bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of the Structured, Comprehensive Clinic-Led, Population-Targeted Diabetes Intervention Program as Compared with the Standard Care Approach
Authors: KUBERAN INDUMATHI , RAO SAMEER , WADHWA NAVNEET
Published: June 2018

We implemented a structured comprehensive Diabetes Management Plan (DMP) which includes monthly diabetologist counselling, pharmacological interventions, dietician review and education, follow-up through face to face and mobile technology, exercise motivation and periodic investigations, at a onetime enrolment cost. ANOVA, Chi-Square test were used for the statistical analysis. We conducted a retrospective analysis of the glycemic measures of effectiveness in patients enrolled with DMP (n=47, males= 32, females = 15; mean age (years) 50.4 ± 9.4, min 27, max 72) compared to the group receiving the conventional Standard Of Care (SOC) over one year (n=47, males= 24, females = 23; mean age (years) 54.3 ± 13.9, min 24, max 78); (p=0.116) from Jan- Dec 2017. At end of one year of follow-up, DMP group (baseline HbA1c 9.1±1.57%) demonstrated higher HbA1c reductions of 1.86±1.10% as compared to the SOC group (baseline HbA1c 8.59±1.5%), which was statistically significant (p=0.046). DMP group (baseline Fasting Blood Glucose (FBG) 167.5±59.32 mg/dl) demonstrated higher FBG reductions of 34.89 ± 36.71 which was highly statistically significant from baseline (p=0.001). However, FBG was not statistically significant as compared to the baseline within the SOC group (baseline 147.25 ± 52.11 mg/dl, (p=0.602); the differences were statistically significant (p=0.005). The dyslipidemia parameters reveal that there was no significant difference in the groups for the change in LDL-C (p=0.36), total cholesterol (p=0.16) and HDL-C (p=0.11). The DMP group had significant elevation in HDL-C (11.8%, p=0.001). DMP with compulsory periodic interventions is useful as a better glycemic management tool and resource optimisation, as done in DMP, in an emerging economy would be useful model to emulate even for the developed world to manage the cost of diabetes care.

Disclosure

I. Kuberan: None. S. Rao: None. N. Wadhwa: None.
Mitochondrial Glycerol 3-Phosphate Dehydrogenase Improves Skeletal Muscle Regeneration in Obesity and Diabetes
Authors: QU HUA , ZHENG YI
Published: June 2018

While adult mammalian skeletal muscle is stable due to its post-mitotic nature, muscle regeneration is still essential throughout life for maintaining functional fitness. During certain diseases, such as the modern pandemics of obesity and diabetes, the regeneration process becomes impaired, leading to the loss of muscle function, and contributing to the global burden of these diseases. However, the underlying mechanisms behind the impairment are not well defined. Here we identify mitochondrial glycerol 3-phosphate dehydrogenase (mGPDH) as a critical regulator of skeletal muscle regeneration. Specifically, it regulates myogenic markers and myoblast differentiation by controlling mitochondrial biogenesis via CaMKKβ/AMPK. mGPDH deletion (mGPDH-/-) attenuated skeletal muscle regeneration in vitro and in vivo while mGPDH overexpression improved the insufficient regeneration in mdx mice. Moreover, in patients and animal models of obesity and diabetes, mGPDH expression in skeletal muscle was reduced, further suggesting a direct correlation between its abundance and muscular regeneration capability. Rescuing mGPDH expression in obese (HFD, ob/ob) and diabetic (STZ) mice by AAV led to a significant improvement in their muscle regeneration (Figure 1). Our study provides a new mechanism and potential therapeutic target for skeletal muscle regeneration impairment.

Disclosure

H. Qu: None. Y. Zheng: None.
Higher Dietary Intake of Vitamin D Is Associated with Lower Incidence of Diabetic Nephropathy in Japanese Patients with Type 2 Diabetes
Authors: HORIKAWA CHIKA , AIDA REI , TANAKA SHIRO , TANAKA SACHIKO , KAMADA CHIEMI , YOSHIMURA YUKIO , ARAKI ATSUSHI , MORIYA TATSUMI , KATAYAMA SHIGEHIRO , SONE HIROHITO
Published: June 2018

Evidence for optimal dietary intake of vitamin D for prevention of diabetic complications is sparse although associations between low vitamin D intake and high incidence of diabetes and vitamin D supplementation and improvement in insulin resistance were reported. We aimed to investigate the relationship between vitamin D intake and the incidence of diabetes complications in Japanese patients with type 2 diabetes aged 40-70 years with HbA1c≥6.5%. The present analysis was conducted as a multicenter prospective study on the incidence of and risk factors for macro- and microvascular complications among 22Japanese patients with type 2 diabetes from outpatient clinics in 59 university and general hospitals in Japan.Analyzed were 1516 responders to a baseline dietary survey assessed by the Food Frequency Questionnaire based on food groups. Primary outcome was the 8-year risk of nephropathy, retinopathy, and cardiovascular disease (CVD). Cox regression analyses estimated hazard ratios (HRs) for dietary intake adjusted for age, gender, body mass index, HbA1c, smoking, energy intake, and other confounders. Mean vitamin D intake in quartiles ranged from 5.4 to 18.7μg/day. After adjusting for confounders, HRs of diabetic nephropathy in the 2nd, 3rd, and 4th quartiles for vitamin D intake compared with the 1st quartile were 0.7 (95% confidence interval 0.4-1.3, p=0.29), 1.2 (0.6-2.2, p=0.61), and 0.33 (0.14-0.79, p=0.01), respectively. There was no significant associations of vitamin D intake with retinopathy and CVD in the 2nd to 4th quartiles relative to the first quartile (retinopathy: 1.2 (0.9-1.6, 0.4), 0.8 (0.5-1.2, p=0.23), and 0.7 (0.5-1.0, p=0.08); CVD: 1.1 (0.7-1.7, p=0.83), 1.2 (0.7-2.0, p=0.62), and 0.7 (0.4-1.3, p=0.22)). Findings suggested that high vitamin D intake was associated with a lower incidence of diabetes nephropathy among Japanese patients with type 2 diabetes.

