bluuebunny/crossref_metadata_2025 huggingface dataset:
1569-P: Cholesterol Efflux Capacity (CEC) and HDL Subspecies Associate with Estimated Insulin Sensitivity (eIS) in Type 1 Diabetes (T1D)
Authors: BUCKNER TERESA , BORNFELDT KARIN , HEINECKE JAY , VAISAR TOMAS , SNELL-BERGEON JANET K.
Published: June 2019

People with T1D have higher HDL cholesterol (HDLc) yet are more insulin resistant and have increased cardiovascular disease (CVD) risk than people without diabetes. We hypothesized that HDL is dysfunctional in people with T1D, explaining this paradox. We examined the association between eIS, serum HDL CEC, and HDL subspecies in adults with T1D. This study was conducted in a sub-cohort (N=134) randomly selected from the Coronary Artery Calcification in type 1 diabetes study (N=652). eIS was calculated using a validated equation that includes waist circumference, triglycerides, adiponectin, diastolic blood pressure and insulin dose. We quantified CEC from a macrophage cell line (J774) and through the cholesterol transport proteins ABCA1 and ABCG1 and HDL particle concentration and size using calibrated ion mobility analysis. The analyzed HDLs were extra small (XS-HDL), small (S-HDL), medium (M-HDL) and large (L-HDL) populations. Associations were assessed by multivariable linear regression. J774 and ABCA1 CEC were negatively associated with eIS, as was S-HDL (Table). eIS positively associated with L-HDL, whereas other HDL metrics were not associated with eIS. Higher eIS associated with fewer S-HDL particles and reduced macrophage- and ABCA1-mediated CEC, suggesting novel interactions among insulin sensitivity and HDL metrics, which may contribute to CVD risk in T1D.

Disclosure

T. Buckner: None. K. Bornfeldt: None. J. Heinecke: None. T. Vaisar: Consultant; Self; MedImmune. Research Support; Self; MedImmune. J.K. Snell-Bergeon: None.

Funding

American Diabetes Association (7-13-CD-10 to J.K.S-B.)
1571-P: Dietary Quality, Weight Loss, and Diabetes Incidence in the Diabetes Prevention Program (DPP)
Authors: ALLAIRE BENJAMIN , TJADEN ASHLEY H. , APOLZAN JOHN W. , DABELEA DANA , DELAHANTY LINDA M. , EDELSTEIN SHARON , HOSKIN MARY A. , JAACKS LINDSAY M. , TEMPLE KARLA A. , VENDITTI ELIZABETH M. , WYLIE-ROSETT JUDITH ,   DPP RESEARCH GROUP
Published: June 2019

We evaluated whether dietary quality is a predictor of reduced diabetes risk and/or weight loss, independent of caloric intake in the diverse DPP cohort, a randomized clinical trial of adults at risk for diabetes. This secondary analysis included the 2920 participants (90.3% of randomized) with complete baseline and 1-year data (967 intensive lifestyle (ILS), 979 metformin, 974 placebo). Dietary intake was assessed using a 117-item food frequency questionnaire. Dietary quality was quantified using the Alternative Healthy Eating Index 2010 (AHEI), which ranges from 0 to 110 with higher scores corresponding to healthier diets. Participants were 50.8 ±10.6 years, 67.5% female, 44.7% minority race/ethnicity and baseline AHEI was 44.2 ±10.4. ILS participants had greater improvement (p<0.001) in AHEI over 1-year (4.2 ±9.0) compared to metformin (1.2 ±8.5) and placebo (1.4 ±8.4). We examined the association between AHEI change and weight change from baseline to 1 year using linear regression. One-year AHEI change and incident diabetes, based on fasting and 2h OGTT glucose, was evaluated using Cox proportional hazards models over an average 3 years follow-up. All models were evaluated within treatment group and adjusted for demographics, smoking, alcohol use, family history of diabetes, caloric intake, physical activity, BMI and AHEI, and change in caloric intake and physical activity. Models testing incident diabetes were further adjusted for baseline fasting and 2h glucose. AHEI change was associated with weight loss in ILS [β per unit increase (SE) -0.12 kg (0.03, p<0.001)], metformin [-0.09 kg (0.02, p<0.001)] and placebo [-0.05 kg (0.02, p=0.01)]. However, AHEI change did not predict incident diabetes in any group: hazard ratio per unit increase (95% CI) 1.00 (0.98-1.03) for ILS, 1.00 (0.98-1.02) in metformin and 1.00 (0.98-1.02) in placebo, before or after adjustment for weight change. Our results suggest that diet quality helps achieve weight loss, an important factor in diabetes prevention.

Disclosure

B. Allaire: None. A.H. Tjaden: None. J.W. Apolzan: None. D. Dabelea: None. L.M. Delahanty: Advisory Panel; Self; Jana Care Inc., Omada Health, Inc., Weight Watchers International, Inc. S. Edelstein: None. M.A. Hoskin: None. L.M. Jaacks: None. K.A. Temple: None. E.M. Venditti: None. J. Wylie-Rosett: None. DPP Research Group: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases
1573-P: Branched-Chain Amino Acids, Dietary Protein, and Improvement in Hepatic Fat and Abdominal Fat Distribution in Weight-Loss Diet Intervention: The POUNDS Lost Trial
Authors: LI XIANG , SUN DIANJIANYI , ZHOU TAO , BRAY GEORGE , SACKS FRANK , QI LU
Published: June 2019

Background: Recent evidence has related high levels of plasma branch-chained amino acids (BCAAs) with liver and visceral fat. We examined the associations of plasma BCAAs with liver fat and abdominal fat distribution and assessed the potential modification of weight-loss diet interventions on these relations.

Methods: The current study included 184 participants with available data on plasma BCAAs, hepatic fat and abdominal fat distribution over 2 years, who were randomly assigned to 1 of 4 diets varying in macronutrient components.

