bluuebunny/crossref_metadata_2025 huggingface dataset:
1228-P: Health Care Avoidance and Diabetes-Related Care among Medicare Beneficiaries with Type 2 Diabetes
Authors: NG BOON PENG , TOWNE SAMUEL D. , LAMANNA JACQUELINE B. , PEACH BRIAN C. , PARK CHANHYUN
Published: June 2020

Healthcare avoidance among those with type 2 diabetes (T2D) can lead to increased risk for and severity of medical complications, resulting in potentially significant health and economic burdens. We examined the association between healthcare avoidance and diabetes-related care among Medicare beneficiaries with T2D. We analyzed the nationally representative 2017 Medicare Current Beneficiary Survey Public File of 2,001 Medicare beneficiaries aged ≥65 years with reported T2D. Three dichotomous outcomes were analyzed using multivariate survey-weighted logistic models including: i) self-testing blood glucose to manage one’s diabetes; ii) having had a health professional’s examination of one’s feet in the last year; and iii) maintaining one’s A1C ≤ 7.5% or average fasting blood test of ≤ 140 mg/dL all/most of the time (defined as "proper maintenance"). Among beneficiaries with T2D, 22.3% reported healthcare avoidance or “do anything to avoid going to the doctor.” Of those with healthcare avoidance, 58.7% reported oral medication use alone, 12.2% reported insulin use alone, and 19.4% reported both insulin and oral medication use, while 9.7% reported not using any medication to manage their diabetes. Further, 13.6% reported self-testing blood glucose to manage their diabetes, 25.1% reported having a health professional examine their feet in the last year, and 72.1% reported proper maintenance of blood glucose. Those with healthcare avoidance were less likely to report proper maintenance of blood glucose (OR= 0.65; 95% CI = 0.44,0.95; p < 0.026). Healthcare avoidance was not associated with the i) and ii) outcomes. This study found that those with healthcare avoidance were less likely to maintain proper blood glucose levels, making them especially at-risk of experiencing potentially preventable complications and costly care. Thus, stakeholders should target interventions (e.g., clinical outreach) to reduce the likelihood of healthcare avoidance among this vulnerable population.

Disclosure

B. Ng: None. S.D. Towne: None. J.B. LaManna: None. B.C. Peach: None. C. Park: None.
1230-P: Advantages of Network-Based Blood Glucose Team Management on Hyperglycemic Patients in Noncritical Units
Authors: ZHU YING , YANG MIAO , ZHOU HUI , XIA WEI , LI PENGQIU , YANG YAN
Published: June 2020

Purpose: To provide a new system of in-hospital blood glucose team management combining with network blood glucose monitoring system, and analyze the effect on hyperglycemic patients’ blood glucose control lived in non-critical care units.

Methods: Hyperglycemic patients admitted to non-critical care units were divided into two groups. They were intervened actively by the hospital’s blood glucose management team and routine consultation group, respectively. A better method with shorter hospital stay and inpatient diabetes cost could be selected by comparing the two blood glucose management methods.

Results: Compared to routine consultation group, the team management group had higher detection rate of hyperglycemia (18.49% vs16.17%, P<0.01) and glycosylated hemoglobin (51.53% vs. 30.97%, P<0.01), lower incidence rate of hyperglycemia (59.24% vs. 61.59%, P<0.01), severe hyperglycemia (3.56% vs. 5.19%, P<0.01) and clinically significant hypoglycemia (0.26% vs. 0.35%, P<0.05). Simultaneously, blood glucose drift (mmol/L) (2.50 (1.83, 3.25) vs. 2.76 (2.01, 3.57), P<0.01), blood glucose coefficient of variation (%) (28.86 (22.70, 34.83) vs. 29.80 (23.47, 36.13), P<0.01), maximum blood glucose fluctuation (mmol/L) (9.30 (6.20, 13.10) vs. 10.10 (7.00, 14.40), P<0.01), nosocomial infection (5.42% vs. 8.05%, P<0.05), hospitalization days (7 (3, 12) vs. 8 (4, 14), P < 0.01) and hospitalization expenses (10,000 yuan) (1.62 (1.01, 3.35) vs. 1.89 (1.29, 4.47), P < 0.01) of patients were managed by team management group all decreased.

Conclusion: In-hospital blood glucose team management combined network blood glucose monitoring system effectively improved the blood glucose control and fluctuation level of patients, who admitted to non-critical care units, thereby reducing hospital stay and inpatient hyperglycemia cost.

Disclosure

Y. Zhu: None. M. Yang: None. H. Zhou: None. W. Xia: None. P. Li: None. Y. Yang: None.
1235-P: Identifying Trends in the Management of Inpatient Diabetes at a University Teaching Hospital, 2008-2018
Authors: JANKOVIC IVANA , CHEN JONATHAN
Published: June 2020

Introduction: A substantial proportion of inpatients experience hyperglycemia during hospitalization. Use of basal insulin has been recommended by ADA guidelines since 2007, however the uptake of this recommendation has been slow. Here, we characterize the adoption of basal insulin in inpatients at one adult academic hospital.

Methods: De-identified data from the hospital’s electronic health record repository was used to identify a cohort of patients who received subcutaneous insulin during their hospitalization between 03/26/2008 and 12/30/2018. To capture patients for whom a generalist could be expected to manage their hyperglycemia, we excluded patients receiving insulin via pump, U-500 insulin, single doses >100U, or insulins ordered < 10 times, as well as those with a creatinine > 2mg/dL at any time during admission.

Results: In the cohort of 61,947 inpatient encounters in which insulin was given, no basal insulin was ordered in 61%, decreasing from a 78% in 2008 to 53% in 2018. The annual number of encounters in which insulin was given increased >20% over the decade. The proportions of blood glucoses (BGs) > 200 mg/dL (28% vs. 14%) or <70 mg/dL (1.2% vs. 0.6%) were higher for patients ordered for basal insulin. Although hypoglycemia decreased over time (1.2% to 0.9% of BGs), hyperglycemia increased (16% to 26% of BGs).

