bluuebunny/crossref_metadata_2025 huggingface dataset:
1581-P: Increase of Diabetes and Obesity among Descendants of First-Generation Filipino Immigrants to Italy
Authors: PIERALICE SILVIA , TORO ROSSELLA DEL , KHAZRAI YEGANEH MANON , MADDALONI ERNESTO , MAURIZI ANNA RITA , MANFRINI SILVIA , POZZILLI PAOLO
Published: June 2019

Aims: Filipino people are one of the largest immigrant populations in Italy. Aim of this study was to assess differences in T2D, prediabetes and obesity between native Italians and Filipino immigrants living in Rome. Changes in metabolic characteristics and dietary habits between first-generation immigrants and their descendants were examined.

Methods: A cross-sectional survey was carried out adopting principles of community-based participatory research. A total of 132 first-generation Filipinos aged 35-60 years resident in Rome for ≥ 5 years, 164 age and sex-matched native Italians and 27 descendants of the first-generation immigrants aged 10-18 years were studied. Diabetes history and dietary habits were investigated by standardized questionnaires; anthropometrics, blood pressure and fasting capillary blood glucose were measured.

Results: T2D, impaired fasting glucose and obesity were all more prevalent among first-generation immigrants (13.5%, 35.4% and 41.7% respectively) than Italians (7.2%, 22.6% and 36.8%). Descendants showed higher prevalence of overweight and obesity (48.1%) than first-generation immigrants (p<0.05). First-generation immigrants consumed traditional food more days per week compared to their descendants, who preferred western food, with a large consumption (>4 times/week) of eggs (96%), processed meat (74%) and sweet foods or beverages (96%). Body Mass Index was directly related to years spent in Italy (r=0.19, p=0.03) and educational level (r=0.19, p=0.04). Size of household was directly related to weight gain in first-generation immigrant women (r=0.40, p<0.001).

Conclusion: This survey reveals a higher prevalence of diabetes and its risk factors among the Filipino community resident in Rome. Obesity prevalence is higher in the second-generation, probably due to unhealthy changes in dietary pattern. These alarming data stress the need of appropriate health programs addressed to the minority groups immigrating in western countries.

Disclosure

S. Pieralice: None. R. Del Toro: None. Y. Khazrai: None. E. Maddaloni: Speaker's Bureau; Self; Merck & Co., Inc., Pikdare. A. Maurizi: Consultant; Self; AstraZeneca. S. Manfrini: None. P. Pozzilli: None.
159-LB: Relationship between Hypoglycaemia (Hypo), Outcomes and Empagliflozin (EMPA) Treatment Effect in EMPA-REG OUTCOME
Authors: ZINMAN BERNARD , FITCHETT DAVID H. , MATTHEUS MICHAELA , WANNER CHRISTOPH , GEORGE JYOTHIS T. , VEDIN OLA , INZUCCHI SILVIO E. , JOHANSEN ODD ERIK
Published: June 2019

In EMPA-REG OUTCOME, EMPA in 7020 patients with type 2 diabetes mellitus and CV disease significantly reduced 3P-MACE (14%), CV death (38%), all-cause death (32%) and heart failure hospitalization (HHF) (35%.) In addition, HbA1c was reduced but not associated with increased hypo. We investigated the relationship between on-trial hypo with a range of CV outcomes, using adjusted Cox regression models with time-varying covariate for hypo. We employed two hypo definitions: HYPObroad: time to first symptomatic hypo adverse event (AE) with plasma glucose [PG] ≤ 70mg/dL, any hypo AE with PG < 54mg/dL, or severe hypo AE. HYPOstrict: hypo AE with PG < 54mg/dL, or severe hypo AE.

HYPObroad occurred in 28% of participants in each group, whereasHYPOstrict in 19%.In the placebo group, hypo was associated with an increased risk of HHF using both HYPObroad (HR 1.91, [95% CI: 1.25, 2.93], Fig A) or HYPOstrict (1.72 [1.06, 2.78]) and for myocardial infarction (MI) using only HYPObroad (1.56 [1.06, 2.29], Fig A.) EMPA reduced 3P-MACE, CV and all-cause death, and HHF, regardless of occurrence (Fig B) or severity of hypo (p-for interactions > 0.05).

In conclusion, in this post hoc analysis, hypo was associated with an increased risk of MI and HHF but no other investigated CV outcomes. Hypoglycemia did not influence the cardio-protective effect of EMPA.

Disclosure

B. Zinman: Advisory Panel; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc. Consultant; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc. D.H. Fitchett: Speaker’s Bureau; Self; Boehringer Ingelheim International GmbH, Lilly Diabetes. Other Relationship; Self; Boehringer Ingelheim International GmbH, Novo Nordisk A/S. M. Mattheus: Employee; Self; Boehringer Ingelheim Pharma GmbH&Co.KG. C. Wanner: Advisory Panel; Self; Bayer AG, Boehringer Ingelheim International GmbH, Merck Sharp & Dohme Corp. Board Member; Self; Boehringer Ingelheim International GmbH. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly Diabetes, Mitsubishi Tanabe Pharma Corporation. J.T. George: None. O. Vedin: Employee; Self; Boehringer Ingelheim International GmbH. S.E. Inzucchi: Consultant; Self; vTv Therapeutics, Zafgen, Inc. Other Relationship; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Novo Nordisk A/S, Sanofi. O. Johansen: Employee; Self; Boehringer Ingelheim International GmbH.