Results: Decrease in plasma BCAAs after weight loss was significantly associated with improvement in hepatic density (a marker for hepatic fat; p=0.03) and reduction in visceral fat (p=0.01). We also found that a decrease in BCAAs was associated with decreased insulin, HOMA-IR, and triglycerides (p<0.05 for all). Moreover, we observed significant interactions between total plasma BCAAs and dietary protein on hepatic density (p-interaction=0.01). Individuals with a larger decrease in total BCAAs had a greater increase in hepatic density when consuming a high protein diet.

Conclusion: Our findings indicate that weight-loss diets decrease BCAAs, which are in turn associated with the reduction of hepatic and visceral fat. Finally, dietary protein modifies the direction of these associations.

Disclosure

X. Li: None. D. Sun: None. T. Zhou: None. G. Bray: Advisory Panel; Self; Herbalife International of America, Inc., Medifast. F. Sacks: None. L. Qi: None.

Funding

National Heart, Lung, and Blood Institute (HL0791981, HL034594, HL126024); National Institute of Diabetes and Digestive and Kidney Diseases (DK115679, DK091718, DK100383, DK078616); Boston Nutrition Obesity Research Center (DK46300); United States-Israel Binational Science Foundation (2011036); American Heart Association (0730094N to L.Q.)
158-OR: Major Adverse Cardiovascular Events for Kidney Disease Patients Treated with Metformin or Sulfonylurea
Authors: ROUMIE CHRISTIANNE , CHIPMAN JONATHAN J. , MIN JEA YOUNG , HUNG ADRIANA M. , HACKSTADT AMBER J. , GREEVY ROBERT A. , GRIJALVA CARLOS G. , ELASY TOM , GRIFFIN MARIE R.
Published: June 2019

Background: Safety concerns limit metformin use in kidney disease. We compared major adverse cardiovascular events (MACE) for metformin or sulfonylureas users with reduced glomerular filtration rate (GFR).

Methods: A retrospective cohort combined Veterans Administration, Medicare, and National Death Index databases. Metformin or sulfonylurea users were followed from renal threshold (GFR <60 ml/min or creatinine 1.4/1.5 [female, male] mg/dL) until MACE, treatment change, loss to follow-up, non-cardiovascular death or study end. MACE included myocardial infarction, stroke, transient ischemic attack hospitalization or cardiovascular death. The analysis compared MACE hazard for metformin vs. sulfonylurea users in a matched weighted cohort accounting for competing risks of non-persistence or non-cardiovascular death.

Results: There were 67752 and 28976 persistent metformin and sulfonylurea users who reached renal threshold. The weighted cohort included 24683 metformin vs. 24801 sulfonylurea patients; 98% male; 82% white, median age 70 years (62.8, 77.8). Median GFR was 56 ml/min [51.6, 58.2] and HbA1c 6.6% [6.1, 7.1]. Metformin users had lower cause specific hazard of MACE vs. sulfonylurea (adjusted HR 0.81 [0.75, 0.87]). Subgroup results were similar by age, race and GFR.

Conclusion: Compared to sulfonylureas, metformin use in patients with reduced GFR is associated with lower MACE risk.

Disclosure

C. Roumie: None. J.J. Chipman: None. J. Min: None. A.M. Hung: None. A.J. Hackstadt: None. R.A. Greevy: None. C.G. Grijalva: None. T. Elasy: None. M.R. Griffin: None.

Funding

U.S. Department of Veterans Affairs (CX000570-06)
1583-P: Intake of Fish and Related Nutrients in Association with Obesity in Japanese Patients with Type 2 Diabetes (T2D)
Authors: HATTA MARIKO , FUJIHARA KAZUYA , MATSUBAYASHI YASUHIRO , TAKEDA YASUNAGA , NEDACHI RINA , ISHII DAI , HORIKAWA CHIKA , KATO NORIKO , MAEGAWA HIROSHI , SONE HIROHITO ,   JDDM STUDY GROUP
Published: June 2019

Although cardiovascular risk and mortality increases in the presence of comorbid obesity among patients with T2D while fish intake is known to decrease such risks, the association between obesity and fish intake is only poorly understood. Thus, we aimed to clarify these possible associations, including the effects of fish-related nutrients. Analyzed were 1891 Japanese patients with T2D (mean age, 62 y; men, 62%) who completed the Food Frequency Questionnaire. BMI>25 was defined as obesity. Associations between obesity and intake of fish and related nutrients were analyzed by quintiles. Vitamin B12 (VB12) (correlation coefficient, 0.97), vitamin D (VD) (0.94), and long-chain omega-3 polyunsaturated fatty acids (n-3) (0.74) were significantly and potently associated with fish intake. Odds ratio (OR) for obesity was significantly decreased to approximately 0.6 in patients in Q4 (men, 80-108g; women, 77-103g) and Q5 (>108g; >103g) of fish intake compared to Q1 (<37g; <40g) (Table). Intake of all three nutrients showed significant inverse trends with obesity, as did fish intake. Results were unchanged even after additional adjustment by use of medications, including insulin. Dietary instructions for daily fish intake of ≥100g could be provided to decrease the risk of obesity in Japanese patients with T2D. Underlying mechanisms via the related nutrients examined await further investigation.

Disclosure

M. Hatta: None. K. Fujihara: None. Y. Matsubayashi: None. Y. Takeda: None. R. Nedachi: None. D. Ishii: None. C. Horikawa: None. N. Kato: None. H. Maegawa: Research Support; Self; Antares Pharma, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.
1584-P: Associations of Dietary Patterns with Atherosclerosis in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) Study
Authors: BASU ARPITA , ALMAN AMY C. , SNELL-BERGEON JANET K.
Published: June 2019

Background: Among the modifiable risk factors, diet plays an important role in the risks and progression of atherosclerotic cardiovascular disease (ASCVD). However, few studies have examined this association in people with type 1 diabetes (T1D) who are at a greater risk of developing ASCVD than nondiabetic (non-DM) controls.