Conclusions: Despite improvements since basal insulin became a guidelines recommendation, the rate of inpatient basal insulin orders remained < 50% as of 2018 at one academic center. The number of patients receiving insulin and the proportion of hyperglycemia has increased, whereas the incidence of hypoglycemia in this population decreased over time.

Disclosure

I. Jankovic: None. J. Chen: None.

Funding

Diabetes, Endocrinology, and Metabolism Training Grant (5T32DK007217-44)
1241-P: Prevalence of Prediabetes and Type 2 Diabetes among a High-Risk Adolescent and Young Adult Population
Authors: OLSON MICAH , KONOPKEN YOLANDA P. , KELLER COLLEEN , PATRICK DONALD L. , WILLIAMS ALLISON , AYERS STEPHANIE , KNOWLER WILLIAM C. , PENA ARMANDO , SOLTERO ERICA G. , SHAIBI GABRIEL Q.
Published: June 2020

Background: Despite the epidemic of pediatric obesity, the prevalence of type 2 diabetes (T2D) during childhood remains low. Although obesity in youth portends cardiometabolic disease later in life, longitudinal data describing the progression of T2D into young adulthood are scarce.

Methods: We evaluated glycemic status (normal, prediabetes, or T2D) in a cohort of Latino youth with obesity (n=396; age 14.5±1.4; 55.6% male, BMI 33.9±5.3), and in a sub-set of participants who were re-engaged as young adults (n=39; age 20.8±1.0; 38.5% male, BMI 41.7±8.1). Glycemic status was determined from an oral glucose tolerance test with hyperglycemia classified according to ADA criteria.

Results: Among adolescents, the prevalence rates for normal, prediabetes, and T2D were 69.9%, 28.1%, and 1.3% respectively; while prevalence rates in young adults after a 5-year follow-up period were 64.1%, 25.6%, and 10.3%, respectively. Of the adolescents with normal glucose status at baseline who returned as young adults (n=28), 5 (17.9%) developed prediabetes, and 1 (3.6%) developed T2D. Of those with prediabetes at baseline (n=11), 4 (36.4%) reverted to normal glucose status, 4 (36.4%) remained prediabetic, and 3 (27.3%) developed T2D. Young adults with T2D were more likely to have a parental history of T2D than those who did not develop T2D (50% vs. 11%, p=0.04).

Conclusion: Despite strong risk factors, the prevalence of T2D among a cohort of Latino adolescents with obesity was low (1.3%). Of those who had normal glucose status during adolescence, the prevalence rate of T2D after a 5-year follow-up period was similarly low (3.6%), while for those with prediabetes during adolescence, the prevalence rate of T2D at follow-up was substantially higher (27.3%). Stratifying obese youth by glycemic status significantly affects the long-term prediction of developing T2D, which may have important implications for medical-decision making and resource allocation when managing youth with multiple T2D risk factors.

Disclosure

M. Olson: None. Y.P. Konopken: None. C. Keller: None. D.L. Patrick: None. A. Williams: None. S. Ayers: None. W.C. Knowler: None. A. Pena: None. E.G. Soltero: None. G.Q. Shaibi: None.

Funding

National Institute on Minority Health and Health Disparities (P20MD002316, U54MD002316); National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK107579)
1266-P: Puberty Is Associated with a Rising HbA1c, Even in Healthy Normal Weight Youth
Authors: KELSEY MEGAN M. , HILKIN ALLISON M. , SEVERN CAMERON , PYLE LAURA , NADEAU KRISTEN J. , ZEITLER PHILIP
Published: June 2020

Objective: ADA definitions of prediabetes are applied to children, yet little is known about the impact of the transient insulin resistance of puberty on glycemia. We aimed to evaluate the longitudinal trajectory of hemoglobin A1c (HbA1c) in youth with normal weight and with obesity as they progressed through puberty.

Methods: Youth with normal weight (n=47, 49% female) or obesity (n=37, 62% female) of mixed race/ethnicity (Non-Hispanic White 34%, Hispanic 45%, Non-Hispanic Black 13%) entered the study in Tanner stage 2-3 (T2-3) and were followed until T5. Study visits were done at T2-3, T4, and T5 and included an IV glucose tolerance test, DXA, and fasting laboratory studies. HbA1c was measured by high-performance liquid chromatography and insulin sensitivity (Si), acute insulin response to glucose (AIRg), and disposition index (DI) were calculated. Group differences in HbA1c over time and time-dependent predictors of HbA1c were evaluated by mixed models, with and without adjusting for sex, race/ethnicity, and DXA %Fat.

Results: Mean HbA1c was higher in youth with obesity (5.30±0.08%) vs. normal weight (5.10±0.06%, p=0.04) at baseline and each subsequent time point; differences were attenuated by adjusting for %Fat. HbA1c increased from T2/3 to T5 in the whole cohort (0.16±0.05%, p=0.004), and in youth with obesity (+0.18±0.08%, p=0.08), or normal weight (+0.14±0.05%, p=0.02); findings were similar after adjusting for sex, race/ethnicity, and %Fat. In a multivariate model adjusted for sex and race/ethnicity, HbA1c was associated with leptin (β=0.005, p=0.01) and adiponectin (β=-0.01p=0.02); these associations are similar after adjusting for %Fat. HbA1c was not associated with Si, AIRg or DI.

Conclusions: Obesity is associated with higher HbA1c than normal weight during puberty. However, HbA1c increased during puberty, independent of body weight and composition. This increase in HbA1c is associated with changes in adipokines, but not with typical predictors of progression to diabetes (Si, DI).

Disclosure

M.M. Kelsey: Other Relationship; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp. A.M. Hilkin: None. C. Severn: None. L. Pyle: None. K.J. Nadeau: None. P. Zeitler: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Eli Lilly and Company, Merck & Co., Inc.

