bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial/Ethnic Disparities in the Prevalence of Diabetes and Prediabetes among Four Million Overweight and Obese Adults in the U.S.
Authors: ZHU YEYI , ARTERBURN DAVID , DALEY MATTHEW F. , DESAI JAY R. , FITZPATRICK STEPHANIE L. , HORBERG MICHAEL A. , KOEBNICK CORINNA , MCCORMICK EMILY V. , OSHIRO CARYN , YOUNG DEBORAH R. , FERRARA ASSIAMIRA
Published: June 2018

Racial/ethnic disparities in diabetes remain a persistent public health concern. We aimed to examine racial/ethnic disparities in the prevalence of diabetes and prediabetes by body mass index (BMI) category, in a large racial/ethnically and regionally diverse cohort of overweight and obese insured adults in the U.S. Data were from the Patient Outcomes Research to Advance Learning (PORTAL) network-Overweight and Obese Cohort, a consortium of 3 integrated health care systems. A total of 4,490,649 members (50% white, 22.7% Hispanic, 11.3% black, 10.6% Asian, 1.4% Native Hawaiian/Other Pacific Islander, 0.6% American Indian/Alaskan Native, and 4.3% other/unknown) aged ≥18 years during 2012 or 2013, with a BMI ≥23.0 kg/m2 were included. Ascertainment of diabetes and prediabetes were based on diagnosis codes, medication use, and laboratory results according to the ADA criteria. Age-adjusted prevalence was derived by BMI and racial/ethnic groups. Overall, the age-standardized prevalence of diabetes and prediabetes was 17.5% and 34.5%, respectively. A linear increasing trend was observed in prevalence of diabetes and prediabetes across BMI categories within racial/ethnic groups (all P-for-trend <0.001), except for prediabetes among Asian and Native Hawaiian/Other Pacific Islander, who tended to have a higher prevalence of diabetes and prediabetes compared to white across BMI categories, even more pronounced at a lower BMI. At BMI 23.0-24.9 kg/m2, the age-standardized prevalence of diabetes among Asians was 16.9%, comparable to that among white at BMI 30.0-34.9 kg/m2; the age-standardized prevalence of prediabetes was 37.3% among Asians at BMI 23.0-24.9 kg/m2, even higher than that among white at BMI ≥50.0 kg/m2.

In conclusion, disproportional impact of BMI on diabetes and prediabetes among minority groups highlight the importance of tailored screening, prevention, and intervention strategies to mitigate the risk of diabetes and prediabetes.

Disclosure

Y. Zhu: None. D. Arterburn: None. M.F. Daley: None. J.R. Desai: None. S.L. Fitzpatrick: None. M.A. Horberg: None. C. Koebnick: None. E.V. Mccormick: None. C. Oshiro: None. D.R. Young: None. A. Ferrara: None.
Plasma Lipidomic Profiles in Relation to Incident Type 2 Diabetes among Women with a History of Gestational Diabetes Mellitus
Authors: LI JUN , LIANG LIMING , HU FRANK , ZHANG CUILIN , TOBIAS DEIRDRE
Published: June 2018

Background: Dyslipidemia is a risk factor of type 2 diabetes (T2D). Women with a history of gestational diabetes (GDM) have a greater T2D risk; however, whether lipids patterns contribute to risk of progression remains unclear.

Methods: We conducted a nested case-control study of incident T2D among women enrolled in the Nurses’ Health Study II reporting a history of GDM prior to the first blood collection (1995-1999) and followed-up through 2013. Plasma lipidomics containing 180 metabolites were measured in a subset of 175 incident cases and 176 age-matched controls by liquid chromatography-mass spectrometry. We constructed lipid networks using a weighted-correlation algorithm, and examined the association of individual lipids and sub-networks with T2D risk using logistic regression, adjusting for established T2D risk factors.

Results: We identified 39 lipids species significantly associated with T2D risk (FDR<0.05), and observed different association patterns (in which associations were differed by numbers of carbon and double-bonds) across various lipid classes. We constructed 5 co-regulating lipid sub-networks, one of which (featuring the interactions between diacylglycerol, triacylglycerol, and phosphatidylethanolamine with mid-length carbon and less double-bonds) was significantly associated with incident T2D risk (odds ratio for increasing quartiles was 1 [reference], 2.4, 3.4, and 4.4; P-trend=0.0008). The addition of significant lipid species to a base model (13 traditional risk factors and medications) to predict incident T2D increased the c-statistics from 0.83 to 0.90 (P=0.001) with a corresponding categorical net reclassification index of 0.27 (P<0.001) in cross-validation.

Conclusions: The dysregulation of certain lipid specie/class may contribute to a higher risk of incident T2D after a GDM pregnancy. Plasma lipid species and the network signatures may aid future clinical risk assessment and targeted interventions.

Disclosure

J. Li: None. L. Liang: None. F. Hu: None. C. Zhang: None. D. Tobias: None.
Racial Differences in the Correlation of HbA1c to Early and Late Postprandial Glycemic Responses in Adults with Prediabetes
Authors: HSIA DANIEL S. , MARLATT KARA , PETERSON COURTNEY M. , RAVUSSIN ERIC
Published: June 2018

Fasting plasma glucose (FPG), 2-hour oral glucose tolerance test (OGTT), and hemoglobin A1c (HbA1c) are used to screen for prediabetes and diabetes. While HbA1c testing offers the convenience of a single blood draw without fasting, it is known to have confounders such as age, race, and red blood cell turnover rate to name a few. Furthermore, dynamic tests such as the OGTT and mixed-meal tolerance test (MMTT) are usually better at detecting β-cell dysfunction and insulin resistance when insulin is measured. We sought to determine how well HbA1c values correlated with glucose levels during a MMTT and whether the correlation varied by race. Baseline data from a clinical trial of 59 adults [27 white and 32 African American (AA)] with prediabetes defined as either FPG of 100-125 mg/dL and/or HbA1c of 5.7-6.4% were used. In this cohort, we correlated HbA1c to glucose levels at 30 and 120 mins after ingesting a standardized meal (smoothie) of 400 kcal (20% protein, 40% fat, and 40% carbohydrate). Mean FPG was higher in white participants (108±10 mg/dL) compared to AA participants (102±10 mg/dL) (p<0.05), while HbA1c was marginally higher in AA participants (5.7±0.2%) compared to white participants (5.6±0.3%) (p<0.01). In the white participants, HbA1c correlated with glucose 30-mins post-meal (r=0.46, p<0.03) but did not in AA participants (r=0.11, p>0.53). In AA participants, HbA1c correlated with glucose 120-mins post-meal (r=0.48, p<0.01) but did not in white participants (r=0.22, p=0.28). Thus, in this cohort, white adults with prediabetes showed greater impairment of fasting glucose than AA adults, despite lower HbA1c levels. Moreover, a higher HbA1c correlated with an impaired early glycemic response in white adults; whereas, a higher HbA1c correlated with impaired glucose tolerance in AA adults. These results may suggest racial differences in early vs. late postprandial responses that should be accounted for when screening for prediabetes and diabetes.

