bluuebunny/crossref_metadata_2025 huggingface dataset:
You Can Build It, and They Will Come—Working with Industry Allies to Build Successful Continuing Education Programs for Your Hospital
Authors: ANTINORI-LENT KELLIE , TURKA JOANNE F. , HAWKINS KATHRYN
Published: June 2018

One of the most important responsibilities of inpatient diabetes educators is ensuring patients admitted to the hospital with diabetes are prepared for discharge. Not all hospitals have a diabetes educator on staff. Some, only one. Either way, the educational needs, the training and preparation for discharge, must be addressed. Our 520-bed acute care hospital has 1 diabetes educator. With 40% of all patients having diabetes, a team, not 1 individual, was needed. An interactive, interdisciplinary, entertaining, boot camp-style class was created. The mission: train staff nurses, dietitians, and pharmacists to be both comfortable and confident with teaching diabetes self-management skills at the bedside. The goal: ensure diabetes patients were thoroughly prepared and safe for discharge. The cost of implementing a successful program can be a barrier to program development. To overcome this, diabetes educators who worked in industry were invited to be a part of the program. We worked closely with our Lead Nurse Planner and the Continuing Education office to be certain all policies were followed. To measure the program’s success, a pre-and post-quiz and survey were given to participants. Evaluation of quiz scores demonstrate improved understanding of key patient education information. Evaluation of the surveys reveal improved understanding and confidence with teaching diabetes “survival skills.” Class evaluations are nothing but positive. In 3 years, Diabetes Boot Camp has spread to 5 other hospitals and trained more than 250 nurses, dietitians, and pharmacists. New in 2017, the survey and quiz are mailed to participants 6 and 12 months post-class. This is to evaluate the retention and usefulness of the class over time. A Diabetes Boot Camp2 was also created. Held once thus far, this class focuses on providing healthcare providers hands on experience with insulin pumps and sensors as well as learning how to care for hospitalized patients who wear these devices.

Disclosure

K. Antinori-Lent: Consultant; Self; Becton, Dickinson and Company. J.F. Turka: None. K. Hawkins: Employee; Self; Dexcom, Inc..
Virtual Education for Older Adults with Type 2 Diabetes during Transitions
Authors: WHITEHOUSE CHRISTINA R. , LONG JUDITH A. , MALONEY LORI MCLEER , HOROWITZ DAVID A. , BOWLES KATHRYN
Published: June 2018

Compared to older adults without type 2 diabetes (T2D) older adults with T2D have higher rates of hospital admission and readmission. Despite having a diagnosis of T2D, attendance of diabetes self-management education (DSME) classes by older adults is low. Hospitalizations are an opportune time to engage older adults with T2D, currently no interventions exist utilizing telehealth and DSME for this population during transitions. The purpose of this study is to demonstrate the feasibility of providing DSME through telehealth to older patients with T2D following a hospital admission. We conducted a qualitative study using semi-structured, face-to-face interviews with older adults with T2D engaged in a post-discharge DSME telehealth transitions intervention. Hospitalized older adults (≥ 55 years of age) with T2D were recruited. An advanced practice nurse certified diabetes educator provided one in-person home visit within 48 hours of discharge and weekly DSME sessions via electronic tablet for four additional weeks. After completion of the program, eight patients were asked to describe their experience using the tablet to receive DSME, describe any behavior changes, and if they would accept future education virtual visits. Interviews were audio-recorded, transcribed verbatim and content analyzed thematically. Participants (50% male, aged 57-73 years, 75% African American), cited inconvenience and lack of availability as the leading cause for prior DSME non-attendance. Participants described an increased awareness of dietary habits and more frequent monitoring of glucose. Seven out of 8 participants indicated they would participate in future virtual DSME sessions. Every participant indicated the technology was easy to use and would recommend sessions to others. Our findings support ADA recommendations to improve transitions and to evaluate DSME need at this critical time. Technology use is feasible to enhance availability and convenience for continued DSME in the home after a hospital admission.

Disclosure

C.R. Whitehouse: None. J.A. Long: None. L. McLeer Maloney: None. D.A. Horowitz: None. K. Bowles: None.
Insulin Titration Algorithms Incorporated into a Patient Glucose Diary Result in Significant Improvements in Glucose Profiles and A1C
Authors: JOHNSON MARY L. , DREON DARLENE M. , LEVY BRIAN L. , BERGENSTAL RICHARD M.
Published: June 2018

A 44-week, multinational RCT compared efficacy, safety, and subject preference for bolus insulin initiation using a wearable bolus insulin delivery patch (Patch, Calibra Medical) vs. an insulin pen (Pen, NovoLog FlexPen®) in 278 T2D subjects on basal insulin (0.52 U/kg) (A1C: mean ± SD, 8.7% ± 1.0, BMI: 32.6 kg/m2, duration: 15 y), using insulin titration algorithms incorporated into a patient diary.

At randomization, basal insulin dose was divided 1:1, basal:bolus. Subjects used SMBG patterns weekly to adjust insulin doses. The diary also included algorithms for adjusting bolus insulin at each meal if SMBG was above or below target and if meal size was larger or smaller than usual.

At 44 weeks there was significant (p<.0001) improvement in A1C with both Patch (mean ± SD 7.0% ± 0.1) and Pen (7.0% ± 0.1). In addition, 7-point SMBG profiles improved dramatically from baseline to Week 44, showing improved fasting glucose and near-normal post-meal values using this set of algorithms (Fig). Total insulin doses increased (Patch: 1.33 U/kg; Pen: 1.38 U/kg), with a basal:bolus ratio of 40:60 in both groups. There was a low incidence of adverse events and hypoglycemia with no difference between groups.

In summary, by making weekly insulin adjustments based on simple algorithms embedded in a patient glucose diary, T2D subjects can significantly improve A1C values and 7-point glucose profiles.

