bluuebunny/crossref_metadata_2025 huggingface dataset:
The Decartes’ paradox and the modern philosophy as the foundation farse
Authors: Brdar Milan
Published: June 2021

In this article the author identifies a paradox at the heart of Descartes?
foundationalist project. The components of the paradox are as follows: on
the one hand, ontological certainty of cogito, on the other hand, its
epistemic uncertainty: it is impossible for the solus ipse to establish the
elementary truth: at present it is impossible to determine whether it is now
night or daylight. For Descartes the solution consists of introducing God
and in believing in His existence. But this is no solution whatsoever, for a
subject would require direct contact with God in order to receive clear and
distinct ideas, which are at the same time marks of their truth. The author
concludes the following: firstly, Descartes managed to establish a
foundation for nothing; secondly, the Cartesian project that includes the
necessity of contact with God as a way to attain the Truth, becomes
completed only in Hegel?s philosophy of Absolut Knowledge (in Wiss. der
Logik), along with his justification provided in the Phenoimenologie des
Gesites. The post-Hegelian philosophy, however, has engendered its own
paradox by abandoning Hegel?s own solution despite it being fully Cartesian
in its character. This was the consequence of abandoning God and declaring
Hegel?s philosophy as a deplorable conservative revival of theology;
something that was beyond understanding by modern philosophers. The
abandonment of God had as its consequence the return to the Cartesian
paradox, which reopened the question of truth - connected to the Cogito, and
the question of sense (Sinn) - connected to the sum of human subject. The
neglect of God leads to the departure from ratio-centrism in two ways: the
epistemic perspectivism and relativism, on the one hand, and Nihilism,
voluntarism with decisionism, along with existentialism, on the other.
Consequently, with the death of God, and the fall of Hegel?s system, the
modern metaphysics of subjectivity reveals itself as founded merely on the
Will to power - as a will for God, until Hegel, and a will against God,
subsequently. Thus, Heidegger was right when he said that Nietzsche?s Will
to Power was the end of the Western metaphysics. The author complements this
finding by adding that this kind of metaphysic had already been concealed
within the Descartes Meditations from the start, in the forms of the will
for the Reason and the will for God. Finally, the author concludes that the
modern philosophy completes its own Odyssey of looking for a foundation by
abandoning the Hegelian solution, blind to the fact that Hegel?s solution
was the only consequent Cartesian one. The ultimate result was the fall of
ratio-centrism into nihilism, voluntarism, and existentialism, as promoted
under a thin vail of Picodellamirandolian humanism.
1-OR: A Social Media-Based Intervention Improves Glycemic Control in a Low-Income Older Immigrant Population
Authors: HU LU , ISLAM NADIA , KHARMATS ANNA Y. , TAMURA KOSUKE , YANG SHUWEN , XU XINYI , FAN BAOLUN , SEVICK MARY ANN
Published: June 2021

Purpose: Access to in-person diabetes self-management education (DSME) programs is limited in underserved immigrant communities. In this report, we examined the feasibility, acceptability, and potential efficacy of a social media-based DSME intervention in low-income older Chinese immigrants with type 2 diabetes (T2D).

Methods: This was a single-group study in 30 Chinese immigrants with T2D living in NYC. The intervention included 24 culturally and linguistically tailored DSME videos. Over 12 weeks, participants received 2 brief videos each week via WeChat, a free social media app popular among Chinese immigrants. Feasibility was defined as ability to achieve: 1) the recruitment goal (n=30); 2) ­>80% retention; and 3) >80% watch rate. Acceptability was assessed via a satisfaction survey at 6 months. HbA1c was collected at baseline and 6 months

Results: Recruitment was completed prior to the NYC COVID-19 lockdown. Despite COVID-19, the intervention continued without interruption. Participants were mostly female (70.0%), married (63.3%), with limited English proficiency (86.7%), and a mean age of 61.2 (SD=6.7) years old. Most reported an annual household income of < $25,000 (84.0%) and an education of high school or less (63.3%). Thirty participants were recruited within 2 months, 93.3% were retained at 6 months, and a video watch rate of 92.2% was achieved. The mean baseline HbA1c was 7.4% (SD=1.2) and declined by 0.6% (95% CI: 0.3%-0.9%, p=0.001) to 6.8% (SD=0.8) at 6 months. Participants expressed high satisfaction (96.4%), and all strongly agreed or agreed that they preferred this video-based DSME to face-to-face visits.

Conclusions: This pilot study demonstrated that a social media-based DSME intervention is feasible, acceptable, and potentially efficacious in an aging low-income immigrant population with T2D. These findings provide timely implications in the era of COVID-19, suggesting older low-income immigrants can be engaged in mHealth interventions.

Disclosure

L. Hu: None. N. Islam: None. A. Y. Kharmats: None. K. Tamura: None. S. Yang: None. X. Xu: None. B. Fan: None. M. Sevick: None.

Funding

National Institutes of Health (K99MD012811, R00MD012811)
102-LB: Six-Month Glycemic Control with a Hybrid Closed-Loop System in Type 1 Diabetes Patients during COVID-19 Pandemic in Argentina
Authors: PROIETTI ADRIAN E. , ANGÓS MARCIAL A. , DAIN ALEJANDRO , ECHENIQUE MARIELA I. , KABAKIAN MARÍA L. , PAZ MARIA P. , RAGGIO MARCELA , RUBIN GRACIELA B. , SALEME ANTONIO , SANTUCCI MARIA P. , CASTRO MATIAS , DAGHERO ANDREA , GROSEMBACHER LUIS A.
Published: June 2021

Background and Aims: Despite recent technological advances, optimal glycemic control remains a challenge in people with type 1 diabetes (T1D). Hybrid closed loop (HCL) systems with automated algorithm-derived adjustment of basal insulin delivery, aims to improve glycemic control without adding additional therapy burden or educational investments.