Disclosure

D.S. Hsia: None. K. Marlatt: None. C.M. Peterson: None. E. Ravussin: Board Member; Self; Amway. Consultant; Self; Amway, Janssen Research & Development. Research Support; Self; Amway, Novartis Pharmaceuticals Corporation, Sanofi-Aventis, Weight Watchers International, Inc., Ethicon US, LLC..
Cardiometabolic Disease Risk Assessment Predicts Incident Diabetes in a Large and Diverse Population
Authors: WILKINSON LUA , MEHTA TAPAN , GARVEY W. TIMOTHY
Published: June 2018

Background: Risk scores for predicting type-2 diabetes mellitus (T2DM) have been developed, but few have included adequate African-Americans.

Objective: To derive and validate scoring systems to predict future diabetes in populations including caucasian- and African-Americans, weighted by sex and race.

Design, Setting, and Participants: We estimated 9.5-year risk of T2DM in participants with valid follow-up data taken from 12,1321 people in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, and externally validated it in 9,712 participants from the Atherosclerosis Risk in Communities study.

Methods: Cardiometabolic disease scores were calculated for each sex-race pair using quantitative clinical data. Incidence diabetes was defined as fasting glucose ≥ 126 mg/dL, non-fasting glucose ≥ 200mg/dL, currently on medication for T2DM, or self-report. Covariates included: sex, race, and age; waist circumference; blood pressure; HDL cholesterol; fasting triglycerides or on lipid-lowering medication. We assigned a simple integer score for each risk factor component using logistic regression coefficients for each sex-race pair. Discrimination was assessed with area under the receiver operating characteristic curves (AROCs).

Results: Diabetes incidence rates at a median follow-up of 9.5 years were 18.3% and 18.7% in African-American men and women, and 12.3% and 9.2% in caucasian-American men and women. Weighted covariates differed more by race than sex (p = 0.001). The AROCs ranged from 0.72 for black men to 0.78 for white women. Externally validated models performed well; AROC was 0.75 (black men) to 0.83 (white women).

Conclusion: The weighted CMDS score has high model discrimination using readily available clinical data, and can be used to quantify T2DM risk based on race- and sex- specific data; thus, diabetes prevention can be targeted to high risk individuals in a manner that optimizes outcomes, benefit/risk ratio, and cost-effectiveness.

Disclosure

L. Wilkinson: None. T. Mehta: Employee; Spouse/Partner; Becton, Dickinson and Company. Consultant; Self; NuTech Medical. W. Garvey: Advisory Panel; Self; Novo Nordisk Inc., Merck & Co., Inc.. Research Support; Self; Sanofi, Pfizer Inc., Novo Nordisk Inc., AstraZeneca, Merck & Co., Inc., Elcelyx Therapeutics, Inc., Lexicon Pharmaceuticals, Inc., Eisai Inc..
Depression Screening in Adolescents with Type 1 Diabetes Mellitus
Authors: KIM GRACE K. , RELAN SHILPI , TOSUR MUSTAFA , AGARWAL SWASHTI , JINDAL ISHITA , MOORJANI TRACY PATEL , FEGAN-BOHM KELLY , GALLAGHER KATHERINE A. , HENDRIX KRISTEN
Published: June 2018

Background: Adolescents with type 1 diabetes mellitus (T1D) are at increased risk for depressive symptoms relative to youth without diabetes, which is associated with poor diabetes outcomes (Hood et al, 2014). As part of ongoing Quality Improvement initiatives at Texas Children’s Hospital (TCH), we evaluated two validated depression screening measures, the PHQ-2 and PHQ-9: Modified for Teens, to standardize our depression screening process.

Objectives: We sought to (1) review screening outcomes from youth with T1D who completed both the PHQ-2 and PHQ-9, (2) determine which measure provided the greatest sensitivity to identifying depressive symptoms, and (3) create a standardized process for implementation of the more sensitive screen.

Methods: Data was collected by a chart review of PHQ-2 and PHQ-9 scores for all patients with T1D age 12-17 seen at TCH Endocrine clinic sites between January 1 –December 31, 2017. A positive screen was defined as PHQ-2 score ≥ 3 and PHQ-9 score ≥ 5. We then created an algorithm based on the more sensitive screen for referrals to mental health services.

Results: Of 961 eligible patients, 84% were screened using PHQ-2 and 15% using both the PHQ-2 and PHQ-9. Of the patients who completed both measures, the positive screening rate was 20% in PHQ-9 vs. 4% in PHQ-2. None of the patients with “moderate” PHQ-9 (≥5-9) screened positive on the PHQ-2, and only 1 patient with “severe” PHQ-9 (≥10) score screened positive on PHQ-2. Of the 3 patients who endorsed suicidality on the PHQ-9, none had a positive PHQ-2. 80% of patients who received both screens completed the screens within 2 months of each other.

Discussion: PHQ-2 depression screen may be less sensitive than PHQ-9 for capturing depressive symptoms in youth with T1D. We have created a standardized algorithm implementing PHQ-9 into the clinic flow and looking at optimizing mental health referrals.

Hood KK, Lawrence JM, Anderson A, Bell R, et al. Metabolic and inflammatory links to depression in youth with diabetes. Diabetes Care 2012;35:2443-2446.

