bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender wage gap decomposition methods: Comparative analysis
Authors:   HSE University, Moscow, Russian Federation, Roshchin Sergey , Yemelina Natalya ,   HSE University, Moscow, Russian Federation
Published: June 2021

This study introduces a comparative analysis of the gender wage gap decomposition methods with the Russian Longitudinal Monitoring Survey (RLMS) data for 2018. To decompose the differences in average wages, approaches based on the Oaxaca–Blinder decomposition are used. Apart from the mean wages, the study focuses on other distribution statistics. Using the quantile regressions, the wage gap between men and women is decomposed for the distribution parameters such as median, lower and upper deciles. The decomposition estimates of conditional and unconditional (based on recentered influence functions) quantile regressions are compared.
A cross-sectoral analysis of the relation between labor productivity and labor compensation in the European Union
Authors:   Rauf Denktas University, Turkey, Fofack A.D. , Temkeng S.D. ,   University of Buea, Cameroon
Published: June 2021

The aim of this paper is to assess and compare the link between labor productivity and compensation in four industries — air transport, electronics, finance, and telecommunications — of twenty‐five member states of the European Union (EU) from 2000 to 2014. The long‐run and short‐run dynamics of productivity and compensation are analyzed using the pooled mean group (PMG), the mean group (MG) and the dynamic fixed effects (DFE) estimators. The results confirm the existence of a gap between productivity and compensation in each of those industries as mentioned in previous studies. However, the results show that despite that gap, the link between the two variables is not broken. That is, productivity and compensation are not only linked in the long run, but they also return to their long‐run equilibrium after every short‐run disturbance. The econometric analysis also reveals that the relation between productivity and compensation does not follow a significantly different pattern from one industry to the other. These findings robust to alternative models, estimation techniques and across industries, suggest that there are some other cross‐sectoral factors preventing productivity gains to be fully reflected on paychecks.
Influence of some ARFIMA model parameters on the accuracy of financial time series forecasting
Authors:   Perm State University, Perm, Russian Federation, Garafutdinov Robert
Published: June 2021

The influence of ARFIMA model parameters on the accuracy of financial time series forecasting on the example of artificially generated long memory series and daily log returns of RTS index is investigated. The investigated parameters are deviation of the integration order value from its «true» value, as well as the memory «length» considered by the model. Based on the research results, some practical recommendations for modeling using ARFIMA have been formulated.
Optimizing the role of informal learning in the perspective of Islamic education during the Covid-19 pandemic
Authors: Wardani Annisa Arsya , Suharto Toto
Published: June 2021

Online learning is chosen during the Covid-19 pandemic. The problem that occurs is teachers as educators cannot directly supervise the development of students, so they need help from the informal educational institution.. In this context, parents take the role of facilitators during online learning. Not only limited to the educational function of parents, but it also has many roles that can be optimized so that children can grow and develop properly. The purpose of this study is toportray the role of families, especially parents in optimizing their role when online learning is present during the Covid 19 pandemic. The method used in this research was qualitative descriptive. This study used the data triangulation method as a technique to measurethe validity of the data. The analysis technique used in this research was interactive model analysis. The interactive analysis included data reduction, data presentation, and conclusions. The main results of this study were parents, apart from being an educational institution, whoalso took a role of being shaping children's character and personality that is to stimulate children's linguistic intelligence. Parents can also stimulate children's intrapersonal intelligence by adapting to behavior that is appropriate to the local cultural environment. The contribution of this research includes the function of parents which is not only maximizing scientific education but also deepening the internalization of spiritual and religious values in children, as well as building good communication is needed to optimize the role of parents to children.
STUDENT SATISFACTION, LOYALTY, AND MOTIVATION AS OBSERVED FROM THE SERVICE QUALITY
Authors: Subandi Subandi , Hamid Muda Setia
Published: June 2021

This study seeks to analyze the effect of service quality on satisfaction, the effect of service quality on loyalty, the effect of service quality on motivation, the effect of satisfaction on loyalty, the effect of satisfaction on motivation, and to analyze the mediation of student satisfaction on the effect of service quality on student motivation and loyalty. In this quantitative research, a questionnaire was distributed to 100 fifth-semester students of Administrative Management Academy Yogyakarta. The samples were selected using a purposive sampling technique. The variable measurement used a Likert scale. Data analysis was carried out using Structural Equation Modeling (SEM) with SmartPLS 3 software. The results of the analysis show that service quality affects student satisfaction, student loyalty, and student motivation. Student satisfaction affects student loyalty and student motivation. Service quality affects student loyalty and student motivation mediated by student satisfaction.
THE ROLE OF EMPLOYEE EMPOWERMENT, TEAMWORK, AND EMPLOYEE TRAINING ON ORGANIZATIONAL COMMITMENT
Authors: Riyadi Restu Purba , Auliya Zakky Fahma
Published: June 2021

This study aims to determine the influence of employee empowerment, teamwork, and employee training on the organizational commitment of employees at the Banyumas Public Works Office. The population used is employees who work at the Department of Public Works of Banyumas Regency. The research method used was a quantitative method with a purposive sampling technique. The data analysis technique used was multiple linear regression. In this study. The data source used was primary data employing SPSS 23.0 software. Data collection methods in this study were questionnaires. The sample of this study was 80 respondents. The results of this study indicate that (1) employee empowerment has a significant influence on organizational commitment, (2) teamwork has a significant influence on organizational commitment, and (3) employee training has a significant influence on organizational commitment.
THE ELEMENTS OF THE MOVIE “KALAM-KALAM LANGIT” AND ITS EFFECT ON VISIT INTENTION OF HALAL TOURISM DESTINATION: THE MEDIATION OF AFFECTIVE IMAGE AND COGNITIVE IMAGE
Authors: Saputra Wawan , Wiyono Azis Slamet
Published: June 2021