Disclosure

C. Horikawa: None. R. Aida: None. S. Tanaka: None. S. Tanaka: None. C. Kamada: None. Y. Yoshimura: None. A. Araki: None. T. Moriya: None. S. Katayama: None. H. Sone: Research Support; Self; Novo Nordisk Inc., Eli Lilly and Company, MSD K.K., Chugai Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Development Center Asia, Pte. Ltd., Daiichi Sankyo Company, Limited, Ono Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Sanofi, Kowa Pharmaceuticals America, Inc., Eisai Inc..
Risk of Nonalcoholic Fatty Liver Disease (NAFLD)-Related Liver Complications in the Diabetic Population in Israel
Authors: GOLDSHTEIN INBAL , FERNANDES GAIL , CHODICK GABRIEL , RAJPATHAK SWAPNIL , KARASIK AVRAHAM
Published: June 2018

In the absence of early non-invasive diagnostic tools, the burden of NAFLD and its related complications in the diabetic (DM) population remains unclear. Using longitudinal data and defined criteria to identify NAFLD patients, this study evaluated the incidence of NAFLD-related liver complication in DM vs. non-DM population. The study utilized the computerized database of a nationally representative payer-provider health fund, including all members enrolled in year 2000 (index) without viral hepatitis or excess alcohol intake. NAFLD was defined as at least 2 of the following criteria: 2+ measurements of elevated liver enzymes (>2 upper normal limit), NAFLD Fibrosis score>-1.455, coded NAFLD Diagnoses, or imaging evidence using natural language processing of 1 million ultrasonography text reports. Cirrhosis, liver transplant and hepatocellular carcinoma (HCC), were detected by diagnoses, procedures, and the national cancer registry. DM was defined using a previously validated registry. Incidence density rates based on person years (PY) since index were compared between NAFLD cases vs. age and sex matched controls (2:1 ratio). The incidence was further stratified by the presence of DM. The total population included 1,083,4subjects with a mean follow-up of 15.1 years (SD=4.2).Out of these, n=61,644 were identified as NAFLD, with a mean age of 52.1 years (SD=13.6) and 23.4% with DM when they met the criteria for NAFLD. The incidence of cirrhosis, HCC and liver transplant was substantially higher in NAFLD cases as compared with matched controls with rate ratios of 5.6 (95% CI: 5.2-6.0), 1.3 (1.2-1.4) and 3.9 (2.9-5.2) respectively. After stratification by DM, rate ratios were 2.2 (95% CI: 2.0-2.3) for cirrhosis, 2.1 (1.8-2.5) for HCC and 2.5 (1.7-3.5) for liver transplant in NAFLD with DM vs. NAFLD without DM. This study shows that patients identified with NAFLD had higher rates of liver complications and these rates were increased among patients with DM.

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. G. Chodick: None. S. Rajpathak: Employee; Self; Merck & Co., Inc. 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.
White Matter Differences and Neurodevelopment Outcomes in Patients with KATP Channel-Related Diabetes
Authors: LEMELMAN MICHELLE B. , WREN-JARVIS JAMIE , SCOTT MEGAN N. , MARTIN RYAN , CARMODY DAVID , WROBLEWSKI KRISTEN , KEEDY SARAH , GREELEY SIRI ATMA W.
Published: June 2018

Background: Patients with KATP channel related diabetes (KATP-DM) experience improved glycemic control with sulfonylurea therapy, but the degree of improvement in their spectrum of neurological dysfunction remains unclear. We hypothesized that patients with KATP-DM have differences in brain white matter and associated neurodevelopmental impairments when compared to those with type 1 diabetes or sibling controls.

Methods: Subjects (8-20 years old) from the Monogenic Diabetes Registry at the University of Chicago included those with KATP-DM (n=8), type 1 or other non-KATP diabetes (n=7), and sibling controls (n=6). All participants had brain MRI with diffusion tensor imagining (DTI) on a 3T Philips Achieva Quasar scanner. Fractional anisotropy (FA) was used as an indirect measurement of myelin in the brain. Subjects also participated in validated neurodevelopmental assessments.

Results: Nonparametric Kruskal-Willis testing of analyzable DTI data [4 KATP-DM, 5 T1DM, 3 siblings] revealed that FA values of the corpus callosum were not statistically different (p=0.58). However, DTI of the white matter tracks in the right hippocampus approached a significant difference among the three groups (p=0.07). Third ventricular volumes among all three groups [9 KATP-DM, 7 T1DM, 5 siblings] were significantly different (p=0.05). Significant differences between groups as determined by one-way ANOVA were found in Perceptual IQ (F (2,14)=4.862, p=.025); visual motor integration (F (2,14)=5.579, p=.017); and graphomotor coordination (F (2,14)=5.399, p=.018).

Conclusion: In this first study using quantitative MRI methods in patients with KATP-DM, DTI revealed no overall difference but possible regional variation in FA, while ventricular volume and neurodevelopmental function were different among this cohort. Larger studies are needed to assess the potential differences in brain white matter as well as the benefits of early sulfonylurea therapy on neurologic development.

Disclosure

M.B. Lemelman: None. J. Wren-Jarvis: None. M.N. Scott: None. R. Martin: None. D. Carmody: Research Support; Self; Novo Nordisk Inc.. K. Wroblewski: None. S. Keedy: None. S.W. Greeley: Research Support; Self; Novo Nordisk Inc..
Effects of Bariatric Surgery on FGF-19 and FGF-21 Levels on Obese Diabetic Women
Authors: AZHARIAN SAHAR , MURPHY ALICE , MCTERNAN PHILIP G. , PIYA MILAN K. , TRIPATHI GYANENDRA
Published: June 2018

Background: Fibroblast growth factor 19 (FGF-19) and FGF-21 regulate glucose tolerance and insulin sensitivity, which in type 2 diabetes mellitus (T2DM) conditions becomes dysregulated. Whilst weight loss can restore this functionality, bariatric surgery can have a specific impact due to mechanical changes on gut/liver physiology. We aimed to analyse the effects of different bariatric surgeries: sleeve gastrectomy (SG), laparoscopic adjusted gastric banding (LAGB) and biliopancreatic diversion (BPD) on changes in FGF-19 and FGF-21 levels.

