bluuebunny/crossref_metadata_2025 huggingface dataset:
1293-P: Health Center Services and Glycemic Control in Latinos with Diabetes
Authors: KATZ JOSHUA , WAN WEN , STAAB ERIN M. , LAITEERAPONG NEDA , BAIG ARSHIYA A.
Published: June 2019

Background: Health centers (HCs) provide care to many racial and ethnic minority patients with diabetes. However, limited research has described the types of services HCs offer and their association with glycemic control.

Objective: To examine the relationship between HC services and glycemic control among Latino patients with diabetes.

Methods: We conducted a cross-sectional observational survey of providers in Midwestern HCs about the services offered at their sites. The provider-level report of HC services was summarized as medians of means per HC. HC-level data on glycemic control was obtained from the Uniform Data System. A linear mixed model was used to assess associations between the presence of HC services and the percent of Latino, non-Hispanic white, and overall patients with A1c <9% served at the HC.

Results: Survey responses were received from 620 providers practicing at 97 HCs in 10 Midwestern states. There were positive associations between percent of Latino patients with A1c <9% and access to community outreach workers/promotoras (p=0.01), and percent of overall patients with A1c <9% and access to a dietician (p=0.002). There were negative associations between the percent of Latino patients with A1c <9% and access to Spanish-speaking front desk staff (p=0.02) and provider education on diabetes (p=0.02). Serving a higher percentage of patients with diabetes who were Latino was negatively associated with the percent of Latino patients with A1c <9% (p=0.0003).

Conclusions: Access to promotoras and dieticians were associated with higher percentage of Latino patients with A1c <9%, suggesting the importance of a multidisciplinary approach to control of diabetes. Spanish-speaking front desk staff and provider education were associated with lower percentage of Latino patients with A1c <9%, likely related to high levels of HC efforts to address care needs. Future studies need to assess how access to specific services impact A1c control among Latinos with diabetes who receive care at community HCs.

Disclosure

J. Katz: None. W. Wan: None. E.M. Staab: None. N. Laiteerapong: None. A.A. Baig: None.

Funding

National Institutes of Health; National Institute of Diabetes and Digestive and Kidney Diseases
1296-P: Self-Reported Symptoms and Frequency of Hypoglycemia in Primary Care Patients with Type 2 Diabetes Mellitus: A Cross-Sectional, Multicenter Study
Authors: XU YINGQI , LEE JOYCE Y.
Published: June 2019

Objective: Hypoglycemia remains an unpredictable side effect of insulin use or oral hypoglycemic agents therapy in patients with diabetes. However, Limited data exist on the prevalence of hypoglycemia in patients attending primary care diabetes clinics. This study aimed to determine the frequency and symptoms of self-reported hypoglycemia in patients with type 2 diabetes (T2DM).

Methods: This was a cross-sectional, multicenter study conducted in three outpatient clinics in Singapore. Patients aged ≥ 21 years old with T2DM and polypharmacy were included. Patients who were unable to communicate independently were excluded. The 5-item self-reported questionnaire about hypoglycemia awareness, symptoms, frequency and measures were administered to all eligible patients.

Results: Among the 254 patients who were eligible for the study, 45.7% experienced at least one hypoglycemic episode in the past seven days. Lightheadness (24.0%) was the most common symptoms reported, followed by weakness (15.8%) and intense hunger (14.2%). Among the patients who reported hypoglycemic symptoms, 52.6% took sweets and 35.1% achieved timely relief. Of the patients who reported hypoglycemia, 11.4% suffered severe hypoglycemia, requiring the assistance of another person to take corrective actions. Overall, approximately 48.0% reported fear of low blood sugar but only 31.9% performed self-monitoring of blood sugar (SMBG) with an average monitoring frequency of 3.31 ± 3.73 times within the last seven days. The severity and frequency of self-reported hypoglydemic symptoms were not associated with HbA1c, age, body-mass index, duration of T2DM and insulin use.

Conclusion: The frequency and severity of self-reported hypoglycemia among patients with T2DM appeared to be high and unrelated to patient demographics or disease control. The use of SMBG should be emphasized among patients with T2DM regardless of type of antidiabetic agents used.

Disclosure

Y. Xu: None. J.Y. Lee: None.
13-OR: Trends in Life-Threatening Hyperglycemia-Related Complications among Commercially-Insured Diabetes Patients Before and After the 2010 Rise in Insulin Prices
Authors: MEIRI AMIR , CALLAWAY KATHERINE , WHARAM J. FRANK
Published: June 2019

U.S. insulin pricing began increasing dramatically in 2010, possibly caused by rising artificial insulin production and market domination by several pharmaceutical companies. Studies over the last 20 years have shown that such high prices are associated with patient rationing of insulin. The commercially-insured population includes patients with both type 1 and 2 diabetes who have experienced increasing cost sharing over the last decade, often in the form of high deductible health plans. This rise in insulin pricing combined with higher cost sharing might increase life-threatening diabetes-related complications. We hypothesized that diabetic ketoacidosis (DKA) and hyperosmolar coma (HOC) would increase after the sharp rise in insulin prices that began in 2010. We applied an interrupted times series design, with 2010 used as the change point given previous research showing that insulin prices began rising sharply in this year. We studied a large commercially insured population with an average annual number of diabetes patients of 507,578 during 2005-2014. Patients with diabetes were identified using a standard algorithm based on ICD9 codes and oral antidiabetes medicines. We calculated annual emergency department visit rates for combined DKA and HOC in this population. We use a first-order autoregressive segmented regression model to determine if there was a change in the complication trend from before to after 2010. The estimated 2005 rate of DKA and HOC emergency department visits was 50.9 per 10,000 diabetes patients (p<0.001), which decreased to 36.2 per 10,000 by 2009 (trend: -3.7 per 10,000 per year; p<0.001). However, from 2010-2014 the complication rate rose by 5.2 per 10,000 per year (p=0.002) relative to the 2005-2009 trend.

In conclusion, life-threatening hyperglycemia-related complications among commercially-insured diabetes patients increased after the 2010 insulin price increase.

