bluuebunny/crossref_metadata_2025 huggingface dataset:
1238-P: Developing a Culturally Tailored Social-Support Group Visit Model for South Asian Immigrants with Type 2 Diabetes in Atlanta
Authors: SHAH MEGHA K. , KURRA NITHIN C. , ALI MOHAMMED K. , NARAYAN K.M. VENKAT
Published: June 2020

Background: Lifestyle interventions can prevent, delay, and improve management of type 2 diabetes (T2D). However, implementation of these programs is challenging in diverse populations. South Asians have higher risk for T2D, yet to date, there have been limited programs specifically for this community. The aim of this project was to develop and test the feasibility of a tailored group visit model for South Asians based in a family medicine clinic.

Methods: In conjunction with a local community-academic board, we conducted focus groups to tailor an existing evidence-based curriculum to a culturally acceptable lifestyle interventions program for South Asians with T2D or prediabetes. Fourteen participants enrolled in the 16-week program focusing on healthy diet, exercise, and weight loss. Weight, blood pressure, cholesterol, HbA1C, were measured at the beginning and end of study. Participants were asked to evaluate each session on level of satisfaction. One tailed t-tests were used to test significance of pre-post changes in outcomes.

Results: Ten of 14 participants had baseline and follow-up data. Participant attendance averaged 50%. Statistically significant reductions in mean weight (-3.16lbs, p<0.05), systolic/diastolic blood pressure (-12.7mmHg, p<0.05/-3.7mmHg p<0.05, respectively), and triglycerides (-62.6 mg/dl, p<0.05) were noted. Overall, participants reported high levels of satisfaction with the program.

Discussion: A lifestyle program based in primary care is feasible and acceptable for South Asian immigrants. Larger studies testing the effectiveness of group programs, based in primary care, in improving cardiometabolic factors and weight reduction are important. Overall, these interventions may have broader application to other culturally cohesive communities.

Disclosure

M.K. Shah: None. N.C. Kurra: None. M.K. Ali: Research Support; Self; Merck & Co., Inc. K. Narayan: None.

Funding

National Center for Advancing Translational Sciences (UL1TR002378, KL2TR002381)
1240-P: Dyslipidemia over Time in Youth with Type 2 Diabetes: The SEARCH for Diabetes in Youth Study
Authors: BRADY RYAN P. , SHAH AMY S. , JENSEN ELIZABETH T. , STAFFORD JEANETTE M. , DAGOSTINO RALPH , DOLAN LAWRENCE M. , KNIGHT LISA M. , IMPERATORE GIUSEPPINA , TURLEY CHRISTINE B. , LIESE ANGELA D. , URBINA ELAINE M. , LAWRENCE JEAN M. , PIHOKER CATHERINE , MARCOVINA SANTICA M. , DABELEA DANA
Published: June 2020

Limited information exists regarding the evolution of dyslipidemia in youth with type 2 diabetes (T2D). Understanding dyslipidemia risk factors may influence treatment.

We studied 212 youth with T2D not on lipid lowering therapy (68% female, 43% non-Hispanic black, mean age 14.9±2.7y at baseline, mean follow-up 7.0±2.0y). Dyslipidemia was defined as HDL-C<35mg/dL, LDL-C>100mg/dL, or triglycerides (TG)>150mg/dL. Progression was defined as normal lipids at baseline, dyslipidemia at follow-up; regression as dyslipidemia at baseline, normal at follow-up; stable abnormal as dyslipidemia at both; stable normal as normal at both. Associations of A1c and abdominal adiposity (waist to height ratio, WHtR) over time (area under the curve, AUC) with progression and stable abnormal were examined and relative risks estimated.

HDL-C progressed, regressed, was stable normal and stable abnormal in 12%, 11%, 62%, and 14%, respectively. Corresponding LDL-C values were 16%, 13%, 43% and 29%; TG were 17%, 11%, 56% and 16%. Each 1% increase in A1c AUC was associated with 13% higher risk of TG>150mg/dL and 22% higher risk of LDL-C>100mg/dL, after adjusting for WHtR (Table). There were no significant associations with WHtR.

In youth with T2D, 33% and 45% had progression or stable dyslipidemia of TG and LDL-C, respectively. Higher A1c over time is associated with worse TG and LDL-C, highlighting the importance of glycemic control.

Disclosure

R.P. Brady: None. A.S. Shah: None. E.T. Jensen: None. J.M. Stafford: None. R. Dagostino: Consultant; Self; Amgen, AstraZeneca, Celgene, Daiichi Sankyo. L.M. Dolan: None. L.M. Knight: None. G. Imperatore: None. C.B. Turley: None. A.D. Liese: None. E.M. Urbina: None. J.M. Lawrence: None. C. Pihoker: None. S.M. Marcovina: None. D. Dabelea: None.

Funding

Centers for Disease Control and Prevention (1U18DP006131, U18DP006133, U18DP006134, U18DP006136, U18DP006138, U18DP006139); National Institutes of Health (1UC4DK108173)
1243-P: NMR-Derived Biomarkers Identify Cardiometabolic Disease Risk in Youth
Authors: CHUNG STEPHANIE T. , MATTA SAMANTHA , MEYERS ABBY , CRAVALHO CELESTE K. , VILLALOBOS-PEREZ ALFREDO , MABUNDO LILIAN , COURVILLE AMBER B. , SAMPSON MAUREEN L. , OTVOS JAMES D. , MAGGE SHEELA N.
Published: June 2020

Youth with obesity have increased risk for cardiometabolic (CM) disease but identifying those at highest risk remains a challenge. 4 potential biomarkers are “byproducts” of clinical NMR LipoProfile® lipid testing: LPIR (Lipoprotein Insulin Resistance Index), GlycA (inflammation marker), BCAA (total branched-chain amino acids), and glycine. All are strongly related to insulin resistance (IR) and type 2 diabetes (T2D) in adults (glycine inversely), but their clinical utility in youth is unclear. We compared fasting levels of these biomarkers in 184 youth (42 lean normal glucose tolerant (NGT), 88 obese NGT and 54 obese with abnormal glucose tolerance (AGT; 20 with T2D and 34 with prediabetes) and determined their relationships with HOMA-IR (homeostatic model of IR) and hemoglobin A1c (HbA1c). Compared to lean and obese NGT, AGT youth had higher systolic blood pressure and HbA1c (Table). All 4 biomarkers were higher in youth with obesity vs. lean, while only LPIR was higher in AGT youth vs. obese NGT (Table). While all 4 were correlated with HOMA-IR, LPIR had the strongest correlation (LPIR: r=0.6; GlycA: r=0.4, glycine: r=-0.4, BCAA: r=0.2, all P<0.01). All 4 correlated with HbA1c (GlycA, LPIR, BCAA: r≥0.3 and glycine: r=-0.3, all P<0.001). Plasma NMR-derived markers were related to CM risk in youth, with LPIR distinguishing between obese NGT and AGT. These biomarkers should be explored as predictive tools for development of IR and T2DM.