Methods: Obese and T2DM women (n=41 BMI>35 Kg/m2) undergoing SG (n=14), LABG (n=13), and BPD (n=14) participated in an ethics approved study. Anthropometry, biochemical data, and adipose tissue (AT) biopsies were collected before and 6 months after surgery. FGF-19, FGF-21 levels and AT inflammation (TLR2, MYD88, TRAF6, IKK and NFkb) was assessed.

Results: Post surgery SG led to 63% reduction in FGF-21 whilst LABG and BPD led to 41% and 4% decrease respectively. There was a significant differences in FGF-21 levels between SG and BPD (p=0.021). Moreover, FGF-21 change in SG positivly correlated with changes in glucose (p=0.019), insulin (p=0.047), HOMA-IR (p=0.022) and triglyceride (p=0.027); absent in BPD and LABG. FGF-21 levels in SG appeared as a significant predictor of HOMA-IR change post surgery (p<0.05). FGF-19 levels post surgery increased by 31% in SG compared to 10% rise in BPD and 39% decrease in LAGB with significant differences between SG and LAGB (p=0.012). FGF-19 change in BPD inversly correlated with changes in weight (p=0.012), BMI (p=0.037), waist circumfrance (p=0.044); absent in SG and LAGB.

Inflamatory markers post surgery were significantly reduced in all surgeries (TLR2: p<0.01, MYD88: p<0.01, TRAF6: p<0.01, IKK: p<0.01 and NFkb: p<0.01).

Conclusion: SG appears to have a beneficial influence on FGF-21 and FGF-19 levels irrespective of reduced AT inflammation. Our FGF findings therfore suggests that SG provides better glucose homeostatis outcomes than LAGB and BPD.

Disclosure

S. Azharian: None. A. Murphy: None. P.G. McTernan: None. M.K. Piya: None. G. Tripathi: None.
The Number of Teeth Is Associated with Diabetic Nephropathy
Authors: KURIHARA WATARU , MIYAKE TERUKI , FURUKAWA SHINYA , SENBA HIDENORI , YAMAMOTO SHIN , SAKIKO YOSHIDA , JOKO KOUJI , UEDA TERUHISA , NIIYA TETSUJI , MIYAOKA HIROAKI , MATSUURA BUNZO , HIASA YOICHI
Published: June 2018

Background: Progression of diabetic nephropathy has serious effects on the life expectancy of diabetic patients. Although diagnoses, lifestyle interventions, and treatment of diabetic nephropathy have been often attempted, diabetic nephropathy has not been sufficiently overcome. Previous studies show that periodontitis, the inflammation of oral cavity, might lead to endothelial and renal dysfunction. Moreover, periodontitis does not only negatively affect glycemic control but is also associated with diabetes-related complications. Therefore, we conducted this study to examine the relationship between number of teeth, which is one of the factors associated with periodontal disease markers, and diabetic nephropathy.

Methods: This study included 1767 patients with type 2 diabetes mellitus, grouped according to number of teeth, with cut-off distribution points of 13 and 27. Diabetic nephropathy was defined using albumin-creatinine ratio (albuminuria, ≥30 mg/mmol creatinine, and macroalbuminuria ≥300 mg/mmol creatinine). Adjustment was made for age, sex, body mass index, hemoglobin A1c, and hypertension status.

Results: Patients with diabetic nephropathy had significantly fewer teeth than those without diabetic nephropathy (albuminuria, p < 0.001; macroalbuminuria, p = 0.002). The group with fewer number of teeth was significantly associated with a higher prevalence of diabetic nephropathy; the adjusted odds ratios (95% confidence intervals) for diabetic albuminuria for 27-32 teeth, 13-26 teeth, and 0-13 teeth were 1.00 (reference), 1.219 (0.932-1.596), and 1.509 (1.147-1.988), respectively (p for trend = 0.003), and for diabetic macroalbuminuria were 1.00 (reference), 1.061 (0.644-1.748), and 1.756 (1.1-2.844), respectively (p for trend = 0.015).

Conclusion: The number of teeth is positively associated with diabetic nephropathy for patients with type 2 diabetes mellitus, and could assist clinicians in the identification of patients at high risk for diabetic nephropathy.

Disclosure

W. Kurihara: None. T. Miyake: None. S. Furukawa: None. H. Senba: None. S. Yamamoto: None. Y. Sakiko: None. K. Joko: None. T. Ueda: None. T. Niiya: None. H. Miyaoka: None. B. Matsuura: None. Y. Hiasa: None.
Characteristics and Mortality of Recurrent Diabetic Ketoacidosis (DKA) in Adults and Children with Type 1 Diabetes (T1D)
Authors: VELLANKI PRIYATHAMA , PENG LIMIN , DHRUV NEIL , RAMOS CLEMENTINA , HAW J. SONYA , GALINDO RODOLFO J. , DAVIS GEORGIA , FAYFMAN MAYA , PASQUEL FRANCISCO J. , UMPIERREZ GUILLERMO E.
Published: June 2018

Recurrent DKA is associated with increased mortality in children; however, data is limited in adults. We compared clinical characteristics and outcomes of adults (≥ 18 years) and children (< 18 years) at enrollment with history of recurrent DKA (≥ 1 episode) within the T1D Exchange clinic registry (n=33,902). DKA episodes were self-reported as those experienced 12 months prior to enrollment and before each study visit.