This study seeks to determine the effect of elements in the movie “Kalam-Kalam Langit” on the visit intention of halal tourism destinations through affective and cognitive image. This study employed a quantitative approach with 100 respondents whose specific criteria of have watched the movie “Kalam-Kalam Langit”. Questionnaires were distributed offline and online using Google Forms. Nonprobability sampling was used for sampling techniques. The data analysis method was multiple regression analysis and multiple testing employing SPSS version 2.3 to determine the relationship of independent and dependent variables through mediating variables. The results show that there is a positive and significant effect of elements in the movie on cognitive and affective images. The results also show that affective and cognitive images have a significant positive effect of the elements in the movie “Kalam-Kalam Langit” on the visit intention of tourist attractions in the movie. However, the results showed that the cognitive image and the affective image did not mediate the effect of the elements in the movie on the visit intention of tourism destinations.
Reduced Laryngeal Sensitivity and its Association with Dysphagia and Cough in Children with Neurological Impairment
Authors: Freitag Nadine , Tews Pia , Hübl Nicole , Krug Katrin , Kristin Julia , Distelmaier Felix , Schramm Dirk
Published: June 2021

Background Silent aspirations are frequent in children with neurological
impairment. They dramatically increase the risk for acute and chronic
respiratory insufficiencies leading to high morbidity and mortality.
Laryngeal sensitivity deficits have been linked to aspirations in adults
and are a suspected cause for dysphagia in children. In a similar
neurological circuit as swallowing, laryngeal receptors trigger coughing
as a protective airway reflex. The aim of this study was to examine the
association between reduced laryngeal sensitivity, aspiration and
coughing in neurologically impaired children. Design and Methods In a
retrospective study, 110 children with suspected dysphagia who received
a clinical evaluation of swallowing and a flexible endoscopic evaluation
of swallowing (FEES) between 2013 and 2019 in the children’s university
clinic Düsseldorf were analyzed. Laryngeal sensitivity was tested by the
endoscopic touch method. Fifty-four patients (49.1%) had neurological
impairments, 56 patients (5.9%) had no or other comorbidities and
served as a control cohort. Associations were computed using χ2-test.
Results Children with neurological impairment suffered from laryngeal
sensory deficit significantly more often and seemed to cough less
frequently than children with no or other comorbidities. Reduced
laryngeal sensitivity could not be correlated to less coughing. Coughing
acted as a predictor of aspiration only in the neurologically impaired
group of children with reduced laryngeal sensitivity. Conclusion Reduced
laryngeal sensitivity is a potential cause of silent aspirations in
children with neurological impairment. However, reduced laryngeal
sensitivity did not lead to significantly less coughing which might be
due to a lack of discrimination between different levels of sensitivity
deficits by the endoscopic touch.
A systematic literature review of community pharmacist-led interventions to optimize the use of antibiotics
Authors: Lambert Maarten , Smit Chloé , Vos Stijn De , Benko Ria , Llor Carles , Paget John , Briant Kathryn , Pont Lisa , Dijk Liset van , Taxis Katja
Published: June 2021

Objectives. The aim of this systematic review is to assess the effects
of community pharmacist-led interventions to optimize the use of
antibiotics and identify which interventions are most effective.
Methods. This review was conducted according to the PRISMA-P guidelines
(PROSPERO: CRD42020188552). PubMed, EMBASE and the Cochrane Central
Register of Controlled Trials were searched for (randomised) controlled
trials. Included interventions were required to target antibiotic use,
be set in the community pharmacy context and be pharmacist-led. Primary
outcomes were quality of antibiotic supply and adverse effects while
secondary outcomes included patient reported outcomes. Risk of bias was
assessed using the ‘Cochrane suggested risk of bias criteria’ and
narrative synthesis of primary outcomes conducted. Results. Seventeen
studies were included covering in total 3,822 patients (mean age 45.6
years, 61.9% female). Most studies used educational interventions.
Three studies reported on primary outcomes, twelve on secondary outcomes
and two on both. Three studies reported improvements in quality of
dispensing where interventions led to more intensive symptom assessment
and a reduction of OTC or wrong choice antibiotic supply. Some
interventions led to higher consumer satisfaction, effects on adherence
were mixed. All studies had unclear or high risks of bias across at
least one domain, with large heterogeneity between studies. Conclusions.
Our review suggests some possible positive results from pharmacist-led
interventions, but the role of the pharmacist needs to be expanded. This
review should be interpreted as exploratory research, as more
high-quality research is needed. Authors did not receive funding for the
review.
Using machine learning for personalized prediction of revision paranasal sinus surgery
Authors: Nuutinen Mikko , Haukka Jari , Virkkula Paula , Torkki Paulus , Toppila-Salmi Sanna
Published: June 2021