Methods: We conducted cross-sectional and longitudinal analyses of data from CACTI study [n=1257; T1D: n=568; non-DM: n=689] collected between March 2000 and April 2002. Participants completed a validated food frequency questionnaire, a physical examination and fasting biochemical analyses (12h fast), and coronary artery calcification (CAC) was measured using electron beam computed tomography. At baseline, dietary patterns based on variations in food group intake were created with principal components analysis (PCA). Logistic regression was used to examine associations of dietary patterns with the CAC prevalence in a model adjusted for age and sex and stratified by diabetes status.

Results: Three dietary patterns were identified using PCA as follows: ‘fruits, veggies, meats, cereal’, ‘baked desserts’ and ‘convenience foods and alcohol’ patterns. At baseline, no significant associations of dietary patterns with CAC prevalence were observed. At year-6, ‘baked dessert’ pattern was significantly associated with increased risk of CAC (<0 vs. 0) in T1D [odds ratios (OR) and 95% CI: 2.05 (1.19, 3.51)], but not in non-DM [0.74 (0.51, 1.06)] when adjusted for age, sex and baseline total calories, as well as duration of diabetes for T1D.

Conclusions: Habitual intake of a dietary pattern that is characterized by an increased intake of added sugar and fats, such as in baked desserts may increase risks of atherosclerosis in T1D. Thus, dietary adjustments to improve this pattern may be atheroprotective.

Disclosure

A. Basu: None. A.C. Alman: None. J.K. Snell-Bergeon: None.

Funding

American Diabetes Association (7-13-CD-10 to J.K.S-B.)
1591-P: The Primordial Prevention Project: Motivating Family Behavior Change through Disclosure of Child's Diabetes Genetic Risk
Authors: WESSEL JENNIFER , SMITH MITCHELL
Published: June 2019

The prevalence of obesity and type 2 diabetes (T2D) in children has risen dramatically. We hypothesized that providing child’s genetic risk information, to families at high T2D risk, would serve as a motivator to improve behaviors related to the development of risk factors for T2D. We conducted a pilot intervention study of parents (n=51) and their children (n=44) aged 2-8. Family’s physical activity, children’s eating behaviors related to obesity (CEBQ); and parent’s attitudes and motivations for lifestyle change were collected at baseline and 3-month follow-up (3MFU). At baseline, saliva samples were collected from children for genotyping of obesity and T2D risk variants identified in genome-wide association studies. Parents were on average 35±6 years old, BMI 31±7 kg/m2, 60% mothers, 31% black and 7% Latino. Children were 4±2 years with a BMI of 72±26 percentiles. At the risk disclosure session, anxiety (STAI-S) and depressive symptoms (POMS) of parents were measured immediately before and after disclosure of child’s risk; and a significant increase in tension (X =2.58, p=0.03) and anxiety (X =-2.98, p=0.002) was observed. Parents then received a quasi-motivational interviewing and behavioral education intervention. After receiving the intervention parents reported a significant increase in their confidence to change their family’s behaviors (X =-0.31, p=0.002) compared to pre-disclosure. This led to 100% of parents committing to a personalized diet or activity change. At 3MFU, children demonstrated a reduction in their desire to drink (X =1.52, p=0.002) and responsiveness to food (X =1.86, p=0.005). In parents, no elevation in depressiveness or anxiety remained. No change in BMI or physical activity was observed in either group. Our data suggest returning genetic risk results can motivate commitment to behavior change. Future work will test whether combining genetic risk with an established lifestyle intervention may facilitate lowering T2D risk.

Disclosure

J. Wessel: Employee; Spouse/Partner; Eli Lilly and Company. M. Smith: None.

Funding

American Heart Association
1601-P: Sarcopenic Obesity and Its Association with Reduced Cognitive Performance in Type 2 Diabetes in Singapore
Authors: SERENA LOW KIAT MUN , LIM SU CHI , ANG KEVEN , TAVINTHARAN SUBRAMANIAM , FANG SUM CHEE
Published: June 2019

Introduction: Little is known of association between sarcopenic obesity (SO) and cognition. We aim to examine body composition, and association between SO and cognitive performance in type 2 diabetes (T2D).

Methods: This was a cross-sectional study on 1,317 patients with mean age 61.7±8.2 years and T2D attending both primary and secondary diabetes care in Singapore. Sarcopenia was defined using multi-frequency bio-impedence estimated appendicular skeletal muscle mass divided by height2 with cut-off for Asians (<5.7 kg/m2 in females; <7 kg/m2 in males). Waist circumference (wc)≥80 cm (females) and 90 cm (males) was used to define abdominal obesity. SO was defined as (1) co-existence of sarcopenia and obesity; or (2) fat mass to fat-free mass (FM/FFM) ratio>0.8. Cognition was assessed using Repeatable Battery for the Assessment of Neuropsychological Status.

Results: The distribution by body composition based on definition muscle mass and wc was: nonsarcopenic nonobese, 20.3%; nonsarcopenic obese, 55.1%; sarcopenic nonobese, 13.2%; sarcopenic obese, 11.4%. In contrast, the prevalence of sarcopenic obesity based on FM/FFM ratio was 20.2%. The sarcopenic obese group had the lowest total and index RBANS scores(p<0.05). Multiple linear regression showed SO defined by FM/FFM ratio was significantly associated with reduced total score even after adjusting for demographics with β=-1.66 (95% CI -2.74 to -0.59; p=0.002), and demographics, education and clinical covariates with β=-1.14 (95% CI -2.14 to -0.14; p=0.026). SO was significantly associated with reduced index scores for immediate memory and language in fully adjusted models with β=-1.81 (95% CI -3.46 to -0.16; p=0.032) and β =-2.34 (95% CI -4.06 to -0.062; p=0.008) respectively.

Conclusions: The differing prevalence of SO based on different measures calls for need to standardize definition. SO was associated with reduced cognitive performance and should be considered in management of cognition in patients with T2D.