Disclosure

G.K. Kim: None. S. Relan: None. M. Tosur: None. S. Agarwal: None. I. Jindal: None. T. Patel Moorjani: None. K. Fegan-Bohm: None. K.A. Gallagher: None. K. Hendrix: None.
Long-Term Incidence of Liver Disease in the Diabetes Population in Israel
Authors: GOLDSHTEIN INBAL , FERNANDES GAIL , KARASIK AVRAHAM , RAJPATHAK SWAPNIL , CHODICK GABRIEL
Published: June 2018

In light of the high variability in the literature on the burden of liver disease in relation to diabetes (DM), this study compared the incidence and risk of liver disease between patients with and without DM in a large population-based cohort. The study utilized the computerized database of a nationally representative payer-provider health fund in Israel. All members without cirrhosis, cancer, viral hepatitis or excess alcohol intake were followed from 2000 to 2017. Liver disease: Cirrhosis, liver transplant and hepatocellular carcinoma (HCC), were detected by coded diagnoses, procedures, and the national cancer registry. DM was defined by a previously validated registry. Age specific incidence density rates were calculated based on person years under observation. Risks of liver transplant, HCC and all-cause mortality in the cirrhotic diabetes patients were described using cox proportional hazards multivariate regression. The cohort included 1,083,4subjects with a mean follow-up of 15.1 years (SD=4.2), 2% with DM at index. A total of 2,511 incident cases of liver complications were observed. Higher incidence rates of cirrhosis were observed in patients with DM at index as compared with DM-free with rate ratios of 7.5 (95% CI: 6.5-8.7), 4.1 (3.8-4.4) and 2.3 (2.2-2.5) among patients aged <40, 40-60 and >60 years old respectively. DM was also associated with higher incidence of HCC (rate ratio 3.6 (95% CI: 3.2-4.1) and 1.7 (1.6-1.8) among ages 40-60 and >60 years old respectively) and liver transplant (rate ratio of 4.5 (3.3-6.2) and 1.6 (1.1-2.2) among ages 40-60 and >60 years old respectively). Among cirrhotic patients (n=1,527), those with DM had an adjusted HR=2.3 (95% CI: 1.2-4.5) for developing HCC, a HR=2.2 (0.9-5.3) for undergoing a liver transplant and a HR of 1.8 (1.5-2.3) for all-cause mortality as compared with DM-free, after controlling for age, BMI, sex and smoking. Diabetes is associated with higher incidence rates and higher risk of liver complications compared to those without diabetes.

Disclosure

I. Goldshtein: None. G. Fernandes: Employee; Self; Merck & Co., Inc.. Employee; Spouse/Partner; Janssen Research & Development. Stock/Shareholder; Self; Merck & Co., Inc.. Stock/Shareholder; Spouse/Partner; Janssen Research & Development. A. Karasik: Stock/Shareholder; Self; Novo Nordisk A/S. Research Support; Self; Novo Nordisk A/S. Advisory Panel; Self; Novo Nordisk A/S, AstraZeneca. Research Support; Self; AstraZeneca. Consultant; Self; Boehringer Ingelheim GmbH. Advisory Panel; Self; Merck & Co., Inc., GlucoMe. S. Rajpathak: Employee; Self; Merck & Co., Inc.. G. Chodick: None.
Meta-analysis of Serum Uric Acid (SUA) and Cardiovascular Events in Diabetes Population
Authors: SHAO YIXUE , SHAO HUI , SHI LIZHENG
Published: June 2018

Background: Recent studies found elevated serum uric acid (SUA) level were associated with type 2 diabetes mellitus (T2DM) progression. However, whether SUA level was relevant to the development of cardiovascular events was inconclusive.

Objective: To explore the association between SUA level and risk of cardiovascular events and all-cause mortality among patients with T2DM.

Method: A systematic literature search was conducted using the Web of Science and PubMed database (1980-2017). Search terms and strategies for PubMed were as follows: using [Title/Abstract] or [MeSH Terms] to search “diabetes”, “serum uric acid”, “cardiovascular disease”, and “all-cause mortality.” Studies that reported associations between SUA and cardiovascular events (i.e., coronary heart disease (CHD) and stroke), and all-cause mortality in patients with T2DM were identified, and these associations were extracted and converted into hazard ratio (HR) of cardiovascular events per 59μmol/l SUA increase. Meta-analysis was conducted to synthesize the associations between SUA level and risk of cardiovascular events, using random effect model to account for possible study heterogeneity. Heterogeneity was assessed using I2, and the meta-analysis was performed using Stata 12.0. This study was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline.

Results: 6 (n=11,750 patients), 4 (n=3034 patients) and 2 studies (n=7792 patients) were identified reporting associations between SUA level and all-cause mortality, CHD and stroke respectively. HR for all-cause mortality, CHD, and stroke per 59 μmol/l increase was 1.150 (95% CI: 1.134, 1.165), 1.002 (95% CI: 0.983, 1.021) and 1.177 (95% CI: 1.070, 1.284), respectively. Heterogeneity bias was found in the analyses.

Conclusion: Overall, SUA were associated with higher risk of all-cause mortality and stroke. However, we found no significant association between SUA level and CHD among T2DM population.

Disclosure

Y. Shao: None. H. Shao: None. L. Shi: None.
Reduced Lower-Limb Muscle Strength in Type 2 Diabetes Patients with Arthritis Is Associated with Impaired Beta-Cell Function
Authors: ZAHARIA OANA P. , PESTA DOMINIK , BOBROV PAVEL , KUPRIYANOVA YULIYA , BÓDIS KÁLMÁN , BURKART VOLKER , HWANG JONG-HEE , MÜSSIG KARSTEN , RODEN MICHAEL , SZENDROEDI JULIA
Published: June 2018