Background: Uncontrolled chronic rhinosinusitis (CRS) needing
consideration of surgery is a growing health problem yet its risk
factors at individual level are not known. Our aim was to examine risk
factors of revision endoscopic sinus surgery (ESS) at the individual
level by using artificial intelligence. Methods: Demographic
and visit variables were collected from electronic health records (EHR)
of 790 operated CRS patients. The effect of variables on the prediction
accuracy of revision ESS was examined at the individual level via
machine learning models. Results: Revision ESS was performed to
114 (14.7%) CRS patients. The logistic regression, gradient boosting
and random forest classifiers had similar performance (AUC values .746,
.745 and .747, respectively) for predicting revision ESS. The best
performance was yielded by using logistic regression and long predictor
data retrieval time (AUC .809, precision 36%, sensitivity 70%) as
compared with data collection time from baseline visit until 0, 3 and 6
months after the baseline ESS (AUC values .668, .717 and .746,
respectively). The number of visits, number of days from the baseline
visit to the baseline ESS, age, CRS with nasal polyps (CRSwNP), asthma,
NERD and immunodeficiency or its suspicion were associated with revision
ESS. Age and the number of visits before baseline ESS had non-linear
effects for the predictions. Conclusions: Intelligent data
analysis found important predictors of revision ESS at the individual
level, such as visit frequency, age, Type 2 high diseases and
immunodeficiency or its suspicion.
A possible connection between phosphate tungsten bronzes properties and Briggs-Rauscher oscillatory reaction response
Authors: Maksimovic Tijana , Maksimovic Jelena , Tancic Pavle , Potkonjak Nebojsa , Nedic Zoran , Joksovic Ljubinka , Pagnacco Maja
Published: June 2021

The calcium phosphate tungsten bronze (Ca-PWB) has been synthesized and
characterized (TGA, DSC, XRPD, FTIR, SEM). The influence of solid insoluble
materials Ca- PWB, as well as lithium doped (Li-PWB) and cation free
phosphate tungsten (PWB) bronzes on the oscillatory Briggs-Rauscher (BR)
reaction dynamics, is compared. The results show that doping with Li and Ca
reduces sensitivity of the BR reaction towards bronzes addition. These
findings suggest the usage of the BR reaction as an innovative method for
testing of different properties of bronze material. The behavior of PWB in
the BR reaction is significantly changed with divalent cation (Ca2+) doping.
The reasons for the different bronzes behavior were found in their
calculated unit cell volumes. Namely, the compressed Ca-PWB unit cell volume
indicates the difficult availability of the active site for heterogeneous
catalysis. Hence, the linear correlation (slope) of the BR oscillogram?s
length (?osc) vs. mass of bronze in BR reaction might be considered as a new
parameter for the evaluation of the bronzes catalytic activity.
TEM and DFT study of basal-plane inversion boundaries in SnO2-doped ZnO
Authors: Ribic Vesna , Recnik Aleksander , Drazic Goran , Podlogar Matejka , Brankovic Zorica , Brankovic Goran
Published: June 2021

In our recent study (Ribic et al. 2020) we reported the structure of
inversion boundaries (IBs) in Sb2O3-doped ZnO. Here, we focus on IBs that
form in SnO2-doped ZnO. Using atomic resolution scanning transmission
electron microscopy (STEM) methods we confirm that in SnO2-doped ZnO the IBs
form in head-to-head configuration, where ZnO4 tetrahedra in both ZnO
domains point towards the IB plane composed of a close-packed layer of
octahedrally coordinated Sn and Zn atoms. The in-plane composition is driven
by the local charge balance, following Pauling's principle of
electroneutrality for ionic crystals, according to which the average
oxidation state of cations is 3+. To satisfy this condition, the cation
ratio in the IB-layer is Sn4+: Zn2+=1:1. This was confirmed by concentric
electron probe analysis employing energy dispersive spectroscopy (EDS)
showing that Sn atoms occupy 0.504 ? 0.039 of the IB layer, while the rest
of the octahedral sites are occupied by Zn. IBs in SnO2-doped ZnO occur in
the lowest energy, IB3 translation state with the cation sublattice
expansion of ?IB(Zn-Zn) of +91 pm with corresponding O-sublattice
contraction ?IB(O-O) of -46 pm. Based on quantitative HRTEM and HAADF-STEM
analysis of in-plane ordering of Sn and Zn atoms, we identified two types of
short-range distributions, (i) zigzag and (ii) stripe. Our density
functional theory (DFT) calculations showed that the energy difference
between the two arrangements is small (~6 meV) giving rise to their
alternation within the octahedral IB layer. As a result, cation ordering
intermittently changes its type and the direction to maximize intrinsic
entropy of the IB layer driven by the in-plane electroneutrality and 6-fold
symmetry restrictions. A long-range in-plane disorder, as shown by our work
would enhance quantum well effect to phonon scattering, while Zn2+ located
in the IB octahedral sites, would modify the bandgap, and enhance the
in-plane conductivity and concentration of carriers. Keywords
Why don’t mourners do geometry? St Maximus the Confessor and St Gregory the Theologian’s Oration 27
Authors: Jeftic Andrej
Published: June 2021

The paper deals with St Maximus? Ambiguum 14 in which this Byzantine
theologian interprets a paragraph from the famous First theological oration
of St Gregory the Theologian. By way of comparison, the Cappadocian states
that Eunomian theological discussions are misplaced in the same manner as
doing geometry would be in the time of mourning. Maximus faced a rather
difficult task of interpreting this odd comparison. In response to this
challenge, he offered several different interpretations, admitting that he
would be grateful to anyone who might offer a better solution of this
ambiguity. Some scholars who dealt with the text criticism of this very
oration did precisely this by suggesting that ?the geometry? (?????????)
represented a lapsus calami which replaced the original phrase ?the
immoderate laughter? (???? ???????), while others refused to accept their
proposal. Reflections are offered in conclusion on the authority present in
the patristic texts, both in case of Maximus as well as in the case of
contemporary patristic scholars.
1012-P: Diabetes Is Not Associated with Worse Outcomes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Authors: ATLURI RAMTEJ , RAMIREZ MARCELO , SHAKA HAFEEZ , MURTHI MUKUNTHAN , CORPUZ CARLOS GABRIEL D. , VELAGAPUDI SUJITHA , VELAZQUEZ GENARO
Published: June 2021

Background: Diabetes mellitus (DM) is a multisystem metabolic disorder shown to have adverse effects on lung physiology, immune responses, and antimicrobial defenses. However, the impact of DM on the development of poor in-hospital outcomes in patients with Acute COPD exacerbation (AECOPD) is unclear. We aimed to assess this very impact in our study.

Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2018. About 394,929 hospitalizations had AECOPD as a primary diagnosis and were stratified based on the presence of DM using ICD-10 codes. Multivariate regression analysis was used to adjust for confounders and analyze variables. The selection of covariates was done with a univariate screen and literature review.

Results: Out of the 394,929 hospitalized patients with AECOPD, 123,425 patients had DM. In-hospital mortality in AECOPD patients with DM was lower than those without (0.78% vs. 1.17%, p<0.001). Mean length of stay (LOS) and patient costs (PC) were higher in those with DM (4.1 vs. 3.92 days and $9242 vs. $8710 respectively). When adjusted to patient demographics, comorbidities and hospital characteristics, AECOPD patients with DM had a lower risk of mortality (aOR=0.49, p<0.001), myocardial infarction (MI) (aOR=0.58, p<0.001), pulmonary embolism (PE) (aOR=0.71, p=0.011), and stroke (aOR=0.68, p=0.047), as well as a higher risk develop an AKI (aOR=1.07, p=0.024). COPD patients with DM had less LOS by 0.09 days (p=0.007) and PC by $236 (p=0.03) after adjusting for similar covariates. There was no statistical significance in the risk of developing respiratory failure (aOR=0.97, p=0.165) and sepsis (aOR=0.74, p=0.173).

Conclusion: DM in AECOPD did not have worse outcomes in terms of in-hospital mortality, LOS, and PC. DM patients had lower risk of MI, PE, and stroke, however, had higher risk of AKI. Further investigation is needed to understand the exact correlation between the paradoxical nature of outcomes in AECOPD in those with DM.

Disclosure

R. Atluri: None. M. Ramirez: None. H. Shaka: None. M. Murthi: None. C. D. Corpuz: None. S. Velagapudi: None. G. Velazquez: None.
1026-P: Rates and Disparities of Hypoglycemic and Hyperglycemic Emergencies and Mortality among U.S. Adults with Diabetes, 2009-2018
Authors: MCCOY ROZALINA G. , SWARNA KAVYA SINDHU , GALINDO RODOLFO J. , VAN HOUTEN HOLLY , O’CONNOR PATRICK J. , SHAH NILAY
Published: June 2021

Severe hypoglycemia and hyperglycemia in diabetes management are dangerous yet potentially preventable. Data on contemporary trends of these events, mortality following their occurrence, and potential racial/ethnic disparities are limited. We used claims data from OptumLabs Data Warehouse to 1) examine rates of hypoglycemic and hyperglycemic emergencies among U.S. adults with diabetes between 2009 and 2018; 2) quantify 30-day and 1-year all-cause mortality after these events adjusted for age, sex, race/ethnicity, and U.S. region; and 3) assess for disparities by race/ethnicity.

Among 3,709,936 adults with diabetes (age 60.2 [SD, 13.7] years, 49.2% female, 58.5% White), the adjusted rate of hypoglycemic emergencies per 1000 person-years decreased by 41% from 2009 to 2018, from 16.2 (95% CI, 15.8-16.6) to 9.6 (9.4-9.8). The adjusted rate of hyperglycemic emergencies increased by 24%, from 4.6 (4.5-4.8) to 5.7 (5.6-5.9). Black patients had the highest risk of both events compared to Whites, with RR 1.7 (1.7-1.8) for hypoglycemic and 1.5 (1.4-1.5) for hyperglycemic emergencies. All-cause 30-day and 1-year mortality did not change over time. In 2018, 30-day adjusted mortality was 1.6% (1.4-1.8) and 1.3% (1.1-1.5) after hypoglycemic and hyperglycemic emergencies, respectively, while 1-year mortality was 10.3% (9.8-10.9) and 4.7% (4.2-5.2). The risks of 30-day and 1-year mortality after hypoglycemic emergencies were lower among Black (OR 0.85 [0.76-0.96] and OR 0.91 [0.87-0.96], respectively) and Hispanic (OR 0.81 [0.68-0.97] and OR 0.70 [0.64-0.76]) patients compared to Whites. There was no association between race/ethnicity and 30-day mortality after hyperglycemic emergencies, while the risk of 1-year mortality was lower among Hispanic patients (OR 0.73 [0.63, 0.85]) compared to Whites.

New strategies are needed to prevent hypoglycemic and hyperglycemic emergencies among people with diabetes, particularly among racial/ethnic minorities.

Disclosure

R. G. Mccoy: None. K. Swarna: None. R. J. Galindo: Consultant; Self; Abbott Diabetes, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi US, Valeritas, Inc., Research Support; Self; Dexcom, Inc., Novo Nordisk. H. Van houten: None. P. J. O’connor: None. N. Shah: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (K23DK114497)
1031-P: Wnt Regulation and Collagen Gene Expression in the Bone of Type 2 Diabetes Patients
Authors: LEANZA GIULIA , TRAMONTANA FLAVIA , CANNATA FRANCESCA , PICCOLI ALESSANDRA , FARAJ MALAK , VIOLA VIOLA , STROLLO ROCKY , NAPOLI NICOLA , POZZILLI PAOLO
Published: June 2021