Aim: To evaluate the effectiveness of HCL system in Latin American subjects with T1D and who received a completely virtual training.

Methods: Prospective observational data analysis that included consecutive patients with T1D that initiated treatment with MiniMed™ 670G system in Argentina. Baseline and follow up visits at days 28, 90 and 180 were carried out and data was downloaded from Carelink™ Personal at each visit. Patient training and follow-up were performed completely virtual through video conference.

Results: A total of 104 patients were included, age: 32.8 ± 17.2 (range 8-77). Subjects were previously on MDI+SMBG (26%), MDI+isCGM (12.5%), CSII+SMBG (9.6%), CSII+isCGM (2.9%), and SAP-TS (49%). Baseline GMI was 7.3 ± 0.8%. Time in range (TIR) 70-180 mg/dl significantly increased regardless of prior therapy from 62.1±14.8 % at baseline to 74.6±8.6 %, 74.2±9.8 % and 74.3±9.6 % at days 28, 90 and 180 respectively (p<0,05). Mean glucose levels decreased from 166,1mg/dL at baseline to 152.9 mg/dL (p<0,05) at day 180. GMI was also reduced from 7.3% to 6.9% (p<0,05). Sensor wear time and Auto Mode use were 89.1% and 88.6% respectively, by the end of the study. All patients completed virtual training successfully.

Conclusions: Our findings confirm that the use of MiniMed™ 670 System allows patients to achieve glycemic control within recommended targets in a non-selected population in Argentina. Virtual education appears to be suitable for patient training on HCL therapy during current COVID-19 pandemic situation.

Disclosure

A. E. Proietti: None. M. P. Santucci: None. M. Castro: Employee; Spouse/Partner; Medtronic. A. Daghero: Employee; Spouse/Partner; Medtronic. L. A. Grosembacher: None. M. A. Angós: None. A. Dain: None. M. I. Echenique: None. M. L. Kabakian: Speaker’s Bureau; Self; Abbott, Medtronic. M. P. Paz: Speaker’s Bureau; Self; Medtronic. M. Raggio: Speaker’s Bureau; Self; Abbott, Medtronic, Roche Diabetes Care. G. B. Rubin: None. A. Saleme: Advisory Panel; Spouse/Partner; Abbott Diabetes, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk.
1054-P: Incidence of Micro- and Macrovascular Complications among Persons with Type 2 Diabetes with and without Severe Mental Illness: A Nationwide Study
Authors: SCHEUER STINE H. , KOSJERINA VANJA , LINDEKILDE NANNA , POUWER FRANS , CARSTENSEN BENDIX , JØRGENSEN MARIT E. , BENROS MICHAEL E. , ANDERSEN GREGERS S.
Published: June 2021

Background: Severe mental illness (SMI) is linked with a higher incidence of type 2 diabetes (T2D); however, it is unclear whether persons with SMI and T2D have a higher incidence of diabetes complications compared to persons with T2D only. We calculated incidence rate ratios (IRR) and incidence rates (IR) of micro- and macrovascular diabetes complications among persons with T2D and SMI compared to those with T2D only.

Methods: We used Danish nationwide registers to follow all persons with T2D from 1996 to 2018. IRR and age-specific IR of first event of each diabetes complication was estimated using Poisson regression models with risk time as offset comparing persons with T2D with and without SMI, while adjusting for sex, age, diabetes duration, calendar year, substance abuse and Charlson’s Comorbidity Index.

Results: A total of 371,625 persons with T2D were on average followed for 6.9 - 7.6 year depending on the complication outcome. Persons with T2D and SMI (n=29,249) were younger at T2D diagnosis than persons with T2D only (mean [SD], 59 [15] vs. 63 [14] year). In total, 73,598 (27%) developed cardiovascular disease (CVD), 25,846 (7%) developed retinopathy, 20,191 (5%) developed nephropathy, and 6,796 (2%) underwent an amputation during follow-up. Persons with T2D and SMI had an increased risk of CVD (IRR: 1.14 (95% CI: 1.11-1.18)) and nephropathy (IRR: 1.11 (95% CI: 1.03-1.16)), and a decreased risk of retinopathy (IRR: 0.83 (95% CI: 0.78-0.86)) compared to persons with T2D only when adjusting for confounders. The risk for amputations were similar in persons with T2D with and without SMI (IRR: 1.00 (95% CI: 0.90-1.12)). The increased risk of CVD and nephropathy in persons with SMI were persistent in all ages except for the ages 80-95 year.

Conclusion: Persons with T2D and SMI have a slightly higher risk of CVD and nephropathy and a lower risk of retinopathy compared to persons with T2D only.

Disclosure

S. H. Scheuer: None. V. Kosjerina: None. N. Lindekilde: None. F. Pouwer: None. B. Carstensen: Stock/Shareholder; Self; Novo Nordisk. M. E. Jørgensen: Research Support; Self; Boehringer Ingelheim International GmbH, Sanofi-Aventis, Stock/Shareholder; Self; Novo Nordisk A/S. M. E. Benros: None. G. S. Andersen: Stock/Shareholder; Self; Novo Nordisk A/S.
1055-P: The Machine Learning Prediction Model NASHmap Identifies Higher Insulin Resistance in Type 2 Diabetes Mellitus (T2DM) Patients at Risk for Nonalcoholic Steatohepatitis (NASH)
Authors: TIETZ ANDREAS , BADER GIOVANNI , DOCHERTY MATT , REINHART BRENDA , BALP MARIA-MAGDALENA , PEDROSA MARCOS , ACHARYA SANDIP K. , LOEFFLER JUERGEN , SCHATTENBERG JÖRN M.
Published: June 2021

Background: Phenotypic methods such as elevated liver tests and/or the presence of obesity or hypertension are often used to identify patients with T2DM at risk for NASH. Machine learning (ML) models allow the prediction of outcomes with many interacting features and may be superior to phenotype in the context of NASH and T2DM. Here we present an intergroup comparison between patients with T2DM predicted as positive or negative for NASH by NASHmap, a ML model showing high prediction performance in real-word datasets.