Funding

Boehringer Ingelheim; Eli Lilly and Company
1595-P: Triglyceride and Glucose (TyG) Index as a Predictor of Mortalities
Authors: KIM KYUNG-SOO , HWANG YOU CHEOL , AHN HONG-YUP , PARK SUNG-WOO , PARK CHEOL-YOUNG
Published: June 2019

Triglycerides and glucose (TyG) index is a useful marker of insulin resistance and a predictor of nonalcoholic fatty liver disease (NAFLD), incident hypertension, cardiovascular events, and subclinical atherosclerosis. The aim of this study was to evaluate the association between TyG index and mortalities in a Korean population using a large health study database. A total of 318,224 subjects (165,131 men and 153,093 women) in the Kangbuk Samsung Health Study cohort were enrolled. A comprehensive annual or biennial health examination was performed to all subjects from 2002 through 2012. Normal glucose tolerance (NGT) was defined as fasting plasma glucose < 100 mg/dL and HbA1c < 5.7%, and having no history of diabetes. The presence of NAFLD was ascertained by ultrasonography in the absence of other known liver diseases. Mortality data (from 2002 through 2012) were derived from the Korea National Statistical Office.The cumulative overall mortality was 0.51% (1,613 deaths) during a median 5.66-year follow-up. In subject with NGT, higher TyG index was associated with an increased risk of death from all causes (HR 1.12; 95% CI 1.03-1.22), cardiovascular disease (HR 1.26; 95% CI 1.02-1.55), and liver disease (HR 1.26; 95% CI 1.02-1.55) but not from cancer, after adjusting for age, sex, and body mass index. In addition, when we have analyzed according to the presence of NAFLD in this group, higher TyG index was only associated with an increased risk of death from all causes in subject without NAFLD (HR 1.16; 95% CI 1.05-1.29). However, there was no significant association between TyG index and mortalities in subject with prediabetes and diabetes. Interestingly, TyG index was associated with overall mortality in subjects with metabolic syndrome (HR 1.31; 95% CI 1.17-1.47) although it was not associated with specific mortalities. In subjects without metabolic syndrome, TyG index was not associated with death from all and specific causes. The TyG index might predict mortalities in subjects with NGT and metabolic syndrome.

Disclosure

K. Kim: None. Y. Hwang: None. H. Ahn: None. S. Park: None. C. Park: None.
1597-P: Incidence of Diabetes in Young Adult South Asians Compared with Pima Indians
Authors: VENKAT NARAYAN K.M. , KONDAL DIMPLE , KOBES SAYUKO , DEEPA MOHAN , DAYA NATALIE R. , PATEL SHIVANI A. , ANJANA RANJIT MOHAN , STAIMEZ LISA R. , ALI MOHAMMED K. , GUJRAL UNJALI , PRABHAKARAN DORAIRAJ , SHIVASHANKAR ROOPA , KADIR MASOOD , SELVIN ELIZABETH , MOHAN VISWANATHAN , HANSON ROBERT L. , TANDON NIKHIL
Published: June 2019

South Asians have a high burden of diabetes at younger ages. We compared diabetes risk in South Asians aged 20-44 years living in India (Delhi and Chennai) and Pakistan (Karachi) with Pima Indians, a population with the world’s highest incidence of diabetes. We analyzed prospective cohort data from the Pima Indian Study (Pima, n=1852), and the Center for Cardiometabolic Risk Reduction in South Asia Study (CARRS, South Asians, n=6676). We defined diabetes as fasting glucose ≥126 mg/dl, HbA1c ≥ 6.5%, or medication use. At baseline, on average, the South Asians were less obese than Pima (BMI, kg/m2: 24.4 vs. 33.8; Waist, cms 82.5 vs.107). Age-standardized diabetes incidence (cases/1000 person-years, 95% CI) was lower in South Asians than in Pima (Men: 14.2, 12.2-16.2 vs. 37.3, 31.8-42.8; Women: 14.8, 13.0-16.5 vs. 46.1, 41.2-51.1). Incidence among 20-24 year old were 80% and 87% lower, respectively, among South Asian men and women, but the risk differential narrowed at older ages (Table). In those with BMI <25 kg/m2, the risk of diabetes was over five times higher in South Asian men than in Pima. Among those with BMI ≥30 kg/m2, diabetes incidence in South Asians was nearly as high as in Pima. Intriguingly, diabetes incidence is higher in nonobese South Asian than in Pima men but not in women. In obese South Asians, diabetes incidence is perilously close to that in the Pima, and is a cause for major concern, as obesity levels continue to rise in South Asia.

Disclosure

K. Narayan: None. D. Kondal: None. S. Kobes: None. M. Deepa: None. N.R. Daya: None. S.A. Patel: None. R. Anjana: None. L.R. Staimez: None. M.K. Ali: None. U. Gujral: None. D. Prabhakaran: None. R. Shivashankar: None. M. Kadir: None. E. Selvin: None. V. Mohan: None. R.L. Hanson: None. N. Tandon: None.

Funding

National Heart, Lung, and Blood Institute; Department of Health and Human Services (HHSN268200900026C); United Health Group, Minneapolis, MN; National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024)
1598-P: Incidence of Diabetes in South Asian Adults in Urban India/Pakistan Compared with Blacks and Whites in U.S.
Authors: VENKAT NARAYAN K.M. , KONDAL DIMPLE , DAYA NATALIE R. , PATEL SHIVANI A. , DEEPA MOHAN , ANJANA RANJIT MOHAN , STAIMEZ LISA R. , GUJRAL UNJALI , KOBES SAYUKO , SHIVASHANKAR ROOPA , ALI MOHAMMED K. , KADIR MASOOD , PRABHAKARAN DORAIRAJ , HANSON ROBERT L. , MOHAN VISWANATHAN , SELVIN ELIZABETH , TANDON NIKHIL
Published: June 2019

Populations in economic transition have a high diabetes prevalence even at lower body mass indices (BMI). We compared diabetes incidence in South Asians ≥45 years in urban India (Delhi and Chennai) and Pakistan (Karachi) with blacks and whites in U.S. Prospective analyses were done using data from the Center for Cardiometabolic Risk Reduction in South Asia Study (CARRS, South Asians, n=3,136), and the Atherosclerosis Risk in Communities Study (ARIC, blacks, n=3,059; whites, n=9,924). We defined diabetes as fasting glucose ≥126 mg/dl, HbA1c ≥ 6.5%, or medication use. South Asians were less obese than blacks and whites (BMI, kg/m2: 24.9 vs. 28.2 vs. 26.0; Waist, cms 87.5 vs.97.5 vs. 95.2). Age-standardized diabetes incidence (cases/1000 person-years, 95% CI) in South Asian men was similar to blacks and 1.6 times than whites (26.0, 22.2-29.8 vs. 26.2, 22.7-29.7 vs. 16.1, 14.8-17.4); and in South Asian women slightly higher than blacks and 3 times than whites (31.9, 27.5-36.2 vs. 28.6, 25.7-31.6 vs. 11.3, 10.2-12.3). In those with BMI <25 kg/m2, the diabetes risk was 2.6 times higher in South Asian men, and 5.3 times in women than in whites. In those with BMI ≥30 kg/m2, diabetes incidence in South Asian men and women were 2.6 and 2.1 times higher than in whites.

