINSON MATTHEW M. , NAIR K. SREEKUMARAN
Published: June 2021

Exercise training enhances insulin sensitivity (Si) in humans. However, it is to be determined which phenotypic and muscle molecular changes underwrite this change in Si. We sought to understand the mechanisms behind increased Si following 12 weeks of high intensity aerobicinterval (HIIT), resistance (RT), or combined (CT) exercise training in 30 young and 24 old humans. Measurements included Si estimated from a two-stage hyperinsulinemic-euglycemic clamp, and a host of independent variables including VO2 peak, muscle mitochondrial respiration, Liver FWF (Fat-Water-Fraction), visceral and subcutaneous fat, and gene expression from muscle biopsies. We performed a univariate and multivariate analysis of Si vs. phenotypic changes induced by training. After adjusting for age, sex and exercise group, VO2max was positively associated with an increase in Si from pre to post exercise (p=0.032). Interestingly, within the RT group alone, positive association between VO2max and Si (p=0.05) and negative association between liver FWF and Si (p=0.034) were observed. Within the HIIT group, there was a positive association between muscular strength and Si (p=0.04). Separate multivariate models assessed the effect of muscle gene expression changes on Si while adjusting for age, training type, response to training, VO2max, and mitochondrial function. Enrichment Analysis of genes associated with Si showed upregulation of genes in Branched-Chain Amino Acid (BCAA) and Lysine metabolism, although the latter was specifically upregulated with HIIT. Products of lysine metabolism, such as alpha-aminoadipic acid have been implicated in development of insulin resistance and BCAA are involved in signaling of insulin response. A strong positive association of Si with both BCAA (FDR 0) and lysine metabolism (FDR 0.008) following HIIT and a weaker correlation between Si and BCAA metabolism (FDR 0.002) following RT indicates the role of muscle AA metabolism as a common factor contributing to enhanced Si following exercise training.

Disclosure

A. Prabha kumar: None. S. Dasari: None. M. W. Pataky: None. J. Crook: None. C. T. Ball: None. K. Klaus: None. I. R. Lanza: None. M. M. Robinson: Stock/Shareholder; Self; GE Healthcare. K. Nair: None.

Funding

National Institutes of Health (R01AG09531)
510-P: Prevalence of Mental, Behavioral, and Developmental Disorders among Youth with Diabetes, United States (2016-2019)
Authors: BARRETT CATHERINE E. , BULLARD KAI M. , PARK JOOHYUN , KOYAMA ALAIN , MERCADO CARLA , CLAUSSEN ANGELIKA H. , NEWSOME KIM , PAVKOV MEDA E.
Published: June 2021

Diabetes (DM) is among the most common chronic diseases diagnosed in youth in the United States. In adults, a bi-directional relationship has been demonstrated between DM and mental, behavioral, and developmental disorders (MBDD). Such comorbidities may significantly impact the quality of life of patients with DM and disease management. However, little is known about the association of DM and MBDD in youth. To examine the magnitude of overlap between these chronic conditions, we calculated prevalence estimates using the 2016-2019 National Survey of Children’s Health, an annual, cross-sectional survey of non-institutionalized US children aged 0-17 years (N = 131,774). Parents were asked if their child was ever diagnosed with DM or with any of the following MBDDs: attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, learning disability, intellectual disability, developmental delay, anxiety, depression, behavioral or conduct problems, Tourette syndrome, or speech disorder. We present crude prevalence estimates and predictive margins adjusted for age, sex, and race/ethnicity, both weighted to be representative of the US youth population. Among US youth, prevalence estimates were 0.45% (95%CI: 0.36-0.55) for DM and 22.7% (22.2-23.2) for any MBDD. Crude prevalence of any MBDD varied by DM status (DM: 43.7% [34.5-53.4]; no DM: 22.6% [22.1-23.1]). Compared with youth without DM, those with DM had a higher adjusted prevalence of any MBDD (prevalence ratio: 1.55 [1.20-2.00]) and individual MBDDs (p <.05), except for ADHD, Tourette syndrome and speech disorder. These results suggest a significant health burden with more than 2 out of 5 youth with DM having any MBDD. Future work examining potential causal pathways could be beneficial. Understanding associated factors may ultimately lead to future preventative strategies for MBDD and DM in youth.