Disclosure

S.T. Chung: None. S. Matta: None. A. Meyers: None. C.K. Cravalho: None. A. Villalobos-Perez: None. L. Mabundo: None. A.B. Courville: None. M.L. Sampson: None. J.D. Otvos: Employee; Self; LabCorp. S.N. Magge: None.

Funding

National Institutes of Health (to S.T.C., L.M., A.B.C.)
1246-P: Mental Health among Youth Living with Type 2 Diabetes in Manitoba: A Cross-Sectional Study
Authors: MCGAVOCK JONATHAN , WICKLOW BRANDY , SELLERS ELIZABETH , KROEKER KRISTINE , BLYDT-HANSEN TOM , DART ALLISON
Published: June 2020

Introduction: Mental health comorbidities are common in persons with type 2 diabetes (T2D). The magnitude of mental health comorbidities in youth with T2D and possible protective factors against comorbidities, remain unclear, as previous studies have not compared outcomes with population-based samples or included measures of resilience.

Methods: We performed a cross-sectional analysis of 178 Indigenous youth (15 yrs IQR: 13-17 yrs) with T2D from the iCARE cohort study and 270 randomly sampled population-based controls (15-24 yrs), from the Canadian Community Health Survey - Mental Health Component. Overall positive mental health and flourishing were assessed with the Mental Health Continuum-Short Form. Depression, anxiety and severe mental illness (SMI) were assessed with the Kessler Distress Scale. Measures of resilience were assessed in youth with T2D using the 64-question Resiliency Scales for Children and Adolescents.

Results: Youth with T2D, were more likely to be female (65 vs. 49%), Indigenous (96 vs. 29%), live remotely (70 vs. 26%) and within a low income neighbourhood (p<0.0001 for all characteristics). After adjusting for these differences, youth living with T2D displayed lower positive mental health (-11.0, 95%CI: -13.3, -8.6), higher distress (3.53, 95% CI: 2.76, 4.29) and higher depression scores (2.76, 95% CI: 2.19, 3.32). Youth with T2D were also more likely to have SMI (aOR: 5.81, 95% CI: 2.2, 15.4) and are less likely to be flourishing (aOR 0.27, 95%CI: 0.18, 0.41) compared to population based controls. A sense of mastery and relatedness were associated with higher positive mental health and less depression and anxiety in youth with T2D.

Conclusion: Youth with T2D live with a profound degree of mental health comorbidities relative to the general population of in Manitoba, Canada. Future studies are required to address the specific mental health needs youth with T2D and determined best clinical care practices.

Disclosure

J. Mcgavock: None. B. Wicklow: None. E. Sellers: None. K. Kroeker: None. T. Blydt-Hansen: None. A. Dart: None.

Funding

Canadian Institutes of Health Research; Diabetes Canada; Research Manitoba
1249-P: Type 2 Diabetes in Prepubertal Children under 10 Years Old
Authors: ASTUDILLO MARCELA , REFAEY AHMAD K. , TOSUR MUSTAFA , SILLER ALEJANDRO F. , MCKAY SIRIPOOM , BALASUBRAMANYAM ASHOK , BACHA FIDA , REDONDO MARIA J.
Published: June 2020

Only a few cases of type 2 diabetes (T2D) have been reported in children younger than 10 years of age. Given the aggressiveness of youth-onset T2D and the accelerated development of comorbidities and complications, recognition of this unique subgroup and its characteristics is imperative. We aimed to determine the prevalence and characteristics of children with T2D diagnosed <10 years old (y/o) at a large academic pediatric hospital in the Southwestern U.S. We conducted a retrospective review of electronic medical records of 1,138 children and adolescents up to 21 years of age who were given a diagnosis of T2D in our clinic. We compared the demographic and biochemical characteristics at the time of diabetes diagnosis between children diagnosed <10 y/o vs. ≥10 y/o, and by puberty status within the <10 y/o group. In our overall T2D population, 67.3% were females, 9.9% non-Hispanic White (NHW), 59% Hispanic (Hisp), 26.8% African-American (AA). The mean age at diagnosis was 13.8± 2.6 (±SD) y/o (range 3.0-21.7). The children diagnosed with T2D <10 y/o constituted 5.6%, n=64 of our total T2D population; mean age 8.8± 1.0 y/o (range 4.1-9.9). 52.2% were prepubertal (Tanner Stage [TS]-I). 81.2% had islet autoantibodies test available (including GAD, ICA-512 and IAA) and all had negative results. Children with T2D diagnosed <10 y/o were more likely to be female (79.7%) than youth diagnosed ≥10 y/o (61.4%, p=0.003). We observed no racial/ethnic distribution differences between the two groups (p=0.58). Within the group diagnosed <10 y/o, children who were prepubertal, compared with those at ≥TS-II, were more likely to be male (33.3% vs. 0%, p=0.035), had a higher BMI-Z score (2.71 vs. 2.47, p=0.036), and tended to have a different racial/ethnic distribution (83.3% Hisp and 16.7% AA vs. 45.5% and 54.6%, respectively, p=0.057).

In conclusion, less than 10% of youth with T2D are diagnosed under age 10 years; those in this group who are prepubertal (>50%) are distinctly atypical and have other unique characteristics that warrant further study.