Adults in urban India/Pakistan have higher diabetes incidence than U.S. whites. Even nonobese South Asian adults have markedly higher risk of diabetes compared to whites.

Disclosure

K. Narayan: None. D. Kondal: None. N.R. Daya: None. S.A. Patel: None. M. Deepa: None. R. Anjana: None. L.R. Staimez: None. U. Gujral: None. S. Kobes: None. R. Shivashankar: None. M.K. Ali: None. M. Kadir: None. D. Prabhakaran: None. R.L. Hanson: None. V. Mohan: None. E. Selvin: None. N. Tandon: None.

Funding

National Heart, Lung, and Blood Institute; Department of Health and Human Services (HHSN268200900026C); United Health Group, Minneapolis, MN; National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024)
161-OR: Autoantibodies Directed to Deamidated Post-translationally Modified IA-2 Epitopes in Type 1 Diabetes
Authors: ACEVEDO-CALADO MARIA J. , PIETROPAOLO SUSAN , YU LIPING , MICHELS AARON W. , PIETROPAOLO MASSIMO
Published: June 2019

Autoimmune disorders such rheumatoid arthritis (RA) harbor autoantibodies against a variety of post-translationally modified (PTM) proteins. We aimed to investigate whether PTM epitopes of IA-2, a major autoantigen related to type 1 diabetes (T1D), are targeted by autoantibody responses. The extracellular domain of IA-2 (IA-2-ec) was synthesized incorporating deamidated amino acid residues (IA-2ec-PTM) previously found to elicit T cell responses in T1D patients. IA-2ec-PTM was then subjected to immunoprecipitation with sera from T1D patients. Notably, autoantibody reactivity towards IA-2ec-PTM was present in 28% of T1D patients as compared to ~9% of serum reactivity against the native IA-2ec. The area under the ROC curve (ROC AUC) of IA-2ec-PTM autoantibodies revealed that these autoantibodies can adequately distinguish between T1D patient and control groups (ROC AUC: 0.7132; P < 0.0001). Relatives of T1D probands (from the TrialNet Pathway to Prevention Study) carrying both IA-2ec-PTM AAb and the high-risk HLA-DRB1*04-DQB1*03:02 haplotype progressed rapidly to onset of T1D (Stage 3) compared to those relatives who did not carry these immunologic abnormalities (P = 0.003). Understanding the mechanisms underlying PTMs of islet autoantigens, such as IA-2ec-PTM, is critical to develop new research to determine the ability of modified epitopes to induce islet autoimmunity, their potential role as biomarkers of islet cell injury as well as breaking immune tolerance to islet cell antigens through neo-antigen formation.

Disclosure

M.J. Acevedo-Calado: None. S. Pietropaolo: None. L. Yu: None. A.W. Michels: Stock/Shareholder; Self; IM Therapeutics. M. Pietropaolo: None.

Funding

National Institutes of Health
1611-P: Diabetes by Air, Land, and Sea: Effects of Military Deployment on A1c and BMI
Authors: FOLARON IRENE , TRUE MARK W. , WARDIAN JANA L. , KAZANIS WILLIAM H. , TATE JOSHUA M. , SAUERWEIN TOM J. , GRAYBILL SKY , CLERC PHILIP G. , JENKINS CRAIG
Published: June 2019

United States (U.S.) military service members with diabetes (DM) are restricted from working in austere locations due to concerns over potential glycemic decompensation. However, the policies guiding these duty restrictions may be overcautious and are unsubstantiated by systematic analysis. To address this knowledge gap, we conducted a retrospective study characterizing service members with DM who deployed overseas and analyzed changes in their A1c and BMI before and after deployment. In all branches of the U.S. military (Air Force, Army, Marines, Navy), active duty service members with DM completed 11,206 individual deployments lasting ≥90 days between 2004-2017. Of those, 668 (6%) completed a pre- and post-deployment A1c check within 90 days of departure and repatriation. The majority (81.3%) did not have an A1c check before and/or after deployment. For those with A1c values prior to deployment, 64.5% had an A1c < 7%, 20.2% had an A1c between 7-7.9%, 8.4% had an A1c between 8-8.9%, and 6.9% had an A1c ≥ 9%. Most (61.2%) were taking DM medications, of which metformin was the most common (66.2%), followed by sulfonylureas (22.5%). Despite policy restrictions, 6% deployed on insulin. Coincident hypertension (29%) and lipid disorders (33.1%) were common, but ≤ 1% had microvascular complications. BMI was checked pre- and post-deployment on 3083 individual deployments (28%). Mean A1c and BMI did not significantly change pre- and post-deployment (A1c pre- 6.89% vs. post- 6.93%, p = 0.58; BMI pre- 28.9 kg/m2vs. post- 28.7 kg/m2, p = 0.14). U.S. military medical policies restrict deployments for service members with DM due to a perceived risk of decompensation when medical resources are scarce. However, our data demonstrate that A1c and BMI do not significantly change, suggesting that select service members with DM can maintain adequate glycemic control during deployments. The lack of A1c surveillance for the majority of service members with DM surrounding deployment is concerning and should prompt changes in policy.