Disclosure

M.L. Johnson: Research Support; Self; Calibra Medical, Medtronic, Sanofi, Novo Nordisk Inc., Abbott, POPS! Diabetes Care, National Institute of Diabetes and Digestive and Kidney Diseases, Dexcom, Inc., Hygieia, JDRF. D.M. Dreon: Employee; Self; Calibra Medical. B.L. Levy: Employee; Self; LifeScan, Inc. R.M. Bergenstal: Research Support; Self; Johnson & Johnson Services, Inc.. Consultant; Self; Johnson & Johnson Services, Inc.. Research Support; Self; Abbott. Advisory Panel; Self; Abbott. Research Support; Self; Becton, Dickinson and Company. Consultant; Self; Becton, Dickinson and Company. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., AstraZeneca, Takeda Pharmaceuticals U.S.A., Inc., Dexcom, Inc.. Stock/Shareholder; Self; Merck & Co., Inc.. Research Support; Self; Eli Lilly and Company, Sanofi. Advisory Panel; Self; Sanofi, Roche Pharma. Research Support; Self; Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc.. Research Support; Self; Medtronic. Consultant; Self; Medtronic. Research Support; Self; Hygieia. Advisory Panel; Self; Hygieia, Glooko, Inc.. Research Support; Self; JAEB Center For Health Research, JDRF, National Institute of Diabetes and Digestive and Kidney Diseases.
What Is Deterring DSME Service? Perspectives of Diabetes Educators
Authors: SIMINERIO LINDA M. , HAMM MEGAN , KRALL JODI
Published: June 2018

Diabetes self-management education and support (DSMES) is considered a cornerstone of diabetes mellitus (DM) care, yet numbers of people receiving DSMES is shockingly low. In response, new delivery models are being implemented in diverse practice sites to improve referral processes and participation. The study purpose was to gain insights from diabetes educators (DEs) providing DSME in a variety of settings to identify current perspectives on barriers and solutions. Thirty-five DEs from inpatient, outpatient, insurer-based, primary care (PC), specialty practices, and telemedicine models, participated in a focus group facilitated by a skilled moderator. DEs also completed worksheets to get feedback and record views they did not have the opportunity to share in the group. The discussion was transcribed verbatim, and responses from worksheets were coded by topic. Both transcript and topic codes were summarized to capture dominant themes. DEs expressed feelings of failure in meeting patient needs too late in the course of DM and that primary prevention be considered a major responsibility. DEs perceived that providers underappreciate DSME services (e.g., think it is limited to nutrition and lifestyle education), consider DSME reserved for complex patients (e.g., comorbidities), and use DSME as punishment for patients with uncontrolled DM (e.g., poor diet). Although DEs in models with direct provider contact had similar sentiments, they found building trust and first hand demonstration of their unique skill set were effective means for changing provider perceptions. For patients, advertising campaigns were recommended to inform patients about the role of the DE and benefits of DSME, particularly at critical and meaningful time points (e.g., starting insulin, disruption in social support).

In summary, findings highlight persistent barriers, namely negative connotations surrounding DSME and suggest a need for a paradigm shift that supports positive communication to garner appeal for this effective service.

Disclosure

L.M. Siminerio: None. M. Hamm: None. J. Krall: None.
Collaborative Formative Evaluation for Implementation of Primary Care–Based Peer Support in the Shanghai Integration Model
Authors: COUFAL MUCHIEH M. , TANG PATRICK Y. , FISHER EDWIN B. , JIA WEIPING
Published: June 2018

Peer support (PS) is effective in promoting diabetes self-management, but pragmatic models are needed for specific cultural contexts and healthcare systems. Although rare in China, recent government priorities have created opportunities for PS by encouraging the integration of specialty/hospital with primary/community care. In particular, the Shanghai Integration Model coordinates specialty/hospital care with primary care in Community Health Centers (CHCs), providing an organizational base for implementation of PS. This study reports formative evaluation for PS within the Shanghai model, emphasizing collaboration with CHCs.

Intervention refinement was guided by structured interviews with 15 CHC staff and patients and a focus group with as well as monthly feedback from CHC staff. Based on these, the intervention emphasizes education on medication use, healthy diet, and sustaining physical activity among older adults, and addresses diabetes distress and barriers to insulin treatment.

Results of this collaborative formative evaluation include focus on group as opposed to individual PS with theme-based, interactive activities co-led by CHC staff along with peer leaders. In addition, peer leaders follow-up with individuals and organize neighborhood activities for physical activity, healthy diet, and feelings of comradery.

To date, PS has been implemented in 9 CHCs, involving 74 trained peer leaders, reaching 885 adults. Mean age is 68.24, years with diabetes is 12.52, and HbA1c lower than expected at 7.36%. Counter to common difficulties in reaching men, 41.1% are male. Only 14.2% are taking insulin but 75.9% take oral medications. Important implementation benchmarks include clinician buy-in, high retention, positive participant and peer leader feedback, and extension of programs through engagement with neighborhood residential committees. Collaboration with CHC staff in program refinement have been important in implementation success.

Disclosure

M.M. Coufal: Research Support; Self; Sanofi, Merck Foundation, Novo Nordisk Inc. P.Y. Tang: Research Support; Self; Sanofi, Merck Foundation, Novo Nordisk A/S. E.B. Fisher: Research Support; Self; Sanofi, Novo Nordisk Inc.. Consultant; Self; Novo Nordisk Inc.. Research Support; Self; Merck Foundation. W. Jia: None.
Prevalence of Impaired Glucose Tolerance in Adolescent Patients with Polycystic Ovary Syndrome in an Urban Health Care Center
Authors: GUPTA JYOTSNA , ANTAL ZOLTAN , CENSANI MARISA
Published: June 2018

Introduction: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting young women and has been associated with an increased risk of impaired glucose tolerance and type 2 diabetes mellitus. However, there is scarce pediatric literature on glucose abnormalities in adolescent patients with PCOS. The study objective was to examine the prevalence of abnormal glucose metabolism in the evaluation of diabetes risk in this patient population.