Disclosure

M. Astudillo: None. A.K. Refaey: None. M. Tosur: None. A.F. Siller: None. S. Mckay: None. A. Balasubramanyam: None. F. Bacha: Research Support; Self; AstraZeneca, Takeda Development Center Americas, Inc. M.J. Redondo: None.
125-OR: Polyunsaturated Omega-6 Fatty Acids Reduce Axonal Mitochondrial Trafficking in Dorsal Root Ganglion Sensory Neurons
Authors: RUMORA AMY , LOGRASSO GIOVANNI , MCGRATH JACKSON D. , LENTZ STEPHEN I. , FELDMAN EVA L.
Published: June 2020

Peripheral neuropathy is a prevalent complication of diabetes and prediabetes characterized by distal-to-proximal peripheral nerve damage. Dyslipidemia is a contributory factor that underlies neuropathy development in type 2 diabetes and prediabetes. However, the molecular pathways that underlie sensory neuron dysfunction in peripheral neuropathy associated with diabetes and prediabetes are unknown. Our recent lipidomic and transcriptomic analyses identified altered metabolism of polyunsaturated omega-6 fatty acid linoleic acid in the peripheral nerves of prediabetic mice with neuropathy. However, the molecular effect of linoleic acid on sensory neurons remains unknown. Since sensory dorsal root ganglion (DRG) neurons are dependent on trafficking mechanisms to transport healthy mitochondria throughout the length of the axon, we evaluated the effect of linoleic acid on axonal mitochondrial trafficking and function in DRG neurons. Primary DRG neurons from adult C57BL/6J mice were treated with physiological concentrations of linoleic acid ranging from 31.25-250 µM for 24 hours. Following treatment, we evaluated the effect of linoleic acid treatments on mitochondrial trafficking, mitochondrial membrane potential, ATP level, and apoptosis in DRG neurons. Interestingly, all concentrations of linoleic acid ranging from 31.25-250 µM preserved mitochondrial membrane potential and ATP level in DRG neurons. In line with these results, linoleic acid treatments did not stimulate neuronal apoptosis. However, physiological diabetic concentrations of 250 µM linoleic acid significantly impaired mitochondrial trafficking in the axon of DRG neurons. Overall, these results suggest that elevated levels of linoleic acid impair axonal mitochondrial trafficking without effecting mitochondrial function, and that defects in mitochondrial trafficking of sensory neurons may contribute to neuropathy pathogenesis in diabetes and prediabetes.

Disclosure

A. Rumora: None. G. LoGrasso: None. J.D. McGrath: None. S.I. Lentz: None. E.L. Feldman: Consultant; Self; Novartis Pharmaceuticals Corporation.

Funding

American Diabetes Association (7-12-BS-045 to E.L.F.); National Institutes of Health (1R24082841, 1DP3DK094292); National Institute of Diabetes and Digestive and Kidney Diseases (T32DK101357, F32DK112642, K99DK119366, P30DK020572); NeuroNetwork for Emerging Therapies; A. Alfred Taubman Medical Research Institute
1254-P: Trauma and Loss-of-Control (LOC) Eating Relate to Elevated Type 2 Diabetes (T2D) Risk in Adolescents
Authors: JIMENEZ VIRGINIA , HILKIN ALLISON M. , VERROS MEGAN M. , CLARK EMMA L. , CASAMASSIMA MILENA , MILLER REAGAN L. , PYLE LAURA , KELSEY MEGAN M. , SHOMAKER LAUREN B.
Published: June 2020

Objective: Traumatic events, including abuse, neglect, and other dangerous/shocking experiences, are commonly observed in adolescents with T2D. Research has shown there is a link between trauma and poorer health outcomes, yet, the extent to which trauma increases risk for developing T2D is not well understood. Trauma may heighten T2D risk through LOC eating, which can arise to cope with negative emotions. Our aim was to evaluate the links of trauma and LOC eating with T2D risk in adolescent girls with obesity.

Methods: Participants (n=65, mean±SD 15.2±1.6y) were girls at-risk for T2D based on BMI ≥85%ile, ≥1 family member with T2D, and elevated depression (Center for Epidemiologic Studies Depression [CES-D] score ≥21). Trauma history (presence vs. absence) was assessed with the Schedule for Affective Disorders and Schizophrenia for School-Aged Children, and LOC eating (presence vs. absence) with the Eating Disorder Examination. T2D risk was assessed as HbA1c and Matsuda Whole Body Insulin Sensitivity Index (WBISI), derived from a 7-sample 2-hr OGTT. ANCOVA tested differences in HbA1c and WBISI by trauma and LOC, controlling for age, BMIz, race/ethnicity, and depression.

Results: Trauma history was endorsed in 40.6% and LOC eating in 36.4% of girls. Girls with and without a trauma history reported similar rates of LOC (36.4% vs. 37.5%, p=.93). Girls with trauma had higher HbA1c (5.7±0.06%) vs. those with no trauma (5.5±0.05%, p=0.04), with no difference in WBISI (p=0.32). Girls with LOC had worse WBISI vs. those with no LOC (3.0±0.53 vs. 4.8±0.40, p<0.01), with no difference in HbA1c (p=0.21).

Conclusions: Trauma history and LOC eating were unrelated to each other, but each related to different aspects of elevated T2D risk. Attention to both factors may warrant consideration in intervening to lessen T2D risk in teens with obesity and elevated depression.