Methods: We evaluated a subgroup of patients from a large T2DM clinical trial database (2002-2012) who had data for 14 NASHmap parameters. These include clinical observations and routine laboratory parameters but not HOMA-IR. We compared the profile of patients predicted by NASHmap (NASH positive or negative) using 17 parameters (14 NASHmap and 3 additional parameters). We compared HOMA-IR values between NASHmap positive and negative patients in the subgroup where the values were available.

Results: The clinical database had 23038 metabolically compensated T2DM patients without chronic liver disease of other etiologies. Data for all 14 NASHmap parameters were available in 4336 patients. NASHmap positive patients were younger, had higher HbA1c, liver enzymes, triglycerides, WBC, body mass index, platelets, and a higher rate for hypertension. Data for HOMA-IR were available in 1208 patients. Median HOMA-IR value was 4.2 in NASHmap positive group vs. 2.6 in NASHmap negative group. Patients in both groups had a similar median duration of diabetes.

Conclusion: Overall, the patients identified as at risk for NASH by NASHmap showed a metabolically unfavorable phenotype indicated by the higher HOMA-IR values in this group that the ML algorithm is also able to detect. ML models may be an important tool in effectively identifying patients at risk for NASH in electronic health records and clinical care.

Disclosure

A. Tietz: Employee; Self; Novartis AG, Stock/Shareholder; Self; Novartis AG. G. Bader: Employee; Self; Novartis AG. M. Docherty: Employee; Self; ZS Associates. B. Reinhart: Employee; Self; ZS Associates. M. Balp: Employee; Self; Novartis AG. M. Pedrosa: Employee; Self; Novartis AG. S. K. Acharya: Employee; Self; Novartis Healthcare Pvt. Ltd., Employee; Spouse/Partner; Novartis Healthcare Pvt. Ltd. J. Loeffler: Employee; Self; Novartis AG, Stock/Shareholder; Self; Novartis AG. J. M. Schattenberg: Advisory Panel; Self; Boehringer Ingelheim International GmbH, Consultant; Self; Boehringer Ingelheim, BMS, Echosens, Genfit, Gilead Sciences, Intercept Pharmaceuticals, Madrigal, Novartis, Novo Nordisk, Nordic Bioscience, Pfizer, Roche, Sanofi, Siemens Healthcare GmbH, Zydus, Bristol-Myers Squibb Company.
1058-P: The 2018 World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) Score and Diabetes Risk in the Diabetes Prevention Program Outcomes Study (DPPOS)
Authors: SHAMS-WHITE MARISSA M.M. , TJADEN ASHLEY H. , EDELSTEIN SHARON , BASSIOUNI SARAH , KIM CATHERINE , PI-SUNYER XAVIER , TEMPLE KARLA A. , VENDITTI ELIZABETH M. , REEDY JILL , HECKMAN-STODDARD BRANDY M. ,   GROUP DPP RESEARCH
Published: June 2021

Lifestyle changes may reduce the burdens of diabetes and cancer. We examined how changes in the 2018 WCRF/AICR Score, reflecting key cancer prevention recommendations, are associated with diabetes risk. The Diabetes Prevention Program (DPP) randomized adults with prediabetes to a lifestyle intervention (ILS), metformin (MET), or placebo (PLB) for a mean of 3.2 years, with follow-up in DPPOS for 11 years. The Score includes 7 components: weight, physical activity, plant-based diet, red/processed meat, sugar-sweetened drinks, fast foods, and alcohol (0-7 points, with 7 as the best total score). Scores were estimated at years 0, 1, 5, 6, 9, and 15 for participants with complete baseline data (N = 3,147). Covariates included sex, age, race/ethnicity, marital status, education, family history of diabetes, hormone therapy (females), and energy intake. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) stratified by treatment group estimated the association of Score changes with diabetes risk in DPP and DPPOS within and between groups. There were significant Score improvements within all groups over 15 years (p < 0.001); the differences between groups were only significant after 1 year (p < 0.001; 15 years: p = 0.137). For every 1-unit improvement in Score during DPP, there was a 29% and 16% lower diabetes risk in ILS (95% CI: 0.58 - 0.88) and PLB (95% CI: 0.72 - 0.99), respectively, and no significant association in MET. The time-dependent Score improvements in ILS and PLB were significantly associated with lower diabetes risk through year 15 (ILS HR: 0.86, 95% CI 0.77 - 0.96; PLB HR: 0.85, 95% CI 0.76 - 0.95). Changes in weight, physical activity, and plant-based diet appeared to be drivers of the Score’s effect. Findings suggest that Score improvements are associated with a long-term, lower risk for diabetes among adults with prediabetes. Future research can explore how this risk reduction impacts cancer risk.

Disclosure

M. M. M. Shams-white: None. B. M. Heckman-stoddard: None. D. Research group: None. A. H. Tjaden: None. S. Edelstein: None. S. Bassiouni: None. C. Kim: None. X. Pi-sunyer: None. K. A. Temple: None. E. M. Venditti: None. J. Reedy: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (U01DK048489)
106-LB: Real-Life Efficacy and Safety of IDegLira in Type 2 Diabetic Patients during COVID-19: A 6-Month Follow-Up by Teleconsultation in Bucaramanga, Colombia
Authors: PARRA SERRANO GUSTAVO A. , TORRESLANGHAMMER MARIA PAULA , SERRANOGOMEZ SERGIO , PINTOARIAS ANDREA J.
Published: June 2021

Objective: Determine impact of degludec / liraglutide (ideglira) on HBA1c, fasting glucose, total daily insulin dose (TDID), hypoglycemia in adults with type II Diabetes Mellitus (T2DM), during covid-19 and follow-up by teleconsultation