Disclosure

K. Low: None. S. Lim: None. K. Ang: None. S. Tavintharan: None. C. Sum: None.

Funding

National Medical Research Council of Australia (NMRC/CIRG/1398/2014)
1607-P: Prevalence and Correlates of Potential Glycemic Overtreatment and Undertreatment among U.S. Adults with Diabetes
Authors: MCCOY ROZALINA G. , LIPSKA KASIA J. , HOUTEN HOLLY VAN , SHAH NILAY
Published: June 2019

Poor glycemic control increases the risk of long-term complications, while overtreatment exposes patients to hypoglycemia. In this study, we examined the rates and correlates of potential overtreatment and undertreatment among adults (≥18 years) with diabetes using OptumLabs® Data Warehouse, an administrative claims dataset of commercial and Medicare Advantage enrollees across the U.S. Patient comorbidities were ascertained in 2014. Demographics, HbA1c, glucose-lowering medications, and attributed provider (internal medicine [IM], family medicine [FM], endocrinology) were ascertained in 2015. Patients were classified as potentially over- or undertreated based on their HbA1c, treatment regimen, and clinical complexity.

The study cohort was comprised of 215,429 adults with diabetes; mean age 65.0 years, 59.4% white, 4.2% with type 1 diabetes, 23.1% ≥75 years, and 12.1% clinically complex. Overall, 21.3% were undertreated (22.7% low complexity, 10.9% high complexity) and 7.7% overtreated (5.4% low complexity, 23.8% high complexity).

Younger age, male sex, black/Hispanic race/ethnicity, type 1 diabetes, FM management, and low clinical complexity were associated with glycemic undertreatment (Table). Younger age, male sex, white/Asian race/ethnicity, type 1 diabetes, endocrine management, and high clinical complexity were associated with glycemic overtreatment.

Disclosure

R.G. McCoy: None. K.J. Lipska: Consultant; Self; Health Services Advisory Group (HSAG). Research Support; Self; National Institute on Aging. Other Relationship; Self; Centers for Medicare and Medicaid Services. H. Van Houten: None. N. Shah: None.

Funding

American Association of Retired Persons; OptumLabs; National Institute of Diabetes and Digestive and Kidney Diseases (K23DK114497)
1613-P: Increased Risks of Temporary and Permanent Work Disability among People with Type 1 and Type 2 Diabetes Mellitus: A Danish Register-Based Longitudinal Study with Up to 17 Years Follow-Up
Authors: NEXO METTE A. , PEDERSEN JACOB , CLEAL BRYAN , BJORNER JAKOB B.
Published: June 2019

Background and Aim: Diabetes has been associated with considerable work disability, but different risks of disability have not been assessed systematically among people with type 1 (T1D) and type 2 diabetes mellitus (T2D). This study evaluated risks of long-term sickness absence (LTSA), unemployment, return to work and disability pension in individuals with T1D or T2D.

Method: We observed individuals with T1D (n=431), T2D (n=4,047) and without diabetes (n=101,295) in Danish national registers of health, work and social benefits from 1994 -2011. In a multi-state model, Cox proportional analyses estimated hazard ratios (95% Confidence Intervals) of each transition between work, LTSA, unemployment and disability pension. Analyses were performed separately for men and women.

Results: Compared to people without diabetes, women and men with T1D and T2D had significantly higher hazard ratios of LTSA and disability pension (Table 1). Except for women with T1D we observed significantly higher risks of unemployment. Women with T2D had significantly lower chances of returning to work from LTSA or unemployment.

Conclusions: People with T1D and T2D have elevated risks of temporary and permanent work disability. Future studies should include all work-related outcomes to avoid underestimating the burden of living with T1D and T2D.

Disclosure

M.A. Nexo: None. J. Pedersen: None. B. Cleal: None. J.B. Bjorner: Employee; Self; Optum Patient Insights.
1615-P: A Multicountry Trend Analysis of Diabetes Incidence
Authors: MAGLIANO DIANNA J. , ISLAM RAKIBUL M. , CHEN LEI , CARSTENSEN BENDIX , PAVKOV MEDA E. , GREGG EDWARD W. , TABESH MARYAM , KOYE DIGSU , HARDING JESSICA L. , SHAW JONATHAN E. ,   GLOBODIAB WRITING GROUP
Published: June 2019

Several studies have suggested a fall or stabilisation of diabetes incidence rates in the last decade. We therefore conducted a multi-country analysis of trends in diabetes incidence over time. Data from 16 countries comprising 17 administrative sources and one set of annual surveys were analysed according to a standard protocol mainly from the period 1995-2015. We modelled incidence rates using age and calendar time as quantitative variables (scored as the midpoint of each interval), and using restricted cubic splines with 6 knots for age and one knot per 4 years of observation for calendar time. The estimated rates from the models were presented as age- and sex-standardized rates (standardized to the 2010 EU population) for each centre to provide an overview of general trends. To formally assess temporal changes in incidence rates, we also fitted joinpoint models with joinpoints at one of the dates 2009, 2010, 2011, and 2012, estimating the average trend before and after the joinpoint. Among the 18 populations we assembled, 4 of the studies were from predominantly non-Europid populations (Taiwan, Korea, Singapore, Hong Kong) and only 2 of the studies were from middle-income countries (Ukraine and Latvia). In general, from 2000 (or when data were available) until 2010 we saw increasing trends in incidence rates in populations from the U.S., Canada, Australia, Denmark, UK, Spain, Scotland and Latvia, while we saw decreasing incidence rates in Israel, Italy, UK, Hong Kong, Taiwan and Korea. In contrast, after 2010, incidence rates appeared stable or decreasing in 14/18 centres, with U.S. (Kaiser Permanente Healthcare), Ukraine, Singapore, and Taiwan showing increasing trend of diabetes incidence.

In conclusion, incidence rates of diabetes have shown a tendency to stabilise or even fall across some high-income populations in Europe, Asia, Canada and Australia. Patterns in low to middle income countries may be different, but little information is currently available from these.