Disclosure

I. Folaron: None. M.W. True: None. J.L. Wardian: None. W.H. Kazanis: None. J.M. Tate: None. T.J. Sauerwein: Speaker's Bureau; Self; AstraZeneca, Merck & Co., Inc. S. Graybill: None. P.G. Clerc: None. C. Jenkins: None.
1612-P: Insulinogenic Index and HOMA-ß Are Independent Risk Factors for Future Type 2 Diabetes
Authors: SATO KYOKO K. , HAYASHI TOMOSHIGE , UEHARA SHINICHIRO , ONISHI YUKIKO , LEONETTI DONNA L. , KAHN STEVEN E. , FUJIMOTO WILFRED Y. , BOYKO EDWARD J.
Published: June 2019

β-cell dysfunction is major risk factor for type 2 diabetes. As HOMA-β reflects fasting β-cell function and insulinogenic index reflects early phase insulin response during an oral glucose tolerance test (OGTT), these two indices represent different aspects of insulin and glucose metabolism. It is not known whether HOMA-β and insulinogenic index are independently associated with type 2 diabetes risk. In a prospective cohort study, 415 nondiabetic Japanese-American men and women were followed for 10-11 years. Insulin sensitivity was assessed by HOMA-IR. β-cell activity was assessed by HOMA-β [fasting plasma insulin (μU/mL) × 360/(fasting plasma glucose (mg/dL) - 63)] and the insulinogenic index [Δinsulin (30-0 min) (μU/mL)/Δglucose (30-0 min) (mg/dL)] obtained during a 75-g OGTT. Type 2 diabetes was diagnosed as fasting plasma glucose level ≥126 mg/dL, 2-hour glucose level ≥200 mg/dL, or taking glucose-lowering medications. Logistic regression analysis was used to estimate odds ratios (OR) of incident diabetes. A total of 95 participants developed type 2 diabetes over 10-11 years. Insulinogenic index and HOMA-β were independently associated with the risk of type 2 diabetes. In multiple-adjusted models that included insulinogenic index, HOMA-β, HOMA-IR, age, BMI, gender, and family history of diabetes, OR of future type 2 diabetes for tertile 2 and 3 of insulinogenic index were 0.43 (95% CI, 0.22-0.85) and 0.31 (0.14-0.67), respectively, compared to tertile 1, and those for tertile 2 and 3 of HOMA-β were 0.31 (0.14-0.69) and 0.25 (0.10-0.63), respectively, compared to tertile 1. HOMA-IR was also associated with the risk of type 2 diabetes independent of these two indices. OR of tertile 2 and 3 of HOMA-IR were 1.75 (0.82-3.74) and 9.17 (3.78-22.28), respectively, compared to tertile 1.

In conclusion, both higher insulinogenic index and HOMA-β were independently associated with a lower risk of type 2 diabetes independent of insulin sensitivity.

Disclosure

K.K. Sato: None. T. Hayashi: None. S. Uehara: None. Y. Onishi: None. D.L. Leonetti: None. S.E. Kahn: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Intarcia Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk A/S. Consultant; Self; Neurimmune. Other Relationship; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk A/S. W.Y. Fujimoto: None. E.J. Boyko: None.
1616-P: Mortality Rates due to Diabetes Mellitus in Costa Rica, 2007-2017
Authors: JIMENEZ-MONTERO JOSE G.
Published: June 2019

Introduction: Diabetes mellitus is a major health problem in Costa Rica. Its prevalence is rapidly increasing achieving 12.8% and represents a burden for the health system. Changes in mortality due to diabetes have not being fully evaluated.

Objective: To describe specific diabetes mortality and life expectancy in diabetics from 2007 to 2017.

Material and Methods: Death certificates (classification CIE-10) were obtained from the Instituto Nacional de Estadistica y Censos from 2007 to 2017. Total mortality, standardized diabetes mortality rates per 100.000 habitants (SDMR) and deaths due to diabetic nephropathy were assessed. The years of life lost (YLL) due to diabetes was determined using data of life expectancy at birth per 1000 habitants. Gini coefficient, Lorenz curve, Index of Human Development and the Public Morbidity Report were employed to explain changes in diabetes mortality.

Results: Total mortality in Costa Rica remained invariable through the study period. From 2006 to 2014 the SDMR was constant (14.5 to 15.2) However, SDMR steadily peak from 15.2 to 26.3 during the last three years. Compared to males, SDMR was higher in females, the excess of mortality due to diabetes in females ranged from 1.7 to 4.8 deaths per 100.000 habitants. Up to 2013 the YLL ranged from 30 and 20 deaths per 1000 habitants in females and males, respectively. Nonetheless, YLL increased in females and males to 48.9 and to 34.3 at the end of the study. Deaths associated to diabetic renal disease increased. Index of Human Development did not explain the increase in diabetes mortality. Public Health Care Coverage in diabetics reached 40%. HbA1c, LDL and blood pressure control goals were achieved in 41%, 35% and 52%, respectively and 11% of diabetics accomplished the triple goal. Low Public Health Care Coverage in diabetics was seen in two provinces with the higher SDMR.

Conclusions: In Costa Rica deficient coverage and poor diabetes management may explain the changes in SDMR.

Disclosure

J.G. Jimenez-Montero: None.
162-OR: Identification of Autoantibodies to ZnT8 Extracellular Epitope(s) in Patients with T1D
Authors: GU YONG , MERRIMAN CHENGFENG , WENZLAU JANET M. , YU LIPING , FU DAX
Published: June 2019

Previous studies demonstrate ZnT8 is displayed on the β-cell surface upon insulin secretion and IgG from ZnT8A-positive T1D patient sera stains the surface of live pancreatic β-cells. To further identify autoantibodies (AAb) to the ZnT8 extracellular epitope(s) (ZnT8ec) and to develop a ZnT8ec AAb assay, we first stabilized its native structure without the N-terminal domain (a.a 66-369; R325 or W325) by forming ZnT8-intracellular domain-Ab (ZnT8ic) complexes prior to release from liposome membranes. Sulfo-tagged ZnT8-Ab complexes were used as antigen in our electrochemiluminescence (ECL) AAb assay to analyze 130 sera (96 T1D patients, 22 T2D patients and 12 normal controls). Autoantibodies to ZnT8ec were identified in T1D patient sera by cross-reactivity of sera previously identified as exclusively ZnT8R or W positive, and ZnT8A negative sera. The prevalence of ZnT8ec AAbs in T1D patients was 21% (22/96: 5/37 of R+ sera, 7/24 of W+ sera and 8/35 of ZnT8A- sera) compared to 1/22 T2D patients and 0/12 normal controls. These are the first biochemically defined AAbs from T1D sera reported to target the β-cell surface. Further analysis of the role of these autoantibodies in β-cell autoimmunity and T1D etiopathology will be interesting and important for future studies.