Methods: A retrospective analysis of female patients aged 11-18 years who were evaluated for PCOS at the Pediatric Endocrinology clinics of Weill Cornell Medicine between January 2002 and December 2017 and underwent a 75-g oral glucose tolerance test (OGTT) at our institution. Patients with abnormal glucose tolerance were identified by blood glucose level of > 140 mg/dl at 2 hours on the OGTT and impaired fasting glucose was defined as blood glucose level of 100-125 mg/dl as per American Diabetes Association (ADA) criteria.

Results: We utilized a sample size of 286 patients with PCOS diagnosis; 111 patients had OGTT results available. Patients on metformin at time of initial visit or at time of OGTT were excluded. 24 patients had impaired glucose tolerance (21%) and 1 patient met criteria for diagnosis of type 2 diabetes mellitus (0.9%). In addition, 2 patients with impaired glucose tolerance were also noted to have impaired fasting glucose (1.8%).

Conclusions: In one of the largest adolescent studies to date assessing dysglycemia in PCOS, we describe the prevalence of abnormal glucose metabolism in over one fifth (21.9%) of our patient population. Based on our results, we recommend that all pediatric patients with a diagnosis of PCOS undergo formal oral glucose tolerance testing. Further studies are needed to better determine the timing and frequency of this testing, as well as its utility in clinical care.

Disclosure

J. Gupta: None. Z. Antal: None. M. Censani: None.
Effect of Preadmission Diabetes Intervention (PREHAB) on Postoperative Patient Outcomes in Cardiac Surgery
Authors: ARNAOUT AMEL , GOGE SANDHYA
Published: June 2018

People living with diabetes are at an increased risk of developing heart disease. In patients undergoing coronary artery bypass grafting (CABG), a preexisting diagnosis of diabetes has been identified as a risk factor for postoperative sternal wound infections and prolonged hospital stay. At the University of Ottawa Heart Institute (UOHI) the wait time for elective cardiac surgery is four months. There is literature that supports the use of cardiac prehabilitation to improve postoperative outcomes such as length of stay, functional capacity and perioperative complications. However, there is no published evidence on whether pre-admission diabetes interventions lead to the same results.

The aim of this study is to introduce a novel prehabilitation program for diabetes.

Target Population: All elective cardiac surgery patient screened for diabetes with an HBA1C of greater than 6.5%.

Primary Outcomes: The primary outcome is improvement in glycemic control from screening to time of elective cardiac surgery in those patients who completed prehabilitation program.

Secondary Outcomes: The secondary outcomes measured are effect of prehabilitation on length of stay and surgical site infections.

Prehabilitation Methodology: In those who have an elevated HBA1C a screening phone call by cardiac rehabilitation nurse. A two hour prehabilitation session that cover topics such as nutrition, exercise and mental health. Group medical appointment led by a diabetes nurse.

Results: 24 patients have completed the full prehabilitation program. The mean HBA1C from screening to time of surgery dropped from 7.64% to 7.3% which was not statistically significant. One surgical site infection developed in this group compared to 3 infections in the group that did not attend.

Conclusions: Wait times for elective cardiac surgery is an opportune time to intervene and optimize patients’ medical fitness for surgery and improving patient self-management of chronic medical conditions like diabetes.

Disclosure

A. Arnaout: Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc., Medtronic. Advisory Panel; Self; Novo Nordisk Inc.. Research Support; Self; Allergan, Sanofi. S. Goge: Speaker's Bureau; Self; AstraZeneca.
Upregulation of Skeletal Muscle FGF-21 Is Linked to Weight Loss following a Lifestyle Intervention in Humans with Obesity
Authors: MULYA ANNY , ZHANG HUI , KIRWAN JOHN P.
Published: June 2018

Skeletal muscle has emerged as an endocrine organ that is capable of secreting myokines that regulate metabolic function via interorgan crosstalk. Two of these myokines are fibroblast growth factor 21 (FGF-21) and growth differentiation factor 15 (GDF15). Both have been described as metabolic mediators that regulate energy homeostasis and insulin sensitivity, thus leading to increased weight loss in obese diabetic rodent models. We hypothesized that aerobic exercise would improve FGF-21 and GDF15 gene and protein expression in insulin resistant skeletal muscle. Older obese subjects (n=15; 66±1 years; 34±1 kg/m2) were recruited and participated in a 12-week supervised aerobic exercise training program (1h/d at ≈ 85% HRmax). Body composition, cardio-metabolic testing and vastus lateralis muscle biopsies were performed before and after the intervention; gene and protein expression were determined by quantitative-real time PCR and Western blot analysis, respectively. Lifestyle intervention increased clamp-derived insulin sensitivity, aerobic capacity (P<0.0001), and fat oxidation (P<0.05), and reduced body weight, BMI and fat mass (P≤0.0001). Exercise training increased expression of skeletal muscle myokines, FGF-21 (gene: P=0.05; protein: P=0.02) and GDF15 (gene: P=0.04). Changes in skeletal muscle FGF-21 were positively correlated with changes in GDF15 (r=0.61, P=0.02), as well as carnitine palmitoyl transferase 1B (r=0.54, P=0.03), and pyruvate dehydrogenase kinase 4 (r=0.52, P=0.05), enzymes important for lipid and glucose oxidation, respectively. The improvement in FGF-21 gene expression was negatively correlated with percent reduction in body weight (r=-0.63, P=0.009), BMI (r=-0.63, P=0.009) and fat mass (r=-0.61, P=0.02). We conclude that exercise training regulates FGF-21 and GDF15 myokine expression, and for FGF-21 this effect may contribute to loss of body fat, suggesting a novel role for FGF-21 in human adipose tissue metabolism.