Methods: Secondary analysis of an anonymized database of sixty one patients with T2DM, evaluated hba1c, fasting glucose, TDID, and hypoglycemic episodes, Before, 3 and 6 months after IDEGLIRA. Weight could not me measured due to teleconsultation limitation. Performed univariated analysis of cuantitative viariables, bivariated analysis of clinical variables pre and post ideglira treatment. patients received tele-education by a diabetes educator for insulin titration

Results: 59% women, previos IDEGLIRA: 45.9% used 1 oral antidiabetic 29.5% used 2 and 55.7% used oral antidiabetics plus insulin. 54.1% used basal insulin regimen, the mean TDID was 38 units previous ideglira use, and 26 U after use (p= 0.0001). The mean for HBA1c levels was 8.44% (SD:1.4) prior to the use of ideglira, 7.78% (SD: 0.9) at 3rd month and 7.4% (SD:0.91) at 6th month. Significant differences were found when comparing zero months to three months (p= 0.01), and zero to six months (p= 0.0001), and comparing 3 and 6 months (p=0.003). Goal of hba1c <7% was 10% before ideglira, 19% at 3rd month and 43% at 6th month, There was statistical diference between 0 to 3 and 0 to 6th month (p= 0.01). Mean fasting glucose level was 149.1 mg/dL, 125.4 mg/dL and 108.9 mg/dL for 0, 3 and 6 months respectively. Differences were found between 0 and 3 months (p=0,04), and 0 and 6 months (p= 0.01). None of these patients presented any episode of severe hypoglycemia during follow up.

Conclusion: in this real life COVID-19 teleconsultation follow up for 3 and 6 months, The use of ideglira showed statistically significant changes on HBA1c, fasting glucose levels and TDID without causing severe hypoglycemia.

Disclosure

G. A. Parra serrano: None. M. Torreslanghammer: None. S. Serranogomez: None. A. J. Pintoarias: None.
1060-P: Associations of Dietary Patterns and Nutrients with Biomarkers of Inflammation in Adults with and without Type 1 Diabetes
Authors: BASU ARPITA , CHIEN LUNG-CHANG , ALMAN AMY C. , SNELL-BERGEON JANET K.
Published: June 2021

Background: People with type 1 diabetes (T1D) have a greater risk of developing cardiovascular diseases than people without diabetes. Inflammation plays a key role in atherosclerosis and diet has been known to modify inflammation. However, little is known about this association in T1D.

Methods: We conducted a six-year longitudinal analysis of data from Coronary Artery Calcification in Type 1 Diabetes study [n=1255; T1D: n=563; non-DM: n=692] collected at baseline, year 3 and year 6. Participants completed a validated food frequency questionnaire, a physical examination, and fasting (12h overnight fast) biochemical analyses. Biomarkers of inflammation and atherosclerosis [C-reactive protein (CRP), fibrinogen, plasminogen activator inhibitor-1 (PAI-1), homocysteine (hcy) and adiponectin] were determined in serum samples at three time points. Dietary patterns were identified using factor analysis. Generalized estimating equations were used to examine associations of dietary patterns with inflammation in models adjusted for traditional cardiovascular risks.

Results: In a multivariate model, increasing intake of carbohydrates and total fats were positively associated with CRP [β (95% CI): 0.013 (0.003, 0.023) and 0.025 (0.011, 0.039), respectively) and fibrinogen (0.007 (0.005, 0.010) and 0.010 (0.006, 0.014), respectively) when adjusted for age, sex, time, total calories, and diabetes status. Dietary fiber revealed an inverse association with CRP [-0.014 (-0.021, -0.007)], PAI-1 [-0.009 (-0.015, -0.003)], and hcy [-0.002 (-0.005, 0.000)], and a positive association with adiponectin [0.005 (0.000, 0.009)]. A dietary pattern characterized by ‘veggies, meats and alcohol’ was positively associated with adiponectin [0.022 (0.001, 0.043)].

Conclusions: Dietary carbohydrates and total fats were associated with biomarkers of inflammation and atherosclerosis, while fiber revealed protective associations in adults with and without T1D.

Disclosure

A. Basu: None. L. Chien: None. A. C. Alman: None. J. K. Snell-bergeon: Stock/Shareholder; Self; GlaxoSmithKline plc.

Funding

National Institutes of Health (R01HL61753)
1071-P: Long-Term Renin-Angiotensin System Inhibitor Use and Risk of Pneumonia and Pneumonia-Related Death in Type 2 Diabetes
Authors: SHI MAI , YANG AIMIN , LAU ERIC S.H. , WU HONGJIANG , FAN BAOQI , KONG ALICE P. , LUK ANDREA , MA RONALD C. , CHAN JULIANA C. , CHOW ELAINE
Published: June 2021

Introduction: Angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) are renin angiotensin system inhibitors (RASi) which can reduce the proinflammatory-vasoconstricting activity of ACE/angiotensin II and enhance the anti-inflammatory-vasodilatory activity of ACE2/angiotensin 1-7. These drugs may be protective across a range of respiratory infections including bacterial and viral pneumonias. We examined long-term use of ACEi/ARBs on the risk of first pneumonia hospitalization and pneumonia-related death in Chinese patients with type 2 diabetes (T2D).

Methods: Prospective analysis of 16,285 Chinese T2D patients with new RASi use observed between 2001 and 2019. Overlap weighting was performed to balance baseline characteristics. We used time-dependent Cox model to estimate the hazard ratio (HR) of outcomes while adjusting for the time-varying covariates.