Funding

American Diabetes Association (1-11-JF-23 to M.M.K.); Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD057022-04); University of Colorado Center for Women’s Health Research; Children’s Hospital Colorado Research Institute; National Institute for Diabetes and Digestive and Kidney Diseases (DK048520-13); National Center for Advancing Translational Sciences (UL1TR001082)
1282-P: Assessment of Pancreas Volume and Shape Dynamics Longitudinally after T1D Diagnosis
Authors: VIROSTKO JOHN , WILLIAMS JONATHAN M. , HILMES MELISSA A. , WRIGHT JORDAN J. , DU LIPING , KANG HAKMOOK , RUSSELL WILLIAM E. , MOORE DANIEL J. , POWERS ALVIN C.
Published: June 2020

The pancreas is smaller in individuals with T1D, but the correlation between pancreas volume and disease progression is not well established. Longitudinal pancreas volume measurements indicate that pancreas volume declines over the first year after diagnosis with T1D. To further assess pancreas volume and shape, we performed MRI imaging in 55 participants imaged at the onset of T1D and at multiple timepoints up to 5 years after diagnosis. In this cohort, 106 MRIs were performed in the first year after diagnosis, 52 MRIs in the second year, 26 in the third year, 4 MRIs in the fourth year, and 4 MRIs in the fifth year. In a primarily adolescent population, controls without T1D had increasing pancreas volume measured over a year of follow up (p = 0.01), but individuals with T1D followed up to 5 years after diagnosis showed no increase (p = 0.598). When normalizing pancreas volume by body weight (referred to as pancreas volume index) to control for adolescent weight gain, pancreas volume index declined in the 5 years after T1D diagnosis (p < 0.0005), compared with a stable pancreas volume index over time in controls (p < 0.05, difference in slopes over time). A separate cohort of individuals with longstanding T1D (n = 22, mean duration = 23 years, range 13 - 57 years) were imaged a single time. Pancreas volume index in individuals with T1D duration greater than 10 years was significantly smaller than in individuals with duration shorter than 10 years (p < 0.001). In addition to alterations in pancreas volume, we found changes in pancreas shape in T1D. The surface area to volume ratio of the pancreas is higher in T1D than in controls, indicating a thinner pancreas in T1D (p < 0.001). Furthermore, the surface area to volume ratio was stable over time in T1D, but decreased over follow up in controls (p < 0.05). These data indicate altered longitudinal pancreas dynamics in the 5 years after T1D onset compared with controls, indicating impaired pancreas growth in adolescents with T1D.

Disclosure

J. Virostko: None. J.M. Williams: None. M.A. Hilmes: None. J.J. Wright: None. L. Du: None. H. Kang: None. W.E. Russell: None. D.J. Moore: None. A.C. Powers: None.

Funding

JDRF (3-SRA-2019-759-M-B, 3-SRA-2015-102-M-B)
1291-P: Characterization of Gut Microbiota in Lean Type 1 Diabetes, Overweight Type 1 Diabetes, and Healthy Controls
Authors: GOWDA SHASHIKALA B. , FARRELL RYAN M. , MACLEISH SARAH A. , SALEM IMAN , RETUERTO MAURICIO A. , GHANNOUM MAHMOUD A.
Published: June 2020

Background: The incidence of type 1 diabetes (T1D) and overweight/obesity is on the rise. Previous studies showed altered gut microbiota in children with T1D where gut microbial differences between obese and lean children without diabetes were reported. The purpose of the study was to characterize the microbial composition of lean and overweight children with T1D at disease onset in comparison to healthy controls.

Methods: We enrolled 26 children with T1D at disease onset including 15 lean and 11 overweight T1D and compared them with age, gender and BMI matched 14 lean and 8 overweight controls. Stool swabs were collected and DNA extraction was performed using Qiagen DNA mini kit. Bacterial regions v3, v4 were amplified using 16s primers. Amplicons were cleaned, barcoded, size selected and sequencing was completed on Ion Torrent S5 sequencer.

Results: The four most abundant phyla in both groups were Proteobacteria, Firmicutes, Bacteroidetes and Actinobacteria. At the genus level, noted significant increase in pro-inflammatory microbes such as Serratia in T1D compared to controls without diabetes (P value= 0.047). Overweight T1D had marked decrease in the beneficial genus Lactobacillus compared to overweight controls. Similar observation was reported when lean T1D was compared to matched lean controls. Although not significant, anti-inflammatory genera like Clostridium had lower relative abundance in obese T1D compared to their lean counterparts. At the species level, when overweight T1D were compared to their matched controls, there was a marked reduction in L. brevis and L. Zeae known for their anti-inflammatory effects (P value = 0.038, 0.046 respectively).

Conclusion: Our study showed alterations in the gut microbiome in children with T1D with significant increase in pro-inflammatory microbes. Additionally, being overweight negatively impacted the microbiome.

Disclosure

S.B. Gowda: None. R.M. Farrell: Research Support; Self; TODAY study. Stock/Shareholder; Self; Dexcom, Inc., Tandem Diabetes Care. S.A. MacLeish: None. I. Salem: None. M.A. Retuerto: None. M.A. Ghannoum: None.
1303-P: Comparative Performance of a Recurrent Neural Network (RNN) and Logistic Regression (LR) Model to Predict Diabetic Ketoacidosis (DKA) among Youth Postdiagnosis with Type 1 Diabetes (T1D)
Authors: WILLIAMS DAVID D. , DASS SARINA , BASS JONATHAN , PATTON SUSANA R. , MEHTA SANJEEV N. , MCDONOUGH RYAN , MULLANEY COLIN , DAVOLIO LEONARD , CLEMENTS MARK A.
Published: June 2020

Preventing dangerous and costly episodes of DKA is a goal of diabetes care, but clinicians lack tools to predict DKA events. We sought to compare performance characteristics of an RNN model with that of a LR model to predict hospital admission for DKA in the next 180 days. We developed an RNN model using training (n=1453) and testing (n=1530) datasets restricted to youth <18 yo with T1D >30 days. In this sample, 6% (90/1530) of youth were admitted for DKA over 180 days. The model considered >500 features per quarter from discrete medical record data and free-text clinical documents. For comparative purposes, we developed an LR model using a testing dataset derived from the same sample (n=1388). The LR model included 10 evidence-based variables derived from critical review of the literature: number of previous DKAs (p<0.001), most recent A1c (p<0.001), age, gender, race, ethnicity, duration of T1D, days since most recent A1c, multiple daily injections vs. pump therapy, and public vs. private insurance. We used model output parameters to produce probability of DKA admission. RNN yielded an AUC=0.77 [95% CI: 0.71,0.83] while LR produced an AUC=0.79 [95% CI: 0.74,0.85]. We generated rank-ordered lists of the 90 youth with highest probability of DKA admission for both models and measured performance at different thresholds in rank-ordered lists. For ranks 1-5, RNN yielded precision (Pr)=100% (all 5 members on the list experienced a DKA admission) and LR yielded Pr=80%. For ranks 1-10, RNN yielded Pr=100% and LR yielded Pr=70%. For ranks 1-25, RNN yielded Pr=48% and LR yielded Pr=44%. An RNN model, in terms of precision, performs favorably relative to LR in predicting future DKA for a rank-ordered list of youth. Patient lists rank-ordered by DKA risk can be used by clinicians to identify youth with T1D for intensive intervention.