We identified 1758 people with recurrent DKA after diagnosis (Table). Median follow-up was 3.6 years. Adults with recurrent DKA had more islet cell or pancreatic transplant, less insurance and higher mortality compared to children, but less DKA at diagnosis. In both children and adults, mortality was higher with age (children: OR 1.24, 95% CI 1.02,1.50; adults: OR 1.09, 95% CI 1.06, 1.11) and no insurance (children: OR 3.83, 95% CI 1.32, 11.09; adults: OR 2.29, 95% CI 1.12, 4.69). Children with recurrent DKA had higher mortality (OR: 4.21, 95% CI 1.28, 13.86) compared to adults (OR: 2.36, 95% CI 0.53, 10.46). DKA at diagnosis of T1D was associated with higher mortality in adults (OR: 2.97, 95% CI 1.44, 6.11) but not in children (OR: 1.40, 95% CI 0.49, 3.97).

Adults and children with recurrent DKA have poor control but differ in socioeconomic factors and presentation of T1D. Even though adults present less with DKA at diagnosis, presentation with DKA is associated with higher mortality.

Children (n=1193)Adults (n=565)p-valueAge, years12.3 ± 3.931.9 ± 14.8<0.001Duration of DM, years5.2 ± 3.615.7 ± 11.6<0.001BMI, kg/m221.5± 4.925.2 ± 4.9<0.001HbA1c (%)9.6 ± 1.99.8 ± 2.30.55Female, n (%)628 (55)316 (59)0.17Race, White n (%)773 (65)371 (66)0.47Pump Use, n (%)457(38)244(43)0.13Islet cell or pancreatic transplant, n (%)0 (0)10 (9.1)<0.001No Insurance, n (%)6 (0.8)26 (7.6)<0.001DKA at diagnosis, n (%)577 (59)135 (46)<0.001Death, any cause, n (%)6 (0.5)9 (1.6)0.025Data are presented as mean ± SD unless noted otherwise

Disclosure

P. Vellanki: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., AstraZeneca. L. Peng: None. N. Dhruv: None. C. Ramos: None. J. Haw: None. R.J. Galindo: None. G. Davis: None. M. Fayfman: None. F.J. Pasquel: Consultant; Self; Merck Sharp & Dohme Corp., Sanofi, Boehringer Ingelheim Pharmaceuticals, Inc. G.E. Umpierrez: Research Support; Self; Sanofi US, Merck & Co., Inc., Novo Nordisk Inc., AstraZeneca. Advisory Panel; Self; Sanofi, Intarcia Therapeutics, Inc..
Association between Glycemic Control and Visits with Diabetes Care Team in Youth with Type 1 Diabetes
Authors: TRAVIS KATE , JONES AUSTIN , LYONS SARAH , DESALVO DANIEL J.
Published: June 2018

Clinical care of youth with type 1 diabetes (T1D) involves a multidisciplinary team including diabetes provider, registered dietitian (RD), certified diabetes educator (CDE), and social worker (SW) or psychologist. There is limited evidence to guide the ADA recommendations for visit frequency, so this study sought to evaluate the association between visit frequency and glycemic control. A cross-sectional analysis of demographic, clinical, and visit frequency data was performed from 1,995 T1D youth with diabetes duration ≥ 1 year, and ≥ 1 diabetes clinic visit during a 1-year period at a pediatric diabetes center. Patient demographics included 50.6% female, age 13.9±4.2 years, T1D duration 6.3±4 years, HbA1c 8.6±1.8%, and race/ethnicity: 52.4% white, 23.4% Hispanic, 16.7% black, and 7.7% other. The cohort averaged 2.9±1.3 annual provider visits. Patients with 3 or 4 annual provider visits had statistically lower mean HbA1c than those with 1, 2, or ≥ 5 visits (Figure 1). In total, 43.6% attended ≥1 CDE, 50.5% RD, and 71.8% SW/psychology visit. Seeing a CDE, RD, or SW/psychologist was not associated with lower HbA1c among the overall cohort, but was associated with lower HbA1c among privately insured patients. These findings reflect the complex, multidimensional nature of T1D management. Further investigation into clinical, psychosocial, and patient-reported outcomes beyond glycemic control is warranted.

Disclosure

K. Travis: None. A. Jones: None. S. Lyons: None. D.J. DeSalvo: Consultant; Self; Dexcom, Inc.. Speaker's Bureau; Self; Insulet Corporation.
Altered Neural Dynamics during a Flanker Attention Task in Patients with Type 1 Diabetes
Authors: EMBURY CHRISTINE M. , MCDERMOTT TIMOTHY J. , WIESMAN ALEX I. , BRAU KAITLIN , DESOUZA CYRUS , DRINCIC ANDJELA , WILSON TONY W.
Published: June 2018

Background: Patients with type 1 diabetes appear to have deficits in specific cognitive domains, particularly in attention and executive function (1). In this study, we used magnetoencephalography (MEG; 2), a noninvasive functional neuroimaging method, to identify neuronal changes in attention processing in otherwise healthy young adults with type 1 diabetes during euglycemia.

Methods: Adults with type 1 diabetes and no micro- or macro-vascular complications (N = 38) completed a visual selective attention task during MEG. A demographically-matched control group without type 1 diabetes was used for comparison. Each trial began with a fixation cross presented centrally, followed by a row of 5 arrows. Participants were asked to respond regarding the direction of the middle arrow (right index finger for left, right middle finger for right) and ignore the flanking arrows that were presented in either the same (congruent condition) or opposite direction (incongruent condition). All MEG data was processed following standard protocols (3), and the resulting images of functional brain activity were examined statistically.

Results: While no differences in reaction time or accuracy were found between groups, patients recruited a more widespread network of task relevant brain regions compared to controls, particularly the prefrontal cortex and anterior cingulate. Patients had a greater alpha increase from baseline in the anterior cingulate (p < .01), an important brain region in attention, and in the prefrontal cortex (p < .01) as compared to controls, likely reflecting compensatory mechanisms at play.