Insulin levels might affect the integrity of musculoskeletal structures. We hypothesized that in type 2 diabetes patients (T2D) with arthritis musculoskeletal impairment is associated with insulin secretion. This analysis of the German Diabetes Study comprised T2D with (T2D+A (n[m/f]=12[4/8], age 63±9 years, BMI 34.8±7.2 kg/m2) or without arthritis (T2D-A: 22[12/10], 59±13 years, 32.8±6.5 kg/m2) and healthy controls (CON: 18[10/8], 42±16 years, 25.3±4.1 kg/m2). Group comparison analyses were adjusted for age, sex and BMI. T2D duration was <5 years. Beta-cell function was assessed from C-peptide levels during glucagon stimulation test (GST) and intravenous glucose tolerance tests (IVGTT), insulin sensitivity (IS) from hyperinsulinemic-euglycemic clamps. Isometric knee extension force (KEF) was assessed with a dynamometer and range of motion (ROM) was measured using a goniometer. IS was comparable in T2D+A and T2D-A (3.5±0.7 vs. 5.1±2.4 mg*kg-¹*min-¹), but lower than in CON (11.5±3.3 mg*kg-¹*min-¹, p<0.05). Hemoglobin A1c (HbA1c) was similar in T2D+A and T2D-A (53±6 vs. 51±11 mmol/mol), but higher than in CON (33±3 mmol/mol, p<0.05). In T2D+A, C-peptide secretion (IVGTT) was 43% and 63% lower (p<0.05) than in T2D-A and in CON, respectively. C-peptide secretion (IVGTT) correlated inversely with HbA1c levels in T2D+A (r=-0.81, p<0.05) and T2D-A (r=-0.60, p<0.05). In T2D+A, KEF was 60% lower than in CON (19±11 kg vs. 47±12 kg, p<0.05) and correlated negatively with C-peptide secretion (GST; r=-0.99, p<0.05). ROM was 8% and 19% lower (p<0.05) in T2D+A than in T2D-A and CON, respectively. Within T2D+A, ROM was negatively correlated with insulin secretion (IVGTT; r=-0.64, p<0.05).

In conclusion, musculoskeletal impairment is associated with decreased beta-cell function in T2D patients suffering from arthritis, possibly mediated by chronic hyperglycemia.

Disclosure

O.P. Zaharia: None. D. Pesta: None. P. Bobrov: None. Y. Kupriyanova: None. K. Bódis: None. V. Burkart: None. J. Hwang: None. K. Müssig: None. M. Roden: Speaker's Bureau; Self; Boehringer Ingelheim GmbH. Research Support; Self; Boehringer Ingelheim GmbH. Consultant; Self; Poxel SA. Research Support; Self; Danone Nutricia Early Life Nutrition, GlaxoSmithKline plc., Nutricia Advanced Medical Nutrition, Sanofi. J. Szendroedi: None.
The Natural Course and Risk Factors for Progression of Diabetic Retinopathy-KNDP Prospective Cohort Study
Authors: MOON HYUN UK , JEON JA YOUNG , LEE SOOJIN , HAN SEUNG JIN , KIM HAE JIN , CHUN KI HONG , KIM TAE HO , KIM YOUNG SEOL , WOO JEONG-TAEK , AHN KYU JEUNG , NAM MOONSUK , BAIK SEI HYUN , PARK YONGSOO , LEE KWANWOO
Published: June 2018

Introduction: We investigated the annual incidence rate and risk factors for progression of diabetic retinopathy in The Korea National Diabetes Program.

Method: The Korean national Diabetes Program (KNDP) is a prospective, multicenter, and observational cohort study performed on type 2 diabetic patients in Korea. The study started in May 20and continued to follow-up until March 2014. Of the 3,949 patients enrolled in the KNDP, we analyzed 2962 patients who had both eyes photographed and assessed at baseline and further follow-up. An ophthalmologist evaluated and graded the funduscopic findings. Diabetic reinopathy (DR) was classified as 4 stages which were no DR, NPDR, PDR and blindness. We calculated the annual incidence rate from stage to stage. We analyzed the risk factor for progression of diabetic retinopathy.

Results: The mean follow-up time (SD) was 4.1 (1.7) years. The mean age and DM duration were 54.6 (9.8) years and 6.7 (6.5) years, respectively. The mean level of fasting glucose and HbA1c was 144 (50) mg/dl and 7.7 (1.7), respectively. Of those, patients with diabetic retinopathy was 691 (23.4%). The annual progression rate from no retinopathy to NPDR was 3.28% (295/2271). Patients progressed directly from NPDR to PDR at a rate of 3.13% (85/871). Three of 200 patients with PDR progressed to blindness, at an annual rate of 0.57%. Patients who further progressed retinopathy had older age, longer DM duration, higher levels of HbA1c, higher systolic blood pressure, and more history of cerebrovascular disease than those who didn’t progress retinopathy.

Conclusion: We reported the results of larger scale on DR progression than previous study of Korea. When compared to previous studies, the disease progression has improved over the 2 decades in Korean patients with type 2 diabetes. Our findings are consistent with other recent small studies from Korea. This study also confirmed risk factors for DR progression.

Disclosure

H. Moon: None. J. Jeon: None. S. Lee: None. S. Han: None. H. Kim: None. K. Chun: None. T. Kim: None. Y. Kim: None. J. Woo: None. K. Ahn: None. M. Nam: None. S. Baik: None. Y. Park: None. K. Lee: None.
Applying 8-oxoGuo for Prediction of Mortality in Patients with Type 2 Diabetes and Microalbuminuria—A Post-Hoc Analysis of the Steno-2 Trial
Authors: KJAER LAURA K. , OELLGAARD JENS , HENRIKSEN TRINE , GÆDE PETER , PEDERSEN OLUF , POULSEN HENRIK E.
Published: June 2018

RNA oxidation product, 8-oxo-7,8-dihydroguanosine (8-oxoGuo), has been associated with mortality in two cohorts of patients with type 2 diabetes (T2D). However, the potential effect of registered treatments decreasing urine 8-oxoGuo level remains unraveled. In the Steno-2 study intensified multifactorial intervention compared with conventional multifactorial therapy cut by half mortality in T2D patients with microalbuminuria. We assessed association between total mortality and 8-oxoGuo from advanced baseline and for 19.9 years, and from end of 7.8 years of intervention for 12.1 years.

In 1993, 160 T2D patients with microalbuminuria were included in the trial. Urine samples were available from 155 patients in 1995 (advanced baseline) and from 125 patients in 2001 (end of intervention). Cox regression was used for log2-transformed 8-oxoGuo and dichotomized (cut-off at median; low vs. high RNA oxidation).

During a follow-up of 19.9 years after advanced baseline, 89 died. From the end of 7.8 years of intervention and during remaining 12.1 years of observation, 61 of 125 died. From advanced baseline and onwards, no association between 8-oxoGuo and mortality was found (p=0.40). From end of intervention and onwards, a doubling of 8-oxoGuo showed a hazard ratio (HR) of 3.(95% CI [1.86−5.12]; p<0.001; z-score=4.36) after multiple adjustments. Patients with low 8-oxoGuo in the intensive-therapy group had the lowest risk of dying compared with high 8-oxoGuo in the conventional group from advanced baseline and onwards, HR 0.40 (95% CI [0.21−0.75]; p=0.004), and from end of intervention and onwards, HR 0.28 (95% CI [0.13−0.60]; p=0.001) adjusted for age and sex.