Disclosure

Y. Gu: None. C. Merriman: None. J.M. Wenzlau: None. L. Yu: None. D. Fu: None.
1622-P: HbA1c, Blood Pressure, and Cholesterol (ABC) Control in Patients with Type 2 Diabetes from Tibet in China
Authors: CHENGHUI ZHANG , MINGXIA LI , SUYUAN WANG , YUNHONG WU
Published: June 2019

Aim: Diabetes has rapidly become an epidemic all over the world. In 2013, the prevalence of type 2 diabetes (T2D) in China was reported to be 10.4%. The Qinghai-Tibet Plateau is the world’s highest plateau, people lived in there usually have a high-calorie diet and low fruit and vegetable intake. The aim of this study was to describe the current control of HbA1c (A), blood pressure (B) and LDL-c (C) in patients with T2D from Tibet based on electronic medical records.

Methods: Patients aged 18-79 years with T2D documented from 2014 to 2018 were enrolled in this study. Clinical and biochemical characteristics were collected from EMRs. Control criteria were defined base on the 2017 Chinese Guidelines for the Prevention and Treatment of type 2 diabetes.

Results: A total of 1999 patients with type 2 diabetes were included in the study. The mean (SD) age of the subjects was 55.2 (10.5) years. The median diabetic duration was 7.0 (range: 0.1-32) years and 879 (43.9%) patients were female. Among patients, 653 (32.7%) patients had a normal weight (BMI < 24 Kg/m2), 874 (43.7%) patients were overweight (24 ≤ BMI < 28Kg/m2) and 472 patients were obesity (BMI ≥ 28 Kg/m2). Only 321 (16.1%) patients had controlled HbA1c concentration below 7.0%, 965 (48.3%) had poor controlled HbA1c (HbA1c < 9%). The prevalence of hypertension was 46.8% and 742 (37.1%) patients had controlled blood pressure (systolic blood pressure <130 mmHg and diastolic blood pressure < 80 mmHg). Controlled LDL-c concentration (<1.8 mmol/L with coronary heart disease and 2.6 mmol/L without the disease) was found in 1046 (52.3%) patients. In all patients, 848 (42.4%) patients achieved at least one target, 526 (26.3%) patients achieved at least two targets and only 70 (3.5%) patients achieved all three targets.

Conclusions: Despite the potential selection bias, the glycemic controls is quite low in the present study, even few patients achieved all ABC targets. More intensive T2DM management with complementary efforts is warranted in this population.

Disclosure

Z. Chenghui: None. L. Mingxia: None. W. Suyuan: None. W. Yunhong: None.
1630-P: Glycemic Burden and Treatment Effectiveness in Young-Onset Type 2 Diabetes
Authors: KE CALVIN , LUK ANDREA , SHAH BAIJU R. , STUKEL THERESE , LAU ERIC S. , MA RONALD C. , KONG ALICE P. , CHOW ELAINE , CHAN JULIANA C.
Published: June 2019

Objective: To examine how T2D onset age affects A1C trajectory and A1C lowering with insulin and other drugs.

Methods: We conducted a cohort study (2000-16) in adults aged 18-75 years (y) with young-onset T2D (YOD; onset age <40 y) and usual-onset T2D (UOD; onset age ≥40 y). In the Hong Kong Diabetes Registry (n=21,016), we estimated the mean glycemic burden (area under curve of A1C over time) across the lifespan, stratifying by onset age. In the population-based Hong Kong Diabetes Surveillance Database (n=328,199), we examined the effect of onset age on A1C trajectory for incident T2D using linear mixed effects models, accounting for drugs using time-varying covariates. We followed for 10 y, censoring at death or insulin start. For those started on insulin (n=20,877), we used similar methods to examine the effect of time to insulin start on the post-insulin A1C trajectory.

Results: Glycemic burden was tripled in YOD versus UOD (38.8 versus 11.8 A1C-y). After accounting for drugs, YOD was associated with a higher baseline A1C (7.6%) and slope (0.05%/y) versus UOD (7.4%, 0.00%/y). Non-insulin drugs lowered A1C similarly across onset ages. The post-insulin A1C remained elevated for YOD, regardless of time to insulin start, but improved significantly for UOD.

Conclusions: YOD is associated with an aggressive A1C rise and excess glycemic burden despite insulin and other drugs. More effective strategies are needed to lower A1C in people with YOD.

Disclosure

C. Ke: None. A. Luk: None. B.R. Shah: None. T. Stukel: None. E.S. Lau: None. R.C. Ma: Advisory Panel; Self; Boehringer Ingelheim International GmbH. Research Support; Self; AstraZeneca, Bayer AG, Pfizer Inc. Stock/Shareholder; Self; GemVCare. Other Relationship; Self; AstraZeneca. A.P. Kong: Advisory Panel; Self; Lilly Diabetes. Research Support; Self; AstraZeneca, Lilly Diabetes. Speaker's Bureau; Self; Abbott. Other Relationship; Self; AstraZeneca, Novartis Pharmaceuticals Corporation, Sanofi. E. Chow: Research Support; Self; Powder Pharmaceuticals Inc., Sanofi-Aventis. J.C. Chan: Board Member; Self; Asia Diabetes Foundation. Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Medtronic, Merck Sharp & Dohme Corp., Sanofi-Aventis. Research Support; Self; Amgen Inc., AstraZeneca, Lee Powder, Lilly Diabetes, Pfizer Inc., Sanofi-Aventis. Speaker's Bureau; Self; Ascensia Diabetes Care. Stock/Shareholder; Self; GemVCare.