Disclosure

D.D. Williams: None. S. Dass: None. J. Bass: Employee; Self; Cyft, Inc. S.R. Patton: None. S.N. Mehta: None. R. McDonough: None. C. Mullaney: Employee; Self; Cyft. L. Davolio: Employee; Self; Cyft Inc. M.A. Clements: Consultant; Self; Glooko, Inc. Other Relationship; Self; Glooko, Inc.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust (G-2017PG-T1D019)
1306-P: Impacting Youth with Poorly Controlled Type 1 Diabetes
Authors: CHAMBERS MELISSA , SHAIBI GABRIEL Q. , KAPADIA CHIRAG R. , HOEKSTRA FRAN , PUFFENBERGER SYNTHIA S. , TOUGER LESLIE , RADCLIFFE IVY K. , HOLZMEISTER LEA ANN , OLSEN KIRI A.
Published: June 2020

Background: Youth with poorly controlled type 1 diabetes (T1D) are at increased risk for morbidity yet very few interventions have targeted this vulnerable population. The purpose of this study was to test the feasibility, acceptability and preliminary efficacy of an intensive, team-based intervention program for youth with HbA1c ≥ 9.5%.

Methods: Forty patients (age 14.1±2.3 years, 53% male) with T1D (duration 6.5±4.3 years) were enrolled in an intensive, 4-month team-based intervention that included a visit with their primary endocrinologist and a pediatric psychologist at baseline as well as up to 6 encounters (in-person visits and calls) with a Certified Diabetes Educator (CDE). The CDE encounters were designed to establish goals, support behavior changes, review glucose logs, and make interim dose adjustments as needed. Feasibility was measured by the number of patients approached and the number of patients who ultimately agreed to participate, acceptability was measured by attendance and attrition rates, and preliminary efficacy was assessed by changes in HbA1c and diabetes-related Quality of Life (QoL). Data were collected at baseline and 4 months.

Results: Of the 42 patients who were approached, 40 agreed to participate, and 35 (87.5%) completed the 4-month program. CDE engagement with patients included an average of 3 phone calls and 3 in-person visits. Compared to baseline, HbA1c reduced from 12.0%±1.6 at baseline to 11.0%±1.9 at the 4 month visit (p<0.001) and QoL increased from 61.0±12.3 to 64.7±11.0 (P<0.05).

Conclusion: Intensive team-based interventions in pediatric patients with poorly controlled T1D can improve glycemic control and QoL.

Disclosure

M. Chambers: None. G.Q. Shaibi: None. C.R. Kapadia: None. F. Hoekstra: None. S.S. Puffenberger: None. L. Touger: None. I.K. Radcliffe: None. L. Holzmeister: None. K.A. Olsen: None.

Funding

Thomas J. Beatson, Jr. Foundation
1308-P: Parental Resilience Is Linked to Parental Mental Health and Glycemic Control in Adolescent with Type 1 Diabetes
Authors: LUO DAN , LI MINGZI
Published: June 2020

Background: Parents of adolescent with type 1 diabetes experience increased levels of diabetes distress and depression, which is linked to adolescent glycemic control. Parental resilience might be able to improve parental mental health and facilitate adolescent glycemic control. Nevertheless, these relationships have not yet been confirmed.

Objective: To examine relationships between parental resilience, mental health (diabetes distress and depression), and adolescent glycemic control, as well as determine if parental resilience is the mediator of the association between parental mental health and adolescent glycemic control.

Methods: Parents of adolescents with type 1 diabetes (age 13-19) completed a measure of resilience, diabetes distress and depressive symptoms as part of a screening questionnaire. Adolescents’ HbA1c was obtained from medical records.

Results: Parental resilience was negatively related to maternal depressive symptoms, diabetes distress, and positively related to adolescents’ HbA1c value (all P < 0.01). In multivariate analyses, resilience was the only significant predictor of glycemic control.

Conclusions: Given the links between parental resilience, parental mental health, and youth’ glycemic control, parental resilience may be important to consider when targeting both parents’ and adolescents’ adaptation to type 1 diabetes.

Disclosure

D. Luo: None. M. Li: None.
131-OR: GLP-1R in the Nodose Ganglion Modulate Intestinal Lipoprotein Production via a Neuroendocrine Mechanism
Authors: HOFFMAN SIMON S. , ADELI KHOSROW
Published: June 2020

Diabetic dyslipidemia is characterized by overproduction of ApoB48-containing chylomicron particles, which are an independent risk factor for the development of cardiovascular disease. Chylomicron production is regulated in-part by gut-derived hormones such as glucagon-like peptide (GLP)-1. Notably, we have shown that GLP-1 acts in a neuroendocrine manner; activating GLP-1 receptor (GLP-1R) containing vagal neurons in the portal vein thereby reducing postprandial lipemia. GLP-1Rs have also been identified in the vagal nodose ganglion (NG), however their relevance to lipoprotein metabolism is yet unknown.

Syrian Golden hamsters received bilateral NG injections of either PBS vehicle, the GLP-1R agonist exendin-4, the GLP-1R antagonist exendin 9-39, or a combination of both. To investigate the propagation of vagal signalling from the portal bed hamsters received injections of GLP-1 or PBS vehicle into the portal vein, and concurrent NG injections of either exendin-4 or exendin 9-39. In addition, selective deafferination of GLP-1R-containing NG neurons was achieved via nodose injection of the cytotoxin saponin conjugated to exendin-4. After treatment, all animals received a gavage of olive oil, and an intravenous infusion of tyloxapol to prevent lipoprotein clearance. Postprandial accumulation of TG-rich lipoproteins was assessed via blood draws over a 6-hour period. Triglyceride-rich lipoprotein (TRL) fractions were then isolated via density ultracentrifugation for biochemical analysis.