Disclosure

A. Mulya: None. H. Zhang: None. J.P. Kirwan: None.
Acute Resistance Exercise Improves Postprandial Lipid Metabolism in Men with Obesity and Prediabetes
Authors: BITTEL ADAM , BITTEL DANIEL , PATTERSON BRUCE W. , MITTENDORFER BETTINA , CADE WILLIAM T.
Published: June 2018

Purpose: The purpose of this study was to characterize the effect of acute resistance exercise on post-prandial lipid metabolism in obese men with prediabetes using a novel dual-tracer approach.

Participants: Ten men with obesity (age 47 ± 10, BMI 33 ± 2) and prediabetes (fasting glucose 110 ± 4 mg/dL, HbA1c 5.6% ± .2%, 2-hour OGTT glucose 162 ± 14 mg/dL).

Methods: Randomized cross-over design. Participants completed a 1-hour bout of whole-body resistance exercise (RE: 8 exercises, 3 sets, 12 reps, 80% 1RM), or 1-hour of rest on separate visits. Participants received a constant infusion of [U-13C16] palmitate and consumed a mixed meal containing 10 mg/kg body weight of [(13C4-palmitate)3] tripalmitin to assess incorporation of endogenous and exogenous fatty acids into postprandial lipids, respectively. Plasma samples were analyzed for total triglyceride (TG), chylomicron, triglyceride rich lipoprotein (TRL), and fatty acid concentrations and isotopic enrichment of tracers. Indirect calorimtery was used to measure whole-body lipid oxidation. Skeletal muscle biopsies were used to measure muscle mitochondrial fatty acid oxidation capacity using high-resolution respirometry.

Results: Compared to rest, a single bout of RE reduced post-prandial total TG, chylomicron-TG, VLDL-TG, and TRL-TG concentration area under the curve (all p<0.05). Enrichment analyses revealed the contribution of meal-derived TG to circulating chylomicrons and TRL was significantly reduced after RE, as was the contribution of TG in chylomicrons that came from the meal (all p<0.05). RE increased whole-body lipid oxidation for up to three hours after the exercise session, and significantly improved skeletal muscle oxidative capacity (p=.031).

Conclusions: Resistance exercise improves post-prandial lipid clearance and oxidation, thereby reducing post-prandial triglyceride excursions in men with obesity and prediabetes. These improvements could lower the risk of CVD and progression to T2DM.

Disclosure

A. Bittel: None. D. Bittel: None. B.W. Patterson: None. B. Mittendorfer: None. W.T. Cade: None.
Identification of >150 Novel Exercise-Regulated Circulating Factors
Authors: ROWLAND LESLIE , MIDDELBEEK ROELAND , PAN HUI , DREYFUSS JONATHAN , GOODYEAR LAURIE J.
Published: June 2018

Physical activity is critical for the prevention and treatment of type 2 diabetes and other chronic diseases. We hypothesize that exercise training alters the circulating milieu, and these factors mediate some benefits of exercise. To discover novel circulating factors we used an integrated metabolomic and proteomic approach. Male S-D rats (n=8/group) were trained for 3 weeks by voluntary wheel running (6.1 ± 2.4 km/day) or sedentary. Plasma was collected 6 hours after removal from wheel cages and analyzed by non-targeted metabolomics and SomaScan proteomics. Trained rats had lower body and fat weights, lower fasting insulin, and improved glucose tolerance vs. sedentary (all p<0.05). Metabolomics detected 273 metabolites and training significantly increased 9 and decreased 13 (p<0.05). Proteomics detected 1310 proteins and training increased 94 and decreased 35 (p<0.05). Integrated analysis combining metabolomic and proteomic data showed training significantly altered pathways of glucose metabolism, VEGF signaling, and heat stress. Correlation analyses between metabolic parameters and metabolites or proteins were also done to identify novel factors that may function to improve health (Table). Of the training-regulated metabolites and proteins, >90% are previously unknown exercise factors. These factors are potential therapeutic targets and provide unique insight into the complex changes that occur with exercise training.Significant Correlations for Metabolites and Proteins with Metabolic Parameters and Training VolumeMetabolitesProteinsTotal number correlated2 most significant (Pearson r)Total number correlated2 most significant (Pearson r)Fasting Insulin5D-Sedoheptulose-1-7-phosphate (0.682), Imidazoleacetic acid (0.675)12Formimidoyltransferase-cyclodeaminase (0.727), Cathepsin F (-0.675)Glucose Tolerance area under the curve6Thiamine (-0.610), Fructose 6-phosphate (0.608)98MAP kinase 14 (-0.860), Roundabout homolog 3 (0.850)Metabolic Efficiency (calories consumed/weight gained)13Cystathionine (-0.784), 2-ketohexanoic acid (0.732)9IGF binding protein 1 (0.802), Thrombopoietin (0.754)Training Distance25UDP (-0.964), Cystathionine (-0.834)176Cysteine-rich with EGF-like domain protein 1 (-0.953), Tyrosine-protein phosphatase non-receptor type 11 (-0.914)

Disclosure

L. Rowland: None. R. Middelbeek: None. H. Pan: None. J. Dreyfuss: None. L.J. Goodyear: None.
Combination of Canagliflozin and Exercise Training Leads to Lipid-Dependent Energy Expenditure in Skeletal Muscle in Obese Diabetic Mice
Authors: TANAKA KENICHI , TAKAHASHI HIROKAZU , SASAKI KAZUYO , INOUE KANAKO , MATSUDA YAYOI , EGUCHI YUICHIRO , ANZAI KEIZO
Published: June 2018

Background and Aim: Sodium-glucose cotransporter 2 (SGLT2) inhibitors exert multiple metabolic effects. Exercise training is a robust treatment of obesity and diabetes, but the effect of SGLT2 inhibitors on exercise training is unclear. We investigated the association between canagliflozin (CAN) and training effects on skeletal muscle and liver in obese diabetic mice.