Increased circulating sclerostin levels and accumulation of advanced glycation end-products (AGEs) are two potential mechanisms underlying low bone turnover and increased fracture risk in type 2 diabetes (T2D). Recent data from our group have shown that T2D affects the expression of genes controlling bone formation (SOST and RUNX2) and that accumulation of AGEs is associated with impaired bone microarchitecture. Whether the expression of the Wnt beta-catenin target genes is altered in T2D, and whether AGEs accumulation it is associated with type 1 Collagen (COL1A1) alteration is still unknown. We hypothesized that increased SOST gene expression leads to downregulation of Wnt β- catenin target genes (TCF/LEF1) and AGEs accumulation is related to a downregulation of COL1A1 in bones from subjects with T2D. We analyzed bone tissue from femoral heads of 14 T2D postmenopausal women (mean HbA1c 6.5%) and 21 age- and BMI-comparable nondiabetic women undergoing hip replacement surgery. We found that TCF-LEF1 was significantly lower in T2D compared to non- diabetic subjects (p=0.0092). Dickkopf -1 (DKK-1), the other inhibitor of beta-catenin-dependent Wnt signalling besides sclerostin, was not different between groups (p=0.1083). However, analysis of correlation showed that DKK-1 increases with age (r2=0.038; p=0.043) and HbA1c (r2=0.503; p=0.048) in T2D subjects. COL1A1 gene expression was lower in T2D compared to controls although significance was not fully reached (p=0.0564). Importantly, AGEs bone content was significantly higher in T2D compared to nondiabetics (1.5 fold increase; p<0.0001).

In conclusion, our data show that even in patients with relatively good glycemic control, T2D affects the expression of collagen and Wnt beta-catenin target genes. We also found that accumulation of AGEs is possibly associated with alteration in collagen gene expression. We provide novel insights that may help understand the mechanisms underlying bone fragility in T2D.

Disclosure

G. Leanza: None. F. Tramontana: None. F. Cannata: None. A. Piccoli: None. M. Faraj: None. V. Viola: None. R. Strollo: None. N. Napoli: None. P. Pozzilli: None.

Funding

Campus Bio-Medico University
105-OR: An Exploratory Phase 2a, Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Effect of Cotadutide on Energy Balance in Overweight and Obese Subjects with Type 2 Diabetes Mellitus
Authors: GOLUBIC RAJNA , KENNET JANE , PARKER VICTORIA E. , ROBERTSON DARREN , LUO DAN , HANSEN LARS , JERMUTUS LUTZ , AMBERY PHILIP , PARK ADRIAN , EVANS MARK
Published: June 2021

Background: Cotadutide is a GLP1/glucagon receptor dual agonist under development for the treatment of nonalcoholic steatohepatitis and type 2 diabetes (T2D) with diabetic kidney disease. Early-phase clinical studies show that cotadutide achieves clinically significant weight loss. We aimed to establish mechanistically to what extent this effect is mediated via changes in energy intake (EI) or energy expenditure (EE).

Methods: We conducted a phase 2a single-center randomized double-blind placebo-controlled trial in overweight/obese adults (BMI 27-40 kg/m2) with T2D (HbA1c 6.5-8%). Participants underwent a 16-day single-blind placebo run-in and were randomized to double-blind 42-day cotadutide or placebo. Cotadutide was given subcutaneously, up to 300 µg daily. Primary outcome: % weight change from day 17 to day 59. Secondary outcomes: % and absolute changes in EI (ad libitum lunch), and EE (indirect calorimetry).

Results: A total of 19 (63%) cotadutide and 9 (78%) placebo participants completed the study. Least-squares (LS) mean weight change was -3.98% (90% CI -4.85%, -3.10%) and -1.40% (90% CI -2.66%, -0.13%) for cotadutide and placebo, respectively, p= 0.011 between groups. The cotadutide group had a striking 35% lower EI vs. placebo: LS mean -35.0% (90% CI -61.8%, -8.2%), p=0.037. Total EE (kJ/kg lean mass) after cotadutide treatment decreased vs. placebo: -6.0% vs. 0.3%, p<0.001. Significant reductions in absolute resting and activity EE were noted with cotadutide after 42 days, but there was no change in resting EE (8.5%; cotadutide vs. placebo 1.2%, p=0.177) after 16 days of therapy despite a reduction in body weight. No additional safety concerns were raised.

Conclusions: Weight loss caused by cotadutide is predominantly due to reduced EI rather than increased EE. Transient preservation of EE in the early phases of cotadutide treatment may reflect glucagon receptor engagement.

Disclosure

R. Golubic: None. M. Evans: Advisory Panel; Self; Pila Pharma, Zucara Therapeutics Inc., Other Relationship; Self; Abbott Diabetes, Medtronic, Novo Nordisk, Research Support; Self; AstraZeneca, Imcyse. J. Kennet: None. V. E. Parker: Employee; Self; AstraZeneca, Stock/Shareholder; Self; AstraZeneca. D. Robertson: Employee; Self; AstraZeneca, Employee; Spouse/Partner; GlaxoSmithKline plc., Stock/Shareholder; Self; AstraZeneca. D. Luo: None. L. Hansen: Employee; Self; AstraZeneca. L. Jermutus: Employee; Self; AstraZeneca, Stock/Shareholder; Self; AstraZeneca. P. Ambery: Employee; Self; AstraZeneca. A. Park: Other Relationship; Self; Novo Nordisk.
1076-P: First-Fill Failure with Antihyperglycemic Medications: A Systematic Literature Review
Authors: AHMED NEHAL M. , PETERS SADIE , COOKE CATHERINE E.
Published: June 2021

Introduction: Antihyperglycemic medications are often a necessary component of diabetes treatment to achieve adequate glycemic control and reduce the risk of complications. First fill failure (FFF) occurs when a patient does not obtain a newly prescribed medication and therefore does not take even the first dose. This phenomenon is an important clinical consideration, and the objective of this study is to summarize the evidence describing FFF with antihyperglycemic medications.