NG injection of exendin-4 significantly reduced postprandial plasma TG and TRL. The ability of portal GLP-1 to reduce postprandial lipemia was lost with 9-39 injection into the NG, suggesting that active GLP-1R in this ganglion are requisite to elicit this effect. Finally, selective deafferination of NG GLP-1R containing neurons caused significant rises in postprandial TG and TRL, underscoring the importance of vagal signalling in intestinal lipoprotein regulation.

Disclosure

S.S. Hoffman: None. K. Adeli: None.

Funding

Canadian Institutes of Health Research (967131)
1310-P: Trends in Pediatric Admissions for Diabetic Ketoacidosis in the U.S.: Analysis of the 2006-2016 Kid Inpatient Database
Authors: EVERETT ESTELLE M. , COPELAND TIMOTHY , MOIN TANNAZ , WISK LAUREN E.
Published: June 2020

Background: Rates of diabetic ketoacidosis (DKA) have been rising despite many medical advances. National studies in the U.S. describe higher rates in younger populations, although studies have not closely characterized U.S. trends in pediatrics.

Methods: We conducted a study using the national Kids’ Inpatient Database to identify pediatric admissions for DKA in years 2006, 2009, 2012, and 2016. Newborn admissions were excluded. We used descriptive statistics to describe prevalence of DKA admissions, DKA rates and trends among all pediatric admissions. Logistic regression was used to evaluate differences in DKA rates overtime within subgroups and determine factors associated with DKA trends.

Results: We identified 12,271,107 admissions of which 149,713 were for DKA. Among those with DKA, there was a high prevalence of those 15-20yo (58%), female sex (54%), white race (50%), and publicly insured (44%). Most were from urban areas (81%), the bottom two income quartiles (58%) and hospitalized in large (60%), private hospitals (71%), and in southern states (40%). When compared to all pediatric admissions, rates of DKA were highest in those 12-14yo, of male sex, black race, second income quartile and with charity care. Patients from non-urban areas and those hospitalized in private and small hospitals also had higher rates. There was a large rise in DKA admissions rates per 10,000 admissions from 94.6 in 2006 to 184.6 in 2016. The rate of change was similar within most subgroups. The characteristics positively associated with DKA admission after adjustment were age 12-14yo, male sex, black race, publicly insured or self-pay, lower income, and hospitals that were private, small, or located outside the northeast.

Conclusions: Rates of DKA admission have increased from 2006 to 2016. Although there were disparities among subgroups admitted, the rise in rate overtime was similar within most subgroups. Further studies are needed to understand drivers of admission in this population.

Disclosure

E.M. Everett: None. T. Copeland: None. T. Moin: None. L.E. Wisk: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (1K01DK116932-01)
133-LB: Cardiovascular Outcomes in Older Adults Initiating Empagliflozin vs. DPP-4 Inhibitors and GLP-1 Receptor Agonists: A Subgroup Analysis from the EMPRISE Study
Authors: PATORNO ELISABETTA , PAWAR AJINKYA , BESSETTE LILY G. , NAJAFZADEH MEHDI , WEXLER DEBORAH J. , FRANKLIN JESSICA , DERUAZ-LUYET ANOUK , BRODOVICZ KIMBERLY , KOENEMAN LISETTE , SCHNEEWEISS SEBASTIAN
Published: June 2020

EMPRISE aims to study the effectiveness, safety and healthcare utilization of empagliflozin (EMPA) in routine care patients. In an interim analysis, we assessed the comparative cardiovascular (CV) effectiveness of EMPA in older adults. Using data from Medicare (2014-2017), we identified 11,579 pairs of 1:1 propensity score-matched patients ≥66 years with type 2 diabetes initiating EMPA or a DPP-4 inhibitor (DPP-4i), and 17,500 pairs initiating EMPA or a GLP-1 receptor agonist (GLP-1RA). We assessed hospitalization for heart failure (HHF), defined as a HF discharge diagnosis in the primary (HHF-Specific) or in any position (HHF-Broad) and a modified MACE outcome (MI, stroke, or all-cause mortality). We estimated HR and 95% CI adjusting for >140 baseline covariates. Compared to DPP-4i, EMPA was associated with a decreased risk of HHF [HHF-Specific: 0.43 (0.30-0.63); HHF-Broad: 0.57 (0.47-0.69)] and MACE [HR (95% CI) = 0.63 (0.50-0.79)]. Compared to GLP-1RA, EMPA had a reduced risk of HHF [HHF-Specific: 0.67 (0.50-0.91); HHF-Broad: 0.83 (0.71-0.96)] and a similar risk of MACE [1.02 (0.85-1.23)](Table 1). Results for the individual components of MACE were consistent and robust to competing risks. These findings, addressing the comparative effectiveness of EMPA in routine care patients with mean age of 72 years, complement available information from RCTs.

Disclosure

E. Patorno: Other Relationship; Self; Boehringer Ingelheim International GmbH. A. Pawar: None. L.G. Bessette: None. M. Najafzadeh: None. D.J. Wexler: Other Relationship; Self; Novo Nordisk A/S. J. Franklin: None. A. Deruaz-Luyet: Employee; Self; Boehringer Ingelheim International GmbH. Employee; Spouse/Partner; Sanofi-Aventis Deutschland GmbH. K. Brodovicz: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. L. Koeneman: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. S. Schneeweiss: None.

Funding

Boehringer Ingelheim
1350-P: Ehealth Technologies for Gestational Diabetes Mellitus: Summary of Features and Effectiveness: Scoping Review
Authors: BALAJI BHAVADHARINI , HALPERIN ILANA , MUKERJI GEETHA , LIPSCOMBE LORRAINE
Published: June 2020

Background: There has been growing availability of ehealth technologies (ETs) for management of gestational diabetes mellitus (GDM). While ETs have the potential to improve the efficiency and quality of GDM care, the nature of information and support provided through such technologies and their benefits are unclear. This review aims to summarise data on features and outcomes for ETs specific to GDM.