Conclusions: These results indicate that type 1 diabetes affects neural activity in attention networks of patients who are otherwise healthy and without major comorbidities, reflecting the recruitment of compensatory neural responses to complete task goals.

Disclosure

C.M. Embury: None. T.J. McDermott: None. A.I. Wiesman: None. K. Brau: None. C. Desouza: Consultant; Self; Novo Nordisk A/S, Sanofi. Research Support; Self; Merck & Co., Inc.. Advisory Panel; Self; Medscape. A. Drincic: None. T.W. Wilson: None.
Chronic Kidney Disease (CKD) in U.S. Adults with Self-Reported Cardiovascular Disease (CVD)—A National Estimate of Prevalence by KDIGO 2012 Classification
Authors: WANG TONGTONG , XI YUZHI , LUBWAMA ROBERT N. , KORO CAROL
Published: June 2018

Overall prevalence of CKD in the U.S. adult general population was estimated to be 14.8%. But data on the prevalence of CKD among CVD population are limited.

Using the NHANES 2007-2014 data, we conducted a cross-sectional analysis of an adult sample with self-reported CVD (n=2325), aged ≥18 years, to assess prevalence of CKD in U.S. adults with CVD using KDIGO 2012 classification. Participants with CVD were identified based on self-reported personal interview data on a broad range of health conditions—congestive heart failure, coronary heart disease, angina, stroke, or heart attack. Appropriate sample weights were used to provide a national estimate.

Results of prevalence of CKD in U.S. adults with self-reported CVD are presented in Table 1. The prevalence of moderately to severely decreased renal impairment based on eGFR below 60 ml/min/1.73m2 was 24.9%: 14.1% with Stage 3a, 7.8% with Stage 3b, and 3.0% with Stage 4 or 5. The prevalence of mildly decreased renal impairment (stage 2, eGFR=60-90 ml/min/1.73m2) was 45.2%: 36.8% with UACR<30 mg/g (normal to mildly increased albuminuria), 7.4% with UACR≥ 30-300 mg/g (moderately increased albuminuria) and 1.1% with UACR >300mg/g (severely increased albuminuria).

This study confirms the high prevalence of CKD in CVD, and provides insights into distribution by CKD categories based on the KDIGO 2012 classification.

Disclosure

T. Wang: Employee; Self; Merck & Co., Inc.. Stock/Shareholder; Self; Merck & Co., Inc.. Employee; Spouse/Partner; Janssen Pharmaceuticals, Inc.. Y. Xi: None. R.N. Lubwama: None. C. Koro: Employee; Self; Merck & Co., Inc.. Stock/Shareholder; Self; GlaxoSmithKline plc..
The Waist Circumference That Predicts Insulin Resistance in Africans Is Higher in Women than Men—A Population-Specific Study
Authors: KABAKAMBIRA JEAN DAMASCENE , BRIKER SARA M. , BAKER RAFEAL L. , COURVILLE AMBER B. , MABUNDO LILIAN , DUBOSE CHRISTOPHER , CHUNG STEPHANIE T. , MIZANUR RAHMAN MD. , SUMNER ANNE E.
Published: June 2018

Waist circumference (WC) is an inexpensive marker of both insulin resistance (IR) and visceral adipose tissue (VAT). As Africa is experiencing a rapid rise in diseases related to IR such as diabetes and heart disease, identifying the WC of risk in Africans would have great clinical utility. Yet the WC which predicts IR in Africans is unknown. Further WC varies by race and gender and cannot distinguish between VAT and subcutaneous adipose tissue (SAT). Nonetheless the International Diabetes Federation states until more data is available, WC thresholds determined in whites (men 94 cm; women 80 cm) should be applied to Africans. However, data from South Africa suggests that the WC threshold which best predicts IR in black women is between 90 and 100 cm and higher in women than men. Whether this is true in Africans from other regions is unknown. Our goals were to determine in Africans (a) the WC which best predicts IR and (b) whether sex differences in VAT and SAT distribution contribute to sex differences in the WC of risk. Therefore, 360 blacks born in Africa (West 52%, Central 23%, East 25%) and living in the United States (men 68%, age 38±10y (mean±SD)) had CT scans to measure VAT and SAT. OGTT were performed to determine glucose tolerance status. IR was defined by the lowest quartile of the Matsuda Index. AUC-ROC and Youden Index were used to determine the WC which best predicted IR. Compared to women, men had lower BMI (27.2±3.9 vs. 28.6±5.4, P<0.001), higher VAT and lower SAT (both P<0.001). The optimal WC for the prediction of IR in men and women were 91 cm and 96 cm, respectively. Regression analyses with VAT and sex as independent variables and either SAT or WC as dependent variables revealed an interaction (P<0.001) between sex and VAT. So at the same VAT, both SAT and WC were higher in women than men. Overall, in Africans the WC which optimally predicts IR is 91 cm in men and 96 cm in women. Higher SAT at the same level of VAT explains why the WC which predicts IR is higher in African women than men.

Disclosure

J. Kabakambira: None. S.M. Briker: None. R.L. Baker: None. A.B. Courville: None. L. Mabundo: None. C. DuBose: None. S.T. Chung: None. M. Rahman: None. A.E. Sumner: None.
Relationship between Glycemic Control and Treatment Intensity in Patients with Type 2 Diabetes
Authors: IGLAY KRISTY , HANNACHI HAKIMA , ENGEL SAMUEL S. , LI XUEYING , O'CONNELL DAVID J. , MOORE LORI M. , RAJPATHAK SWAPNIL
Published: June 2018

Previous studies have shown suboptimal glycemic control among patients with type 2 diabetes (T2D); however, the level of glycemic control has not been specifically evaluated for different degrees of treatment intensity. To assess this, we used the Quintiles Electronic Medical Record database to examine T2D patients ≥18 years with ≥1 encounter from Oct 2014 to Sept 2015, ≥1 year of available medical history, ≥1 HbA1c measure, and no insulin use at their last recorded encounter. Of the 678,447 eligible patients, median age was 65 years, 54% were female, and median HbA1c was 6.5%. The table shows the distribution of HbA1c range vs. treatment intensity. Overall, 32% of patients had suboptimal HbA1c levels (≥7%). Of those patients, 10% were untreated, 35% were on monotherapy, and 55% were not at goal despite being on 2 or 3+ agents. In patients with HbA1c ≥9%, 9% were untreated and 28% were on monotherapy. Among patients at the treatment target of <7%, only 24% were on dual or triple therapy, suggesting that patients on monotherapy who are not at goal were not consistently advanced to dual/triple therapy. Results were generally similar when subgroups with/without cardiovascular disease were examined.