Disclosure

A. Meiri: None. K. Callaway: None. J. Wharam: None.

Funding

National Institutes of Health; Centers for Disease Control and Prevention
131-OR: Effects of Dapagliflozin, Metformin, or Exercise on Glucose Metabolism in Individuals with Prediabetes: The PRE-D Trial
Authors: FÆRCH KRISTINE , BLOND MARTIN B. , AMADID HANAN , NIELSEN LEA BRUHN , VISTISEN DORTE , CLEMMENSEN KIM K. , PEDERSEN CAMILLA HARTMANN , KARSTOFT KRISTIAN , RIED-LARSEN MATHIAS , JØRGENSEN MARIT E.
Published: June 2019

Introduction: We assessed the effects of dapagliflozin, metformin or exercise on glucose metabolism in individuals with prediabetes.

Methods: 120 participants were randomized to 13 weeks of either: 1) dapagliflozin (DAP, 10 mg once daily); 2) metformin (MET, 1700 mg daily); 3) exercise (EXE, 5x30 min/week); or 4) control (CON, no treatment). Participants were tested at baseline and after 6 and 13 weeks of intervention with oral glucose tolerance tests with 0, 30, 60, 120 min samples performed at baseline and at 13 weeks. Treatments were stopped the day before the last visit (two days before in EXE). Intention-to-treat analyses were conducted (baseline-adjusted).

Results: 44% were men. At baseline, the median (Q1;Q3) age was 62 (54;68) years, BMI 30.8 (28.6;34.3) kg/m2, HbA1c 41 (39;43) mmol/mol (5.9 (5.7;6.1)%), fasting plasma glucose (FPG) 5.6 (5.2;5.8) mmol/L, and fasting serum insulin (FSI) 72 (47;99) pmol/L. HbA1c decreased in DAP at 6 weeks (Table 1). All groups showed reductions of around 1 mmol/mol at 13 weeks. MET, and to a lesser extend DAP, decreased FPG. FSI was reduced by 19-25% in all treatment groups, except for EXE at 13 weeks. The iAUCglucose increased by 66% in MET, and iAUCinsulin decreased somewhat in DAP and EXE.

Conclusion: All treatments slightly improved HbA1c and fasting measures. Only DAP and EXE showed signs of improvements in postprandial glucose metabolism.

Disclosure

K. Færch: Research Support; Self; Ascensia Diabetes Care, AstraZeneca, Unilever. Stock/Shareholder; Self; Novo Nordisk A/S. M.B. Blond: None. H. Amadid: None. L.B. Nielsen: None. D. Vistisen: Stock/Shareholder; Self; Novo Nordisk A/S. K.K. Clemmensen: None. C.H. Pedersen: None. K. Karstoft: Employee; Self; Novo Nordisk A/S. M. Ried-Larsen: Other Relationship; Self; Novo Nordisk A/S. M.E. Jørgensen: Research Support; Self; Amgen Inc., AstraZeneca, Danish Diabetes Association, Sanofi-Aventis. Stock/Shareholder; Self; Novo Nordisk A/S.

Funding

Novo Nordisk Foundation; AstraZeneca
1311-P: Machine Learning (ML) Application to Predict Patient Risk of Nonadherence in Type 2 Diabetes Management Using U.S. Claims Databases
Authors: CHEN XIN , FERNANDES GAIL , CHEN JIE , LIU ZHIWEN , BAUMGARTNER RICHARD
Published: June 2019

Medication non-adherence is one of the common leading public health challenges facing the U.S. Poor medication adherence in patients with diabetes, especially type 2 diabetes mellitus (T2DM), may be associated with inadequate glycemic control, increased morbidity and mortality and lead to increased health services utilization and hospital admissions. The use of predictive models based on ML using “big” healthcare data can help identify and predict a subpopulation with high risk of nonadherence, thus providing a scope for improving value in health care and reducing the cost burden. In this study, we extracted 111,180 T2DM patients initiating metformin monotherapy (index date) from the Truven database to train the ML models and predict patients’ level of adherence to metformin monotherapy. Patients must have had at least 6 months of pre-index (baseline) and at least 2 years of post-index (follow-up) data available. Adherence was measured as proportion of days covered (PDC) for metformin in the second year after the index date with PDC >= 0.8 labeled as high-adherence and < 0.8 labeled as low-adherence. A total of 120 variables were extracted including patients’ demographic information, T2DM-related medication and procedure use, comorbidities, and metformin usage information. In the preliminary analysis, random forest classifiers with 80% random split training set and validated with the 20% test set has reached 0.73 accuracy and 0.73 sensitivity. Due to the high dimensionality and sparsity of the features, we will apply further feature engineering and additional non-linear ML models such as XGboosting, BART and super learner to compare with logistic regression model and to optimize the accuracy and sensitivity. A T2DM cohort from Optum claims database will be used for cross-validation to ensure the generalization of the model. This ML model could also be adapted for other therapeutic areas.

Disclosure

X. Chen: Employee; Self; Merck & Co., Inc. G. Fernandes: None. J. Chen: None. Z. Liu: Employee; Self; Merck & Co., Inc. R. Baumgartner: None.
1312-P: Admission Plasma Glucose and HbA1c in Emergency Hospital Admissions by Ethnicity
Authors: MANLEY SUSAN E. , SUSARLA RADHIKA , ROUND RACHEL A. , NIGHTINGALE PETER , WILLIAMS JOHN A. , STRATTON IRENE M. , WEBBER JONATHAN , GKOUTOS GEORGIOS , HANIF WASIM , ROBERTS GRAHAM , GHOSH SANDIP
Published: June 2019

Introduction: As HbA1c is now widely used for the diagnosis of diabetes with WHO cut-off ≥ 48 mmol/mol/6.5%, it is debatable whether the value should vary by ethnicity.

Aim: This study compares plasma glucose and HbA1c in white European WE, South Asian SA, unknown/other U and Afro-Caribbean AC people admitted as an emergency.

Methods: Electronic patient records were interrogated over 1 year (2014/5) for a clinical audit, CARMS-12031R. Glucose was measured on wards with meters/gas machines or the laboratory along with HbA1c on Tosoh G8 HPLC analysers if haemoglobin normal.