Methods: We conducted a systematic literature search of studies on ehealth technologies in EMBASE, OVID, SCOPUS and Web of Science in November 2019. Studies reporting data on use of ETs for management and follow up of women with GDM were included.

Results: We identified 17 studies with data on over 2,000 women with GDM that described ETs for management and follow up of women GDM. The studies were categorised into telemedicine (n=4), web-based (n=4) and smartphone application (n=9). The types of studies included in the review include randomized controlled trials (n=9), cohort studies (n=3), quasi experimental study (n=3) and focus group discussions (n=2). Some features of the ETs include electronic transfer of blood glucose data, bidirectional communication with physician, web based lifestyle program and a virtual diary to log blood glucose measurements (BGM), step count and dietary intake. Studies evaluating telemedicine and web based systems showed significant reductions in the number of in person clinic visits during pregnancy (2 studies), better glycemic control (2 studies), lowered insulin use (2 studies), and weight loss after delivery (1 study). Studies that evaluated smartphone applications showed significantly higher adherence to BGM (4 studies), patient satisfaction (92% in one study) and acceptance through thematic evaluation of app (5 studies), supporting the potential of smartphone app for managing GDM.

Conclusion: Ehealth technologies have the potential to improve management and outcomes for women with GDM.

Disclosure

B. Balaji: None. I. Halperin: Advisory Panel; Self; Tandem Diabetes Care. Speaker’s Bureau; Self; Abbott, Boehringer Ingelheim (Canada) Ltd., Dexcom, Inc., Novo Nordisk Inc., Sanofi. G. Mukerji: None. L. Lipscombe: None.
1352-P: Maternal Subclinical Hypothyroidism in the First Trimester Is Not Related to Gestational Diabetes Mellitus
Authors: LI PING , LIN SHUO , FAN JIANHUI
Published: June 2020

This study aims to evaluate the relationship between subclinical hypothyroidism (SCH) during the first trimester and gestational diabetes mellitus (GDM) that was happened later on in our cohort. A total of 6530 pregnant women who first visited before 13+6 gestational weeks and accepted routinely prenatal services in the third affiliated hospital of Sun Yat-Sen University from January 2015 to September 2018 were finally met the inclusion criteria and recruited. Thyroid functions were performed at the first visit and a 2h 75-g OGTTwas performed between 24-28 weeks. The glucose levels of OGTT were shown no differences between SCH and euthyroid women [0 hour: 4.17 mmol/L (3.99-4.38) vs. 4.16 mmol/L (3.97-4.39), P = 0.730; 1 hour: 7.61 mmol/L (6.64-8.66) vs. 7.68 mmol/L (664-8.75), P = 0.449; 2 hour: 6.66 mmol/L (5.85-7.68) vs. 6.75 mmol/L (5.93-7.74), P = 0.142]. The incidence of GDM was no change as the TSH level increased in either TPOAb negative or positive SCH women (all P > 0.05). After using the multivariate logistic regression analysis adjusted for confounders (maternal age, educational levels and preBMI), elevated TSH and TPOAb status also had no effect on the incidence of GDM (Table 1). These results suggested maternal SCH in the first trimester was not related to GDM, regardless of the TPOAb status or the TSH levels.

Disclosure

P. Li: None. S. Lin: None. J. Fan: None.

Funding

Science and Technology Planning Project of Guangdong Province (2017A020215026); Medical Scientific Research Foundation of Guangdong Province (A2017314)
1363-P: Continuous Glucose Monitoring (CGM) of Postprandial (PP) Glycemic Responses in Pregnancies Complicated by Diabetes
Authors: NOSOVA EMILY V. , CASTORINO KRISTIN N. , LEVY CAROL J. , JOHNSON TERRI , SHAH SALONI , HAROUSH GAL , NELSON KRISTEN , O’MALLEY GRENYE , OGYAADU SELASSIE J. , LEVISTER CAMILLA , BRACKETT SCOTT J. , POLSKY SARIT
Published: June 2020

Background: Diabetes in pregnancy portends increased maternal and fetal morbidity and mortality. Glucose testing is advised at 1 or 2 hours Pp. CGM during pregnancy may improve meal-time glycemic monitoring. Limited Pp CGM data exist for gestational diabetes (GDM), type 1 diabetes (T1D), or type 2 diabetes (T2D).

Methods: We report prospective Pp glycemic data for 32 pregnant women collected during a 6-hour YSI clinic session for a 10-day Dexcom G6 CGM accuracy trial. Each subject wore 2 sensors. During the session, food consumption was recorded and analyzed if >5g. Meals were not standardized. CGM and YSI Pp responses within 2 hours of meals and carbohydrate content were evaluated.

Results: Most women had T1D (n=20) (See table). Subjects consumed 1 (n=6), 2 (n=13) or 3 (n=13) meals for a total 71 meals. Mean carbohydrate intake per meal was 29 ± 19 g (range 6-101). Peak CGM values were recorded for 32 morning and 31 afternoon meals in 2 sensors/subject (n=139 values). Pp CGM values peaked at 136 ± 32 mg/dL (range 78-233) at median 60 minutes (interquartile range: 44, 99).

Conclusions: Eating patterns are heterogeneous among pregnant women. These data support 1 hour Pp testing, and CGM use allows more detailed glycemic evaluations around meals. Our YSI results support CGM reliability. Timing of Pp peak glucose levels related to nutrient content in pregnancy needs further evaluation.