Results: There were 6,379 (39.2%) ACEi-users only, 4,065 (25.0%) ARBs-users and 5,841 (35.9%) non RASi-users. During a median observation of 7.6 years, 6.1% had first pneumonia hospitalization, 1.3% died during or within one month of pneumonia hospitalization and 17.6% died from other causes. No association was observed between RASi use and first pneumonia hospitalization. However, RASi-users had lower risk for pneumonia-related death (HR 0.51, 95% CI 0.35-0.76) than non-users [ACEi-users only: HR 0.53 (0.34-0.81); ARBs-users: HR 0.58 (0.32-1.04)]. We also noted reduced risk for all-cause death in RASi-users (HR 0.60, 95% CI 0.54-0.67) [ACEi-users only: HR 0.61 (0.54-0.69); ARBs-users: HR 0.67 (0.57-0.79)].

Conclusions: Long-term use of RASi was associated with reduced risk of pneumonia-related death and all-cause death, but not first pneumonia hospitalization, in Chinese patients with T2D. Relevance to other respiratory infections such as coronavirus-disease 2019 (COVID-19) merits further investigation.

Disclosure

M. Shi: None. E. Chow: Research Support; Self; Medtronic, Speaker’s Bureau; Self; Novartis Pharmaceuticals Corporation, Sanofi-Aventis. A. Yang: None. E. S. H. Lau: None. H. Wu: None. B. Fan: None. A. P. Kong: Advisory Panel; Self; Lilly Diabetes, Speaker’s Bureau; Self; Abbott, AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Lilly Diabetes, Sanofi, Stock/Shareholder; Self; Aptorum. A. Luk: None. R. C. Ma: Other Relationship; Self; AstraZeneca, Medtronic, Research Support; Self; AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Novo Nordisk, Pfizer Inc., Sanofi-Aventis, Tricida, Inc. J. C. Chan: Consultant; Self; Bayer AG, Boehringer Ingelheim International GmbH, MSD Corporation, Sanofi, Other Relationship; Self; Asia Diabetes Foundation, GemVCare, Research Support; Self; Applied Therapeutics, AstraZeneca, Hua Medicine, Lilly Diabetes, Merck KGaA.
1073-P: Incidence of Type 2 Diabetes Mellitus in a Cohort of Transgender Persons
Authors: ISLAM NOREEN , GOODMAN MICHAEL
Published: June 2021

Introduction: Risk of type 2 diabetes mellitus (T2DM) in transgender persons is an area of clinical and research importance. The objective of this analysis was to examine occurrence of T2DM in a cohort of transgender persons receiving gender affirming hormone therapy.

Methods: The current analysis uses data from an electronic health record-based cohort study of persons 12 years and older enrolled in three integrated health care systems. The cohort included 3271 transfeminine members matched to 32,366 cisgender women and 32,349 cisgender men, and 2778 transmasculine members matched to 27,422 cisgender women and 27,391 cisgender men. Matching was based on race/ethnicity, year of birth, study site, and calendar year of membership based on the index date (first evidence of transgender status). Cohort ascertainment spanned nine years from 2006 through 2014 and follow up extended through 2016. Data on T2DM incidence were analyzed using Cox proportional hazard models whereas prevalence was compared using logistic regression; all analyses were adjusted for BMI. Type 1 diabetes cases were excluded from the analysis.

Results: Incidence of T2DM was similar across all groups overall and in the analyses limited to a subcohort of transgender members receiving gender affirming hormone therapy. At baseline, there was a significant difference in the prevalence of T2DM in the transfeminine cohort versus reference cisgender men (odds ratio 1.80, 95% CL: 1.01 to 3.21, p-value 0.05). No significant differences in prevalence were found across the remaining comparison groups.

Conclusion: Transgender people do not appear to be at higher risk for T2DM compared to their cis-gender counterparts regardless of hormone therapy receipt.

Disclosure

N. Islam: None. M. Goodman: None.
1085-P: Defining the Role of Insulin Clearance in Dysglycemia: The Microbiome and Insulin Longitudinal Evaluation Study (MILES)
Authors: WOOD ALEXIS , JENSEN ELIZABETH T. , RAMESH GAUTAM , ARZUMANYAN ZORAYR , LAM KELVIN , BERTONI ALAIN , ROTTER JEROME I. , CHEN YII-DER IDA , GOODARZI MARK O.
Published: June 2021

Insulin resistance and insufficient insulin secretion lead to type 2 diabetes. A role of reduced insulin clearance has been suggested, but few studies have investigated the contribution of insulin clearance while simultaneously examining insulin sensitivity and secretion. The goal of this study was to conduct such an investigation in 224 non-Hispanic White and 129 African Americans individuals from MILES (mean age 59, 62% female). Participants underwent oral glucose tolerance tests from which insulin sensitivity, insulin secretion, insulin clearance, and disposition index were calculated. Logistic regression models (controlling for age, sex, race, and BMI) examined the individual contributions of these traits separately, as well as the joint contribution of insulin sensitivity, clearance, and secretion, to early dysglycemia (prediabetes plus newly diagnosed diabetes; 46% of cohort). Models used standardized predictors such that odds ratios (OR) represent the change in odds of dysglycemia per standard deviation change. Model performance was assessed via Akaike’s Information Criterion (AIC) and area under the receiver operator characteristic curves (AUROC). In separate models, dysglycemia was associated with insulin sensitivity (OR 0.2; 0.14-0.30; P<.001), disposition index (OR 0.13; 0.08-0.20; P<.001) and insulin clearance (OR 0.66; 0.51-0.87; P<.001). In a joint model, only reduced insulin sensitivity (OR 0.04; 0.02-0.08; P<.001) and secretion (OR 0.15; 0.08-0.27; P<.001) were associated with dysglycemia. Models with insulin sensitivity (AIC=376.7; AUROC=0.82), disposition index (AIC=324.8; AUROC=0.87), or three insulin traits (AIC=303.4; AUROC=0.89) had the highest discriminative value. These results suggest that in the race groups studied, insulin resistance and compromised insulin secretion are the main independent defects leading to dysglycemia, while reduced insulin clearance may have a minor contributory role.