Disclosure

V. Jimenez: None. A.M. Hilkin: None. M.M. Verros: None. E.L. Clark: None. M. Casamassima: None. R.L. Miller: None. L. Pyle: None. M.M. Kelsey: Other Relationship; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp. L.B. Shomaker: None.
1256-P: Gender Differences in the Copy Number of 11q11 Gene in European-American Obese Children
Authors: PHILLIPS MEGAN , SELVARAJU VAITHINATHAN , FOUTY ANNA , SANDEY MANINDER , JEGANATHAN RAMESH B. , THANGIAH GEETHA
Published: June 2020

Copy number variants (CNV) provide numerous genetic modifications to human variability between individuals and linked with multiple human diseases. Obesity is one of the highly heritable complex disorders, which is associated with CNVs. A recent report shows that the 11q11 gene, a novel olfactory receptor, and its copy number variants are involved in the early onset of obesity. In the current study, we analyzed the link between 11q11 gene CNV and obesity measures in children. One hundred and twenty-seven participants between the ages of 6-10 years were involved in this study. As per WHO guidelines, anthropometric measurements were recorded, and salivary samples were collected. DNA was extracted from saliva, and the copy number variants for 11q11 gene was measured using digital PCR. The descriptive analysis of 11q11 copy numbers showed a significant increase in girls compared to boys; similarly, African American participants had significant increased CNV compared to European Americans. Only 37% of overweight/obese boys’ participants have high copy number variants compared to 63% of overweight/obese girls. The percentage of overweight/obese participants with high copy number variants was significantly lower in boys compared to girls only in the European American population. Overall, these results suggest that difference in the 11q11 CNV in gender is mainly in European American overweight/obese participants.

Disclosure

M. Phillips: None. V. Selvaraju: None. A. Fouty: None. M. Sandey: None. R.B. Jeganathan: None. G. Thangiah: None.

Funding

U.S. Department of Agriculture (to G.T.)
1259-P: Dyslipidemia of Insulin Resistance Is Associated with Subclinical Inflammation in Youth with Type 2 Diabetes
Authors: VILLALOBOS-PEREZ ALFREDO , CRAVALHO CELESTE K. , MATTA SAMANTHA , MEYERS ABBY , MABUNDO LILIAN , SAMPSON MAUREEN L. , WALTER MARY , COURVILLE AMBER B. , CHUNG STEPHANIE T.
Published: June 2020

The dyslipidemia of insulin resistance (IR), characterized by high triglyceride-rich lipoproteins (TRLP) and low high-density lipoproteins (HDL), is associated with systemic inflammation, small low-density lipoproteins (LDL) and are important risk factors for atherosclerotic disease (ASCVD) in adults. Yet, in youth with type 2 diabetes (T2D) the natural history of ASCVD and the role of low-grade inflammation is still emerging. We compared lipoprotein profiles and inflammatory markers in 21 youth with T2D, within 5 years of diagnosis, to 10 age/BMI matched control youth with normal glucose tolerance (age: 15.8±2.5 (10-23 y) mean±SD (range), Tanner Stage IV-V, BMI: 38.9±6.9 (27.1-57.8 kg/m2). Fasting lipoprotein particle size and number, apolipoprotein B (apoB), and GlycA, a composite marker of inflammation, were derived from the NMR LipoProfile®. Pro-inflammatory markers were measured with multi-plex ELISA assays (C-Reactive Protein (hsCRP), IL-6, IL-8, IL-1β, TNF-alpha). IR was calculated by the Matsuda index during a multi-sample 75g OGTT. Youth with T2D, had higher A1c (7.2±1.3 vs. 5.4±0.3%, P<0.01), lower Matsuda index (1.3±1.2 vs. 2.8±1.4, P<0.01), higher ApoB (75.8±17.5 vs. 50.8±9.2 mg/dL, P<0.01), more small LDL (903.4±413.3 vs. 575.8±146.4 nmol/L, P=0.02) and higher TRLPs particle concentrations (121.3±45 vs. 70.4±30.9 nmol/L, P<0.01). HDL particles were not different between groups. GlycA (439.7±77.8 vs. 363.6±46.7 μmol/L, P=0.01) and hsCRP (0.8±0.9 vs. 0.2±0.2 μmol/L, P=0.01) were higher in T2D, but there were no differences in other inflammatory markers. Both GlycA and hsCRP correlated with small LDL and TRLP (GlycA: both r=0.4, P<0.05); hsCRP: both r=0.5, P<0.01), but not with HDL. The dyslipidemic profile of IR in youth with T2D was associated with subclinical inflammation, supporting the need for longitudinal studies to determine whether reducing inflammation in these youth will be effective as an ASCVD risk reduction strategy.

Disclosure

A. Villalobos-Perez: None. C.K. Cravalho: None. S. Matta: None. A. Meyers: None. L. Mabundo: None. M.L. Sampson: None. M. Walter: None. A.B. Courville: None. S.T. Chung: None.

Funding

National Institutes of Health (to S.T.C., L.M., A.B.C.)
1260-P: Labcorp Data in >19,000 Children with a Diagnosis Code for T2D Show Predominantly Normal Liver Function Tests: Implications for Identifying Nonalcoholic Fatty Liver Disease or Steatohepatitis (NAFLD/NASH)
Authors: PURI MALA , LIZZI-ANSOK KARINA M. , FILOZOF CLAUDIA M. , GOLDSTEIN BARRY J.
Published: June 2020

The majority of pediatric patients with biopsy proven NASH have insulin resistance (IR), however data are scarce as to the relationship between NASH and T2D in children. Clinical guidelines advise using gender-specific ALT levels (girls 22 U/L; boys 26 U/L) to screen obese or overweight children with risk factors such as IR or T2D for NAFLD/NASH. We accessed ALT, AST, and A1C results from the LabCorp® clinical database in children 7-17 years of age with suspected or confirmed T2D, NASH, or both NASH + T2D (having ICD10 codes E11 (T2D), K75.81 (NASH), or E11 + K75.81), from March 2016-2019. Of the 19,522 patients with a T2D code, median ALT values were below the gender specified norms, while 25% were higher. Median ALT levels in both genders with a code for NASH were 2.5 times greater than those with T2D and no NASH code; 72% of those with NASH codes were male. Interestingly, boys with codes for T2D and NASH had higher ALT values, despite higher mean A1C values for girls. These vast LabCorp® data show a male predominance in use of the NASH code. As expected, ALT values are higher among patients with this code relative to the T2D code, with much higher levels among boys with codes for T2DM + NASH. Of those with T2D codes, 25% had ALT values above the cut off, suggesting need for further evaluation to confirm NAFLD/NASH.