Disclosure

E.V. Nosova: None. K.N. Castorino: Research Support; Self; Abbott, Dexcom, Inc., Medtronic, Mylan, Novo Nordisk Inc. C.J. Levy: Consultant; Self; Dexcom, Inc. Employee; Spouse/Partner; Allergan plc. Research Support; Self; Abbott, Dexcom, Inc., Insulet Corporation. T. Johnson: Employee; Self; Dexcom, Inc. S. Shah: Employee; Self; Dexcom, Inc. G. Haroush: None. K. Nelson: None. G. O’Malley: Research Support; Self; Abbott, Dexcom, Inc. S.J. Ogyaadu: None. C. Levister: None. S.J. Brackett: None. S. Polsky: None.
1368-P: Carbohydrate Intake Is Associated with OGTT Levels in Pregnancy
Authors: ROSENBERG EMILY , JAMES KAITLYN , ARENAS JULIANA , CALLAHAN MICHAEL J. , CAYFORD MELODY , NELSON STACEY , BERNSTEIN SARAH N. , THADHANI RAVI , SEELY ELLEN W. , POWE CAMILLE E.
Published: June 2020

Background: Traditionally, a carbohydrate-rich diet in the days preceding an oral glucose tolerance test (OGTT) has been recommended based on classic studies in non-pregnant individuals showing that carbohydrate restriction elevates post-load glucose levels. Instructions on carbohydrate intake given to pregnant women having an OGTT for gestational diabetes (GDM) diagnosis vary. We tested if self-reported carbohydrate intake in pregnancy is associated with OGTT results.

Methods: Pregnant women (N=79) with ≥ 1 risk factor for GDM underwent a fasting 75 g OGTT at 24-30 wks gestation and completed a 24-hr dietary recall using a validated self-administered instrument. We tested for an association between carbohydrate intake in the 24 hrs preceding the OGTT and 1-hour OGTT glucose using linear regression, with adjustment for age, BMI, gestational age, race, and total caloric intake. We also tested for associations with 30-minute and 2-hour OGTT glucose and glucose area under the curve (AUC).

Results: Women with lower carbohydrate intake (<median=235g) were slightly older (34 vs. 32 yrs, P=0.03), but otherwise similar to women with higher intake (BMI, history of GDM in a prior pregnancy, race/ethnicity, fasting glucose). We observed a graded linear relationship between carbohydrate intake and 1-hour OGTT glucose. For every 50 g reduction in carbohydrate intake, there was a 6.2 mg/dl increase in 1-hour OGTT glucose (β=6.2 mg/dl, P<0.01); this remained significant in the adjusted model (β=7.7 mg/dl, P=0.03). Lower carbohydrate intake was also associated with higher 30-minute (unadjusted β=4.4 mg/dl, P<0.01; adjusted β=6.7 mg/dl, P=0.02) and 2-hour OGTT glucose (unadjusted β=4.3 mg/dl, P=0.03; adjusted β=6.9 mg/dl, P=0.05) and glucose AUC (unadjusted β=513, P<0.01; adjusted β=683, P=0.03). Results did not change after excluding women with intake <1000 calories or when % carbohydrate intake was used as the predictor variable.

Conclusion: Carbohydrate restriction or excess before an OGTT may affect the diagnosis of GDM.

Disclosure

E. Rosenberg: None. K. James: None. J. Arenas: None. M.J. Callahan: None. M. Cayford: None. S. Nelson: None. S.N. Bernstein: None. R. Thadhani: None. E.W. Seely: None. C.E. Powe: None.

Funding

National Institutes of Health (K23DK113218); Robert Wood Johnson Foundation; Harold Amos Medical Faculty Development Award (72456)
1390-P: Fetal Growth Acceleration Is Still Common in Well-Controlled Pregnant Women with Type 1 Diabetes Using Real-Time Glucose Monitoring
Authors: DE VALK HAROLD W. , OOSTERWIJK LISA , KAASJAGER KARIN
Published: June 2020

Introduction: Glycemic control has a major effect on fetal growth in women with type 1 diabetes mellitus (DM1), worse control leading to increased growth (large for gestational age (LGA) or very large for gestational age (VLGA) fetus). Currently, we aim at strict control (at least HbA1c ≤ 48 mmol/mol) before and during pregnancy. Real Time Continuous Glucose Monitoring (RTCGM) offers new ways to achieve this. We performed a retrospective chart review of pregnancy outcomes in DM1 to assess outcome and CGM-data in well-controlled women with DM1.

Methods: Forty-eight pregnancies in 25 women were identified between 2016-2019; 19 women with a singleton pregnancy met the inclusion criterion of HbA1c ≤ 48 mmol/mol in 1st and 3rd trimester; 8 women had insufficient CGM-data.; CGM could be analysed in 11 women. LGA was defined as fetal weight > 90th and VLGA > 97.7th percentile. CGM-data were studied during 4 periods: 4-8 weeks gestation, 18-22 weeks, 30-34 weeks and last 8 days before delivery. Target range 3.5-7.8 mmol/L. Time in range (TIR), time below range (TBR) and time above range (TAR) were calculated.

Results: In the 19 women with adequate control, LGA (LGA and VLGA) in 36.8%; simple LGA 15.7%, VLGA 21.1%. There were no congenital malformations. Women with VLGA child were significantly older (p<0.03), had higher BMI (p<0.02) and longer duration of DM1 (p<0.02). In women with normal growth fetus, LGA or VLGA, Time In Range (TIR) was 64.1%, 63.6% and 58.5%; Time Above Range (TAR): 24.4, 34.4 and 39.6%; Time Below Range: 4.0, 2.2 and 2.1%.

Conclusion: Our data show that current implementation of advanced technology was associated with mean TIR below recommended level of >70% and TAR above recommended level (<25%). Prevalence of LGA and VLGA was still increased. Adaptation of care and counselling re needed for improvement in outcome with technology.