Funding

University of Toronto; Royal College of Physicians and Surgeons of Canada; Canadian Society of Endocrinology and Metabolism; Chinese University of Hong Kong; Asia Diabetes Foundation
1641-P: Development and Validation of a Clinical Predictive Score for Insulin Requirement during Glucocorticoid Treatment
Authors: KAWASHIMA MIKAKO , KITADA YOSHIHIKO , KAJITA KAZUO , MORI ICHIRO , ISHIZUKA TATSUO , MURAKAMI DAISUKE , OKADA HIDEYUKI , MORITA HIROYUKI
Published: June 2019

Insulin is often administered for glucocorticoid (GC) -induced hyperglycemia. We have developed and validated a scoring system to predict insulin requirement for optimal control of hyperglycemia during GC treatment through retrospective studies. The Developing set: 303 adults out of 2718 patients, undergoing their first treatment of prednisolone (PSL) with a dosage of 5 mg/day or more for 4 weeks at least, were divided into 2 groups depending on with or without administration of insulin during GC treatment. Risk factors for insulin requirement were identified by a stepwise logistic regression analysis after univariate analyses of clinical parameters before GC treatment between the 2 groups. We constructed a point-addition scoring system, consisting of several categories and their coefficients in each risk factor, derived from another multivariate analysis. We validated it to validation sets A (n=44) and B (n=77) in another two facilities, respectively. Male, FPG, HbA1c, serum CRE, and an initial dose of PSL were identified as the risk factors. The AUC by ROC analysis of the total scores when the Developing set was scored, showed 0.94. The sensitivity, specificity, and accuracy were 90%, 88%, and 88%; 88%, 67%, and 71%; 83%, 76%, and 77% in the Developing set, Validation set A, and B, respectively if the cut off value of the total scores was defined as 19 points. The scoring system: Table is useful.

Disclosure

M. Kawashima: None. Y. Kitada: None. K. Kajita: None. I. Mori: None. T. Ishizuka: None. D. Murakami: None. H. Okada: None. H. Morita: None.

Funding

Sanofi; Eli Lilly Japan K.K.
1645-P: Risk Factors for Household Food Insecurity among Adults with Dysglycemia: Evidence from the 2013-2017 National Health Interview Survey
Authors: FRANCIS LUCINE , TURKSON-OCRAN RUTH-ALMA N , SPAULDING ERIN , KOIRALA BINU , BAPTISTE DIANA , ECHOUFFO TCHEUGUI JUSTIN B. , COMMODORE-MENSAH YVONNE
Published: June 2019

Background: Food insecurity (FI), defined as limited access to nutritious foods, hampers dietary management of dysglycemia. We examined the prevalence of and risk factors for FI among adults with dysglycemia.

Methods: We performed a cross-sectional analysis of data among adults with dysglycemia from the 2013-2017 National Health Interview Survey. We defined dysglycemia as self-reported prediabetes or diabetes diagnosis. FI was defined by an affirmative response on ≥3 questions on the 10-item Food Security Scale. We used Poisson regression and multivariable logistic regressions to estimate the prevalence of and risk factors for FI.

Results: We included 26,960 adults with dysglycemia; mean age was 61 years, and 56% were female. The prevalence of FI among those with dysglycemia was 10%. Risk factors for FI identified included being Nnon-Hispanic black (OR: 1.30; 95% CI: 1.11-1.53), Other race (OR: 1.72; 95% CI: 1.12-2.62); having some college (OR: 1.17; 95% CI: 1.01-1.35), unemployed (OR: 1.57; 95% CI: 1.35-1.83), benefiting from the Supplemental Nutrition Assistance Program (OR: 2.31; 95% CI: 2.02-2.65), and insured (OR:1.51; 95% CI: 1.20-1.91) (Table).

Conclusion: Developing targeted interventions and health policy for improving access to nutritious foods among adults with dysglycemia with risk factors for FI may improve glycemic control in this population.

Disclosure

L. Francis: None. R.N. Turkson-Ocran: None. E. Spaulding: None. B. Koirala: None. D. Baptiste: None. J.B. Echouffo Tcheugui: None. Y. Commodore-Mensah: None.

Funding

National Institute of Nursing Research (to R-A.N.T-O.), (F31DR017328, T32NR012704 to E.S.); National Institute of Diabetes and Digestive and Kidney Diseases (T32NR012704, 3T32DK062707 to R-A.N.T-O.); Ruth L. Kirschstein National Research Service Award (to E.S.); Johns Hopkins Clinical Research Scholars Program (5KL2TR001077-05 to Y.C.M.)
1650-P: Metabolically Healthy Obese Status and Incident Dementia Events among 5.7 Million Elderly People
Authors: BAE JAEHYUN , LEE JI-YEON , CHO YONGIN , LEE MINYOUNG , LEE SANG BAE , LEE INKUK , KANG EUN SEOK , CHO SUNG J. , HAN KYUNGDO , CHA BONG-SOO , LEE YONG-HO
Published: June 2019

Background: Obese individuals with normal metabolic profiles, so-called “metabolically healthy obese (MHO)” status has shown better clinical outcomes via previous studies. However, studies dealing with the association between MHO and dementia, which is deeply associated with metabolic disorders, were still insufficient. We designed this study to assess the association between MHO and the risk of incident dementia.

Methods: The present study is a retrospective cohort study, including 5,669,488 patients aged 60 years old or over without any history of dementia, by using the National Health Insurance System of South Korea. Subjects were divided into 4 groups based on their metabolic health and obesity status. Metabolic health was determined based on the criteria of metabolic syndrome by Adult Treatment Panel-III. Obesity was judged based on the baseline body mass index. The incidence of dementia was checked and compared longitudinally between 4 groups.

Results: When we put the metabolically healthy non-obese group to the reference value (hazard ratio (HR) = 1), MHO group showed the lowest incidence of dementia (HR 0.87, 95% confidence interval (CI) 0.86-0.88). This trend was more prominent when we followed up the risk of Alzheimer’s disease as a subgroup analysis (HR 0.85, 95% CI 0.83-0.86). Non-obese subjects with metabolic syndrome showed significantly increased risk for overall dementia (HR 1.20, 95% CI 1.19-1.21), especially for vascular dementia (HR 1.41, 95% CI 1.38-1.45).

Conclusion: MHO status was associated with lower risk for dementia, especially for Alzheimer’s disease.