Disclosure

D.J. Magliano: None. R.M. Islam: None. L. Chen: None. B. Carstensen: Consultant; Self; Leo Pharma. Speaker's Bureau; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk Inc. M.E. Pavkov: None. E.W. Gregg: None. M. Tabesh: None. D. Koye: None. J.L. Harding: None. J.E. Shaw: Advisory Panel; Self; Abbott, Merck Sharp & Dohme Corp. Speaker's Bureau; Self; AstraZeneca, Mylan, Roche Diabetes Care, Sanofi-Aventis.

Funding

Centers for Disease Control and Prevention
1618-P: Time Trends of Diabetes Prevalence and Incidence in France: A Nationwide Study
Authors: FUENTES SONSOLES , FOSSE-EDORH SANDRINE , BERNILLON PASCALE , BONALDI CHRISTOPHE , COSSON EMMANUEL
Published: June 2019

Background: Our objective was to assess trends on incidence and prevalence rates of pharmacologically-treated diabetes in France between 2010 and 2016.

Methods: Diabetes cases were identified in the National Health Data System (SNDS), covering the whole of France, i.e., 66 million people, through a validated algorithm based on antidiabetic drugs reimbursements. Incident cases were identified as new diabetes cases in people free of diabetes during the 2 previous years. For a given year, mean number of residents in France was used to calculate prevalence and incidence rates. Finally, Poisson models were applied to assess possible effects of age, sex and geographical region on time trends.

Results: Prevalence slightly increased from 4.3% in 2010 to 4.9% in 2016, with a significant increasing annual time trend for the period of 1.9% (95% CI: 1.7%-2.1%). After adjustment, the increasing time trend was more important among people under 45 and people over 75 years. In 2012, incidence was 4.2 while in 2016 it was 3.9 cases per 1000 person-years. A non-significant decreasing annual time trend was observed for the period 2012-2016 (-1.3%, 95% CI -2.8%, 0.2%). This decreasing time trend was stronger in adults over 45 years and among women, after adjustment.

Conclusion: Between 2010 and 2016, the prevalence of diabetes increased while incidence of diabetes remained stable. Further efforts on diabetes prevention are required.

Disclosure

S. Fuentes: None. S. Fosse-Edorh: None. P. Bernillon: None. C. Bonaldi: Employee; Spouse/Partner; Novartis France. E. Cosson: Board Member; Self; Abbott, Boehringer Ingelheim Pharmaceuticals, Inc., LifeScan, Inc., Lilly Diabetes, Medtronic, Merck Sharp & Dohme Corp., Novartis France, Novo Nordisk A/S, Roche Diagnostics France, Sanofi. Research Support; Self; Air Liquide, Lilly Diabetes, Novo Nordisk A/S, Roche Diagnostics France, Roche Foundation, Sanofi.

Funding

Santé Public France
1620-P: Trends in Cannabis Use among Patients with Diabetes—The National Survey on Drug Use and Health, 2005-2017
Authors: ALSHAARAWY OMAYMA
Published: June 2019

Cannabis legalization for medical and recreational uses has increased, driven by the more permissive attitudes towards cannabis. Potential beneficial effects of cannabinoids have been reported in studies of diabetic retinopathy and neuropathy. Higher prevalence of diabetic ketoacidosis, however, was reported in type 1 diabetes patients who use cannabis. Whether cannabis use has changed over time among patients with diabetes is unknown. Here, we estimate the prevalence of cannabis use among participants with diabetes in the National Survey on Drug Use and Health (NSDUH, 2005-2017), a large nationally representative sample of the United States non-institutionalized population aged 12 years and older. Audio computer-assisted self-interview system (ACASI) assessed cannabis use in the participant residence. During the ACASI, participants were asked whether a doctor or health care professional had ever told them that they had diabetes. The number of NSDUH participants with diabetes ranged from 1537 (weighted % = 6.7) in 2005 to 2919 (9.3%) in 2017. The prevalence of past 30-day cannabis use among diabetes patients was 1.7% (95% CI = 1.1, 2.6) in 2005, increasing to 4.8% (95% CI = 3.8, 6.0) in 2017. Similarly, past 12-month use has increased from 2005 to 2017. This increasing trend is observed across age, sex, ethnic self-identification and education subgroups, and in states with or without medical cannabis laws.

In summary, cannabis use has increased ∼180% in NSDUH participants with diabetes from 2005 to 2017. Physicians should educate patients on cannabis use, including its effects on appetite and gastric emptying, and its effect on perception and treatment adherence, which can be crucial in insulin-dependent diabetes. Additional research is also needed to understand the effect of cannabis on glucose metabolism and diabetes complications.

Disclosure

O. Alshaarawy: None.

Funding

National Center of Complementary and Integrative Health (R00AT009156); Michigan State University
1621-P: Nonlinear Relationship between Elevated Hemoglobin Level and the Risk of Glucose Intolerance in Tibet Residents
Authors: SUYUAN WANG , YUNHONG WU , CHENGHUI ZHANG , MINGXIA LI
Published: June 2019

Introduction: The aim of this study is to explore the relationship between hemoglobin level and the risk of glucose intolerance in Tibet residents.

Method: Eligible participants were aged from 20 to 80 years old, living in Tibet plateau for more than 3 months. The exclusion criteria were diagnosed diabetes, anemia or other hematological diseases, having been received transfusion in the past month. OGTT test was performed. Logistic regression and generalize additive models was used to explore the relationship between hemoglobin level and the risk of impaired glucose intolerance.

Result: A total of 818 people was enrolled in our research, including 586 (71.6%) male and 232 (28.4%) female. Participants were divided into normal group (Hb<210, n=747), and polycythemia group (Hb>210, n=71). There were 229 (30.66%) and 33 (46.48%) people were glucose intolerance in two groups separately (P<0.001). The odds ratio for male and female patients were 1.821 (95% CI 1.026-3.232) and 0.603 (95% CI 0.940-2.824), respectively. After stratified by sex, we find a “J” shaped relationship in male participants (Figure), and the turning point was 196g/L.

Conclusion: Elevated hemoglobin level is associated with increasing risk of glucose intolerance in male participants. When hemoglobin level is over 198g/L, the risk raised obviously as the hemoglobin level raising in male Tibet residents.