Results: There were 30,664 people of whom 22,045 (72%) had glucose recorded and 2,083 (7%) HbA1c. 1,904 (6%) had both glycaemic markers and were aged 64 (50-78) years, median (IQ range); 839 (44%) female; 560 (29%) prior diabetes diagnosis; 1,405 (74%) WE, 296 (16%) SA, 112 (6%) U and 91 (5%) AC. Glucose was 7.4 (5.8-10.6), 8.6 (6.2-12.3), 8.1 (5.9-10.7), 7.0 (5.9-11.6) mmol/L and HbA1c 42 (37-55), 50 (41-70), 42 (38-60), 46 (39-70) mmol/mol/6.0 (5.5-7.2), 6.7 (5.9-8.6), 6.0 (5.6-7.6), 6.4 (5.7-8.6)%, respectively. HbA1c was higher relative to glucose in SA and AC compared to WE and U, p<0.001.

Conclusions: Haematological differences related to red blood cell turnover may account for the variance; this should be recognised by those involved in producing protocols/guidelines for diagnosis. More research is required on using HbA1c to confirm undiagnosed diabetes in admissions.

Disclosure

S.E. Manley: None. R. Susarla: None. R.A. Round: None. P. Nightingale: None. J.A. Williams: None. I.M. Stratton: Consultant; Self; Novo Nordisk A/S. Research Support; Self; Bayer AG, Boehringer Ingelheim International GmbH. J. Webber: None. G. Gkoutos: None. W. Hanif: Advisory Panel; Self; Boehringer Ingelheim International GmbH. Consultant; Self; Novo Nordisk A/S. Research Support; Self; AstraZeneca, Janssen Diagnostics, Sanofi. Speaker's Bureau; Self; AstraZeneca, Novartis AG, Novo Nordisk A/S. G. Roberts: None. S. Ghosh: Advisory Panel; Self; Abbott. Other Relationship; Self; Mylan.
1315-P: A Novel Microsimulation Model for Evaluating CVD Risk Assessment with Coronary Artery Calcium in Diabetes
Authors: FERKET BART , HUNINK MYRIAM , MASHARANI UMESH , MAX WENDY , FLEISCHMANN KIRSTEN
Published: June 2019

Background: Several studies including the Multi-Ethnic Study of Atherosclerosis (MESA) have demonstrated the value of coronary artery calcium (CAC) for CVD risk prediction. However, whether CAC can refine risk assessment for patients with diabetes to improve long-term outcomes at reasonable cost is uncertain. We therefore developed a microsimulation model and determined its internal validity.

Methods: We constructed a state-transition microsimulation model (R and TreeAge software) with Well, Post CVD, and Death states using data on 5,492 MESA participants (N=607 with diabetes at baseline, median follow-up 8.6 years). To generate individualized transition probabilities, we used Cox regression of coronary heart disease, heart failure, stroke, and competing death with age as time scale. Microsimulations were based on baseline risk factors (sex, ethnicity, smoking, diabetes, bp, lipids, BMI, CAC) with incident diabetes (N=610), CAC and CVD as transient states. We compared predicted with observed 9-year risks and calculated C-statistics.

Results: Our model showed good calibration and discriminative performance across the various outcomes in the MESA cohort at 9 years (Table).

Conclusion: We developed a new microsimulation model that will be used to evaluate long-term cost effectiveness of CAC-based risk assessment in diabetes. Validity will be further evaluated in independent external data.

Disclosure

B. Ferket: None. M. Hunink: None. U. Masharani: Research Support; Self; Clementia Pharmaceuticals. W. Max: None. K. Fleischmann: None.

Funding

American Diabetes Association (1-18-ICTS-041 to K.F.)
1316-P: Adiponectin-Related Genetic Variation and Dietary Pattern Associations with Metabolic Health in Children across Weight Status: From a Large Cohort Study
Authors: GAO SHAN , LI GE , WILLI STEVEN M. , GROUP BCAMS STUDY , LI MING
Published: June 2019

Adiponectin and related genetic variants are associated with adipose tissue function and cardio-metabolic risks. Moreover, dietary patterns affect metabolic health partly through modulating secretion of adiponectin from adipose tissue. We aimed to examine interactions between adiponectin related genetic variants and dietary patterns on metabolic health in different weight status. Childhood lifestyle factors, adiponectin and six related genetic variants (loci in/near ADIPOQ, CDH13, WDR11FGF, CMIP and PEPD) from GWAS were assessed in 3,482 children aged 6-18 years from BCAMS cohort in 2004. In 2015, 352 of these individuals completed an in-depth follow-up examination. Being metabolically unhealthy was defined as having any metabolic syndrome component or a HOMA-IR≥3.0. In multiple models, rs6773957 at ADIPOQ locus (OR=1.25, 95% CI=1.08-1.46, P =0.004) and rs4783244 at adiponectin receptor CDH13 locus (OR=0.83, 95% CI =0.70-0.98, P =0.025) were significantly correlated with metabolic risks independent of adiponectin levels and life-style factors in normal weight children, and these associations were less obvious in overweight/obesity group. Moreover, we observed a significant interaction effect between rs6773957 and dietary patterns (P =0.008) for metabolic health in normal weight children. The adiponectin-decreasing allele at rs6773957 locus was associated with greater metabolic risks in response to unfavorable dietary patterns, while no significant genotype effect was found in healthy dietary patterns. Similar interaction was found in the subgroup analysis using longitudinal data (P=0.033).

In conclusion, healthy dietary patterns might affect adiponectin gene expression, which may particularly improve adipose tissue function and metabolic health independently of weight change. ADIPOQ locus confers more metabolic risks in healthy dietary patterns when contrasted with adverse dietary patterns.

Disclosure

S. Gao: None. G. Li: None. S.M. Willi: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Roche Diagnostic USA. Research Support; Self; Jaeb Center for Health Research, National Institute of Allergy and Infectious Diseases, Sanofi-Aventis. Other Relationship; Self; National Institute of Diabetes and Digestive and Kidney Diseases. M. Li: None.