Disclosure

A. Wood: None. E. T. Jensen: None. G. Ramesh: None. Z. Arzumanyan: None. K. Lam: None. A. Bertoni: None. J. I. Rotter: None. Y. Chen: None. M. O. Goodarzi: None.

Funding

National Institutes of Health (R01DK109588)
1093-P: Incidence of Primary Nonadherence to Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) and Glucagon-Like Peptide-1 Agonists (GLP-1A) in an Integrated Health Care System
Authors: LUO JING , FELDMAN ROBERT , ROTHENBERGER SCOTT D. , FISCHER MICHAEL , KORYTKOWSKI MARY T. , GELLAD WALID F.
Published: June 2021

Background: The incidence and predictors of primary nonadherence (when a medication is prescribed but not dispensed) for newer glucose lowering medications including SGLT2i and GLP-1a is not known.

Methods: Using a database that links electronic health records with commercial claims from an integrated health system in PA (UPMC), we identified patients with T2D newly prescribed an SGLT2i or GLP-1a from 2011-2019. We measured the incidence of 30-day primary nonadherence to both overall and by individual drug. We used multivariable logistic regression to examine patient and provider factors associated with primary nonadherence.

Results: Our cohort included 5,505 commercially insured adults (mean age 50[SD11]) with T2D newly prescribed an SGLT2i (n=2,844) or GLP-1a (n=2,661). Overall, 1,867(34%) patients did not fill their first prescription. Among the most commonly prescribed drugs, the incidence of primary nonadherence was lowest for dulaglutide(30%) and highest for canagliflozin(44%). In a multivariable model, age>65 (OR 1.3, 95%CI:1.06-1.61), hypertension (OR 1.18, 95%CI:1.02-1.35), and number of hospitalizations (OR 1.39, 95%CI:1.16-1.65) was associated with an increased odds of primary nonadherence. Female sex (OR 0.88, 95%CI:0.77-0.99), PAD (OR 0.73, 95%CI:0.57-0.93), having a HbA1c value (OR 0.76, 95%CI:0.64-0.89), having a creatinine value (OR 0.82, 95%CI:0.71-0.94), and having an endocrinologist vs. PCP prescribe the index drug (OR 0.77, 95% CI:0.65-0.91) were associated with decreased odds of primary nonadherence.

Conclusions: In this integrated health system, 1 out of 3 patients prescribed a SGLT2i and GLP-1 agonist did not fill their prescription within 30 days. Older age and increasing morbidity predicted higher odds while more active engagement with providers, including diabetes specialists, was associated with reduced odds of primary nonadherence.

Disclosure

J. Luo: Consultant; Self; Alosa Health, Research Support; Self; Health Action International. R. Feldman: None. S. D. Rothenberger: None. M. Fischer: None. M. T. Korytkowski: None. W. F. Gellad: None.

Funding

National Center for Advancing Translational Sciences (KL2TR001856)
1098-P: Admission Blood Glucose but Not HbA1c Predicts Mortality in People with Diabetes Hospitalized with COVID-19 Infection
Authors: CHAUDHURI SOUMYABRATA ROY , MAJUMDER ANIRBAN , SANYAL DEBMALYA , BISWAS AJOY , BHATTACHARJEE KINGSHUK
Published: June 2021

Background: Previous studies have documented several biochemical, clinical and radiological risk factors for mortality in patients with COVID-19. Early identification of the patients who are most likely to develop critical course will enable informed decisions and shall facilitate the provision of timely supportive treatment in advance and thus may reduce mortality.

Methodology: This is a multicentric retrospective study aimed to explore the role of hyperglycaemia (admission blood glucose and HbA1c) in predicting mortality in diabetic patients hospitalised for COVID-19.

Results: A total of 133 patient records were analysed retrospectively who were admitted to three tertiary care hospitals between 15/05/2020 to 15/11/2020. Multiple logistic regression indicated that the capillary blood glucose (CBG) on admission was an independent risk factor for mortality in DM patients with COVID-19 (Odds Ratio [OR] = 1.132, 95% confidence interval [CI]: 1.012-1.216), p=0.043 whereas HbA1c failed to predict mortality (Odds Ratio [OR] = 1.119, 95% confidence interval [CI]: 0.981-1.216), p=0.357. The optimal admission CBG level for predicting mortality was 243.50 mg/dL, with an area under the curve (AUC) of 0.879 (95% CI: 0.767-0.990) with a corresponding sensitivity of 88.9 and specificity of 72.7 at this cut-off. As revealed by the receiver-operating characteristic (ROC) analysis, HbA1c failed to predict mortality with an AUC of 0.565 (95% CI: 0.307-0.782).

Conclusion: The present study demonstrated that a high level of admission CBG and not HbA1c was an independent risk factor for mortality of COVID-19 patients with DM.

Disclosure

S. Roy chaudhuri: None. A. Majumder: None. D. Sanyal: None. A. Biswas: None. K. Bhattacharjee: None.
1103-P: Risk Factors for Visit Cancellations in a Tertiary Care Referral Clinic Specializing in Diabetic Eye Disease
Authors: GILBERT CATHERINE , FICKWEILER WARD , ADAM ATIF , SUN JENNIFER
Published: June 2021