Methods: A systematic literature review using Medline (PubMed) identified articles from 2010-2019 that researched FFF to antihyperglycemic medications. To be included, studies must have reported on the prevalence, associated factors, or patient-reported reasons. Studies that solely evaluated non-adult populations, employed weaker study designs (i.e., case reports/series), performed interventions, were conducted outside of the USA, or were not written in English were excluded.

Results: The search identified 2,289 unique articles from which 11 studies were included. Estimates of the prevalence of FFF to new antihyperglycemic medications (n=8 studies) ranged from 9-21% of patients, and 1-54% of prescriptions. Results varied due to differences in study populations, data sources and whether “new prescription” was defined as no prior history of the specific medication or the medication class. Associated with FFF (n=2 studies) were higher out-of-pocket costs for the antihyperglycemic medication, non-English speaking, and non-white race/ethnicity. Patient-reported reasons for FFF (n=2 studies) included not believing the medication was needed or planning to improve health behaviors, financial burden, and concern for side effects.

Conclusion: Up to one-fifth of patients are unsuccessful in initiating a newly prescribed antihyperglycemic medication. Addressing the reasons behind FFF may improve medication initiation and contribute to better health and outcomes of those with diabetes.

Disclosure

N. M. Ahmed: None. S. Peters: None. C. E. Cooke: None.
1077-P: Alcohol Consumption, Smoking Habits, and the Risk of Incident Glomerular Hyperfiltration in Subjects with Impaired Fasting Glucose
Authors: SHIBATA MIKIKO , SATO KYOKO K. , UEHARA SHINICHIRO , NISHIDA NORIMITSU , OKAMURA KAORI , SHIBATA IZUMI , KOH HIDEO , OUE KEIKO , MORIMOTO MICHIO , HAYASHI TOMOSHIGE
Published: June 2021

Although glomerular hyperfiltration (GHF) is a major risk of diabetic nephropathy and it is important to prevent GHF in subjects with prediabetes, it is not known which factors are associated with the risk of GHF. We prospectively examined the relationship of alcohol consumption and smoking habits to the risk of GHF in subjects with impaired fasting glucose (IFG). Study population was 2811 middle-aged Japanese men who had IFG, no proteinuria, no GHF, and no low estimated glomerular filtration rate (eGFR) at baseline, and who did not have low eGFR before the onset of GHF during the follow-up period. GHF was defined as eGFR ≥117 mL/min/1.73 m2, which was the upper 2.5th percentile value of eGFR in the all study population of our cohort. Low eGFR was defined as eGFR <60 mL/min/1.73 m2. Based on daily alcohol consumption, subjects were classified as follows: non-drinkers, 0.1-23.0, 23.1-46.0, and ≥46.1 g ethanol/day. As for smoking habits, subjects were divided into non-smokers, past smokers, and current smokers. During the 6-year follow-up period, 103 men developed GHF. After adjusted for BMI, fasting plasma glucose, systolic blood pressure, use of anti-hypertensive medications, and regular physical exercise, both daily alcohol consumption and smoking habits were independently associated with the risk of the incident GHF. Multiple-adjusted HRs of incident GHF for those who drank 0.1-23.0, 23.1-46.0, and ≥46.1 g ethanol/day were 0.94 (95% CI, 0.46-1.95), 1.34 (0.66-2.70), and 2.48 (1.19-5.15), respectively, compared with non-drinkers. Multiple-adjusted HRs of those for past smokers and current smokers were 0.86 (0.42-1.75), and 1.77 (1.00-3.14), respectively, compared with non-smokers.

In conclusion, high daily alcohol consumption and current smoking increased the risk of GHF in subjects with IFG.

Disclosure

M. Shibata: None. T. Hayashi: None. K. K. Sato: None. S. Uehara: None. N. Nishida: None. K. Okamura: None. I. Shibata: None. H. Koh: None. K. Oue: None. M. Morimoto: None.
1081-P: Serum Total Adiponectin Level Is Associated with Onset of Diabetes in Male Japanese: Tokushima Cohort Study
Authors: HATA AKIKO , MIYOSHI MASASHI , NAKAO TAKAYUKI , ICHIHARA TAKAKO , TAMURA AYAKO , MINAGAWA TAKAKO , KUWAMURA YUMI , FUNAKI MAKOTO
Published: June 2021

Emerging evidence suggests that adiponectin secreted from adipocytes may have a preventive effect on the development of type 2 diabetes, attributable to an increase in insulin sensitivity and suppression of inflammation. However, when the East Asian population is considered, dysfunction of insulin secretion, besides insulin resistance and inflammation, has been assumed to play a significant role in the development of diabetes. Thus, the aim of the present study was to examine whether there is an association between a decrease in serum total adiponectin level and the incidence of diabetes in male Japanese, with consideration of insulin secretory function. We here report a prospective occupational-based cohort study, which was conducted during 2010-2019 in Japan. Briefly, 851 male workers without diabetes aged over 20 years were followed up prospectively. Diabetes was defined as either: 1) fasting plasma glucose ≥ 126 mg/dl, 2) HbA1c ≥ 6.5%, 3) medication for hyperglycemia or 4) postprandial plasma glucose ≥ 200 mg/dl during the follow-up period. Hazard ratios (HRs) with 95% confidence intervals (CIs) of serum total adiponectin level for the incidence of diabetes were estimated using a Cox proportional hazards model. In multivariate analysis after adjusting for age, BMI, smoking habit, alcohol intake, regular exercise, family history of diabetes, HDL-C, triglyceride, hypertension and HOMA-β, HR of developing diabetes was 8.61 [95%CI: 1.87 to 39.77, P=0.01] in the lowest quartile of serum total adiponectin, compared with the highest quartile. Furthermore, the risk of diabetes was 36% higher (P<0.01) per 1 µg/ml decrement of serum total adiponectin level in the multivariate-adjusted model. These results suggest that serum total adiponectin level could be a biomarker for the onset of diabetes in male Japanese, even with consideration of the ability of fasting insulin secretion and adjustment of its impact.