In T2D patients with microalbuminuria, urine 8-oxoGuo level after 7.8 years of multifactorial intervention was associated with total mortality during 12.1 years of post-trial follow-up. Patients with low 8-oxoGuo in the intensified multifactorial group had the lowest risk of dying.

Disclosure

L.K. Kjaer: None. J. Oellgaard: None. T. Henriksen: None. P. Gæde: None. O. Pedersen: None. H.E. Poulsen: None.
Cardiovascular Outcomes and Mortality in Type 2 Diabetes with Associated Cardio-Renal-Metabolic Comorbidities
Authors: ARNOLD SUZANNE V. , HUNT PHILLIP R. , CHEN HUNGTA , MACLACHLAN SHARON , REPETTO ENRICO , VORA JITEN , KOSIBOROD MIKHAIL
Published: June 2018

Cardio-renal-metabolic comorbidities (CRMCs) associated with type 2 diabetes (T2DM) increase patient morbidity and mortality. We evaluated the incremental contribution of various CRMCs to the risk of myocardial infarction, stroke, or cardiovascular death (MACE), heart failure (HF), and all-cause mortality (ACM) in patients with newly diagnosed T2DM. Using ICD-9 codes, T2DM patients were identified in a U.S. EMR (Humedica/Optum) database along with other CRMCs (hypertension {HTN}, hyperlipidemia {HPLD}, chronic kidney disease {CKD}) at the time of T2DM diagnosis. Patients’ records were assessed for the occurrence of MACE, HF, and ACM. Between 1 Jan 2011 and 31 Mar 2015, 180722 incident T2DM patients were identified (age {mean [SD]}: 62.4 [13.5], 52.0% male) with/without CRMCs: T2DM only (n=25114; 13.9%), T2DM+HTN (n=20863; 11.5%), T2DM+HPLD (n=13274; 7.3%) T2DM+HTN+HPLD (n=52415; 29.0%), and T2DM+HTN+HPLD+CKD (9.9%). The risk of MACE, HF and ACM increased with a greater number of CRMCs (Table), CKD being associated with the highest incremental risk for ACM. In patients with new diagnosis of T2DM, the risk of MACE, HF, and death increased incrementally with a greater number of CRMCs; with CKD being the main driver of mortality. These results may have implications for risk factor management, and potentially selection of treatment strategies among T2DM patients with various CRMCs.

TableMACE, HF, and ACM rates in patients with incident T2DM and cardio-renal-metabolic diseasesOutcomesCRMCs at time of T2DM DiagnosisEvent rate (95% CI) events/100 PYIncremental % increase in relative riskMACET2DM only5.16 (5.00, 5.32)ReferenceT2DM + HTN + HPLD7.04 (6.91, 7.18)36T2DM + HTN + HPLD + CKD9.15 (8.87, 9.43)30HFT2DM only4.84 (4.69, 5.00)ReferenceT2DM + HTN + HPLD6.24 (6.12, 6.37)29T2DM + HTN + HPLD + CKD8.40 (8.14, 8.66)35ACMT2DM only2.26 (2.16, 2.37)ReferenceT2DM + HTN + HPLD2.57 (2.50, 2.64)14T2DM + HTN + HPLD + CKD5.19 (5.01, 5.38)102ACM, all-cause mortality; CI, confidence interval; CRMCs, cardio-renal-metabolic comorbidities; CKD, chronic kidney disease; HF, heart failure; HTN, hypertension; HPLD, hyperlipidemia; MACE, myocardial infarction, stroke, or cardiovascular death; PY, patient-years; T2DM, type 2 diabetes mellitus.

Disclosure

S.V. Arnold: None. P.R. Hunt: Consultant; Self; AstraZeneca, Sanofi US. H. Chen: Employee; Self; AstraZeneca. S. MacLachlan: Consultant; Self; AstraZeneca. E. Repetto: Employee; Self; AstraZeneca. J. Vora: Other Relationship; Self; AstraZeneca. M. Kosiborod: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Amgen Inc., Sanofi, Boehringer Ingelheim GmbH, GlaxoSmithKline plc., Glytec Systems, Merck & Co., Inc., Novo Nordisk A/S, Janssen Pharmaceuticals, Inc., ZS Pharma, Inc., Intarcia Therapeutics, Inc., Novartis AG. Research Support; Self; AstraZeneca, Boehringer Ingelheim GmbH.
Projections of Prevalence of Diabetes With and Without CKD in Southwestern American-Indians
Authors: PAVKOV MEDA E. , HOYER ANNIKA , GREGG EDWARD W. , BRINKS RALPH , BENNETT PETER H.
Published: June 2018

The combination of high diabetes prevalence, declining mortality trends and high chronic kidney disease (CKD) prevalence has raised concerns about the future burden of CKD in the American Indian population. We modeled the future prevalence of diabetes and CKD in a Southwestern American Indian population well-characterized for type 2 diabetes using data from research examinations conducted on 4,476 participants between 1965 and 2007. Diabetes was assessed by 2-hour glucose tolerance testing, CKD was defined by estimated GFR (eGFR) <60 ml/min/1.72 m2. Estimates of age-specific prevalence of diabetes without CKD (p1) and with CKD (p2) were projected through 2030, using illness-death models of the observed prevalence, incidence and death rates for men and women (Figure). For women 40 years old, p1 is projected to decline from 42.2% in 2010 to 17.1% in 2030, whereas p2 is projected to increase from 3.3% to 34.9% in the same decades. Among 40 year-old men, p1 is projected to decline from 42.3% in 2010 to 29.8% in 2030, concurrent with an increase in p2 from 3.4% in 2010 to 8.2% in 2030. Similar trends were observed for older ages, whereas for those younger than 40 years, the increase in p2 was most prominent among women.

In conclusion, the model provides assessment of the future burden of diabetes and diabetes-related CKD, projecting a marked increase in the proportion of people with diabetes who will have CKD over the next two decades.