Patient cancellations of scheduled visits may result in missed opportunities for timely treatment and counseling and adversely impact quality of patient care. Identification of risk factors for cancellations might allow clinicians to define subgroups more likely to miss visits and interventions that prevent lapses in care. The purpose of this study was to identify patient factors associated with visit cancellations in patients followed at a tertiary care referral center for diabetes eye care. A retrospective review of the Joslin Diabetes Center’s Beetham Eye Institute electronic medical record was performed for patients with a first visit in 2016 and subsequent follow-up data. Analyses adjusted for repeated measures from the same patient. A total of 1,785 patients with diabetes (46.5% type 1, 53.5% type 2) were evaluated with baseline mean ± SD diabetes duration 24.5 ± 0.6 yrs, A1c 8.0 ± 0.1; 44.0% were female, 64.7% White, 10.3% Black and 4.0% Asian. Baseline diabetic retinopathy (DR) severity in the eye with more advanced disease was no DR in 40.3%, nonproliferative DR in 40.8% and proliferative DR (PDR) in 19.0%. Over the study time period, 333/13,085 (2.5%) visits were cancelled by patients. Bivariate analyses revealed increased cancellations were associated with older age (OR:1.00, p = 0.02), Asian versus White race (OR:3.77, p = 0.003), longer DM duration (OR:1.01, p < 0.05), the presence of DM complications (OR:1.43, p = 0.02), not being insured by Medicare (OR:1.29, p = 0.01), and the presence of PDR (OR:2.28, p = 0.004). After backwards elimination analysis, only PDR remained significantly associated with cancellations. These findings suggest that patient cancellations may be associated with DR severity. Future studies should explore this relationship in expanded patient datasets and the relationship of cancelled to missed visits in order to better understand potential barriers to follow up for patients undergoing diabetes eye care.

Disclosure

C. Gilbert: None. W. Fickweiler: None. A. Adam: None. J. Sun: Other Relationship; Self; Novo Nordisk, Roche Pharma, Research Support; Self; Adaptive Sensory Technology, Boehringer Ingelheim Pharmaceuticals, Inc., KalVista Pharmaceuticals, Optovue, Roche Pharma.

Funding

Massachusetts Lions Eye Research Fund
1115-P: Household Food Insecurity and Cognitive Function in Youth and Young Adults with Type 1 Diabetes
Authors: LIESE ANGELA D. , BROWN ANDREA D. , SHAPIRO ALLISON , FRONGILLO EDWARD A. , WILKENING GRETA , FRIDRIKSSON JULIUS , MERCHANT ANWAR , HENKIN LEORA , JENSEN ELIZABETH T. , REBOUSSIN BETH A. , SHAH AMY S. , MARCOVINA SANTICA M. , DOLAN LAWRENCE M. , DABELEA DANA , PIHOKER CATHERINE , MENDOZA JASON A.
Published: June 2021

Household food insecurity (HFI) is the limited or uncertain availability of nutritionally adequate and safe foods and has been associated with decreased cognitive function in persons without diabetes. In persons with diabetes, little is known about the impact of HFI, but cognitive function is known to decline with diabetes duration and poorer glycemic control. We evaluated the cross-sectional association of HFI with cognitive function in youth and young adults (YYA) with type 1 diabetes (T1D), focusing on executive function as measured with the NIH Toolbox Cognition Battery (score range 39-146) and a potential interaction of HFI with glycemic control (high risk >9% vs. optimal/suboptimal ≤9% HbA1c). Age-adjusted composite fluid cognition score was modeled using multivariable linear regression, with HFI (≥3 affirmations on US Household Food Security Survey Module) as the predictor, controlling for covariates. Among 1,272 YYA with T1D (mean age 21, diabetes duration 11 years, 57% non-Hispanic white), 55% had high-risk glycemic control and 18% were food insecure. Food insecure T1D YYA had a 2.7 (SD=1.2) lower fluid cognition score than their food secure peers (93.7 vs. 96.4, p=0.03). Adjustment for sex, race/ethnicity, diabetes duration, site, and glycemic control attenuated this association (β=1.2, p=0.30). However, glycemic control turned out to modify the association of HFI with cognition (multiplicative interaction in adjusted model p<0.01). Among YYA with HbA1c ≤9%, food insecure individuals had a lower mean fluid cognition score than the food secure (99 vs. 104, p<0.02); for YYA with high-risk glycemic control, no association was observed. In this cross-sectional study, food insecurity has a detrimental relationship with cognition among T1D YYA, particularly among those with optimal/suboptimal glycemic control levels. Longitudinal research is needed to further delineate the temporal relationships between household food insecurity, glycemic control, and cognition.

Disclosure

A. D. Liese: None. B. A. Reboussin: None. A. S. Shah: None. S. M. Marcovina: None. L. M. Dolan: None. D. Dabelea: None. C. Pihoker: None. J. A. Mendoza: None. A. D. Brown: None. A. Shapiro: None. E. A. Frongillo: None. G. Wilkening: None. J. Fridriksson: None. A. Merchant: None. L. Henkin: None. E. T. Jensen: None.

Funding

National Institutes of Health (1R01DK117461, 1UC4DK108173)
1116-P: Macronutrient Intake and Risk of Progression to Type 1 Diabetes in TrialNet
Authors: LUNDGRIN ERIKA L. , VISWANATHAN ANURADHA , JOHNSON SUZANNE B. , NORRIS JILL M. , ISMAIL HEBA M. , WOOD JAMIE R. , THOMAS ALICIA J. , BECKER DOROTHY J.
Published: June 2021

Background: Prior research found that children at risk for type 1 diabetes (T1D) with increased dietary intake of sugar and higher glycemic index foods had quicker progression from islet autoimmunity (IA) to T1D diagnosis. However, this has not yet been studied in another population.

Objective: To investigate the role of macronutrients in the progression to T1D in TrialNet’s cohort of individuals with IA, including older children and adults.

Methods: Baseline dietary data derived from a food frequency questionnaire (FFQ) estimating intake over the past year, and longitudinal clinical data until development of T1D were obtained for individuals with IA from TrialNet’s Pathway to Prevention Study. Proportional hazard regression analysis stratified by age group (1-4 yrs, 5-12 yrs, 13-22 yrs, and 23+ yrs old) was used to evaluate the time from IA detection to T1D diagnosis, with regard to average daily dietary intake of carbohydrates, protein, fat, sugar, fiber, glycemic index, and glycemic load, after adjusting for confounders.