Disclosure

W. Suyuan: None. W. Yunhong: None. Z. Chenghui: None. L. Mingxia: None.
1623-P: Changes in Glycemic and Insulin Distributions among U.S. Adults without Diabetes by Socioeconomic Position, 1988-2016
Authors: CHENG YILING J. , IMPERATORE GIUSEPPINA , BULLARD KAI M. , MERCADO CARLA , GREGG EDWARD W.
Published: June 2019

National surveys in the U.S. have shown an increased incidence of diagnosed diabetes through 2009 followed by consistent reductions. Whether similar population-level changes are occurring in A1C, fasting glucose (FPG), and fasting insulin (FI) is unknown. It is also unknown whether changes in these glucose metabolism measures vary by socioeconomic position (SEP). We analyzed morning fasting data on 22,492 men and non-pregnant women aged ≥20 years without any diabetes from the National Health and Nutrition Examination Survey 1988 through 2016. Family income to poverty ratio (IPR) and education level were used as measures of SEP (Table). We adjusted all estimates for age, sex, and race/ethnicity accounting for the sampling design using linear/quantile regression. There were significant increases in mean levels of A1C (annual percentage change: 0.1%) and FI (1.8%) from 1988-1994 to 2011-2016 (all p <0.05) and no statistically significant changes in FPG. Patterns for medians of measurements by SEP and year were similar (Table). The risk of hyperinsulinemia was increasing among the U.S. adults, especially among lower IPR population. The increases in insulin levels in the context of little changes in glucose levels suggests a worsening of insulin resistance at the population level.

Disclosure

Y.J. Cheng: None. G. Imperatore: None. K.M. Bullard: None. C. Mercado: None. E.W. Gregg: None.
163-OR: Sensitivity Analysis of Alternate Definitions of Multiple Islet Autoantibody Positivity
Authors: LIU BIN , GHALWASH MOHAMED , ANAND VIBHA , KOSKI EILEEN , NG KENNEY , DUNNE JESSICA L. , LUNDGREN MARKUS , LARSSON HELENA ELDING , HAGOPIAN WILLIAM , VEIJOLA RIITTA , FROHNERT BRIGITTE I. ,   T1DI STUDY GROUP
Published: June 2019

The development of multiple islet autoantibodies (IA) predicts progression to type 1 diabetes (T1D), and forms the basis of current staging of T1D. However, age at seroconversion, persistence of IA, and frequency of sampling influence the determination of multiple IA status. Individual IA may appear at different timepoints and fluctuate. This analysis aims to understand how differences in the stringency of multiple IA status definition impact risk estimates of progression to stage 3 T1D.

We combined data from three birth-cohort studies (N=18,537): DAISY (U.S.), DiPiS (Sweden) and DIPP (Finland), defining four groups by IA positivity pattern and accounting for variability in persistence and timing in concurrent and sequential patterns of IAA, IA2A, and GADA. Subjects were placed exclusively in their most stringent IA group. Cumulative incidence of progression to T1D was estimated by survival analysis and log-rank test, which showed group differences (p<0.0001). T1D risk 15 years after seroconversion [95% CI] increased according to increasing stringency of the definition: Single IA/Persistent 10% [6%, 14%], multiple IA/Any 17% [3%, 29%], multiple IA/Same Visit 40% [17%, 57%], and multiple IA/Persistent 74% [69%, 77%]. Enhanced understanding of the characteristics of IA patterns can better inform recruitment for intervention studies and improve communication of risk during pre-symptomatic T1D screening.

Disclosure

B. Liu: None. M. Ghalwash: None. V. Anand: None. E. Koski: None. K. Ng: None. J.L. Dunne: None. M. Lundgren: None. H. Elding Larsson: None. W. Hagopian: Research Support; Self; Novo Nordisk A/S. R. Veijola: None. B.I. Frohnert: None.

Funding

JDRF
1647-P: High Serum YKL-40 Concentration Is Associated with One-Hour Post-Load Hyperglycemia
Authors: IKEDA YUKIO , HISAKAWA NAOKO , TAKATA HIROSHI , OHGURO TAKASHI , NISHIUCHI JUNKO , KUMON YOSHITAKA
Published: June 2019

Objective: Postprandial hyperglycemia is associated with oxidative stress and low-grade inflammation, which is involved in the pathogenesis of cardiovascular disease. The aim of this study was to examine whether post-load plasma glucose during oral glucose tolerance tests (OGTT) affect inflammatory biomarkers in nondiabetic subjects.

Methods: We recruited 322 nondiabetic Japanese subjects including 252 with a normal glucose tolerance (NGT) and 70 with an impaired glucose tolerance (IGT). All subjects underwent OGTT and measurement of several inflammatory biomarkers.

Results: No significant differences were observed in white blood cell counts, high-sensitive CRP, high-mobility group box 1 protein (HMGB1) or S100A8/A9 levels between NGT subjects with 1-h post-load plasma glucose (1h-PG) < 155 mg/dL and subjects with 1h-PG ≥ 155 mg/dL. Conversely, NGT subjects with 1h-PG ≥ 155 mg/dL exhibited higher YKL-40 levels than subjects with 1h-PG < 155mg/dL (101.6 ± 85.8 vs. 61.6 ± 53.9 ng/mL, P < 0.0001). No significant difference was observed in YKL-40 levels between NGT subjects with 1h-PG ≥ 155 mg/dL and subjects with IGT. YKL-40 levels, but not white blood cell counts, high-sensitivity CRP, HMGB1 or S100A8/A9, showed significantly positive correlations with 1h-PG (r = 0.251, P < 0.0001). Multiple regression analysis showed that YKL-40 levels were independently associated with 1h-PG, as were age, gender, alanine transaminase and systolic blood pressure.

Conclusions: In nondiabetic subjects, serum YKL-40 levels correlated positively with post-load plasma glucose levels. YKL-40 is produced by several cell types such as activated macrophages, vascular smooth muscle and endothelial cells, and plays an important role in the innate immune response, angiogenesis and remodeling of extracellular matrix. Elevated YKL-40 levels related to postprandial hyperglycemia may contribute to the progression of atherosclerosis and cardiovascular events.