Disclosure

J. Bae: None. J. Lee: None. Y. Cho: None. M. Lee: None. S. Lee: None. I. Lee: None. E. Kang: None. S.J. Cho: None. K. Han: None. B. Cha: None. Y. Lee: None.
1655-P: Primary Care Visits and Ambulatory Care Sensitive Diabetes Hospitalizations among Adult Alabama Medicaid Beneficiaries
Authors: BRONSTEIN JANET M. , HUANG LEI , AGNE APRIL A. , MONDESIR FAVEL L. , PRESLEY CAROLINE A. , RIGGS KEVIN R. , PISU MARIA , LEVITAN EMILY B. , CHERRINGTON ANDREA
Published: June 2019

Objective: To describe patterns of care use for adult Medicaid beneficiaries with diabetes and the association between primary care utilization and Ambulatory Care Sensitive (ACS) diabetes hospitalizations.

Methods: This retrospective cohort study analyzes Alabama Medicaid claims data from January 2010 to April 2018 for 52,549 covered adults ages 19 to 64 with diabetes. Individuals were characterized by demographics, comorbidities, and health care use including primary, specialty, mental health, pharmaceutical, laboratory and hospital care. Characteristics of those with and without any ACS diabetes hospitalization are reported. A set of 118,758 observations was created, pairing information on primary care use in one year with ACS hospitalizations in the following year. Logistic regression analysis was used to assess the impact of primary care use in one year on the occurrence of an ACS hospitalization in the following year.

Results: One third of the cohort had at least one ACS diabetes hospitalization over their observed periods; hospital users tended to have multiple ACS hospitalizations. Hospital users had more comorbidities and pharmaceutical and other types of care use than those with no ACS hospitalizations. Controlling for other types of care use, comorbidities and demographics, having a primary care visit in one year was significantly associated with a reduced likelihood of ACS hospitalization in the following year (adjusted odds ratio comparing 1-2 primary care visits versus none 0.79, 95% confidence interval 0.73-0.85).

Conclusions: Program and population health interventions that increase access to primary care can have a beneficial effect of reducing excess inpatient hospital use for Medicaid covered adults with diabetes.

Disclosure

J.M. Bronstein: None. L. Huang: None. A.A. Agne: None. F.L. Mondesir: None. C.A. Presley: None. K.R. Riggs: None. M. Pisu: None. E.B. Levitan: Consultant; Self; Novartis Pharmaceuticals Corporation. Research Support; Self; Amgen Inc. A. Cherrington: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases
1657-P: Performance of Insulin Sensitivity Indices vs. the Hyperinsulinemic Euglycemic Clamp in Chronic Kidney Disease
Authors: MCMULLAN BARBARA C. , AKWO ELVIS A. , HUNG ADRIANA M.
Published: June 2019

Background: Patients with chronic kidney disease (CKD) are at high risk of cardiovascular disease (CVD) and premature death. Insulin resistance (IR) is prevalent in CKD and is one of the most important nontraditional CV risk factors in CKD. We investigated the association between practical insulin sensitivity (IS) indices and the gold standard hyperinsulinemic euglycemic clamp (HEGC) among CKD (estimated GFR = 15-59ml/min) and non-CKD persons.

Methods: The relationship of insulin sensitivity in kidney disease (RISKD) study was a cross-sectional investigation involving 140 nondiabetic patients (52 CKD and 88 non-CKD). Insulin sensitivity was assessed by the HEGC-derived insulin sensitivity index (ISI), homeostatic model assessment for insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), McAuley index, and leptin-adiponectin ratio (LAR). Spearman correlation (rs) and multivariable linear models were used to investigate the association between the practical indices and ISI.

Results: Compared to non-CKD controls, CKD patients had a higher prevalence of IR based on published cut-points for practical IS markers (HOMA-IR: 83% vs. 32%, p<0.0001; LAR: 60% vs. 46%, p<0.0001). HOMA-IR had the strongest correlation (rs = -0.59, p=0.002) with ISI in CKD patients while McAuley had the weakest correlation (rs = 0.50, p=0.0001). Conversely, in non-CKD controls, McAuley had the strongest correlation with ISI (rs = 0.72, p=0.0001). In multivariable models, sex, leptin, and eGFR were independently associated with ISI (p = 0.04, <0.001, and 0.03 respectively).

Conclusion: Patients with CKD had a higher prevalence of IR. While all IS indices showed significant correlations with clamp-derived ISI, HOMA-IR performed best in CKD patients while McAuley performed best in non-CKD persons. These data suggest that HOMA-IR is the preferred practical index to be used to assess insulin sensitivity in large cohort investigations involving CKD patients.

Disclosure

B.C. McMullan: None. E.A. Akwo: None. A.M. Hung: None.

Funding

U.S. Department of Veterans Affairs (I01CX000982 to A.M.H.)
1658-P: Socioeconomic Position and All-Cause Mortality among Adults with Diagnosed Diabetes across Racial/Ethnic Groups—United States, 1997-2011
Authors: MERCADO CARLA , CHENG YILING J. , SAYDAH SHARON , IMPERATORE GIUSEPPINA
Published: June 2019

Among all adults with diagnosed diabetes (DM), the rate of all-cause mortality is inversely associated with socioeconomic position (SEP). However, the social patterning among adults of different racial/ethnic origin is less clear. We examined changes in 5-year all-cause mortality rates in U.S. adults with diagnosed DM across racial/ethnic groups [non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic] by SEP [education and income to poverty ratio (IPR)]. Using data on 32,986 participants aged ≥25 years with DM from the National Health Interview Survey during 1997-2011, we calculated race/ethnicity stratified mortality rates and changes in rates using predictive margins from Poisson regression adjusted for age. From 1997-2001 to 2007-2011 in adults with education of <high school, mortality rates decreased in NHW [from 30.4 to 24.6 deaths/1000 person-years: change = -5.8 (95% confidence interval: -10.4, -1.2)], NHB [21.7 to 16.8: -4.9 (-9.5, -0.4)], and Hispanics [16.7 to 11.4: -5.3 (-9.7, -1.0)]. In those with a high school education, although mortality rates did not change significantly in NHB and Hispanics, there was a decrease in mortality rate in NHW [25.9 to 21.4: -4.5(-8.2, -0.7)]. No significant changes were observed in those with >high school education during this time. When considering changes related to IPR, there were significant decreases in mortality rates in NHW adults with IPR between 200-399% [26.0 to 20.4: -5.7 (-10.1, -1.2)] and ≥ 400% [23.1 to 15.4: -7.7 (-12.5, -2.9)] but no significant changes for IPR of <100% and 100-199%. In contrast, there was a decrease in mortality rates for IPR <100% in NHB [28.7 to 17.5: -11.2 (-19.6, -2.8)] and Hispanics [16.3 to 10.2: -6.1 (-11.4, -0.7)] but no significant changes for IPRs of 100-199%, 200-399%, or ≥ 400% in these groups. Improvements in mortality rates in U.S. adults with DM by educational attainment were similar across racial/ethnic groups but varied when considering IPR for SEP.