Method: Male mice loaded with a high-fat diet for 4 weeks were housed in a normal cage (sedentary; sed) or wheel cage (WCR). A total of 0.03%w/w CAN was administrated for 2 weeks. Glucose and lipid metabolism of skeletal muscle (gastrocnemius) was analyzed and compared among 4 groups (control/sed, control/WCR, CAN/sed, and CAN/WCR).

Results: Body weight in control/WCR and CAN/sed mice was significantly lower compared with that in control/sed mice, and further weight loss was observed in CAN/WCR mice. There was no difference in running distance between control/WCR and CAN/WCR mice. Control/WCR mice showed lower blood glucose levels than did control/sed mice (200.0±4.2 vs. 231.9±8.7 mg/dL, p=0.01). CAN decreased glucose levels, but there was no difference between CAN/sed (118.9±6.29 mg/dL) and CAN/WCR mice (113.6±4.48 mg/dL). GLUT1 and GLUT4 mRNA levels in skeletal muscle in CAN/sed and CAN/WCR mice were significantly lower than those in control/sed mice. Levels of mRNA of CD36 (× 1.26 in CAN/sed and × 1.31 in CAN/WCR mice, both p<0.05) and CPT1b (× 1.09 in CAN/sed and × 1.21 in CAN/WCR mice, both p<0.05) were significantly higher than those in control/sed mice. CPT1b mRNA levels in CAN/WCR mice were significantly higher than those in CAN/sed mice (p<0.05).

Discussion: CAN promoted transition from glucose to lipid-dependent energy metabolism in skeletal muscle and this effect might have been enhanced by concomitant exercise.

Conclusion: The combination of CAN and exercise may be effective for weight loss in obesity by an increase in lipid energy expenditure.

Disclosure

K. Tanaka: Research Support; Self; Mitsubishi Tanabe Pharma Corporation. H. Takahashi: Research Support; Self; Mitsubishi Tanabe Pharma Corporation. K. Sasaki: Employee; Self; Mitsubishi Tanabe Pharma Corporation. K. Inoue: None. Y. Matsuda: None. Y. Eguchi: None. K. Anzai: Research Support; Self; Mitsubishi Tanabe Pharma Corporation, Sysmex Corporation.
Constant-Moderate and High-Intensity Interval Training Induce Differential Metabolic Benefits on Insulin-Sensitive Tissues in High-Fat Fed Mice
Authors: MARTINEZ-HUENCHULLAN SERGIO F. , BAN LINDA A. , OLAYA LUISA F. , MAHARJAN BABU R. , TAM CHARMAINE , MCLENNAN SUSAN , TWIGG STEPHEN M.
Published: June 2018

Obesity associates highly with metabolic disorders including insulin resistance. To determine if two exercise prescriptions exert differential metabolic benefits in insulin sensitive tissues, we compared isocaloric programs of constant-moderate endurance (END) and high intensity interval training (HIIT), in a mouse model of diet-induced obesity. Male 10 week old C57BL/6 mice were fed a high fat diet (HFD; 45% kcal fat) ab libitum for 10 weeks, achieving 25% excess weight, and for a further 10 weeks they then underwent isocaloric END or HIIT (3x40min sessions/week). Untrained HFD and chow-fed mice acted as controls. At 30 weeks of age, mice were sacrificed and quadriceps muscle, subcutaneous adipose tissue (SAT) and liver were excised. Neither END or HIIT altered the body weight or the fat/lean mass proportion in HFD mice. An insulin tolerance test (0.65 IU/kg*BW) showed HIIT but not END improved insulin sensitivity in HFD mice (p<0.vs. untrained). In quadricep, HFD induced down-regulation of high-molecular weight adiponectin protein, which was similarly normalized by END and HIIT. In contrast HIIT but not END reversed the HFD-driven downregulation of adiponectin receptor 1 (AdipoR1; p<0.05). In SAT, both programs tended to decrease collagen VI protein (p=0.08), whereas only HIIT induced an upregulation in mRNA (3-fold vs. HFD untrained) and protein (2-fold vs. HFD untrained) of UCP1. In liver, only END was able to reverse the collagen I accumulation (2-fold; p<0.05) and downregulation of CTGF (0.5-fold; protein) seen in HFD untrained mice (p<0.05). Our results suggest that HIIT may promote better systemic metabolic effects, compared to END during high-fat fed conditions, which could be explained by the normalization of muscle AdipoR1 and higher UCP1 induction in SAT. However, END was more effective in normalizing liver changes, suggesting differential metabolic effects of END and HIIT during obesity.

Disclosure

S.F. Martinez-Huenchullan: None. L.A. Ban: None. L.F. Olaya: None. B.R. Maharjan: None. C. Tam: None. S. McLennan: None. S.M. Twigg: Advisory Panel; Self; Abbott. Consultant; Self; Abbott. Advisory Panel; Self; Novo Nordisk Inc., Sanofi-Aventis, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company. Speaker's Bureau; Self; AstraZeneca, Merck Sharp & Dohme Corp.. Other Relationship; Self; Abbott.
Correlations between Serum 25-Hydroxyvitamin D and Pancreatic Islet Function in Type 2 Diabetics
Authors: LI NAN , CHEN MING , DONG JIAQI , YANG SHAOLING , XU LU , WANG YANRU , SUN HANG , LI HONG , QU SHEN
Published: June 2018

Objective: The relation between type 2 diabetes mellitus (T2DM) and serum-25-hydroxyvitamin D (25[OH]D) is unclear. We aimed to explore the association of 25(OH)D with islet β cell function and insulin resistance in patients with T2DM.