Disclosure

Y. Ikeda: None. N. Hisakawa: None. H. Takata: None. T. Ohguro: None. J. Nishiuchi: None. Y. Kumon: None.
1649-P: Community Predictors of Diabetes Prevalence and Change in Burden Over Time: U.S. Counties, 2003-2012
Authors: LOPEZ PRISCILLA M. , FELDMAN JUSTIN , RUMMO PASQUALE E. , ELBEL BRIAN , THORPE LORNA
Published: June 2019

Introduction: This study applies a novel epidemiologic approach to perform temporal, multilevel analysis of nationally representative, repeated cross-sectional data to assess the relationship between diabetes and various county-level environmental measures, including socioeconomic context, walkability, and the food environment.

Methods: We obtained data from the 2003-2012 Behavioral Risk Factor Surveillance System, an ongoing, nationally representative, cross-sectional telephone survey of the U.S. noninstitutionalized population ages ≥ 18 years. County-level variables included economic (unemployment), food (convenience store and fast food density), and built environment (active commuting) measures. Using random-effects within-between (REWB), we fit a logistic mixed-effects model to estimate associations between community exposures and odds of prevalent diabetes, adjusted for individual-level demographic and other characteristics. REWB models incorporate temporality into analyses of repeated cross-sectional surveys by using group-mean-centering.

Results: Age-adjusted diabetes prevalence across the study period was 7.9%. County unemployment, fast food density, and convenience store density were positively associated with diabetes prevalence, and active commuting had an inverse association. Odds ratios ranged from 0.95 for an increment in active commuting to 1.05 for convenience store density. Within-county associations were attenuated for convenience stores and fast food restaurants, but within-county change in active commuting was higher (aOR: 0.92; 95% CI: 0.82, 1.02).

Discussion: These analyses demonstrate the utility of REWB models in evaluating effects of group-level exposures on diabetes risk using repeated cross-sectional survey data and provide preliminary evidence towards our hypotheses of community-level drivers of diabetes risk.

Disclosure

P.M. Lopez: None. J. Feldman: None. P.E. Rummo: None. B. Elbel: None. L. Thorpe: None.
1654-P: Decreasing Incidence of Pharmacologically Treated Type 2 Diabetes in Hungary from 2001-2016: A Nationwide Cohort Study
Authors: JERMENDY GYÖRGY , KISS ZOLTAN , ROKSZIN GYÖRGY , ABONYI-TÓTH ZSOLT , WITTMANN ISTVAN , KEMPLER PETER
Published: June 2019

The incidence and prevalence of type 2 diabetes mellitus (T2DM) vary in different regions and depend on several factors. Long-term nationwide epidemiological data are useful to assess trends over time. The aim of the study was to analyze the epidemiological changes of pharmacologically treated T2DM among adult patients in Hungary between 2001 and 2016. Annual incidence, prevalence and all-cause mortality rate of pharmacologically treated T2DM patients (age >18 years) were evaluated from 2001 to 2016. In our analyses we used the central database of the National Institute of Health Insurance Fund Management (Hungary). All data were anonymized at data export. Numbers are age-adjusted and standardized to European Standard Population at 2013. The number of incident cases with newly registered T2DM decreased from 76,645 (858 cases/100,000 person-years) to 29,122 (300 cases/100,000 person-years) resulting in an annual reduction of 11.6% (p<0.001) between 2001 and 2016. The number of prevalent cases continuously increased from 422,707 (4950 cases/100,000 person-years) to the highest number of 737,535 (8135 cases/100,000 person-years) in 2011, which plateaued during the next 3 years and slightly decreased thereafter. The standardized prevalence rate of T2DM increased by 60.5% in the investigated period. The prevalence rate of T2DM increased with increasing age; in 2016 it was ≥20% in patients with age of >60 years. All-cause mortality rate decreased between 2001 and 2016 by 11.8% from 2186/100,000 person-years to 1928/100,000 person-years. Despite a clearly decreasing incidence of pharmacologically treated T2DM in adult patients, the prevalence increased from 2001 to 2011 followed by a 3-year-long plateau and a slight decrease thereafter. These long-term trends with the reduced mortality rate may indicate favorable effects of health promotional activities for preventing and treating T2DM in the period of 2001-2016 in Hungary.

Disclosure

G. Jermendy: None. Z. Kiss: None. G. Rokszin: None. Z. Abonyi-Tóth: None. I. Wittmann: None. P. Kempler: None.
1656-P: Skin Intrinsic Fluorescence (SIF) Scores and Mortality Risk in Type 1 Diabetes (T1D)
Authors: TOMASZEWSKI ERIN L. , ORCHARD TREVOR J. , HAWKINS MARQUIS S. , SONGER THOMAS , MAYNARD JOHN D. , COSTACOU TINA
Published: June 2019

Advanced glycation end products (AGE) are biomarkers for metabolic stress and can be detected in skin collagen non-invasively via skin intrinsic fluorescence techniques (SIF). AGE have been linked to complications in T1D and to mortality in both hemodialysis and type 2 diabetes patients. However, the relationship of SIF scores and mortality in T1D is unknown. This study examined the association of SIF scores to all-cause mortality in T1D. Participants were identified from the Pittsburgh Epidemiology of Diabetes and Complications study, a cohort of individuals diagnosed with childhood-onset T1D from 1950-80. SIF score was measured with the SCOUT DS® device in the year 2003-04 (baseline analytic year) in a convenience sample of 112 participants [mean years of age= 48.9 +/- (7.3), HbA1c=7.6% +/- (1.5), cumulative glycemic exposure over lifetime, or, A1c months=1095.9 +/- (495.2) diabetes duration in years=38.3 +/- (7.3)]. Vital status was assessed as of 12/10/2018, up to which 18 mortality events occurred. Univariately, compared to those who survived, the deceased had longer diabetes duration (p<0.001), higher A1c months (p<0.001), higher SIF scores (p<0.001), and were older (p<0.001). SIF score was significantly associated with mortality after adjusting for baseline diabetes duration; for each one unit increase in SIF score the odds of death increased by 18% (OR=1.18, 95% CI 1.03-1.34). A significant association persisted after adjustment for both baseline diabetes duration and A1c months (OR=1.17, 95% CI 1.02-1.34). These findings support the hypothesis that SIF scores are associated with mortality in T1D. The study sample is limited by sampling method, small size, lack of diversity, and possibly survivor bias. Given these limitations, further studies are required to confirm these findings.