In conclusion, 32% of our cohort had suboptimal HbA1c control. Given the distribution of therapy, opportunity exists to initiate/intensify treatment to improve glycemic control in this population.

Disclosure

K. Iglay: Employee; Self; Merck & Co., Inc.. Stock/Shareholder; Self; Merck & Co., Inc. H. Hannachi: Employee; Self; Merck & Co., Inc. S.S. Engel: Employee; Self; Merck & Co., Inc.. Stock/Shareholder; Self; Merck & Co., Inc.. X. Li: None. D.J. O'Connell: None. L.M. Moore: None. S. Rajpathak: Employee; Self; Merck & Co., Inc..
Immigrants from Sub-Saharan Africa and the Caribbean Experience Different Rates of Obesity but Similar Rates of Diabetes—The New York City Community Health Survey
Authors: HORLYCK-ROMANOVSKY MARGRETHE F. , SUMNER ANNE E. , HUANG TERRY
Published: June 2018

Foreign-born blacks from sub-Saharan Africa and the Caribbean represent 4.2% and 19% of the foreign-born population in New York City (NYC). As foreign-born blacks are often grouped with African Americans, data on risk of obesity and diabetes (DM) in Africans and Caribbeans in NYC is scant. Our goal was to determine (a) if the prevalence of either obesity or DM differed in African and Caribbean immigrants; and (b) whether duration of stay in the United States (U.S.) affected odds of either outcome.

Working with the New York City Community Health Survey 2009-13 data was obtained for 363 blacks born in sub-Saharan Africa (60% male, age 43 ±24y (mean ±SD), BMI 27.1 ±7.8 kg/m2) and 2,539 blacks born in the Caribbean (39% male, age 46 ±23y, BMI 27.9 ±8.5 kg/m2). Weighted logistic regression examined odds of obesity and DM, adjusting for socioeconomic and demographic variables such as age, gender, education, income, marital status, children <18 at home, BMI and duration of stay in the U.S.

Prevalence of obesity in Africans was 16.7% and in Caribbeans was 29.7%. The prevalence of DM was 10.5% in Africans and 14.7% in Caribbeans. Africans had significantly lower odds of obesity [OR=0.60 (95% CI 0.40-0.90) P=0.01], but there was no difference in odds of DM between the two groups. Odds of obesity were higher in African [OR=2.35 (95% CI 1.16-4.78) P=0.02] and Caribbean women [OR=2.20 (95% CI 1.63-2.98) P=<.001] than their male counterparts. In both groups, duration of stay in the U.S. did not affect odds of either obesity or DM.

Overall Africans living in NYC are less obese than Caribbean blacks, but the odds of DM do not differ. This suggests that the association between BMI and DM risk differs in blacks according to region of origin. In short, combining foreign-born blacks into a single category may mask important differences in health status.

Disclosure

M.F. Horlyck-Romanovsky: None. A.E. Sumner: None. T. Huang: None.
Diabetes Treatment in Patients with Renal Disease—How Many Are Receiving Contraindicated Drugs?
Authors: MATA-CASES MANEL , FRANCH-NADAL JOSEP , REAL JORDI , DE CAMPOS KARINE FERREIRA , CEDENILLA MARTA , GÓMEZ ANTÓN , MAURICIO DIDAC
Published: June 2018

Objective: To estimate the CKD (GFR <60 ml/min and/or UACR ≥ 30 mg/g) prevalence among T2DM patients and evaluate the use of antidiabetic drugs based on renal function.

Methods: Retrospective, cross-sectional study, analyzing data from the Spanish electronic records database “Information System for the Development of Research in Primary Care, SIDIAP”, from Jan, 2015 to Dec, 2016. The use of antidiabetic drugs for each stage of chronic renal failure (CRF; GFR<60 mL/min) was evaluated in patients with available records of GFR. Furthermore, the adjusted RR for 5 events (global mortality, cardiovascular mortality, renal failure treated with dialysis or transplantation, acute renal failure and progression of kidney disease) according to KDIGO 2012 guidelines were assessed in those patients with available registers of both UACR and GFR.

Results: From the overall T2DM study population (373,185), 33% (122,296) had CKD, of those, 48% were women, with a mean age of 76 years, a mean T2DM duration of 11 years and a mean HbA1c value of 7.2% (SD 1.37). A total of 336,198 patients (90%) had GFR data, and 94,240 (28%) had CRF. Among those with GFR 30 to < 45 mL/min (29,038; 8.9%), metformin was the most frequently used drug (49.6%), followed by insulin (33.5%), DPP-4i (21%) and sulfonylureas (15.9%). Among patients with GFR < 30 mL/min (13,262, 4%), insulin was the most used drug (50%), followed by DPP-4i (23%), metformin (16%), repaglinide (16%) and sulfonylureas (6.1%). The KDIGO 5 event-adjusted RR distribution among the 236,830 patients with available values of both UACR and GFR was: Low: 60.9%; Mild: 21.6%, High: 9.8% and Very high: 7.7%.