Disclosure

C. E. Barrett: None. K. M. Bullard: None. J. Park: None. A. Koyama: None. C. Mercado: None. A. H. Claussen: None. K. Newsome: None. M. E. Pavkov: None.
511-P: Treatment Burden, Glycemic Control, and Social Determinants of Health in Patients with Type 2 Diabetes
Authors: ROGERS ELIZABETH A. , MANSER SARAH T. , ARRIAZA STEVEN , LINZER MARK
Published: June 2021

Burden of treatment (BoT) is the work of self-management of chronic conditions and its impact on function and well-being. BoT may negatively affect behavioral outcomes. With 90% of patients with type 2 diabetes (T2DM) having at least 1 comorbid condition, BoT may be important to consider, especially among populations experiencing disparities. However, links between BoT and clinical outcomes are unclear. Using a cross-sectional survey and electronic health record data, we sought to determine associations between BoT (using a validated measure) and glycemic control (A1c) among low-income patients with T2DM in 6 safety net primary care clinics, and whether BoT and A1c were related to medication adherence and social determinants of health (SDOH). We used descriptive statistics and correlations, then ANOVA to compare 4 groups by high vs. low A1c (cut at 7%) and BoT (cut at median). Of 192 respondents, average age was 55 with 63% female and 64% non-white; 23% had low health literacy, 26% worried about housing, 35% reported medical-related financial difficulties, and 17% did not always have enough food. Average A1c was 7.6%. While there was no association between A1c and BoT (rho=0.01, p=0.86), both were independently associated with health literacy, perceived self-management self-efficacy, and diabetes-related distress (rho range 0.15-0.65, p=<0.001-0.04). A1c was not associated with medication adherence, but BoT was (rho=0.24, p=0.001). Housing worry, financial difficulties, and food insecurity were higher, and adherence lower, in the High A1c - High BoT group than in the Low A1c - Low BoT group (p=0.006-0.01). For the High A1c - Low BoT and Low A1c - High BoT groups, BoT was more important than A1c for these associations. The relationships between BoT and A1c are complex, but SDOH and adherence may be important mediators. These may be appropriate intervention targets for glycemic control, particularly among low-income and minority patients. Determining causality requires further study.

Disclosure

E. A. Rogers: None. S. T. Manser: None. S. Arriaza: None. M. Linzer: Other Relationship; Self; American College of Physicians, CRICO Malpractice and Harvard University, Research Support; Self; Agency for Healthcare Research and Quality, American Board of Internal Medicine, American Medical Association, Institute for Healthcare Improvement, National Heart, Lung, and Blood Institute, National Institute for Nursing Research.

Funding

National Institutes of Health (K23DK118207)
512-P: Desire for and Experience of Shared Decision-Making and Associations with Patient-Reported Outcomes in Those with Diabetes
Authors: SYVERUD EMILY , MANSER SARAH T. , ARRIAZA STEVEN , ROGERS ELIZABETH A.
Published: June 2021

Diabetes can be associated with distress and perceived treatment burden, which are more common among low-income and non-white populations and act as barriers to good health and quality of life. Interventions that focus on patient participation, such as shared decision-making (SDM), have been shown to improve diabetes outcomes. We sought to understand how participation in SDM is correlated with treatment burden, diabetes-related distress, patient perceived care quality, and diabetes self-management in adults with type II diabetes, and whether a patient’s desire for SDM influences those relationships. We recruited patients from six county hospital primary care clinics to complete a survey with items from validated scales for each of the above concepts along with demographics. We dichotomized responses based on median scores on the Desire to Participate in Shared Decision-Making (DPMD) scale and the Health Care Climate Questionnaire (HCCQ), a measure of the experience of SDM. We created 4 groups by high/low desire for and high/low experience of SDM, then compared mean scores for diabetes distress, perceived self-management, treatment burden, and care quality between the 4 groups using ANOVA. Of 194 respondents, average age was 54.5, with 63% identifying as female, 35% as white, 45% as Black or African-American, and 20% as of Hispanic or Latin origin. Those with high experience of SDM had significantly lower scores for diabetes distress and treatment burden and significantly higher scores for perceived care quality and self-management, regardless of their desire for SDM. Our findings suggest that SDM may be important for mitigating patient distress and treatment burden and improving self-management and satisfaction with care in a low-income minority population. Further research to explore a causal relationship is vital.

Disclosure

E. Syverud: None. S. T. Manser: None. S. Arriaza: None. E. A. Rogers: None.

Funding

National Institutes of Health (K23DK118207)