Funding

National Key Research and Development Program of China (2016YFC1304801); Key Program of Beijing Municipal Science & Technology Commission (D111100000611001, D111100000611002); Beijing Natural Science Foundation (7172169); Beijing Science & Technology Star Program (2004A027); Novo Nordisk (2011A002); National Key Program of Clinical Science (WBYZ2011-873); Chinese Academy of Medical Sciences (2017PT32020, 2018PT32001); Jingxi Scientific Program of Beijing Chaoyang Hospital (JXPY201606)
1324-P: Glucose Metabolism among Obese and Nonobese Children of Mothers with Gestational Diabetes
Authors: LU JUN , GU YUYING , WANG LEISHEN , LI WEIQIN , ZHANG SHUANG , LIU HUIKUN , LENG JUNHONG , LIU JIN , WANG SHUO , HOU LIFANG , BACCARELLI ANDREA , HU GANG
Published: June 2019

Abdominal obesity is more closely associated with diabetes than general obesity in adults, however, it is unknown which kind of obesity is more closely associated with abnormal glucose metabolism in children. We recruited 973 children of mothers with prior gestational diabetes mellitus (GDM). Children’s height, weight, waist circumstance, fasting glucose and insulin were measured using standardized methods. Logistic regression models were used to assess the single and joint associations of general and abdominal obesity with the risks of hyperglycemia (the upper quartile of fasting glucose), insulin resistance (the upper quartile of HOMA-IR), and β-cell dysfunction (the lower quartile of HOMA-% β). Compared with normal weight children, children with general overweight/obesity had higher levels of HOMA-IR and HOMA-%β, higher odds ratios for hyperglycemia (1.56, 95% confidence intervals [CIs] 1.06-2.30) and insulin resistance (3.44, 95% CI 2.32-5.09), and a lower odds ratio for β-cell dysfunction (0.65, 95% CI 0.41-1.04). Children with abdominal obesity had increased insulin resistance (2.54, 95% CI 1.71-3.76) but not hyperglycemia and β-cell dysfunction compared with normal weight children. In the joint analyses, children with general overweight only or with both general and abdominal obesity but not with abdominal obesity only had increased hyperglycemia and insulin resistance compared with normal weight children. General obesity was more closely associated with major abnormal glucose metabolism than abdominal obesity in children of mothers with GDM.

Disclosure

J. Lu: None. Y. Gu: None. L. Wang: None. W. Li: None. S. Zhang: None. H. Liu: None. J. Leng: None. J. Liu: None. S. Wang: None. L. Hou: None. A. Baccarelli: None. G. Hu: None.

Funding

Tianjin Women’s and Children’s Health Center; Tianjin Public Health Bureau; European Foundation for the Study of Diabetes/Chinese Diabetes Society; Lilly Program for Collaborative Research between China and Europe; National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100790 to G.H.); National Institute of General Medical Sciences (U54GM104940 to G.H.)
1339-P: Ratio of Visceral-to-Subcutaneous Fat Area Is Different between Simple Obesity and Type 2 Diabetes in Adolescents
Authors: ABE YURIKO , URAKAMI TATSUHIKO , YOSHIDA KEI , AOKI MASAKO , HARA MITSUHIKO , MORIOKA ICHIRO
Published: June 2019

Background: Visceral fat accumulation is strongly associated with type 2 diabetes (T2DM). In contrast to visceral fat, subcutaneous fat might even be beneficial against metabolic abnormalities.

Objective: To investigate the association between simple obesity or T2DM and the ratio of visceral fat area (VFA) to subcutaneous fat area (SFA) (V/S ratio) in Japanese adolescents.

Design/Methods: An age- and sex-matched retrospective study was conducted in Tokyo Metropolitan Hiroo Hospital, Nihon University Hospital, and Nihon University Itabashi Hospital with ethics approval. Sixty-one adolescents with simple obesity or T2DM aged 10 to 15 years who have been visiting in these outpatient clinics between 2002 and 2018 were enrolled in this study. Simple obesity was defined as BMI ≥95%ile but without T2DM. VFA and SFA were investigated using CT at the umbilical levels. Subjects were classified into 2 groups: simple obesity group (n=38) and T2DM group (n=23).

Results: Comparisons between the 2 groups are shown in Table 1. In simple obesity group, ALT, TC, HDLC or non-HDLC levels were significantly different that those in T2DM group. SFA and V/S ratio in simple obesity group were significantly higher and lower than those in T2DM group, respectively.

Conclusion: V/S ratio is different between simple obesity and T2DM in Japanese adolescents. V/S ratio is the most useful predicter of T2DM in adolescents.

Disclosure

Y. Abe: None. T. Urakami: None. K. Yoshida: None. M. Aoki: None. M. Hara: None. I. Morioka: None.
134-OR: Effects of Tirzepatide (TZP), a Novel Dual GIP and GLP-1 Receptor Agonist, on Biomarkers of Nonalcoholic Steatohepatitis (NASH) in Patients with T2D
Authors: HARTMAN MARK L. , SANYAL ARUN , LOOMBA ROHIT , WILSON JONATHAN M. , BRAY ROSS , NIKOOIENEJAD AMIR , DUFFIN KEVIN L. , ROBINS DEBORAH A. , HAUPT AXEL
Published: June 2019

Nonalcoholic fatty liver disease (NAFLD) is common in T2D patients and increases the risk of NASH and cirrhosis. In a Phase 2 trial, TZP significantly reduced HbA1c and body weight at 26 weeks (≥ 37% achieved 10% weight loss at 2 highest doses). Patients with T2D were randomly assigned (1:1:1:1:1:1) to receive either once-weekly sc TZP (1, 5, 10, or 15 mg), dulaglutide (1.5 mg), or placebo for 26 weeks. Because of the overlap of T2D and NAFLD populations, we measured several NASH related biomarkers to explore whether TZP may have potential efficacy in NASH. These included: ALT, AST, Keratin-18 M30 fragment (K-18, apoptosis marker; Peviva), Pro-C3 (fibrosis marker, a fragment of the NH2-terminal propeptide of type III procollagen; Nordic Bioscience), and adiponectin (adipokine that protects liver from inflammation and fibrosis; Pacific Biomarkers). Results (Table) were analyzed in a modified intent-to-treat population using a mixed model for repeated measures. Significant (p<0.05) decreases from baseline with TZP occurred in ALT (all doses), AST (1, 5, 15 mg), K-18 (5, 10, 15 mg) and Pro-C3 (15 mg); decreases were significant for TZP vs. placebo in K-18 (10 mg) and Pro-C3 (15 mg), and for TZP vs. dulaglutide in ALT (10, 15 mg). Increases in adiponectin with TZP were significant compared to placebo for 10 and 15 mg. Further evaluation of TZP in patients with NASH is warranted.