Conclusion: CKD is a very frequent comorbidity among T2DM patients. The use of antidiabetic drugs is more complex in these patients because many people with kidney disease are often elderly, and have long lasting disease and significant comorbidities. A relevant number of T2DM patients are still treated with contraindicated antidiabetic drugs regarding their renal function.

Disclosure

M. Mata-Cases: None. J. Franch-Nadal: None. J. Real: None. K. Ferreira de Campos: Employee; Self; Merck Sharp & Dohme Corp. M. Cedenilla: Employee; Self; Merck Sharp & Dohme Corp. A. Gómez: Employee; Self; Merck Sharp & Dohme Corp. D. Mauricio: Advisory Panel; Self; AstraZeneca. Research Support; Self; AstraZeneca. Speaker's Bureau; Self; Eli Lilly and Company, GlaxoSmithKline plc.. Research Support; Self; GlaxoSmithKline plc.. Advisory Panel; Self; Janssen-Cilag Pty Limited. Speaker's Bureau; Self; Merck Sharp & Dohme Corp.. Board Member; Self; Merck Sharp & Dohme Corp.. Research Support; Self; Merck Sharp & Dohme Corp.. Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Novo Nordisk A/S. Advisory Panel; Self; Sanofi. Board Member; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Research Support; Self; Sanofi.
Evaluating the Combination of Metabolic Syndrome and Different Body Mass Index Categories to Predict Risk for Mortality among U.S. Adults
Authors: SHI TING HUAI , NATARAJAN SUNDAR
Published: June 2018

Body Mass Index (BMI) categories alone do not necessarily predict negative outcomes. We examined if further stratification based on metabolic syndrome (MetS) provides additional value in predicting mortality. We analyzed population-based data from adults in the National Health and Nutrition Examination Survey from 1999-2010. BMI categories (in kg/m2) were: normal (18.5-25), overweight (25-30) and obese (>30). Normal BMI participants without MetS served as the reference group. After initial unadjusted analyses we performed Cox proportional hazards models controlling for age, gender, race-ethnicity, education, income and smoking. We included 12,048 participants. Unadjusted mortality curves (Figure) show that the normal MetS group had the highest mortality rate, followed by overweight MetS, which in turn is significantly higher than obese MetS. All the no MetS groups had significantly lower mortality than their MetS counterparts. Adjusted Cox regression showed that only the normal MetS (HR 1.7, CI 1.2-2.4) and obese MetS group (HR 1.3, CI 1.1-1.6) had higher hazard rates than the reference group. Metabolic syndrome and obesity categories provide significant additional prediction of mortality. Normal weight subjects with MetS have the highest mortality, in contrast to previous studies. Treatment strategies should incorporate MetS and obesity.

Disclosure

T. Shi: None. S. Natarajan: None.
Gamma Glutamyltransferase and Risk of Dementia in Normal, Prediabetes, and Diabetes Populations—A Nationwide Cohort Study with 6.5 Million People
Authors: HAN EUGENE , LEE MINYOUNG , CHO YONGIN , LEE BYUNG-WAN , AHN CHUL WOO , CHA BONG-SOO , LEE YONG-HO
Published: June 2018

Diabetes is associated with cognitive impairment and increases risk of dementia, but until now the role of gamma-glutamyltransferase (γ-GT) in dementia has not been studied. We thus investigated the impacts of γ-GT and glycemic status on incident dementia in a nationwide cohort study. We determined incident dementia including Alzheimer’s disease and vascular dementia, analyzing data from participants aged 40 years or older in the National Health Insurance Database, collected by the National Health Insurance Service in Korea, from January 2009 to December 2015. During a median follow-up of 7.6 years, 272,657 participants (5.4%) were diagnosed as having dementia at a mean age of 76.5 years. Higher serum γ-GT was associated with increased risk of dementia (HR=1.22, 95% CI=1.20-1.24), and had a strong positive association with early onset dementia (HR=1.32, 95% CI=1.24-1.40). An additive impact of higher γ-GT on dementia was observed regardless of glycemic status, and prevalent diabetes with the highest γ-GT quartile had a 1.8-fold increased dementia risk (HR=1.82, 95% CI=1.78-1.85). This effect of γ-GT concentration in diabetes was more prominent in individuals with vascular dementia (HR=1.94, 95% CI=1.84-2.04). In subgroup analysis, young age, male sex, and relatively healthy subjects with a higher γ-GT quartile had more increased dementia risk.

In conclusion, γ-GT concentration as well as glycemic status could be a future risk factor for dementia in the general population.

Disclosure

E. Han: None. M. Lee: None. Y. Cho: None. B. Lee: None. C. Ahn: None. B. Cha: None. Y. Lee: None.
Socioeconomic Relationship Trends between Diabetes and Postcodes in NSW, Australia
Authors: BURNS KHARIS , HNG TIEN-MING , CHEUNG NGAI WAH
Published: June 2018

Diabetes prevalence is increasing in Australia. The Ausdiab Study 2001 found diabetes affected 7.4% of adults >25y with 0.7% of Australians diagnosed yearly. The distribution of diabetes and standard of care however is not nationally uniform. Health disparities may be due to social disadvantage, ethnicity, age distribution and services access. We examined the distribution of diabetes and level of control based on postcode in NSW at two time periods, to determine if the relationship between the level of care (defined by HbA1c) and geographical distribution had changed with time. Data was sourced from a pathology company performing the bulk of testing, capturing the majority of subjects with diabetes. Subjects were identified by HbA1c measurement. Two periods were examined, 20and 2013. For each subject who had an HbA1c collected, data was extracted for gender, age, postcode, eGFR, lipids and urine microalbumin. Mann Whitney U tests compared differences in parameter medians between the two periods. Spearman correlations and linear regression assessed relationships between socioeconomic disadvantage scale based on postcode (SEIFA), and diabetes control. Data was available for 119018 subjects in 20and 185954 subjects in 2013. During both years, the number of diabetes cases was higher in areas of greater disadvantage and HbA1c was correlated with higher disadvantage score (p<0.01). Control significantly improved over time (Mdn HbA1c 6.5% vs. 6.3%) and the proportion of patients with poor control (HbA1c >7.0%) also improved (36.5% vs. 31.7%) (p<0.01). SEIFA significantly predicted diabetes control in both 20(F (1,119016) =907.4 p<0.01, r2=0.01) and 2013 (F (1,185952)=1940.3 p<0.01, r2=0.01). Control improved within 9/10 SEIFA categories over time (p<0.05) though the gap between socioeconomic tiers remained. Health inequalities in diabetes control parallel socioeconomic disadvantage levels in NSW. Despite an 8 year interim disparities in HbA1c between socioeconomic tiers have not changed.