Disclosure

A. Hata: None. M. Miyoshi: None. T. Nakao: None. T. Ichihara: None. A. Tamura: None. T. Minagawa: None. Y. Kuwamura: None. M. Funaki: Board Member; Self; Mechanogenic, Inc., Consultant; Self; Happy, Inc., Research Support; Self; Japan Tobacco Inc.
1088-P: Can Machine Learning Support Decision for Insulin Initiation in Patients with Type 2 Diabetes?
Authors: FUJIHARA KAZUYA , SONE HIROHITO
Published: June 2021

We examined the ability of machine learning models to predict insulin initiation by specialists and examined whether the machine learning approach could support decision-making by general physicians for insulin initiation in patients with type 2 diabetes. Prescription data from diabetes specialists’ patient registries on antidiabetic agents from 2009 to 2015 were used for 4,860 patients who received initial monotherapy with either insulin (293 patients) or non-insulin (4,567 patients) and had laboratory data. Neural network output was insulin initiation ranging from 0 to 1 with a cutoff >0.5 for the dichotomous classification. Accuracy, recall and area under the receiver operation characteristic curves (AUCs) were calculated to compare the ability of machine-learning decisions on insulin initiation to decisions by logistic regression and 22 general physicians. Then, in comparing the ability of machine-learning and logistic regression decisions to decisions made by general physicians, the gold standard was defined as 80% agreement among 9 diabetes specialists based on patients’ information. AUCs and accuracy according to logistic regression were higher than those of machine learning (AUC of logistic regression, 0.89-0.90; AUC of machine learning, 0.67-0.74). Recall (accuracy of the cases receiving insulin) in machine learning was similar to that of logistic regression analysis (recall of logistic regression, 0.05-0.68; recall of machine learning, 0.11-0.52). The accuracy of logistic regression and the machine learning model was 1.00 and 0.86, respectively, for down sampling ratios of 1:8, which was higher than that of general physicians (0.43) for 7 gold standard cases.

In conclusion, machine learning had higher accuracy in prediction of insulin initiation compared with that of general physicians defined by diabetes specialists’ choice of the gold standard. Assistance by machine learning may be beneficial to any general physician in deciding upon insulin initiation.

Disclosure

K. Fujihara: None. H. Sone: Research Support; Self; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co.

Funding

Japan Society for the Promotion of Science (19H04028)
1089-P: Abnormal Glucose Tolerance Consequences Depend on Etiology: Insulin Resistance vs. ß-Cell Failure
Authors: ISHIMWE MARIE CONSOLATRICE SAGE , HORMENU THOMAS , SHOUP ELYSSA M. , OSEI-TUTU NANA H. , PATTERSON ARIELLE , WENTZEL ANNEMARIE , BAGHERI MOHAMMAD-HADI , DUBOSE CHRISTOPHER , MABUNDO LILIAN , HA JOON , SHERMAN ARTHUR , SUMNER ANNE E.
Published: June 2021

Abnormal glucose tolerance (Abnl-GT) is due to an imbalance between insulin resistance (IR) and β-cell function. Recent data from Africa suggest that β-cell failure contributes to the development of Abnl-GT more than previously recognized. Therefore in 490 African-born Blacks living in the United States (Male 64%, Age 38±10y (mean±SD), we compared the prevalence and metabolic characteristics of Abnl-GT due to IR (Abnl-GT-IR) to Abnl-GT due to β-cell-failure (Abnl-GT-β-cell-failure). Based on OGTT, Abnl-GT was defined as fasting glucose≥100 mg/dL or 2h glucose≥140 mg/dL. Visceral adipose tissue (VAT), triglyceride (TG) and 10y-Cardiovascular Risk-Score (CVD-Risk-Score) were measured. The cohort was divided into quartiles of HOMA-IR and quartiles of Matsuda Index. IR was defined by thresholds at the upper quartile of HOMA-IR (≥2.05) or the lowest quartile of the Matsuda index (≤2.97). Diagnosis of Abnl-GT-IR required both Abnl-GT and IR. Abnl-GT-β-cell failure was defined as Abnl-GT without IR. Abnl-GT occurred in 38% (181/490) of Africans. Of the Africans with Abnl-GT, insulin resistance occurred in 38% (68/181) and β-cell-failure occurred in 62% (113/181) of the Africans. Compared to Africans with Abnl-GT-β-cell-failure, Africans with Abnl-GT-IR had higher BMI (31.0±4.5 vs. 27.4±3.8 kg/m2), VAT (160±72 vs. 111±65 cm2), TG (106±52 vs. 77±39 mg/dL) (all P<0.001) and CVD-Risk-Score (26±24 vs. 19±17) (P<0.05). Independent of whether IR was defined by HOMA-IR or Matsuda index, results were similar. Alcohol intake was higher in the Abnl-GT-IR group (P=0.05), but other potential confounders such as years in the United States, income, education, sedentary behavior and fiber intake did not differ. Overall, Abnl-GT-IR was less common than Abnl-GT-β-cell-failure, but the metabolic profile was worse in Abnl-GT-IR. To determine the clinical course for these two types of Abnl-GT, prospective study design needs to include methodology to both diagnose Abnl-GT and elucidate the cause.