Disclosure

M.L. Hartman: Employee; Self; Eli Lilly and Company. A. Sanyal: Consultant; Self; Ardelyx, Boehringer Ingelheim Pharmaceuticals, Inc., Exhalenz, Gilead Sciences, Inc., Hemoshear, Intercept Pharmaceuticals, Inc., Lilly, Mallinckrodt Pharmaceuticals, Nimbus Therapeutics, Nitto Denko, Novartis Pharmaceuticals Corporation, Pfizer Inc. Employee; Self; Sanyal Bio. Research Support; Self; Bristol-Myers Squibb Company, Conatus Pharmaceuticals Inc., Echosens, Galectin Therapeutics Inc., Immuron Ltd, Merck & Co., Inc., Salix Pharmaceuticals, Sequanna. Stock/Shareholder; Self; Akarna Therapeutics, GENFIT, Natural Shield, NewCo LLC, Tiziana. Other Relationship; Self; Elsevier, UpToDate. R. Loomba: Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc. J.M. Wilson: Employee; Self; Eli Lilly and Company. R. Bray: Employee; Self; Eli Lilly and Company. A. Nikooienejad: Research Support; Self; Eli Lilly and Company. K.L. Duffin: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Pfizer Inc. D.A. Robins: Employee; Self; Eli Lilly and Company. A. Haupt: Employee; Self; Lilly Diabetes. Stock/Shareholder; Self; Lilly Diabetes.

Funding

Eli Lilly and Company
1343-P: A Comparison of C-Peptide and Glucose Responses between Children and Adolescents Who Progress to Type 1 Diabetes (T1D)
Authors: ISMAIL HEBA M. , NATHAN BRANDON M. , PALMER JERRY P. , DIMEGLIO LINDA , SOSENKO JAY M.
Published: June 2019

Type 1 diabetes is a heterogeneous disease with differences in β-cell dysfunction and rates of progression. We thus assessed whether there are differences in C-peptide and glucose responses during 2-hour oral (OGTTs) and intravenous (IVGTTs) glucose tolerance tests between children and adolescents at high risk for T1D. Data from the Diabetes Prevention Trial-type 1 (DPT-1) study participants who progressed to T1D was used for the analysis. We compared C-peptide and glucose responses between children (<10.0 years old; 7.1±1.9 years; n=125) and adolescents (10.0 years to <18.0 years old; 12.8±2.2 years; n=94). The risks for T1D were similar between the children and adolescents (mean 3-year T1D estimates from DPT-1 Risk Score: 63% and 56% respectively), as was the time to diagnosis (2.4±2.1 years vs. 2.5±2.2 years, respectively). Adolescents had higher OGTT derived AUC C-peptide levels (3.8±1.5 ng/ml vs. 1.9±1.4 ng/ml; p<0.001 with BMIZ adjustment), whereas their AUC glucose levels were similar to children (138.6±25.1 mg/dl vs. 139.6±22.8 mg/dl). The 0 to 30 minute C-peptide response from baseline OGTTs was significantly higher among adolescents compared to children (2.6±1.6 vs. 2.1±1.2, p=0.004 with BMIZ adjustment). However, C-peptide and glucose changes for each subsequent 30-minute OGTT interval were nearly identical between the children and adolescents. Similar to the 0 to 30 minute C-peptide response, the first-phase insulin response from baseline IVGTTs was higher in adolescents (114.1±74.0 µU/ml vs. 88.6±59.9 µU/ml; p<0.001 with BMIZ adjustment).

In conclusion, the findings showed that despite a lower early insulin response in children, OGTT glucose levels were not higher. This suggests increased insulin sensitivity. The findings also showed that despite the lower early insulin response, the time to diagnosis did not differ. Other aspects of insulin responsiveness, and perhaps sensitivity, appear to also determine the progression rate to T1D.

Disclosure

H.M. Ismail: None. B.M. Nathan: None. J.P. Palmer: None. L. DiMeglio: Research Support; Self; Amgen Inc., Caladrius Biosciences, Inc., Janssen Research & Development, Medtronic, Sanofi. Other Relationship; Self; Dexcom, Inc. J.M. Sosenko: None.

Funding

National Institutes of Health
1352-P: Ancestry Affects Biomarkers of Pediatric Type 1 Diabetes
Authors: KELLER NANCY , FULLER KEELY E. , SHUM BETTY J. , NOBLE JANELLE
Published: June 2019

Presentation of type 1 diabetes (T1D) appears to differ among patients with different ancestries. In this study, medical record data were taken from type 1 diabetes patients, diagnosed from 2010 to 2017 at a single site, UCSF Benioff Children’s Hospital Oakland (BCHO). Patients were grouped into ancestry classes based on medical records. European (EUR; n = 81), Hispanic (HIS; n = 84), and African (AFR; n = 48) groups were compared for C-peptide levels at diagnosis and for levels of four autoantibodies (aAb); insulin (IAA), protein phosphatase-like IA-2 (IA-2A), glutamic acid decarboxylase (GADA), and zinc transporter (ZnT8A). All aAb measurements were performed at a single reference laboratory in Denver. The proportion of patients with no evidence of any aAb was similar in EUR and AFR groups (5% and 4%, respectively) but higher in HIS (14%). For up to three aAb, the number of aAb was correlated with the number of patients in the EUR (r = 0.96; p = 0.039) and AFR (r = 0.96; p = 0.038) groups but not in the HIS group (r = 0.58; p = 0.24). The pattern of autoantibody positivity differed among groups; most prevalent were IA-2A in EUR (75%), GADA in AFR (75%), and both IA-2A and GADA (both at 68%) in HIS. Differences in aAb patterns did not reach statistical significance but were consistent with published reports. As expected, C-peptide levels were below the normal range in the EUR group, regardless of aAb positivity. In contrast, in the HIS group, mean C-peptide levels were in the normal range for patients with up to three positive aAb; only HIS patients with all four aAb positive had C-peptide levels below the normal range. The AFR group was similar to the EUR group, with below normal C-peptide levels, except that the subset of AFR patients with a single positive aAb had C-peptide in the normal range. Observed differences in C-peptide mean and median values were significant between HIS and EUR groups (mean p = 0.013; median p = 0.046). Differences in biomarkers between HIS and EUR T1D patients may have implications for both differential diagnosis and management of T1D.