Methods: A total of 466 patients with T2DM and 364 healthy people in our hospital from 2016 to 2017 were enrolled. The difference of 25(OH)D between T2DM group and non-DM group was compared. Patients with T2DM were divided into low 25(OH)D group (LVD group, <47.7nmol/L, n=326) and normal 25(OH)D group(NVD group, >47.7nmol/L, n=140). The correlation between fasting plasma glucose(FPG), fasting insulin(FINS), fasting c-peptid(FCP), glycosylated hemoglobin(HbAlc), HOMA-IR, HOMA-β and 25(OH)D were compared.

Results: Serum level of 25(OH)D in T2DM group was significantly lower than non-DM group (42.33±13.79 vs.69.16±10.78, P<0.001). Levels of FPG, FINS, FCP, HbAlc, HOMA-IR, and HOMA-β in LVD group were higher than NVD group, but there was no significant difference. Correlative analysis showed that there was negative correlation between 25(OH)D and FCP (r=-0.101, P=0.03), but there was no significant correlation with FPG, FINS, HbAlc, HOMA-IR and HOMA-β (r=-0.87, 0.043, -0.290, 0.032, 0.017, all P>0.05). The 25(OH)D of Duration ≥ 5 years was lower than the Duration < 5 years (42.39±13.96 vs. 42.46±13.45, P=0.964). The 25(OH)D of HbAlc ≥ 7% was lower than HbAlc < 7% (42.02±13.85 vs. 44.19±13.50, P=0.192). The 25(OH)D in microvascular group was lower than non-microvascular group (40.86±13.82 vs. 43.35±13.72, P=0.059). The 25(OH)D in macrovascular group was higher than non-macrovascula group (42.49±13.95 vs. 42.09±13.23, P=0.807).

Conclusion: The 25(OH)D in patients with T2DM is lower than healthy people and is downtrend with the increase of diabetic duration and HbAlc. There is no definite correlation between 25(OH)D and the pancreatic islet function. The critical significance should be further studied.

Disclosure

N. Li: None. M. Chen: None. J. Dong: None. S. Yang: None. L. Xu: None. Y. Wang: None. H. Sun: None. H. Li: None. S. Qu: None.
Effects of MEDI0382 on Pancreatic and Incretin Hormones
Authors: PARKER VICTORIA E.R. , TSAI LAN-FENG , ROBERTSON DARREN , PETRONE MARCELLA , RONDINONE CRISTINA , HIRSHBERG BOAZ , JERMUTUS LUTZ , AMBERY PHILIP
Published: June 2018

MEDI0382, a GLP-1/glucagon dual receptor agonist, is being developed for the treatment of T2DM. GLP-1 receptor agonists promote glucose-dependent insulin release, suppress glucagon, and increase or have minimal effect on glucose-dependent insulinotropic polypeptide (GIP); knowledge of the effect on GLP-1 is limited. We characterized fasting and postprandial hormone profiles associated with MEDI0382 therapy. In a phase 2a study (NCT02548585), 51 subjects with T2DM and BMI 27-40 kg/m2 received MEDI0382 (uptitrated to 200 µg) or placebo (PBO) daily for 41 days. Glucose, insulin, glucagon, GIP, and GLP-1 were measured at baseline (day -1) and day 41 during a liquid mixed-meal tolerance test. MEDI0382 significantly reduced fasting glucose (-49.9 vs. -19.2 mg/dL for PBO; P < 0.0001) and glucose AUC0-4h (-32.8 vs. -10.2% for PBO; P < 0.0001) in association with increased fasting insulin (2.2 mU/L vs. -3.9 mU/L for PBO; P = 0.016), but postprandial insulin AUC was unchanged. In contrast, fasting and postprandial endogenous glucagon, GIP (Figure), and active and inactive GLP-1 were suppressed, and a delay in their kinetics was observed after MEDI0382 therapy. The results suggest that MEDI0382 is insulinotropic and might also cause delayed gastric emptying. The effects of MEDI0382 on GIP have not been observed with GLP-1 receptor mono-agonists and may represent a footprint of dual GLP-1/glucagon receptor agonism in this complex hormone signaling network.

Disclosure

V.E.R. Parker: Employee; Self; MedImmune. Stock/Shareholder; Self; Accenture. Employee; Self; AstraZeneca. L. Tsai: Employee; Self; MedImmune. D. Robertson: Employee; Self; MedImmune. Employee; Spouse/Partner; GlaxoSmithKline plc. M. Petrone: Employee; Self; MedImmune. Stock/Shareholder; Self; MedImmune. C. Rondinone: Employee; Self; MedImmune. Stock/Shareholder; Self; AstraZeneca, F. Hoffmann-La Roche Ltd., Abbott, AbbVie Inc. B. Hirshberg: Employee; Self; AstraZeneca, MedImmune. L. Jermutus: Employee; Self; AstraZeneca. Stock/Shareholder; Self; AstraZeneca. P. Ambery: Employee; Self; MedImmune. Stock/Shareholder; Self; AstraZeneca.
Effect of a Novel Ficus Carica (Fig) Fruit Extract Standardized in Abscisic Acid on the Glycemic and Insulinemic Responses in Healthy Human Subjects
Authors: ZANGARA ANDREA
Published: June 2018

Abscisic acid (ABA) is a phyto-hormone present in different fruits and has important implications for human health, such as glucose homeostasis, increase of glucose tolerance, insulinemia attenuation, immune and anti-inflammatory functions. Fig extracts represent an important source of ABA and have therefore the potential to provide a natural balance for sugar and insulin control. The objective of this study was to determine the acute postprandial metabolic response on glycemia and insulinemia of standardized fig extracts (ABAlifeTM). Healthy subjects (n=10) consumed a glucose solution and a fig extract at two different concentrations Reference food: Glucose solution (50 g) in 250 mL of water. Test food 1: Glucose solution + 200 mg ABAlife (80 µg ABA) in 250 mL of water. Test food 2: Glucose solution + 100 mg ABAlife (40 µg ABA) in 250 mL of water. The results showed that the addition of ABAlife extracts to a glucose solution was able to reduce considerably both the glycemic index (GI) and insulinemic index (II) values. Fig Extract (100-200 mg) produced lower peak and overall glycemic and insulinemic responses, between 30-120 minutes, compared with reference food of glucose. The supplementation of Fig Extract (200 mg) to a glucose solution was able to produce considerable reductions of the GI and II values (25%, p<0.001 and 24%, p<0.05, respectively). Moreover, a dose response reduction of II was observed with both ABAlife extracts. Therefore, small amounts of ABA from ABAlife extracts could be proposed as an interesting strategy to reduce postprandial glucose and insulin responses and ABA potential to manage glucose metabolism disorders should be investigated in further chronic clinical trials.