Disclosure

M. Ishimwe: None. J. Ha: None. A. Sherman: None. A. E. Sumner: None. T. Hormenu: None. E. M. Shoup: None. N. H. Osei-tutu: None. A. Patterson: None. A. Wentzel: None. M. Bagheri: None. C. Dubose: None. L. Mabundo: None.
1094-P: Attrition Rates among Participants in the National Diabetes Prevention Program: Variation by Organization Type, State, and Region
Authors: ZHANG XUANPING , CANNON MICHAEL , NG BOON PENG , ELY ELIZABETH
Published: June 2021

The National Diabetes Prevention Program (National DPP) has been implemented nationwide, but it remains unclear how implementation varies by organization type, state, and region. To better understand this issue, we examined participant attrition rates using data from the CDC’s Diabetes Prevention Recognition Program. We included those who enrolled from March 2018 through February 2019 and had the opportunity to attend for at least one year in the study population. We limited our analyses to live-delivery organizations (i.e., in-person, distance learning, and combination) to minimize variation by delivery mode. Cumulative attrition rates were calculated by organization type (community centered entities, higher education/extensions, government, medical providers, for-profit and insurers, other), state, and region (West, Southwest, Midwest, Northeast, Southeast). We used cross-tabulation method with chi-square tests. The study population (N=70,194) was 80.8% female, 71.6% white, with a mean age of 55.4 years (SD: 13.0) and mean BMI of 35.5 kg/m2 (SD: 7.3). We found that for-profit and insurer organizations had significantly higher cumulative attrition rates compared to other organization types (through Session 5: 30.3% in for-profit and insurer organizations vs. 10.8%-17.4% in the other types, p<0.05). This pattern continued until Session 16 when similar attrition rates emerged from all organization types. Attrition rates across states also demonstrated large variations (through Session 5: highest (CA): 31.9% vs. lowest (ND): 2.2%, nation average: 17.9%). Northeast and West had higher attrition rates compared to the other three regions (through Session 5: 25.9% in Northeast and 22.6% in West vs. 8.7%-16.2% in the other three regions, p<0.05). Our findings can be used to evaluate program performance and help improve program implementation at the organization, state, and region levels.

Disclosure

X. Zhang: None. M. Cannon: None. B. Ng: None. E. Ely: None.

Funding

Centers for Disease Control and Prevention
110-LB: Efficacy, Safety, and Appropriateness of iGlarLixi, a Fixed-Ratio Combination (FRC) in Type 2 Diabetes (T2D) in Real-World Settings: Results from the ENSURE Study
Authors: CANDIDO RICCARDO , MODUGNO MONICA , GABELLIERI ENRICO , NICOLUCCI ANTONIO , ROSSI MARIA CHIARA , LAROSA MONICA ,   ON BEHALF OF ENSURE STUDY GROUP
Published: June 2021

Randomized clinical trials (RCT) showed benefits of FRC of basal insulin (BI) and GLP1-RAs in terms of glycemic target, no weight gain, low risk of hypoglycemia, and gastrointestinal side effects. Real-world evidence (RWE) complements RCT to assess effectiveness and safety of drugs in clinical practice. The study evaluated the impact of iGlarLixi [once-daily FRC of basal insulin glargine 100 U/mL and GLP1-RA lixisenatide] in T2D. This was a retrospective, multicenter study, based on electronic medical records. All subjects initiating iGlarLixi in May 2018-July 2020 were analyzed. Overall, 25 centers provided data on 675 subjects with the following baseline characteristics (mean and standard deviation or proportion): age: 66.4±10.1 years, 54.2% men, T2DM duration 15.5±11.5 years, HbA1c 8.6±1.4%, and BMI 30.8±5.3 Kg/m2. Before starting iGlarLixi, 67.3% of subjects were treated with BI and 9.9% with GLP1-RA (5.5% as free combinations). Drugs associated with iGlarLixi were not only metformin and SGLT2 inhibitors, as by summary of product characteristics (SmPC); off-label combinations were found in 32.4% of patients (21.4% sulphonylureas). Effectiveness data (N=184) showed that HbA1c decreased by -0.77% [95%CI -1.00;-0.54] after 6 months and by -0.92% [95%CI -1.22;-0.62] in patients treated as by SmPC. Weight significantly decreased by 1.21 Kg. iGlarLixi dose increased by 5.14 U. Rates of blood glucose ≤70 and <54 mg/ml (N=171) were 0.26 and 0.05 events per person-month, respectively. No severe hypoglycemic events occurred. Participants discontinuing iGlarLixi within 6 months were 122 (18.1%). After discontinuation, 45.1% of patients started BI plus short acting insulin. In predominantly overweight/obese T2D people with poor metabolic control and long-lasting disease, effectiveness and safety of iGlarLixi are documented in real life, but improvements in treatment appropriateness are required.

Disclosure

R. Candido: None. M. Modugno: None. E. Gabellieri: None. A. Nicolucci: Advisory Panel; Self; AstraZeneca, Research Support; Self; Novo Nordisk, Pikdare, Sanofi, Shionogi & Co., Ltd., SOBI. M. Rossi: Research Support; Self; Novo Nordisk, Sanofi, Shionogi & Co., Ltd., Swedish Orphan Biovitrum AB. M. Larosa: Employee; Self; Sanofi. On behalf of ensure study group: n/a.

Funding

Sanofi