Disclosure

K. Burns: None. T. Hng: None. N. Cheung: None.
Inverse Associations between Circulating SFRP5 and Adiposity among African-Caribbean Men
Authors: ALI HIRA , ZMUDA JOSEPH M. , CVEJKUS RYAN , KERSHAW ERIN E. , KUIPERS ALLISON L. , BUNKER CLAREANN H. , MILJKOVIC IVA
Published: June 2018

Background: African ancestry populations are at the epicenter of the obesity and diabetes epidemic. Secreted frizzled-related protein 5 (SFRP5) is a novel adipokine and Wnt pathway modulator which is thought to be inversely related with adiposity and diabetes risk, however data in humans is conflicting. Therefore, we examined the association of SFRP5 with parameters of obesity and insulin resistance among an African ancestry population.

Methods: We measured fasting serum SFRP5 in a pilot study of 139 elderly Afro-Caribbean men (mean age 71.7years, mean BMI 27.6 kg/m2). These men represented a random subset of a population-based study comprising ∼3000 African ancestry men with anthropometrics, DXA measured adiposity, and fasting morning blood collections for biomarker analysis. SFRP5 was measured in duplicate in previously unthawed serum with ELISA.

Results: Using Pearson correlations, we found SFRP5 level to be positively associated with age (R = 0.18, p = 0.03) and negatively associated with BMI (R = - 0.14, p = 0.09), waist circumference (R = - 0.18, p = 0.02) and DXA trunk fat (R = - 0.24, p = 0.003), independent of age. Among nondiabetics (N=87), SFRP5 was inversely associated with fasting insulin levels (R = - 0.21, p= 0.04) and to some extent with HOMA-IR (R = -0.20, p = 0.06), independent of age and BMI. However, after adjustment for age and waist circumference, the associations between SFRP5 and fasting serum insulin and HOMA-IR were no longer significant.

Conclusion: Our findings suggest that among African ancestry men, SFRP5 might have a beneficial role against general and central obesity. Our findings also suggest that the link between SFRP5 and diabetes risk in African Ancestry men may be explained by its correlation with central adiposity. Additional larger studies among African ancestry populations are needed to explore this novel biomarker along with its temporal relationship with clinically relevant metabolic outcomes.

Disclosure

H. Ali: None. J.M. Zmuda: None. R. Cvejkus: None. E.E. Kershaw: Consultant; Self; Regeneron Pharmaceuticals, Inc.. A.L. Kuipers: None. C.H. Bunker: None. I. Miljkovic: None.
Overweight Individuals with Type 1 Diabetes Are Less Likely to Present with Diabetic Ketoacidosis—Data from the After Diabetes Diagnosis Research Support System (ADDRESS-2) Cohort
Authors: MISRA SHIVANI , KAUR AKAAL , GODSLAND IAN F. , WALKEY HELEN C. , JOHNSTON DESMOND G. , OLIVER NICK
Published: June 2018

Introduction: Insulin resistance has been proposed to accelerate progression to type 1 diabetes (T1D) in antibody positive relatives of affected individuals. We hypothesised that overweight individuals with confirmed T1D would be less likely to present with diabetic ketoacidosis (DKA), signifying an earlier onset of T1D, due to concomitant insulin resistance.

Methods: The ADDRESS-2 study recruits incident clinician-assigned T1D cases within 6-months of diagnosis and systematically assesses pancreatic autoimmunity by GAD-65, IA-2 and ZnT8 antibodies. People with at least two positive antibodies were selected to confirm diagnosis of T1D and categorised for adiposity according to BMI (adults) or Z-scores (children). Odds ratios (OR) for presentation with DKA were compared, adjusted for potential confounders and sub-analysed by whether adult or child at recruitment.

Results: 31% (969/ 3132) were positive for two or more pancreatic antibodies. Of these 44% (424/969) presented with DKA. The proportions with DKA varied significantly by adiposity: 59% underweight (16/27), 47% normal (280/601), 39% overweight (103/263), 30% obese (19/63) and 40% severely obese (6/15) (p=0.02). When adjusted for age, being overweight or obese was associated with lower risk of DKA in adults (OR 0.58, p=0.006; 0.44, p=0.03, respectively) not children (OR 0.9, p=0.81; 0.51, p=0.12, respectively). Higher adiposity category was associated with higher daily insulin-requirements independent of age, with obesity associated with a 4 unit/day increase (p=0.03) and severe obesity, 11 units/day increase (p=0.008).

Conclusion: Adults with T1D are less likely to present with DKA if overweight or obese. Despite smaller proportions of DKA, insulin requirements are higher. These data suggest that, in adults, T1D presentation is unmasked by the insulin resistance of obesity prior to absolute insulin deficiency and ketoacidosis.

Disclosure

S. Misra: None. A. Kaur: None. I.F. Godsland: None. H.C. Walkey: None. D.G. Johnston: None. N. Oliver: Advisory Panel; Self; Dexcom, Inc., Roche Diabetes Care Health and Digital Solutions, Medtronic. Research Support; Self; Dexcom, Inc., Roche Diabetes Care Health and Digital Solutions. Other Relationship; Self; Novo Nordisk A/S, Takeda Development Centre Europe Ltd..