Disclosure

C. Mercado: None. Y.J. Cheng: None. S. Saydah: None. G. Imperatore: None.
166-OR: AMPK-Dependent Regulation of Skeletal Muscle Mitochondrial Function by FNIP1
Authors: XIAO LIWEI , LIU JING , SUN ZONGCHAO , YIN YUJING , MAO YAN , GAN ZHENJI
Published: June 2019

Skeletal muscle mitochondria are essential for maintaining metabolic homeostasis in response to a myriad of physiologic or pathophysiological stresses. The folliculin (FLCN)-interacting protein 1 (FNIP1) forms a complex with AMP-activated protein kinase (AMPK), and we previously demonstrated that FNIP1 inhibits AMPK activity in myocytes. Using gain- and loss-of-function approaches in mice, we discovered that FNIP1 is necessary, but not sufficient, to suppress AMPK-dependent mitochondrial function in skeletal muscle. Muscles in FNIP1 knockout (KO) mice show enhanced red coloration, oxidative mitochondrial activity, and type I fiber transformation. Surprisingly, no change in mitochondrial oxidative capacity and fiber type switching was observed in transgenic mice overexpressing FNIP1 in muscle (FNIP1Tg), while restoration of the expression of FNIP1 in the KO muscle (FNIP1Tg/KO) reversed the mitochondrial oxidative metabolism program. RNA-seq profiling revealed that 3328 genes showed over 1.5-fold altered in FNIP1 KO muscle, and the majority number (2856) was regulated in a FNIP1-dependent manner. Gene ontology based analysis revealed that the primary FNIP1-altered genes were mitochondrial metabolic genes. Mitochondrial respiration analysis confirmed that both pyruvate- and succinate-driven state 3 respiration rates were significantly higher in FNIP1 KO muscle, whereas restoration of the expression of FNIP1 in KO muscle reduced the mitochondrial function. Importantly, AMPK, but not mTOR, was markedly induced in FNIP1 KO muscle but reduced in FNIP1Tg/KO muscle. Muscle-specific knockout of the two AMPKα subunits (AMPKα1α2 dmKO) reduced mitochondrial function in FNIP1 KO muscle. Similar results were obtained in skeletal myocytes in culture, using AMPK loss-of-function approaches in FNIP1 KO myocyte. Thus, FNIP1 represents a previously unrecognized negative regulator of muscle mitochondrial function and AMPK is vital for FNIP1 actions in skeletal muscle.

Disclosure

L. Xiao: None. J. Liu: None. Z. Sun: None. Y. Yin: None. Y. Mao: None.
1661-P: Outcomes of a Church-Based Lifestyle Intervention among Australian Samoans Living in South Western Sydney (SWS)—A Pilot Study
Authors: NDWIGA DOROTHY , MACMILLAN FREYA , MCBRIDE KATE , ALOFIVAE-DOORBINNIA OLATAGA , REATH JENNIFER , ABBOTT PENELOPE A. , SIMMONS DAVID
Published: June 2019

Objectives: Samoan people are susceptible to early onset of type 2 diabetes and have low primary care participation. We have evaluated the effectiveness of a culturally adapted, church-based intervention delivered by Samoan coaches and Peer Support Facilitators to prevent and manage type 2 diabetes in Samoans associated with 3 churches in South Western Sydney (SWS).

Methods: This pre-post study included Samoans ≥18 years and involved the delivery of 12 lifestyle messages and 10 diabetes messages. Participants completed questionnaires, the diabetes knowledge and behavior questionnaire, anthropometric measurements and provided a non-fasting blood sample (‘new’ diabetes diagnosis was defined if HbA1c or random blood glucose was ≥6.5% (48 mmol/mol) or ≥11.1mmol/l respectively). Obesity was defined using a Pacific body mass index (BMI) threshold ≥32kg/m2.

Results: One hundred participants (70%) participated with 68 (mean age 49.6±14.2 years; female 57.4%) completing data collection 3-8 months after commencing the intervention. The prevalence of obesity was 73% and diabetes was 32.8% (19.8% previously diagnosed; 13% undiagnosed). Overall, HbA1c fell from baseline to follow-up (mean±SD; 6.4±1.7% (46 mmol/mol) vs. 6.0±1.4% (42 mmol/mol); p<0.001). HbA1c reductions were greatest in participants with known diabetes (8.1±2.4% (65 mmol/mol) vs. 7.4±1.8% (57 mmol/mol); p=0.040). The number of participants engaging in moderate and vigorous activities per week increased significantly (336.7±136.3mins vs. 622.6±213.0 mins; p=0.019). Diabetes knowledge increased from baseline to follow-up (45.5±15.7% to 60.3±20.1%; p<0.001). There were no significant reductions in weight, blood pressure or waist circumference at follow-up.

Conclusion: There is a high prevalence of diabetes and its risk factors among Samoans living in SWS. A structured church-based culturally tailored lifestyle intervention showed promise in reducing their diabetes risks.

Disclosure

D. Ndwiga: None. F. MacMillan: None. K. McBride: None. O. Alofivae-Doorbinnia: None. J. Reath: None. P.A. Abbott: None. D. Simmons: Speaker's Bureau; Self; Sanofi-Aventis. Other Relationship; Self; Medtronic.

Funding

South Western Sydney Local Health District; South Western Sydney Primary Health Network; WentWest Health Care; Western Sydney University