Disclosure

M.E. Pavkov: None. A. Hoyer: None. E.W. Gregg: None. R. Brinks: None. P.H. Bennett: None.
Prospective Study on Incidence of Cardiovascular-Renal Diseases, Severe Hypoglycaemia, and Death in Chinese with Latent Autoimmune Diabetes in Adults
Authors: LUK ANDREA , LAU ERIC S. , LIM CADMON K.P. , CHOW ELAINE , MA RONALD C. , KONG ALICE P. , CHAN JULIANA C.
Published: June 2018

Objectives: Few studies have examined the progression to chronic complications in patients with latent autoimmune diabetes in adults (LADA). We compared incidence of cardiovascular-renal diseases, severe hypoglycaemia and death in patients with LADA and type 2 diabetes.

Methods: Between 1995-2012, 1569 Chinese with young-onset (age of diagnosis <40 years) non-type 1 diabetes underwent comprehensive disease assessment at Prince of Wales Hospital, Hong Kong. LADA (n=124 [7.9%]) was identified by positive anti-glutamic acid decarboxylase antibodies measured from stored serum. Patients were followed for new events of cardiovascular disease (CVD), end-stage renal disease (ESRD), severe hypoglycaemia and all-cause death until June 2017.

Results: At baseline, patients with LADA (mean age: 43.4 years, median diabetes duration: 6.0 years) had lower serum C-peptide, BMI and triglyceride but higher HbA1c than patients with type 2 diabetes (mean age: 41.7 years, median diabetes duration: 8.0 years). Use of insulin was more frequent in those with LADA whilst use of non-insulin glucose lowering drugs was comparable. Over follow-up period of 10 years, incidence (in 1000 person-year) of CVD, ESRD, severe hypoglycaemia and death were 4.1, 8.0, 20.2 and 5.5 in LADA, and 10.4, 9.5, 10.8 and 8.8 in type 2 diabetes, respectively. Using Cox regression, patients with LADA had lower hazard to have CVD (hazard ratio [HR] 0.41 [95% CI 0.19-0.89], p=0.024), higher hazard to have severe hypoglycaemia (HR 1.74 [95% CI 1.15-2.62], p=0.008) and similar risks for ESRD and mortality compared with type 2 diabetes, adjusted for age, gender, disease duration, smoking, glycaemic and metabolic indices, and baseline insulin use.

Conclusions: Patients with LADA had lower risks of CVD but higher risks of severe hypoglycaemia than type 2 diabetes.

Disclosure

A. Luk: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc.. Research Support; Self; Sanofi. E.S. Lau: None. C.K.P. Lim: None. E. Chow: Research Support; Self; Sanofi. R.C. Ma: Research Support; Self; AstraZeneca, Bayer AG, Merck Sharp & Dohme Corp., Pfizer Inc.. Advisory Panel; Self; Boehringer Ingelheim GmbH, Nippon Boehringer Ingelheim Co. Ltd. A.P. Kong: Research Support; Self; AstraZeneca. J.C. Chan: Consultant; Self; Bayer AG. Other Relationship; Self; Bayer AG. Consultant; Self; Sanofi. Other Relationship; Self; Sanofi, Eli Lilly and Company, Amgen Inc.. Consultant; Self; AstraZeneca, Merck & Co., Inc., Pfizer Inc.. Other Relationship; Self; Pfizer Inc.. Board Member; Self; Asia Diabetes Foundation. Stock/Shareholder; Self; GemVCare. Other Relationship; Self; Merck Sharp & Dohme Corp.. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novartis AG, Eli Lilly and Company.
Cutaneous Reactions to Continuous Glucose Monitoring and Continuous Subcutaneous Insulin Infusion Devices in Type 1 Diabetes
Authors: SEVERIN RACHEL K. , GANDICA RACHELLE , LEVIN LAURA E. , BELSITO DONALD V. , GARZON MARIA C. , WILLIAMS KRISTEN M.
Published: June 2018

Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) are the standard of care for type 1 diabetes (T1D). There is little reported on skin complications related to these devices. This study documents cutaneous reactions to CGM and CSII devices in children and young adults with T1D.

121 subjects (3-25 years) with T1D and CGM and/or CSII use were recruited over a 3-month period from the Naomi Berrie Diabetes Center at Columbia University Medical Center. A 5-question survey was completed for each subject detailing demographic data and device-related skin problems.

60% of subjects reported skin problems related to CGM and/or CSII use. Terms most frequently used to describe their reactions were red, itchy, painful, and rash. Subjects who used both CGM and CSII were more likely to report skin problems than those who used only CSII (OR [2.9]; p=0.015; 95% CI [1.2, 6.7]). There were no associations between skin problems and age, sex, or race/ethnicity.

22% of subjects with an adverse skin event discontinued use of their device due to their skin problem. 7% were evaluated by a dermatologist. 81% used a range of products to treat their symptoms, with variable perceived clinical effects.

Skin complications related to CSII or CGM devices are common, and may lead to interruption or discontinuation of treatment. Future studies to elucidate the causes are needed.

Table 1Supplemental Products Used By Patients: Effects on Skin ProblemsProduct categoryPatients using products in category (n)Patients reporting clinical improvement (%)Patients reporting no change (%)Patients reporting clinical worsening (%)Patients reporting discordant effects (%)Adhesive barrier wipe2726% (7/27)48% (13/27)11% (3/27)15% (4/27)Transparent film dressing2733% (9/27)48% (13/27)11% (3/27)7% (2/27)Topical steroid2277% (17/22)18% (4/22)0% (0/22)5% (1/22)Adhesive bandage1315% (2/13)54% (7/13)23% (3/13)8% (1/13)Hydrocolloid adhesive pad1369% (9/13)15% (2/13)15% (2/13)0% (0/13)Topical antibiotic1182% (9/11)18% (2/11)0% (0/11)0% (0/11)Adhesive remover1050% (5/10)40% (4/10)10% (1/10)0% (0/10)

Disclosure

R.K. Severin: None. R. Gandica: None. L.E. Levin: None. D.V. Belsito: None. M.C. Garzon: None. K.M. Williams: None.
Nutrient-Dependent Association of Cdk5 Regulatory Associated Protein 1-Like 1 Gene with Insulin Secretion
Authors: MIZUSHIRI SATORU , DAIMON MAKOTO , MURAKAMI HIROSHI , KAMBA AYA , OTAKA HIDEYUKI , MURABAYASHI MASAYA
Published: June 2018

Objective: Since type 2diabetes (DM) is a life-style related disease, life-style should be considered, when association between genetic factors and DM are examined. However, most studies did not examine genetic associations with such consideration, as the case of Cdk5 regulatory associated protein 1-like 1 (CDKAL1) gene, whose reduced activity in β-cell was shown to reduce insulin secretion. Only a study examined association of CDKAL1 polymorphism and glucose tolerance in consideration with a life-style related factor (energy intake) with significant interaction between them. We here examined the association in consideration with the interaction between the gene polymorphism and various nutrient factors including Zn and Mg.