Disclosure

A. Zangara: Employee; Self; Euromed.
Contribution of Eating Behaviours to Glucose Dysmetabolism
Authors: BERTOLI SIMONA , LEONE ALESSANDRO , DE AMICIS RAMONA , BATTEZZATI ALBERTO
Published: June 2018

The contribution of eating behaviors (EBs) and their psychological constructs to glucose dysmetabolism is still debated. To investigate this issue we conducted a cross-sectional study on 4095 subjects seeking a weight loss program, (71.5% females and 71%% of subjects overweight or obese). Serum glucose and insulin were measured, and HOMA (HI) index was calculated. Impaired fasting glucose (IFG) was defined as a serum glucose ≥100 mg/dL. EBs were investigated using the Binge Eating Scale (BES) and the Eating Disorder Inventory 3 (EDI3). Raw scores for binge eating behavior (BE) bulimia (B), drive for thickness (DT) and body dissatisfaction (BD) were calculated. Multivariable linear and logistic regression models, adjusted for sex, age, BMI, smoking and physical activity were used to assess the association of BES and EDI3 with serum glucose, HI and the risk of IFG, respectively. BES score and EDI3 scales were not associated with serum glucose and HI, whereas DT (-0.1 mg/dL, CI 95%:-0.17,-0.04; for 1-point increment in DT scale) and BD (-0.18 mg/dL, CI95%:-0.24,-0.12; for 1-point increment in BD scale) scales were slightly and inversely associated with serum glucose. BE, B and DT were not associated with IFG. Only subjects experiencing BD had a lower risk of IFG (OR=0.72, CI95%:0.61,0.85).

In conclusion, given the very small effect size, BE, B and DT do not seem to contribute in biologically meaningful manner with glucose profile and IFG risk, whereas BD is associated with a lower risk of IFG. Further study to investigate the effect of BD on food habits and dietary pattern are needed to better understand the contribution of psychological constructs of EBs on glucose dysmetabolism.

Disclosure

S. Bertoli: None. A. Leone: None. R. De Amicis: None. A. Battezzati: None.
T1-REDEEM—An RCT to Reduce Diabetes Distress in Adults with Type 1 Diabetes
Authors: FISHER LAWRENCE , HESSLER DANIELLE M. , POLONSKY WILLIAM , MASHARANI UMESH , GUZMAN SUSAN , BOWYER VICKY , STRYCKER LISA A.
Published: June 2018

Diabetes distress (DD) refers to the fears, worries and burdens associated with the diabetes experience. DD is common, is distinct from depression, and has been associated with glycemic level and disease management. T1-REDEEM (Type1-Reducing Distress and Enhancing Effective Management) was an RCT that compared two interventions to reduce DD among adults with type 1 diabetes (T1D). After baseline assessment, participants were randomized to either KnowIt, a diabetes education and management program, or OnTrack, which focused on recognizing, normalizing and addressing DD. Both programs involved a 1-day group workshop followed by four 1-hour online group meetings over 3 months. Recruitment occurred at clinic and community sites in three Western U.S. states and Toronto, Canada. Inclusion criteria were T1D ≥ 12 months, elevated DD (≥ 2.0 on the Diabetes Distress Scale), age ≥ 21 years, HbA1C ≥ 7.5% (58 mmol/mol), and English speaking. Regression models analyzed change in DD and HbA1C at 3 and 9 months; missing values were imputed. Nine-month retention was 87% (N = 301 at baseline). DD was significantly reduced in both study arms (p < .001) at 3 months, with modest additional improvements at 9 months (p < .02). Between-group differences were nonsignificant. However, significant group-by-baseline level interactions for key variables revealed for whom the two interventions were most effective: OnTrack led to significantly greater reductions in DD than KnowIt for those with higher DD, poorer emotion regulation, poorer problem-solving skills, and higher knowledge at baseline; KnowIt led to significantly greater DD reductions for those with lower diabetes knowledge at baseline. There was a modest decrease in HbA1C at 3 months (p = .05) that did not differ by group. Findings suggest that effective interventions to address DD must focus on the emotional side of diabetes, especially for participants with high DD, poor emotion regulation skills, poor problem-solving abilities, and different levels of diabetes knowledge.

Disclosure

L. Fisher: Consultant; Self; Eli Lilly and Company, Abbott, Merck & Co., Inc. D.M. Hessler: Consultant; Self; Eli Lilly and Company. W. Polonsky: Consultant; Self; Abbott, AstraZeneca, Dexcom, Inc., Sanofi, Novo Nordisk Inc., Eli Lilly and Company, Intarcia Therapeutics, Inc., Servier, Ascensia Diabetes Care, Merck & Co., Inc., MannKind Corporation, Glooko, Inc., Roche Diabetes Care Health and Digital Solutions. U. Masharani: None. S. Guzman: Consultant; Self; TypeZero Technologies, Inc.. Board Member; Self; Behavioral Diabetes Institute. Consultant; Self; Becton, Dickinson and Company. V. Bowyer: None. L.A. Strycker: None.
Shared Responsibility Moderates Relations between Psychological Distress and Self-Care among Adolescents with T1D
Authors: ABUJARADEH HIBA , HELGESON VICKI , COHEN SUSAN M. , SEREIKA SUSAN M.
Published: June 2018

Psychological distress and parental involvement in diabetes management are predictors of self-care behaviors among adolescents with T1D. To date, little research has examined parental involvement as a moderator of the association between distress on self-care behaviors. This study examined whether shared responsibility (SR) moderates relations of distress on self-care.