Disclosure

N. Keller: None. K.E. Fuller: None. B.J. Shum: None. J. Noble: Employee; Spouse/Partner; Roche Diagnostic USA.
1360-P: Increase in Diabetic Ketoacidosis at Diagnosis of T1D in Colorado Children, 2010-2017
Authors: ALONSO GUY T. , COAKLEY ALEXANDER , PYLE LAURA , MANSEAU KATHERINE , THOMAS SARAH , REWERS MARIAN , REWERS ARLETA
Published: June 2019

Diabetic ketoacidosis at diagnosis of T1D in children is associated with high cost, higher long-term A1c, and complications. Due to delayed access to medical care, DKA in Colorado increased from 30% in 1998 to 46% in 2012. The rate in most developed countries is <30%. To examine a potential effect of the Affordable Care Act’s overhaul of the U.S. healthcare on the prevalence of DKA at diagnosis, we reviewed records of Colorado residents <18 years old who were diagnosed with T1D in 2010-17 and subsequently followed at the Barbara Davis Center for Diabetes. They account for >80% of children with T1D in Colorado. From 2010-2017, 2137 subjects met inclusion criteria. The rate of DKA rose from 40% to 60%, doubling among privately insured, but increased less among children with public insurance (Figure). In a univariate, unadjusted regression analysis, race/ethnicity other than non-Hispanic white (p<.01), public insurance (p<.0001), and rural residence (p=.02) were associated with higher risk for DKA. Gender and primary language other than English were not significantly associated with DKA. There was a bimodal distribution by age. By 2017, 60% of children presented with DKA. The increase was pronounced in patients with private insurance. This setback paradoxically occurred during a time of increasing health insurance coverage. More study needs to be done to understand what factors are driving these changes.

Disclosure

G.T. Alonso: None. A. Coakley: None. L. Pyle: None. K. Manseau: None. S. Thomas: None. M. Rewers: None. A. Rewers: None.
1363-P: Cyber School: A Marker of High-Risk Youth with Diabetes?
Authors: MARCH CHRISTINE , SIMINERIO LINDA M. , MILLER ELIZABETH , LIBMAN INGRID
Published: June 2019

For many youth with diabetes, school provides a structured and supervised environment for diabetes management. Cyber school is a recent alternative in many states with variable supervision. To our knowledge, no information is available on characteristics of youth with diabetes enrolled in cyber school. We identified 142 youth followed in a large academic diabetes center between 2014-2018. Medical records were reviewed for demographic, anthropometric, clinical, and laboratory data from their first visit after cyber enrollment. The vast majority, 130 (92%), had T1D and were white, 127 (90%). Mean age was 14.0±3.4 years with a duration of diabetes of 5.1±4.3 years. Most, 74 (53%), entered cyber in grades 9-12. Reasons for enrollment were documented for 91 (64%), with medical concerns being the most common, 28 (31%). Forty percent were overweight or obese. Most were managed with multiple daily injections, 104 (73%), compared with insulin pumps, 32 (23%), or other regimens. Very few, 8 (6%), utilized continuous glucose monitors. Mean hemoglobin A1c (HbA1c) for those diagnosed two or more years was 9.4±2.1%, and only 17, (18%), of those youth met the glycemic target of a HbA1c ≤ 7.5%. Dyslipidemia (LDL-cholesterol >100 mg/dL) was highly prevalent at 37%; of those, mean LDL was 131±22 mg/dL. Depression was present in 38/84 (45%) screened youth over age 12 years. Missed clinic visits were common; 76 (54%) missed two or more visits in the 12 months before or after enrollment. Mean HbA1c was significantly higher in those missing two or more visits compared with 0-1 visits (9.4±0.3 vs. 8.0±0.3, p-value<0.01), adjusting for age and duration of diabetes. Mean HbA1c increased with additional visits missed. To our knowledge, this is the first description of youth with diabetes in cyber school. They were characterized by poor glycemic control, limited use of devices, a high prevalence of comorbidities, and poor follow-up. This represents a unique group of high-risk patients who may benefit from additional interventions to ensure adequate follow-up.

Disclosure

C. March: None. L.M. Siminerio: None. E. Miller: None. I. Libman: Consultant; Self; Novo Nordisk Inc.
1369-P: Continuous Glucose Monitoring Interventions in Toddlers with Type 1 Diabetes (T1D)
Authors: LANNING MONICA S. , DIMEGLIO LINDA , LANGE SAMANTHA , DRISCOLL KIMBERLY A. , HANNON TAMARA S. , LAGGES ANN M. , WOERNER STEPHANIE , BUCKINGHAM BRUCE A. , HOOD KOREY K.
Published: June 2019

Introduction: Achieving optimal glycemic control is difficult in children with T1D even with insulin pumps and continuous glucose monitoring (CGM). Additional support focused on improving technology use may improve diabetes management.

Methods: Children aged 2-6 years were enrolled in a 6-month adaptive study design (SMART) utilizing Dexcom G5 CGM. Monthly data were collected to assess time in range (70-180mg/dL) and adherence. If time in range was <60% or adherence was <6 of 7 days worn, participants’ families randomized to one of four interventions focusing on diabetes distress, developmental demands, fear of hypoglycemia, or remote monitoring. Parents completed surveys on diabetes distress, glucose monitoring satisfaction, hypoglycemia fear and confidence at enrollment and study end. HbA1c was collected at study initiation and study end.