Disclosure

M. Puri: Employee; Self; LabCorp. K.M. Lizzi-Ansok: Employee; Self; LabCorp. C.M. Filozof: Employee; Self; Covance. B.J. Goldstein: Employee; Self; Covance / LabCorp.
127-LB: Characteristics of INS-MODY Participants in a National Diabetes Registry
Authors: MCCAULEY MARY , KORKMAZ SERENA , LETOURNEAU-FREIBERG LISA R. , NAYLOR ROCHELLE N. , GREELEY SIRI ATMA W.
Published: June 2020

Introduction: Maturity onset diabetes of the young (MODY) may represent 2-5% of diabetes under 30-35 years. Rarely MODY may be due to mutation in the INS gene. HNF1A mutations are well described causes of MODY and may be treated with low dose sulfonylurea. Our aim was to compare clinical features and treatment of INS-MODY with HNF1A-MODY cohort population.

Methods: Participants enrolled through the U.S. Monogenic Diabetes Registry, with Sanger or next-generation sequencing completed with causal mutations found in INS or HNF1A, diagnosed after 13 months of age. Those with neonatal diabetes due to INS were excluded.

Results: Each group shared similar demographics (Table 1). Common presenting symptoms in each group included polyuria, polydipsia, weight loss, fatigue (Table 1). In the INS cohort, all showed residual c-peptide. None reported DKA. The majority had used insulin, though there were a variety of treatment modalities, even among those with the same mutation (Figure 1). For HNF1A cohort, over 60% had been on insulin or sulfonylurea, with 40% having discontinued insulin.

Conclusion: Review of treatments in INS cohort consist of multiple agents with majority using insulin at some point. If clinical suspicion of MODY, genetic testing may help inform treatment. It appears that some variants of INS-MODY lead to a progressive disease eventually requiring insulin therapy and early insulin may improve outcomes.

Disclosure

M. McCauley: None. S. Korkmaz: None. L.R. Letourneau-Freiberg: None. R.N. Naylor: None. S.W. Greeley: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK104942, P30DK0205950); National Center for Advancing Translational Sciences (UL1TR002389)
1279-P: Early Myocardial Structural Alterations in Youth with Type 1 Diabetes: Preliminary Results from the Cardea Study
Authors: HARNOIS-LEBLANC SOREN , MCNEALIS VANESSA , FRIEDRICH MATTHIAS G. , HULST ANDRAEA VAN , NUYT ANNE MONIQUE , BIGRAS JEAN-LUC , BARNETT TRACIE A. , BENEDETTI ANDREA , DRAPEAU VICKY , HENDERSON MÉLANIE
Published: June 2020

Objectives: To compare traditional risk factors for CVD (adiposity, dyslipidemia, hypertension), and novel early markers (arterial stiffness and myocardial structure), between youth with type 1 diabetes (T1D) and healthy controls.

Methods: We compared 100 youth with T1D (14-18 yrs) and 97 age- and sex-matched controls. BMI z-scores were computed and percent body fat (%BF) measured by DEXA. Age, sex and height-specific z-scores for blood pressure (BP) were calculated. HbA1c and lipids were measured fasted. Carotid-femoral pulse-wave velocity (Sphygmocor) estimated arterial stiffness. Cardiac magnetic resonance measured left ventricular diastolic myomass, papillary mass and average wall thickness. T-tests, Chi-square and Fisher’s exact determined differences between the groups.

Results: There were no differences in ethnicity, sex or pubertal stage across groups. Median T1D duration was 6.1 (IQR=3.3-10.5) yrs; average HbA1c was 8.5% (SD=1.5). Youth with T1D had higher adiposity, modestly higher triglycerides, LDL-c and diastolic BP (albeit in normal range), and increased myomass and average wall thickness, compared with controls (Table).

Conclusions: Early alterations in myocardial structure (by 14-18 yrs), along with adverse profiles in traditional risk factors suggest that CVD prevention should be initiated prior to adolescence in pediatric T1D.

Disclosure

S. Harnois-Leblanc: None. V. McNealis: None. M.G. Friedrich: Board Member; Self; Circle Cardiovascular Imaging Inc. A. Van Hulst: None. A. Nuyt: None. J. Bigras: None. T.A. Barnett: None. A. Benedetti: None. V. Drapeau: None. M. Henderson: None.

Funding

Canadian Society of Endocrinology and Metabolism/AstraZeneca; Fonds de recherche du Québec, Santé; Heart and Stroke Foundation of Canada (G-16-00012590); Canadian Institutes of Health Research (366194)
1284-P: Adolescent Type 1 Diabetes: Technology, Depression, Distress, and Glycemic Control
Authors: PATEL NISHA , SINHA SUNIL K. , HONG K. MING , GLICK BETHANY , HOFFMAN ROBERT P.
Published: June 2020

Background: Diabetes (DM) is a chronic illness that has major impacts on patients’ physical and emotional health. Advances in technology have aimed to improve diabetes control and lessen the burden of self-care by using continuous glucose monitors (CGM) and insulin pumps (CSII) as opposed to multiple dose injections (MDI). The goal of this study was to determine the effects of technology use on depression, DM distress, and DM control.

Methods: Patients with type 1 DM were approached at their endocrinology visits from 2018-2019 to fill out Problem Areas in Diabetes in Teenagers (PAID-T) assessment and Patient Health Questionnaire (PHQ9) screen. Inclusion criteria included age>13 years. Charts were abstracted for demographic (age, insurance) and clinical (A1c, duration of DM, technology use) information. Data was analyzed using x2 square, ANOVA, and Tukey’s test.

Results: Total of 310 patients (mean age 15.11 + 1.40 years) were included in the study with average DM duration of 5.37 + 3.86 years. CGM, CSII, and combined use were higher in the private insurance (PI) group vs. state insurance (SI) (p=0.000). When PAID-T scores were evaluated based on insurance and technology use, only insurance was associated (p=0.013), with SI being linked to higher PAID-T scores. PHQ9 scores were higher in patients with SI vs. PI (p=0.000), whereas technology use was not significant. PAID-T and PHQ9 were not related to DM duration. ANCOVA revealed that A1c was related to technology use (p=0.048), PHQ9 (p=0.018), and PAID-T scores (p=0.000). MDI use, higher PHQ9, and higher PAID-T scores were associated with higher A1c.