Research Design and Methods: Among participants of the population-based Iwaki study of Japanese held in 2014 to 2016, those with information of nutrient factors evaluated by a self-administered diet history questionnaire and CDKAL1 genotype (rs9465871: C/T) were included in the study (n=1656).

Results: Mean HbA1c levels in subjects with the CC genotype were significantly higher than those with the TT genotype (5.87±0.66 vs. 5.77±0.53, p<0.02). Stratification based on the amount of each nutrient intake showed association of the CC genotype with lower insulin secretion evaluated based on C-peptide (CPI) and higher prevalence of DM in the highest tertile alone of fat intake (CC vs. CT+TT: 1.15±0.36 vs. 1.27±0.55, p<0.01, 17.4% vs. 9.9%, p=0.02, respectively), and with lower insulin secretion and higher HbA1c levels in the higher half alone of Zn and Mg intake.

Conclusions: Association of CDKAL1 gene with DM seems to be dependent of nutrient intake such as fat, Mg, and Zn, which indicates interaction between CDKAL1 and nutrient factors on pathophysiology leading to DM.

Disclosure

S. Mizushiri: None. M. Daimon: None. H. Murakami: None. A. Kamba: None. H. Otaka: None. M. Murabayashi: None.
The Impact of Obesity and Lifestyle Status on Cardiovascular Risk Factors in Children and Adolescents with Type 1 Diabetes (T1D)
Authors: LAMPOUSI ANNA-MARIA , DELIS DIMITRIOS E. , XATZIPSALTI MARIA , VAZEOU ANDRIANI
Published: June 2018

Cardiovascular disease is more frequent in patients with T1D than the general population. The aim of the study was to examine the impact of obesity, diet and physical activity (PA) on common cardiovascular risk factors in youth with T1D. Cross-sectional analyses were performed using data from 96 T1D subjects [mean age 13.4 ± 2.7 years, (females 57%), median disease duration 5.3 (range 3.5-8.4) years]. Dietary intake was evaluated by a single 24-hour dietary recall and a food frequency questionnaire (FFQ). Diet quality was assessed with the KIDMED test. The ENERGY-child questionnaire was used for the assessment of PA. Systolic (SBP), diastolic (DBP) blood pressure, HbA1c levels and lipid profile were evaluated. The prevalence of overweight/obesity was 31%. Overweight/obese individuals were in higher SBP percentile, compared to those with normal weight (68.59 ± 26.58 vs. 51.77 ± 26.72, P = 0.006). In multiple regression analysis, higher BMI z-score, was associated with higher ηbA1c (standardized β = 0.334, P = 0.002, R2 = 0.268) and higher triglycerides (standardized β = 0.224, P = 0.05, R2 = 0.095). Most participants (80%) abstained from optimal Mediterranean Diet (MD). Lower KIDMED score was associated with higher ηbA1c (standardized β = - 0.432 P < 0.001, R2 = 0.268). Partial correlation analyses after controlling for confounding factors revealed that BMI z-score was negatively correlated with low fat dairy portions/d (r = - 0.315, P < 0.05), HbA1c was positively correlated with high fat dairy portions/d (r = 0.305, P < 0.05) and SBP percentile was negatively correlated with total milk and yogurt portions/d (r = - 0.313, P < 0.05). Moreover, higher participation in sports (hours/week), was associated with lower DBP percentile (standardized β = - 0.283, P = 0.015, R2 = 0.080). The maintenance of a healthy body weight and a physically active lifestyle, was accompanied by lower BP levels in the participants of this study. Greater adherence to MD was associated with lower HbA1c.

Disclosure

A. Lampousi: None. D.E. Delis: None. M. Xatzipsalti: None. A. Vazeou: None.
Correlation between Niacin and Iron Consumption and Diabetes Prevalence among Different Sex, Age, and Ethnic Groups in the U.S.
Authors: ZHOU YIMING , CHEN NANA , LI DA , SUN WUPING , ZHOU SHI-SHENG
Published: June 2018

Grain fortification with B vitamins (thiamin, riboflavin and niacin) and iron caused a significant increase in niacin and iron, which affect the body’s redox status and induce insulin resistance at high levels. The purpose of the present study was to investigate the correlation between the U.S. per capita niacin and iron consumption and the prevalence of type 2 diabetes by sex, age, and race.

The data on the per capita nutrient consumption in 1909-2010 were from the Economic Research Service (ERS) of the U.S. Department of Agriculture. The ERS data showed that the per capita consumption of niacin and iron has increased from 16 mg/d and 12.5 mg/d to 34 mg/d and 24.5 mg/d, respectively from 1930s to 1990s, and thereafter remained fairly constant. This increase was mainly contributed by fortified grains or refined grains.

The data of diabetes prevalence were from the Center for Disease Control (CDC). The data showed that the prevalence of diabetes begun to increase from 1960s, with two rapidly increasing periods: from 1960s to early-1970s, and from 1990 to the early-2010, especially in some Southern States (e.g., Mississippi, Alabama, and Louisiana, where grain fortification is mandatory), while the prevalence of diabetes remains relatively stable during the 1980s.

We found that the prevalence of diabetes in the U.S. was strongly correlated with the per capita niacin and iron consumption (both r > 9.0). We further analyzed the correlations by age, sex, and race, and also found close correlations between the nutrient consumption and the prevalence of diabetes among sex groups, different racial groups, and different age groups.

In conclusion, excess niacin and iron intake may play an important role in the increased prevalence of type 2 diabetes in the U.S.