Results: Of 77 participants, 52.6% were male, mean age 4.94 ± 1.42y (2.03-7.00), diabetes duration 2.12 ± 1.13y (0.58-4.26). Each participant received an average of 3 intervention sessions. HbA1c decreased and psychological outcomes improved at statistically and clinically significant levels (Table).

Conclusion: Providing interventions that address common diabetes management problem areas may help parents of young children with T1D improve glucose control and quality of life. More work is needed to identify which interventions were associated with the greatest benefit.

Disclosure

M.S. Lanning: None. L. DiMeglio: Research Support; Self; Amgen Inc., Caladrius Biosciences, Inc., Janssen Research & Development, Medtronic, Sanofi. Other Relationship; Self; Dexcom, Inc. S. Lange: Other Relationship; Self; Medtronic MiniMed, Inc. K.A. Driscoll: None. T.S. Hannon: Advisory Panel; Self; Eli Lilly and Company. A.M. Lagges: None. S. Woerner: None. B.A. Buckingham: Advisory Panel; Self; ConvaTec Inc., Novo Nordisk Inc., Profusa, Inc. Consultant; Self; Medtronic MiniMed, Inc. Research Support; Self; Beta Bionics, ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Medtronic MiniMed, Inc., Tandem Diabetes Care. Other Relationship; Self; Insulet Corporation, Tandem Diabetes Care. K.K. Hood: Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc. Speaker's Bureau; Self; Johnson & Johnson Diabetes Institute.

Funding

National Institutes of Health
1375-P: Acquisition of Self-Care in Youth with Type 1 Diabetes (T1D) Varies by Age and Task
Authors: LA BANCA REBECCA O. , VOLKENING LISA K. , LAFFEL LORI M.
Published: June 2019

Aim: In childhood, there is gradual transition of T1D tasks from parents to youth. To assess acquisition of self-care by age, we examined parent report of responsibility across task domains in youth ages 5-18 years.

Methods: Parents of youth with T1D completed the Diabetes Family Responsibility Questionnaire using 3 response options (mainly parent, shared, mainly youth) across 5 T1D domains: Nutrition, Monitoring, Insulin, Communication, and Health Surveillance. Analyses included 3 age groups: 5-10 (Elementary School [ES]), 11-14 (Early Adolescence [EA]), and 15-18 (Late Adolescence [LA]).

Results: Youth (N=148, 50% male) were 12.9±3.2 [X±SD] years, with T1D duration 6.2±3.6 years; 60% pump treated, BG checks 5.6±2.9 X/day, A1c 8.4±1.3%. Parents were 84% mothers, 92% white, 83% married, and 63% college educated. Parent report of youth self-care varied by age and task (Figure). Youth self-care increased as age and T1D duration increased (p<.001). Self-care in Nutrition began in ES, followed by Monitoring and Insulin in EA, and Communication in LA. Health Surveillance (e.g., sick day care) remained mainly under parent care for majority in ES, EA, and LA. In all youth, more parent involvement was related to lower A1c (p<.03).

Conclusion: Recognizing and supporting youth during acquisition of self-care, especially for Nutrition, BG Monitoring, and Insulin, may help to prevent glycemic deterioration later in childhood/adolescence.

Disclosure

R.O. La Banca: None. L.K. Volkening: None. L.M. Laffel: Advisory Panel; Self; Lilly Diabetes, Novo Nordisk A/S, Roche Diabetes Care, Sanofi. Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Janssen Pharmaceuticals, Inc., UpToDate.

Funding

National Institutes of Health (P30DK036836)
1376-P: Glucose-Independent Racial Disparity in HbA1c Is Present at Onset of Type 1 Diabetes (T1D)
Authors: ALAQEEL AQEEL , CHALEW STUART
Published: June 2019

Introduction: HbA1c is an important guide for management, diagnosis and prediction of complications in diabetes. We have shown that young black patients with established T1D have higher HbA1c than white patients even after adjustment for mean blood glucose, RBC indices, age, and gender. We hypothesized that glucose-independent racial disparity in HbA1c is also present at diagnosis of T1D.

Methods: Data was collected by chart review for self-identified white and black patients who presented between Jan 2012 and Nov 2018 to the Hospital ER with untreated new onset T1D. Analyte data is from initial blood sample. Data was collected for date of birth, sex, self-identified race, weight, height, glucose, HbA1c, pH, bicarbonate, insulin, C-peptide, pancreatic autoantibodies, RBC indices. Simple correlation and comparison of means between groups was performed. This followed by multiple variable regression modeling to test the statistical effect of race, gender, age, glucose, RDW-CV and other variables on HbA1c.

Results. We included 191 children with newly diagnosed T1D (69 blacks and 122 whites; 116 M, 75 F). HbA1c was correlated with glucose, insulin, c-peptide, age, RDW-CV, Hb, HCO3. blacks had higher HbA1c 11.9 ±1.9 vs. whites 11.04±2 (P=0.004), higher glucoses 530.6±230.4 vs. 441.9±211.3 mg/dL (P=0.0075), lower C-peptides 0.57± 0.42 vs. 0.76±0.61 ng/mL (P=0.019) and lower pH 7.28±0.15 vs. 7.33±0.12, (P=0.02). There was no statistical difference in age, BMI-z, HCO3 or insulin between the groups. After adjusting for age, sex, glucose, C-peptide and RDW-CV, HbA1c is still higher in blacks, P=0.037. Age, gender, glucose, C-peptide and RDW-CV were also significant covariates in the model.

Conclusions. 1- HbA1c at presentation is influenced by Race, glucose, age, sex, RDW-CV, and c-peptide 2- Even after adjustment for glucose blacks have higher HbA1c than whites 3- Glucose-independent HbA1c racial difference should be taken into account for purposes of diagnosis and management of T1D.