Conclusions: Insurance, a marker of socioeconomic status, is the principal determinant of technology use (CGM and CSII). Insurance, not technology use, is the best predictor of depression and DM distress, which are both strongly associated with higher A1c. Future efforts should be directed at improving both depression and DM distress via access to mental health services to ultimately improve DM control.

Disclosure

N. Patel: None. S.K. Sinha: None. K. Hong: None. B. Glick: None. R.P. Hoffman: Research Support; Spouse/Partner; Provention Bio, Inc.
1288-P: Novel Culturally Sensitive Shared Medical Appointment Model for High-Risk Latino Youth with Type 1 Diabetes: One-Year Follow-Up Postpilot Intervention
Authors: JENSEN RYAN , CAMPBELL KRISTEN , PYLE LAURA , GONZALEZ ANDREA GERARD
Published: June 2020

Objective: A novel, culturally sensitive shared medical appointment (SMA) pilot program was evaluated as a continuing model of care for high risk Spanish speaking Latino patients (LP) with type 1 diabetes (T1D). We examined retention and outcomes of participants one year after the pilot research intervention ended.

Methods: Changes in outcomes for LP in the SMA from the end of the funded pilot program (year 3) to the first year post-intervention (year 4) were assessed. Retention rates, A1c and diabetes technology uptake (insulin pump and continuous glucose monitor (CGM)) were recorded for children (<12 years) and teens (12+ years).

Results: Of the 75 LP enrolled by the end of the funded study period, 64 (85.3%) continued with at least one visit in the SMA in year 4. Average A1c decreased from year 3 to 4, but did not achieve statistical significance (-0.4± 0.3; p=0.128). Teens and children showed a significant increase in insulin pump use in from baseline to Year 4 (Teens: n=35, 26%; p=0.008), (Children: n=12, 75%; p=0.008). Teens and children showed a significant increase in CGM use from baseline to Year 4 (Teens: n=35, 34%; p=0.001) (Children: n=12, 75%; p=0.008).

Conclusions: The novel culturally sensitive SMA model demonstrated to be a well-received program for high-risk Spanish speaking LP youth with high retention rates one year after research concluded. Participants continued to demonstrate increase uptake of diabetes technologies. Additional studies of the effects of the SMA on glycemic control are needed.

Disclosure

R. Jensen: None. K. Campbell: None. L. Pyle: None. A. Gerard Gonzalez: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust (2015PG-T1D060)
129-LB: Evaluation of Attitudes towards Two Glucagon Delivery Devices for Rescue Treatment of Severe Hypoglycemia
Authors: BAJPAI SANJAY K. , CAMBRON-MELLOTT JANELLE , RAIBULET NEDINA K. , PECK EUGENIA Y. , POON JIAT LING , WANG QIANQIAN , MITCHELL BETH , WILL OLIVER , BABROWICZ JANE , CHILD CHRISTOPHER J. , BEUSTERIEN KATHLEEN
Published: June 2020

Objective: This study assessed preference, hesitation using, perceived ease of use, and feeling prepared and protected for nasal glucagon (NG) vs. autoinjector glucagon (AI) for rescue treatment of severe hypoglycemia (SH) among people with diabetes (PWDs), caregivers (CGs) and acquaintances (AQs).

Methods: US PWDs (type 1 or 2, on insulin; n=405), CGs (n=313) and AQs (n=305) completed an online survey, after viewing a description of SH and graphics and descriptions of NG and AI (based on publicly available information at the time of study; prior to access to the final commercial device or their instructions for use). Respondents rated strength of preference for NG vs. AI on 16 attributes using direct elicitation (7-point scale; 1 = ‘very strongly prefer AI‘ and 7 = ‘very strongly prefer NG’, 4 = neutral); 4 items focused on overall preference, being less likely to hesitate using, perceived ease of use, and feeling prepared and protected, and 12 items were averaged to create a preference scale (e.g., size of device, less complicated). This measure was developed using established guidelines for instrument development, including qualitative research and assessment of the measure’s psychometric properties. One sample t-tests evaluated whether mean preference ratings differed from a neutral score.

Results: Across PWDs, CGs, and AQs, NG was preferred over AI (all P<0.001 compared to neutral) on overall preference (4.5, 4.9, and 5.4, respectively), being less likely to hesitate using (4.8, 5.1, and 5.4, respectively), perceived ease of use (4.8, 5.1, and 5.4, respectively) and the preference scale (4.7, 5.0, and 5.3, respectively). CGs and AQs preferred NG vs. AI on feeling prepared and protected (4.6 and 4.8, respectively; both P<0.001 compared to neutral); PWDs were neutral (4.1, P=0.376).

Conclusions: This study provides insights on PWDs’, CGs’ and AQs’ attitudes towards new glucagon devices, which may be considered when making product choices among the glucagon delivery systems.

Disclosure

S.K. Bajpai: Employee; Self; Eli Lilly and Company. J. Cambron-Mellott: Other Relationship; Self; Eli Lilly and Company. N.K. Raibulet: Employee; Self; Eli Lilly and Company. E.Y. Peck: None. J. Poon: Employee; Self; Eli Lilly and Company. Q. Wang: Employee; Self; Eli Lilly and Company. B. Mitchell: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. O. Will: Other Relationship; Self; Eli Lilly and Company. J. Babrowicz: Other Relationship; Self; Eli Lilly and Company. C.J. Child: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. K. Beusterien: Other Relationship; Self; Eli Lilly and Company.
1290-P: Gut Microbiota in New-Onset Pediatric Patients with Type 1 Diabetes: Machine Learning Algorithms to Classify Microorganisms Disease-Linked
Authors: D’ANNUNZIO GIUSEPPE , BIASSONI ROBERTO , SQUILLARIO MARGHERITA , UGOLOTTI ELISABETTA , BARLA ANNALISA , PICCOLO GIANLUCA , MINUTO NICOLA , MAGHNIE MOHAMAD
Published: June 2020