Disclosure

E.L. Tomaszewski: None. T.J. Orchard: Consultant; Self; Boehringer Ingelheim International GmbH. M.S. Hawkins: None. T. Songer: Employee; Spouse/Partner; Boehringer Ingelheim Pharmaceuticals, Inc. J.D. Maynard: Consultant; Self; VisionQuest Biomedical LLC. Employee; Self; Avisa Pharma Inc. T. Costacou: None.

Funding

National Institutes of Health (DK34818); Rossi Memorial Fund
1660-P: Rhinosinusitis, Diabetes Mellitus, and Risk of Atrial Fibrillation: A Nationwide Population-Based Cohort Study
Authors: LIU HAN-WEN , FANG YU-ANN , LEE TING-I , LIU JU-CHI
Published: June 2019

Background: The association between atrial fibrillation (AF) and inflammation has been established. Diabetes mellitus (DM) is associated with increase inflammation and is an independent important risk factor of AF. Moreover, rhinosinusitis is an inflammation of the paranasal sinuses and nasal cavity. However, the association of rhinosinusitis as a risk factor of AF is unknown. The present study aimed to examine the association between rhinosinusitis, DM and AF.

Methods: A total of 229,100 patients with the diagnosis of rhinosinusitis were identified as the study cohort from the Taiwan National Health Insurance Research Database from January 1, 2001, through December 31, 2012. The comparison cohort consisted of patients without rhinosinusitis and were match for age and sex with the study cohort at a ratio of 1:1. Incidence and hazard ratio (HR) of AF were calculated by Multivariable Cox regression models.

Results: The incidence rate of AF was 142.4 per 10,000 person-years (95% CI 136.8-148.0) for the study cohort and 116.5 (95% CI 111.4-121.6) for the comparison cohort. Adjusted HR was 1.17 (95% CI 1.11-1.25) for the total study cohort, 1.18 (95% CI 1.11-1.25) for patients with acute sinusitis and 1.14 (95% CI 1.00-1.31) for chronic sinusitis. In subgroup analysis, HR for patients with DM was 1.23 (95% CI 1.09-1.39) for total study cohort, 1.20 (95% CI 1.06-1.37) for acute sinusitis and 1.44 (95% CI 1.13-1.84) for chronic sinusitis. The risk was less significant for patients with metformin use more than 28 days. HR 1.09 (95% CI 0.94-1.26) for total study cohort, 1.08 (95% CI 0.93-1.26) for acute sinusitis and 1.18 (95% CI 0.85-1.63) for chronic sinusitis.

Conclusion: Rhinosinusitis was associated with the risk of AF. Sinusitis patients with DM had a higher risk than patients without DM. The use of metformin might reduce the risk of AF in DM patients. Further clinical investigation is warranted.

Disclosure

H. Liu: None. Y. Fang: None. T. Lee: None. J. Liu: None.
1663-P: Monophasic Glucose Response Curve Reflective of Glucose Intolerance in Young Mexican Americans
Authors: JENKINS JASMIN , MEZA CESAR , AMADOR MANUEL , MCAINCH ANDREW J. , BAJPEYI SUDIP
Published: June 2019

The glucose response curve of an oral glucose tolerance test (OGTT) has been associated with insulin sensitivity. A monophasic curve has been shown to be more prevalent in hyperglycemic and T2D population. However, it is unknown whether shape of curve in a healthy normoglycemic population can be indicative of risk for developing T2D.

Purpose: We aimed to determine if glucose response morphology, monophasic (M) versus biphasic (B), may be indicative of glucose tolerance and a family history of T2D (FH).

Methods: Normoglycemic Mexican American Males (mean ± SEM; age 23.26 ± 0.66 years, BMI 25.69 ± 0.97 kg/m2) with (n=7) or without (n=7) a FH participated in this study. Body composition was measured by DXA, substrate utilization was measured by indirect calorimetry, maximal aerobic capacity (VO2max) was measured by a standardized graded exercise test. Participants consumed 75 g of glucose while fasting and blood glucose were assessed at 0, 30, 60, 90, and 120 min. Based on Tschritter et al. (2003) classification, glucose response curves were separated into M (n=10) and B (n=4) groups.

Results: There were no significant differences in body weight, BMI, fat mass, fat free mass, resting substrate utilization, VO2max and fasting blood glucose (BG) between groups (all P > 0.05). However, M were significantly glucose intolerant compared to B evident by a greater glucose area under the curve (M: 263.63 ± 11.34 AU; B: 209.20 ± 4.46 AU; p=0.01) and a significantly greater BG levels during OGTT at minute 30 (149.97 ± 8.53 vs. 110.53 ± 12.60 mg/dl; p=0.02), 60 (149.80 ± 9.33 vs. 104.99 ± 17.21 mg/dl; p=0.03) and 90 (116.48 ± 6.62 vs. 71.71 ± 10.11 mg/dl; p< 0.01) compared to B. All individuals with a monophasic OGTT response had a FH whereas most individuals with biphasic OGTT response (7/10) did not.

Conclusion: Although having similar fasting BG, body composition, substrate utilization, and aerobic fitness, a monophasic compared to biphasic, OGTT reflects glucose intolerance and risk for developing T2D.

Disclosure

J. Jenkins: None. C. Meza: None. M. Amador: None. A.J. McAinch: None. S. Bajpeyi: None.