Disclosure

A. Alaqeel: None. S. Chalew: None.
1377-P: Driving Behaviors in Adolescents with Type 1 Diabetes
Authors: ROBERTS ALISSA J. , MOSS ASHLEY , YI-FRAZIER JOYCE
Published: June 2019

Adolescents and adults with type 1 diabetes (T1D) are advised to take precautions when driving to prevent impairment due to hyper/hypoglycemia. Literature shows many adults with T1D do not use proper precautions to avoid glycemic excursions when driving, yet no known studies have examined this in adolescents with T1D. Adolescents may be at elevated risk due to risk-taking behavior associated with this age. The goal of this study is to describe driving related behaviors in adolescents with T1D. Data was collected from 53 adolescents seen in the diabetes clinic between 6/2017 and 12/2018. Driving behaviors were assessed via electronic intake form prior to the clinic visit and reviewed before providers saw patients. Of these 53 participants, 47% were female, average age was 19.4 years (SD 1.5), 53% were on CGM, and 60% were on an insulin pump. Forty-two percent reported checking their blood sugar rarely or never within 30 minutes before driving. If they had a glucose <70 mg/dL prior to driving, 47% reported waiting until a recheck glucose (after treatment) is > 70 mg/dL before driving. Only 40% reported pulling over their vehicle, treating, and waiting until their glucose was >70 mg/dL if experiencing hypoglycemia while driving or being alerted they were becoming hypoglycemic via their CGM. Seventy percent reported always having a source of rapid acting glucose available when driving. In the past month, 43% had a low blood glucose while driving. Further, 11% reported driving within a few hours of consuming alcohol, 9% reported driving while feeling the effects of alcohol or other drugs, 13% reported driving within a few hours of using marijuana, and 47% reported texting while driving. Results demonstrate many adolescents with T1D are not using safe driving practices, particularly around preventing and treating hypoglycemia, which can cause significant cognitive-motor impairment. Furthermore, many adolescents reported unsafe behaviors around substance use prior to driving and texting while driving.

Disclosure

A.J. Roberts: None. A. Moss: None. J. Yi-Frazier: None.
1378-P: Gluten-Free Diet in Children with Recent-Onset Type 1 Diabetes without Coeliac Disease: A 12-Month Intervention Trial
Authors: NEUMAN VÍT , PRUHOVA STEPANKA , KULICH MICHAL , KOLOUŠKOVÁ STANISLAVA , VOSAHLO JAN , ROMANOVA MARTINA , PETRUZELKOVA LENKA , OBERMANNOVA BARBORA , CINEK ONDREJ , SUMNIK ZDENEK
Published: June 2019

Objectives: Data on the role of gluten in type 1 diabetes (T1D) are scarce. We aimed to test whether gluten-free diet (GFD) can decelerate the decline in beta-cell capacity in newly diagnosed non-celiac T1D children.

Methods: Forty-six children (aged 10.2±3.3 years) were recruited into this non-randomized self-selected intervention trial: 26 started with GFD whereas 20 remained on standard diet. Main outcomes were the decline in C-peptide area under the curve (AUC) in mixed-meal tolerance tests and the differences in insulin dose, insulin dose adjusted A1c (IDAA1c) and HbA1c at 12 months. Data were analyzed as intention-to-treat by linear regression models adjusted for baseline parameters. The adherence to GFD was tested by immunoreactive gluten in stool.

Results: Mean decrease in C-peptide AUC was 293 vs.484 pmol/L (p=0.3) at 6 months, and 567 vs. 919 pmol/L (p=0.1) at 12 months in GFD and control group, respectively. The GFD group had a lower insulin dose by 0.22 U/kg/day (p=0.007), lower IDAA1c by 1.5 (p=0.003) and lower mean HbA1c by 7.5 mmol/mol (p=0.01) at 12 months (Figure 1). There was no difference in daily carbohydrate intake between the groups (p=0.4). Immunoreactive gluten was found in the stool of only 3 patients.

Conclusions: GFD kept over the first year after T1D diagnosis was associated with lower insulin demand and lower HbA1c, although the groups did not differ in the C-peptide dynamics.

Disclosure

V. Neuman: None. S. Pruhova: None. M. Kulich: None. S. Koloušková: None. J. Vosahlo: None. M. Romanova: None. L. Petruzelkova: None. B. Obermannova: None. O. Cinek: None. Z. Sumnik: None.

Funding

Ministry of Health of the Czech Republic (16-27994A)
1379-P: Type 1 Diabetes Mellitus and Periodontal Disease—Relationship with Pubertal Stage and Glycaemic Control
Authors: CHAKRABORTY PAMPITA , GHOSH SUJOY
Published: June 2019

Background and Aims: Periodontal disease (PD) has been considered as the sixth complication of diabetes (DM). It has also been suggested that PD may worsen glycemic control. The present study has been designed to establish correlation between periodontal health status with pubertal stage and metabolic control in type 1 diabetes (T1D).

Methodology: Oral hygiene index (OHI), gingival index (GI), probing pocket depth (PPD) and clinical attachment loss (CAL) were recorded in subjects with T1D (110) and healthy siblings (22). Duration, age, HbA1c and presence of microvascular complications was documented.

Result: GI (p=0.044) and PPD (p=0.013) was worse in the cases vs. the controls. Greater PPD (p=0.026) in cases vs. the controls in stage II-IV puberty was seen and both worsening GI (p=0.038) and greater PPD (p=0.027) in the cases vs. controls in stage V despite better OHI (p=0.040). Pubertal staging revealed no difference in any of the studied dental parameters in stage 1. A binary logistic regression model with age, HbA1c and duration of DM as independent continuous variables, detected HbA1c as a significant predictor of PD. HbA1c along with stage of puberty rather than duration of DM and chronological age were found as important predictor of PD. PD was significantly associated with markers of nephropathy and neuropathy. Both the PPD and GI were found to have significant positive correlation with vibration perception threshold and microalbuminuria in the cases. A positive correlation was observed between HbA1c levels and albumin creatinine ratio (ACR) levels, p=0.010.

Conclusion: T1D was more likely to develop PD compared to healthy siblings. Onset and progression of puberty and poorer glycaemic control, rather than duration of DM was associated with greater risk of PD. PD was more likely to be associated with markers of microvascular disease.

Disclosure

P. Chakraborty: None. S. Ghosh: None.

Funding

Department of Science & Technology, Government of India, West Bengal; Research Society for the Study of Diabetes in India