Disclosure

H.W. de Valk: None. L. Oosterwijk: None. K. Kaasjager: None.
1392-P: Assisted Reproduction Technology Treatment and Risk of Gestational Diabetes
Authors: BIANCHI CRISTINA , PELLE CHIARA DELLA , GENNARO GIOVANNI DE , ARAGONA MICHELE , CELA VITO , DELPRATO STEFANO , BERTOLOTTO ALESSANDRA
Published: June 2020

Assisted reproduction technology (ART) treatment has been suggested to increase the risk of gestational diabetes (GDM), though the nature of this association remains unclear. In the attempt to gain more insight in such an association we have carried out a study to evaluate whether ART represents an independent risk factor for GDM in single pregnancies. We collected retrospectively clinical and anthropometric data of 221 ART- and 256 age and BMI matched women with natural conception (NC) screened for GDM between 2011-2019. Out of 477 women, 32 were excluded from the analysis due to multiple pregnancies (PMA: 24; CN: 8). Between the two groups there were no differences in age (ART: 39 ± 5; NC: 38 ± 3 years; ns), BMI (ART: 23.6 ± 4.4; NC: 22.9 ± 3.6 Kg/m2; ns) and family history of diabetes (ART: 31.4%; NC: 24.2%; ns). ART-women were more frequently primiparous (62.6% vs. 22.6%; p<0.0001), while a higher prevalence of previous GDM was observed among NC-women (9.7% vs. 2.6%; p=0.002). The prevalence of GDM in the whole cohort was 36.1% and was significantly higher in women with ART (52.3% vs. 23.4%; p <0.0001). In the whole cohort, risk factors for GDM were: age (OR 1.07 95% CI 1.02-1.13), first degree family history of diabetes (OR 2.02 95% CI 1.31-3.10), previous GDM (OR 2.09 95% CI 1.39- 3.14), pre-pregnancy obesity (OR 3.28; 95% CI 1.57-6.86) and ART (OR 3.59; 95% CI: 2.39 - 5.39). On multivariate analysis, family history of diabetes (OR 1.67; 95% CI: 1.03-2.69), previous GDM (OR 7.05; 95% CI: 2.92-17.04); pre-pregnancy obesity (OR 2.72; 95% CI 1.21-6.13) and ART (OR 4.14; 95% CI 2.65-6.48) were independent risk factors for GDM . Among women requesting ART treatment, at least one in two develops GDM, and ART appears to be an independent risk factors for GDM.

Disclosure

C. Bianchi: None. C. Della Pelle: None. G. de Gennaro: None. M. Aragona: None. V. Cela: None. S. DelPrato: None. A. Bertolotto: None.
1393-P: Residential Inequality and Birth Outcomes of Gestational Diabetes
Authors: THOMAS LEELA , FAWCETT MITCHELL R. , JURKOVITZ CLAUDINE , LENHARD JAMES
Published: June 2020

Introduction: Clinical studies have found disparities in gestational diabetes mellitus (GDM) outcomes due to individual racial and economic differences. In contrast, this pilot study examines the association of structures variations with GDM outcomes by race.

Methods: Data were obtained from a healthcare system for a study population of 2,189 women with GDM, 18 years and above, singleton births, who delivered between January 1, 2014 and December 31, 2018. Clinical data were merged with structural measures of mothers’ census tracts of residence from the U.S. Census Bureau. Outcome variables are mother and infant birth complications. Data are analyzed using zero correlations by race.

Results: Mother’s: white mothers tended to have fewer complications (r=-0.07, p<.05); not other races. For African American women, living in a tract with a higher % of households below the poverty level and higher % of less than $35K earners increased the likelihood of their experiencing Hemorrhage (r=0.11, p<0.03; r=0.12, p<0.05). For women of other races, living in a tract with higher percentage of household below the poverty level increased the likelihood of Hemorrhage (r=0.11, p<.05). For baby’s complications, white infants and infants from other races whose mothers resided in areas with a higher percentage of households below the poverty level had a higher risk of shoulder dystocia while infants of African American mothers who resided in census tracts with a higher percentage of earners below $35K were at higher risk for hospital revisit in <30 days (r=0.12, p<0.05). African American infants from neighborhoods with higher % of household below poverty level and no household vehicle had a higher likelihood of revisit.

Conclusion: Selected results show variations in complications among different races by neighborhood characteristics. The influence of race on GDM outcomes is linked to income and socioeconomic status. Income may be more important to GDM outcomes than race.

Disclosure

L. Thomas: None. M.R. Fawcett: None. C. Jurkovitz: None. J. Lenhard: Speaker’s Bureau; Self; Janssen Pharmaceuticals, Inc.

Funding

National Institutes of Health (U54GM104941)
1397-P: Does Treating Depression in Pregnant Women with Diabetes Improve Diabetes-Related Pregnancy Outcomes?
Authors: SCANNELL MADELINE L. , DUCKHAM HILLARY E. , HERRICK CYNTHIA J. , CARTER EBONY B.
Published: June 2020

Objective: To determine whether there is an association between medical management with psychotherapy and/or SSRIs and improved pregnancy outcomes among pregnant women with coexisting diabetes and depression.

Methods: We performed a retrospective cohort study of women cared for at the Resident Diabetes in Pregnancy Clinic at a large, tertiary referral center from 2007-2017. Inclusion criteria included a diagnosis of T2DM or GDM by the 2-step method, using Carpenter-Coustan criteria, and depression, defined via chart review or baseline pregnancy Edinburgh Depression score >10. Patients with multiple gestations or fetal anomalies were excluded. Women who received medication therapy with SSRIs and/or psychotherapy were compared to those who did not. The primary outcome was large for gestational age birthweight (>90th %). Secondary outcomes included other maternal and fetal diabetes-related outcomes. Demographic characteristics were compared between groups and logistic regression was used to adjust for potential confounders, including advanced maternal age, Black race, BMI, and smoking.

Results: Of 926 women seen during the study period, 255 (28%) had depression and met study criteria—115 with T2DM and 118 with GDM. Of these, 69 (27 %) had no treatment, 149 received an SSRI (58%), 37 received therapy (15%), and 9 (4%) received both. Demographics were similar between groups. Women who received SSRIs had lower rates of LGA infants (17% vs. 25%, aOR 0.51; 95% CI 0.27-0.97), shoulder dystocia (1% vs. 8%, aOR 0.15; 95% CI 0.03-0.71), and umbilical artery cord gas <7.1 than those with no treatment. There were no differences in outcomes between women who received psychotherapy and those who did not. Findings were similar when the analysis was stratified by diabetes type.

Conclusions: Our findings suggest an association between improved diabetes-related pregnancy outcomes and SSRI use in women with diabetes. Further research is needed to determine potential mechanisms.

Disclosure

M.L. Scannell: None. H.E. Duckham: None. C.J. Herrick: None. E.B. Carter: None.

Funding

American Diabetes Association/Pathway to Stop Diabetes (1-19-ACE-02 to E.B.C.); Robert Wood Johnson Foundation (74250); Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD095075)