Disclosure

Y. Zhou: None. N. Chen: None. D. Li: None. W. Sun: None. S. Zhou: None.
Dietary and Media Habits of Young Children in Mumbai
Authors: NIJJAR JASREENA , REVETTE ANNA C.
Published: June 2018

LMIC are increasingly affected by the obesity pandemic and, it is estimated that by year 2030, there will be 80 million people with diabetes in India. Of concern is the emerging threat of obesity and type 2 DM among children. In 2010, World Health Assembly recognized food marketing as a key determinant of childhood dietary patterns, yet few studies in India have assessed exposure to media as a key NCD risk behaviors among children. This qualitative study explores children’s dietary and media use patterns, and aims to identify the ways in which young children in Mumbai are exposed to food marketing. Interviews and focus groups were conducted in June 2017 with purposively sampled dyads that included children aged 7-12 years and their mothers (n=34) from low to middle-income communities in Mumbai. Analysis of data found that children frequently consume packaged food, and characterized it as their favorite type of food. Television proved to be an influential source of information for most children, with most watching between two and four hours during the weekdays. Children reported learning about new food products primarily from TV advertisements. Most children could acquire their favorite food, either by purchasing it themselves or by convincing family members. Use of other forms of media, such as computers, were less prevalent, but most children did report using a mobile phone, which most often belonged to a family member. Parents identified children’s preference for unhealthy food, cost, limited time as barriers to a healthy diet and reported conflicts with their children about food requests. Additionally, most parents confirmed that TV played a significant and negative role in these arguments. Changing food environments and replacement of traditional diets have been found to have deleterious consequences for children. Investing in understanding dietary behaviors and communication activities of young children in Mumbai will support the development of appropriate context-specific intervention strategies at this crucial age.

Disclosure

J. Nijjar: None. A.C. Revette: None.
Skipping Breakfast and Eating Fast Could Be Associated with Metabolic Syndrome—Clinical Cohort Study in Japan
Authors: SENBA HIDENORI , MIYAKE TERUKI , KURIHARA WATARU , SAKIKO YOSHIDA , YAMAMOTO SHIN , FURUKAWA SHINYA , ABE MASANORI , MATSUURA BUNZO , HIASA YOICHI
Published: June 2018

Metabolic syndrome (MetS) has been reported to promote the development of atherosclerotic diseases and lower quality of life. Recently, it has also been reported that MetS could be a risk factor for some types of cancer, such as colon and pancreatic cancer. Several studies have reported that lifestyle, especially eating habits, was closely associated with metabolic diseases. However, the evidence among Japanese subjects is limited. We therefore conducted the present study to perform a cross-sectional evaluation of the relationship between eating habits and the prevalence of MetS among Japanese subjects. The present study included 6,925 Japanese subject (3,532 men and 3,393 women) who had undergone annual health checkups and received a questionnaire that included items on lifestyles such as frequency of skipping breakfast, pace of eating, usual physical activity, sleeping hours, alcohol consumption, and current smoking habits. MetS was diagnosed according to the criteria of the Japanese Society of Internal Medicine. To investigate the association between eating habits and MetS, we used multiple logistic regression analysis. Adjustments were made for age, sex, usual physical activity, sleeping hours, alcohol consumption, and current smoking habits. The results showed that skipping breakfast was positively associated with MetS; the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for MetS in relation to skipping breakfast on the items “eating every day,” “skipping about 3 days per week,” and “skipping almost every day” were 1.00 (reference), 1.22 (0.93-1.60), and 1.41 (1.12-1.79), respectively. Eating fast was also associated with the prevalence of MetS; the adjusted ORs and 95% CIs in relation to an eating pace of “more than 20 min,” “10-20 min,” and “ less than 10 min” were 1.00 (reference), 1.27 (1.02-159), and 1.61 (1.26 2-2.06), respectively. These results suggest that eating breakfast every day and eating slowly would be beneficial to prevent MetS.

Disclosure

H. Senba: None. T. Miyake: None. W. Kurihara: None. Y. Sakiko: None. S. Yamamoto: None. S. Furukawa: None. M. Abe: None. B. Matsuura: None. Y. Hiasa: None.
Predictive Utilities of Blood Pressure Variables on Coronary Artery Disease in Type 1 Diabetes
Authors: GUO JINGCHUAN , ORCHARD TREVOR J.
Published: June 2018

The relative importance of different blood pressure indices on cardiovascular risk in type 1 diabetes (T1D) has not been established. We thus compared the strengths of associations between different baseline and most recent blood pressure measures (systolic pressure [SBP], diastolic pressure [DBP], pulse pressure [PP], mean arterial pressure [MAP], and mid-blood pressure [Mid-BP, the average of SBP and DBP]) and the 25-year risk of coronary artery disease (CAD) in the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood onset T1D (N=605, without baseline CAD). CAD was defined as fatal coronary artery event, non-fatal myocardial infarction, angina, revascularization, or ischemic ECG. Baseline mean age and diabetes duration were 27 and 19 years, respectively. In Cox Proportional Hazards modes, the baseline age-adjusted hazard ratios (HR) associated with one increment in SD for the risk of CAD events (n=219) were 1.49 (95% CI: 1.31, 1.70) for SBP; 1.46 (1.28, 1.67) DBP; 1.26 (1.09, 1.46) PP; 1.50 (1.32, 1.71) MAP and 1.51 (1.32, 1.71) for Mid-BP. There was an interaction between PP and HbA1c that the age-adjusted HR of PP was 1.20 (0.99, 1.45) and 1.38 (1.07, 1.77) in those with HbA1c ≤ 9 and > 9%, respectively. Though area under the receiver operating characteristic curve (AUC) was significantly lower for PP compared with the other four BP indices in overall subjects, the predictive utility of PP for CAD becomes similar to that of other indices in those with higher HbA1c levels (>9 %). Using the most recent data and adjusting for age, the predictive value of SBP was superior to DBP (∆ AUC=0.037, p=.006), MAP (∆ AUC=0.021, p=.018), and Mid-BP (∆ AUC=0.014, p=.031), but not PP (∆ AUC=0.007, p=.552). In sum, SBP appears to be the strongest determinant of CAD risk in T1D patients overall but PP becomes a determinant as strong as SBP in older age and in those with worse glycemic control, consistent with PP reflecting vascular stiffness.

Disclosure

J. Guo: None. T.J. Orchard: None.