Gut microbiota plays a role in human health and autoimmunity. Among environmental factor linked to type 1 diabetes (T1DM) pathogenesis, gut microbiota impairment seems to be involved. We evaluated gut microbial fingerprinting in 31 pediatric patients with new-onset T1DM and 25 healthy children using multiple polymorphic region of the 16S rRNA. We performed machine learning and metagenome functional analyses to identify significant taxa and metabolic pathways and correlate with clinical and metabolic parameters. Inclusion criteria were living in Northern Italy, born from Caucasian parents, singleton birth, personal history negative for acute/chronic gastrointestinal diseases and/or antibiotic or probiotics administration. Different Bacteroidetes species i.e., B.stercoris (q=1,473E-4), B.intestinalis (q=0.010), B.fragilis (q=0.0452) were significantly more frequent in patients as well as B.bifidum, Gammaproteobacteria, Holdemania, Synergistetes and their descendants. Abundance of the Synergistetes (q=0.001), Synergistia (q=4.798E-5), Synergistales (q=2.64E-4) and Synergistaceae (q=0.0017) was reported. Among Deltaproteobacteria descendants, the Desulfovibrionales (q=0.0016), Desulfovibrionaceae (q=0.016) and the Bilophila genus (q=0.036) were significantly lower in patients as well as B.vulgatus, Deltaproteobacteria, Parasutterella and Lactobacillus, Turicibacter genera. BMI-SDS, insulin autoantibodies, glycemia, HbA1c, Tanner and age were the most significant positively or negatively parameters related to specific clusters of taxa. The supervised analyses confirmed the importance of B. stercoris in T1DM patients and a relevant role of Synergistetes and its descendants. The robustness and coherence of our results underline the relevance of studying microbioma using multiple polymorphic regions, different types of analysis and approaches within each analysis.

Disclosure

G. d’Annunzio: Consultant; Self; Sandoz. R. Biassoni: None. M. Squillario: None. E. Ugolotti: None. A. Barla: None. G. Piccolo: None. N. Minuto: None. M. Maghnie: None.
1292-P: Continuous Glucose Monitor Use Protects against the Negative Impact of Fear of Hypoglycemia on Sleep Parameters in Adolescents with Type 1 Diabetes
Authors: HITT TALIA A. , SMITH JENNIFER , FORTH EMILY L. , GARREN PATRIK , OLIVOS-STEWART DIANA , LA VEGA MONICA DE , STUART FIONA , HAWKES COLIN P. , WILLI STEVEN M. , GETTINGS JULIE
Published: June 2020

Background: Adolescents with type 1 diabetes (T1D) are vulnerable to sleep difficulties that may negatively affect mental health and glycemic control. Fear of hypoglycemia (FOH) may contribute to these sleep problems. Although parental FOH has been associated with poor sleep quality in children with T1D, little is known about the relationship between adolescent FOH and sleep outcomes.

Objective: To examine the association between adolescent FOH and sleep parameters and assess how continuous glucose monitor (CGM) use influences these relationships.

Methods: Adolescents ages 14-18 years with T1D completed questionnaires evaluating FOH (Child Hypoglycemia Fear Survey) and sleep parameters (Pittsburgh Sleep Quality Index). Meaningful CGM use was defined as reporting using the device ≥ 50% of the time. Analyses included linear regression and T-tests.

Results: One hundred adolescents (56 female) with a median (IQR) age of 16.3 (15.3,17.6) years and duration of T1D of 5.7 (2.5, 9.5) years completed surveys, and 45 used CGM. FOH was inversely associated with sleep duration (r=0.25, p=0.01) and quality (r=0.22 p=0.03), and positively associated with sleep disturbances (r=0.24, p=0.01). A stratified analysis showed that the inverse relationship between FOH and sleep duration (r=0.29, p=0.03), as well as the association with sleep disturbances (r=0.31, p=0.02) was only significant among those not using CGM. Furthermore, average sleep duration was longer in those using CGM [7.5 hours with CGM vs. 6.8 hours without, p=0.02] and the associations between FOH and sleep duration or disturbance were not significant among CGM users.

Conclusions: Among adolescents with T1D, FOH is associated with reduced sleep duration, poor sleep quality and increased sleep disturbance. Our findings suggest that CGM use could mitigate the negative contribution of FOH on various sleep parameters in this population, a previously unrecognized benefit.

Disclosure

T.A. Hitt: None. J. Smith: None. E.L. Forth: None. P. Garren: None. D. Olivos-Stewart: None. M. De La Vega: None. F. Stuart: None. C.P. Hawkes: None. S.M. Willi: Advisory Panel; Self; Boehringer Ingelheim International GmbH. Research Support; Self; Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Tolerion, Inc. Other Relationship; Self; Caladrius Biosciences, Inc. J. Gettings: None.
1293-P: Efficiency of Screening for Type 1 Diabetes and Celiac Disease in Various Health Care Settings: Autoimmunity Screening for Kids (ASK)
Authors: GENO RASMUSSEN CRISTY R. , WAUGH KATHLEEN , BAXTER JUDITH , STECK ANDREA , FROHNERT BRIGITTE I. , REWERS MARIAN
Published: June 2020

Our goal was to explore feasibility of screening for pre-symptomatic type 1 diabetes (T1D) and celiac disease (CD) in the general population. Efficiency of and barriers to sustainable screening in various health care settings are described. From 2017-2019, the ASK study screened 23,578 children in Colorado. Of those, 0.94% were positive for islet (95% CI 0.82-1.08) and 2.10% for transglutaminase (95% CI 1.92-2.29) autoantibodies. The screening aimed to engage providers in hospital specialty clinics (HSC), emergency departments (ED), private primary care (PPC), government primary care (GPC), diabetes center (BDC), community events (CE), and retail clinics (RC). ASK provided, as needed, on-site screening staff, provider reimbursement, and electronic consenting. Efficiency was defined as #screened/research staff full-time effort per week. The majority (72%) of screenings were completed at an ED or HSC, with 91% of screenings conducted by ASK staff. Highest screening efficiency was in the ED (Figure 1). While efficient, RC yielded small numbers. Challenges to screening program implementation included inconsistent provider time and commitment, limited clinic space, competing priorities, and research constraints. Translation to a sustainable screening in primary care will need to address these challenges in a practice-specific fashion.

Disclosure

C.R. Geno Rasmussen: None. K. Waugh: None. J. Baxter: None. A. Steck: None. B.I. Frohnert: None. M. Rewers: None.