Methods: A secondary analysis was conducted using longitudinal data from 132 adolescents with T1D (53% female; aged 10.7-14.2 years; 1-13 years duration of T1D) and their parents. Adolescents were interviewed and parents completed a questionnaire annually for 5 years. Adolescents and parents reported on the extent to which they shared diabetes care responsibilities. Adolescents reported on distress (depression, anxiety, anger) and self-care. Linear mixed modeling was used to assess whether SR moderated relations of concurrent and lagged psychological distress on self-care.

Results: For concurrent analyses, parent-reported SR moderated relations between both depressive symptoms and anxiety on self-care (p<.001) and anger on self-care (p=.001). For lagged analyses, parent-reported SR moderated relations between depression on self-care (p=.001) and anxiety on self-care (p=.003). Moderation varied over the 5 years. During early to middle adolescence (years 1-4), SR did not moderate relations between distress and self-care; however, during middle to late adolescence (year 5), lower distress was associated with better self-care for higher SR but not associated with self-care for lower levels of SR.

Conclusions: As adolescents get older, lower distress was associated with better self-care for those with higher levels of SR but not for those with low SR. Continuation of SR during adolescence may mitigate the effects of distress on self-care. Healthcare providers should promote parental involvement in diabetes management throughout adolescence for better diabetes outcomes.

Disclosure

H. Abujaradeh: None. V. Helgeson: None. S.M. Cohen: None. S.M. Sereika: None.
Glycemic Variability Associated with Time Spent in Hypoglycemia in Type 1 Diabetes—Explorative Data in Real-World, Real-Time Continuous Glucose Monitoring
Authors: HACHMANN-NIELSEN ELISE , BARTHOLDY TRINE , DJURHUUS CHRISTIAN BORN , KVIST KAJSA
Published: June 2018

Glycemic variability has previously been associated with risk of hypoglycemia. Cornerstone4Care (C4C), a digital patient management program for diabetes mellitus, supports diabetes self-managing and captures patient data inclusive real-world real-time continuous glucose monitoring (CGM) data. The objective was to explore the association between glucose variability and time spent in hypoglycemia (TIH; percent time with interstitial glucose (IG) <54 mg/dL [3.0mmol/L]) and the association between mean IG and TIH in real-world CGM data. Glucose variability was determined based on CGM data from 112 type 1 diabetes (T1D) patients uploaded via the C4C app and calculated as the coefficient of variation (CV) based on the last 14 days’ available CGM data. For each patient a CV-index, mean IG, and proportion of TIH was determined. The variability CV-index ranged from 11% to 56%. Increase in CV appeared to increase TIH. Mean IG did not seem to influence the time spent in hypoglycemia as much. In addition, when CV exceeded the newly recommended cut-off of 36%, the TIH seemed to increase.

In conclusion, higher glucose variability (CV) based on CGM data from T1D was observed to increase the time spent in hypoglycemia. The increase seemed to occur with a CV around 30-36% and seemed to be more independent of mean IG.

Data source: https://www.cornerstones4care.com/.

Disclosure

E. Hachmann-Nielsen: Employee; Self; Novo Nordisk A/S. T. Bartholdy: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. C. Djurhuus: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. K. Kvist: Employee; Self; Novo Nordisk A/S.
Ketones to Success—Does NICH Involvement Influence DKA Discharge Presentation?
Authors: WAGNER DAVID V. , CHUONG ROSE , KOSKELA NATALIE C. , LUZOD HANNAH , BEESON ERYNN , GUTTMANN-BAUMAN INES , HARRIS MICHAEL A.
Published: June 2018

Objective: Youth struggling with diabetes management are at increased risk of DKA. Novel Interventions in Children’s Healthcare (NICH) is designed for youth with T1D who are experiencing or are at high risk of experiencing DKA. Previous findings from smaller samples indicate that youth in NICH are less likely to experience a DKA event and typically experience a shorter average hospital stay. However, counter to physician anecdotes, DKA-related lab values at admission for NICH patients do not differ from labs prior to program involvement. This study aims to determine whether patients in NICH are being discharged when less stable.

Methods: Retrospective chart reviews were conducted on 52 youth enrolled and treated with NICH. Data included presence and number of DKA episodes in the year prior to and the year following NICH enrollment, as well as associated lab values at discharge—ketones, blood glucose level, bicarb, and pH. The mean youth age was 14.7 years (SD=3.5); 55.8% were female; and 92.3% were caucasian. Eighteen youth had lab values associated with DKA discharge available both prior to and during NICH.

Results: Youth were less likely (p=.001) to experience DKA during NICH (35.3%) than prior to NICH (69.2%) and experienced fewer DKA events (t(51)=3.53; p=.001) during NICH (M=1.0; SD=1.8) than prior (M=1.8; SD=2.1). Regarding discharge presentation, only the presence of ketones indicated a significant difference (t(17)=2.11; p=0.5), with patients in NICH being discharged with trace to small ketones on average while in the program, as opposed to negative to trace ketones prior to program involvement.

Conclusions: Youth in NICH experience fewer DKA events and are less likely to experience a DKA during program involvement. In addition, youth are discharged, on average, with a stronger presence of ketones during NICH than prior to program involvement. This may reflect increased medical provider confidence that ketones and associated youth health can be managed at home when NICH providers are involved.

Disclosure

D.V. Wagner: None. R. Chuong: None. N.C. Koskela: None. H. Luzod: None. E. Beeson: None. I. Guttmann-Bauman: None. M.A. Harris: Consultant; Self; Eli Lilly and Company.