Funding

JDRF (3-SRA-2018-564-M-N)
1296-P: Omnipod Personalized MPC Algorithm at Target Glucose of 110mg/dl Is Safe in Children Aged 2-12 Years without Increasing Risk of Hypoglycemia
Authors: SHERR JENNIFER , BUCKINGHAM BRUCE A. , FORLENZA GREGORY P. , GALDERISI ALFONSO , EKHLASPOUR LAYA , WADWA R. PAUL , ZGORSKI MELINDA , KINGMAN RYAN S. , BERGET CARI , LEE JOON BOK , OCONNOR JASON B. , DUMAIS BONNIE , VIENNEAU TODD , HUYETT LAUREN M. , LY TRANG T.
Published: June 2020

Customization of glucose targets in hybrid closed-loop (HCL) systems is important to enable tailored glucose management and safe onboarding across a wide range of users. The safety and performance of the Omnipod HCL personalized model predictive control (MPC) algorithm were assessed with a lower target of 110mg/dL for the first time in children aged 2-12y with type 1 diabetes (T1D) using an investigational device.

Participants with A1C<10.0% completed a 72-96h HCL study conducted in a supervised free-living hotel setting. At HCL start, the glucose target was 120mg/dL, and was lowered to 110mg/dL after 24-48h. There were 1-2 missed lunch boluses, high fat meals, and daily exercise.

Participants (n=12) were (mean±SD): age 6.8±3.1y, T1D duration 3.7±2.9y, and A1C 7.1±0.7%. Despite 1-2 missed meal bolus challenges (mean 43g, range 18-88g CHO), percent time 70-180mg/dL was 76.6±7.2% and 80.4±9.9% with targets of 110mg/dL and 120mg/dL respectively. Outcomes were similar between the targets for mean glucose and time in glycemic ranges (Table). There were no serious adverse events.

The Omnipod personalized MPC algorithm performed well and was safe in children aged 2-12y with T1D when tested at a target of 110mg/dL, even when stress-tested under challenging conditions. This algorithm is being evaluated in an at-home pivotal study with targets 110-150mg/dL.

Disclosure

J. Sherr: Advisory Panel; Self; Bigfoot Biomedical, Cecelia Health. Consultant; Self; Eli Lilly and Company, Lexicon Pharmaceuticals, Inc., Medtronic, Sanofi, T1D Exchange. B.A. Buckingham: Advisory Panel; Self; ConvaTec Inc., Medtronic. Research Support; Self; Beta Bionics, Inc., Dexcom, Inc., Insulet Corporation, Medtronic, Tandem Diabetes Care. G.P. Forlenza: Advisory Panel; Self; Medtronic. Consultant; Self; Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care. Research Support; Self; Abbott, Dexcom, Inc., Insulet Corporation, Medtronic, Tandem Diabetes Care. A. Galderisi: None. L. Ekhlaspour: None. R. Wadwa: Advisory Panel; Self; Eli Lilly and Company, Medtronic. Research Support; Self; Dexcom, Inc., Eli Lilly and Company, MannKind Corporation, Medtronic, Novo Nordisk Inc., Tandem Diabetes Care. M. Zgorski: None. R.S. Kingman: None. C. Berget: None. J. Lee: Employee; Self; Insulet Corporation. J.B. OConnor: None. B. Dumais: Employee; Self; Insulet Corporation. T. Vienneau: Employee; Self; Insulet Corporation. Stock/Shareholder; Self; Insulet Corporation. L.M. Huyett: Employee; Self; Insulet Corporation. T.T. Ly: Employee; Self; Insulet Corporation.

Funding

Insulet Corporation
1297-P: Early CGM Initiation Improves HbA1c in T1D Youth over the First 15 Months
Authors: PRAHALAD PRIYA , DING VICTORIA , ADDALA ANANTA , NEW CHRISTIN , CONRAD BARRY P. , CHMIELEWSKI ANNETTE , GEELS ELENA , LEVERENZ JEANNINE , MARTINEZ-SINGH ANJOLI , SAGAN PIPER , SENALDI JULIANNE , FREEMAN ALEX , SCHEINKER DAVID , HOOD KOREY K. , DESAI MANISHA , MAAHS DAVID M.
Published: June 2020

CGM use is associated with lower HbA1c in people with T1D. We hypothesize early CGM initiation will improve longer term HbA1c.

Youth with newly diagnosed T1D from July 2018 to May 2019 (pilot cohort, n=65), were offered CGM initiation in the 1st month of T1D diagnosis with 62 initiating CGM. We compared HbA1c outcomes in this pilot cohort with those diagnosed in 2014-2016 (control cohort, n=272) with follow-up duration restricted to 15 months. HbA1c trajectories were visualized using locally estimated scatter plot smoothing (Figure 1) and compared using a generalized mixed effects regression model adjusted for baseline characteristics (HbA1c at onset, age, sex, race and insurance type).

Mean HbA1c at diagnosis was higher in the pilot cohort (12.0% vs. 10.7%). Over the first 15 months of T1D, CGM was initiated in 95% of the pilot cohort (78.5% within 30 days), whereas 56% initiated in the control cohort (1.8% within 30 days). Adjusting for baseline characteristics, mean HbA1c levels were 0.5% lower (95%CI: -1.0, -0.1) in the pilot cohort at 3 months and 1.7% lower (95% CI: -2.6, -0.8) at 6 months compared to the control cohort. Differences beyond 6 months were also in the expected direction and statistically significant at the 0.05 level.

Early initiation of CGM in the new onset period was associated with lower HbA1c compared to historic controls. These data suggest that early CGM initiation should be considered a part of standard new onset T1D care.

Disclosure

P. Prahalad: None. V. Ding: None. A. Addala: None. C. New: None. B.P. Conrad: None. A. Chmielewski: None. E. Geels: None. J. Leverenz: None. A. Martinez-Singh: None. P. Sagan: None. J. Senaldi: None. A. Freeman: None. D. Scheinker: None. K.K. Hood: Research Support; Self; Dexcom, Inc. Speaker’s Bureau; Self; LifeScan, Inc., MedIQ. M. Desai: None. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care.