Results: A total of 881 individuals age 1-51 years with at least one autoantibody were included, among whom 73/138 toddlers, 160/388 children, 48/166 adolescent/young adults (AYA), and 27/189 adults developed T1D. Given multiple comparisons, there was no significant association between rate of progression from IA to T1D and daily dietary intake of any macronutrients analyzed, after adjusting for baseline age, BMI, and number of autoantibodies, high risk HLA, and time from IA detection to FFQ completion. Borderline association with higher protein intake among AYA (HR 1.04, 95% CI 1.00-1.08) persisted after sensitivity analysis restricted to those with 2+ autoantibodies (HR 1.05, 95% CI 1.01-1.09).

Conclusions: Baseline dietary macronutrient intake does not appear to influence rate of T1D diagnosis in children, adolescents, or adults with IA. Further study of dietary factors’ complex role in T1D progression is warranted, including effects of a change in diet over time.

Disclosure

E. L. Lundgrin: None. A. Viswanathan: None. S. B. Johnson: None. J. M. Norris: None. H. M. Ismail: None. J. R. Wood: Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Insulet Corporation, Speaker’s Bureau; Self; Xeris Pharmaceuticals, Inc. A. J. Thomas: None. D. J. Becker: None.

Funding

Rainbow Babies & Children’s Foundation; National Institute of Diabetes and Digestive and Kidney Diseases; National Institute of Allergy and Infectious Diseases; Eunice Kennedy Shriver National Institute of Child Health and Human Development; JDRF
1119-P: Improving Clinical Utility of GAD65 Autoantibodies by Electrochemiluminescence Assay When Identifying Autoimmune Adult-Onset Diabetes
Authors: JIA XIAOFAN , GU YONG , VARTAK TANWI , MIAO DONGMEI , DONG FRAN , JERRAM SAMUEL T. , REWERS MARIAN , FERRARA ASSIAMIRA , LAWRENCE JEAN M. , YU LIPING , LESLIE RICHARD D. ,   THE ACTION LADA CONSORTIUM,   THE DIABETES IN YOUNG ADULTS (DIYA) STUDY GROUP
Published: June 2021

Aims: It is important to differentiate the two major phenotypes of adult-onset diabetes, autoimmune type 1 diabetes (T1D) and non-autoimmune type 2 diabetes (T2D). Serum GAD65 autoantibodies (GADA) are the most sensitive biomarker for adult-onset autoimmune T1D, but the clinical value of GADA by current standard radio-binding assays (RBA) remains questionable. The present study focused on the clinical utility of GADA differentiated by a new electrochemiluminescence (ECL) assay in patients with adult-onset diabetes.

Methods: Two cohorts of individuals recently diagnosed with diabetes at ≥20 years of age were analyzed including 771 patients 30-70 years olds from the Action LADA study and 2,063 patients 20-45 year olds from the Diabetes in Young Adults (DiYA) study. Clinical characteristics including requirement of early insulin treatment, BMI, and development of multiple islet autoantibodies were analyzed according to the status of RBA-GADA and ECL-GADA, respectively.

Results: GADA was the most prevalent and predominant autoantibody, >90% in both cohorts with any positive autoantibody. GADA positivity by either RBA or ECL assay significantly discriminated clinical T1D from T2D. However, patients with ECL-GADA in both cohorts were at greatest risk of insulin treatment, multiple islet autoantibodies and lower BMI (all p<0.0001). Among patients GADA positive by RBA, 32.4% (90/278) in the Action LADA study and 25.6% (32/125) in the DiYA study were negative by ECL assay. Patients with GADA detectable by RBA, not confirmed by ECL, had a phenotype more similar to T2D and these RBA-GADA had lower affinity compared to GADA confirmed by ECL assay.

Conclusion: The ECL-GADA assay offers advantages over the RBA-GADA in identification of adult-onset diabetes patients at higher risk of early insulin dependency.

Disclosure

X. Jia: None. L. Yu: None. R. D. Leslie: None. The action lada consortium: n/a. The diabetes in young adults (diya) study group: n/a. Y. Gu: None. T. Vartak: None. D. Miao: None. F. Dong: None. S. T. Jerram: None. M. Rewers: Advisory Panel; Self; Provention Bio, Inc., Consultant; Self; RTI, Research Support; Self; Janssen Research & Development, LLC, JDRF. A. Ferrara: None. J. M. Lawrence: None.

Funding

JDRF (2-SRA-2019-695-S-B); National Institutes of Health (DK32083); 5th Framework Program of the European Union; Centers for Disease Control and Prevention (1U18DP006289)
1121-P: Unmet Social Needs and Depressive Symptomatology among Youth and Young Adults with Type 1 Diabetes
Authors: BROWN ANDREA D. , MENDOZA JASON A. , FRONGILLO EDWARD A. , FLORY KATE , REBOUSSIN BETH A. , JENSEN ELIZABETH T. , DOLAN LAWRENCE M. , BELLATORRE ANNA , MALIK FAISAL , MARCOVINA SANTICA M. , LIESE ANGELA D.
Published: June 2021

Youth and young adults (YYA) with type 1 diabetes (T1D) may be at risk for unmet social needs and depression due to the disease-associated cost and stressors. Little is known about how unmet social needs are linked to depressive symptomatology. These cross-sectional analyses used data from the SEARCH Food Security ancillary study (2018-2020) to examine the association of unmet social needs on depressive symptoms among 685 YYA with T1D. The USDA Household Food Security Survey Module was used to measure household food insecurity (HFI) over the past 12 months (food insecure (≥3 affirmations) vs. food secure). Participants were queried about their primary mode of transportation (personal vehicle vs. other form of transportation) and if they had stable housing (all the time vs. some or none of the time) over the past 90 days. Total number of unmet social needs (0-3) were calculated by summing these items. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression (CES-D) scale (scores 0-60). Linear regression was used to examine the association between number of unmet social needs and depressive symptom scores. Among YYA with T1D (mean age 23.4, SD 4.6 years), 17.1% had HFI, 14.0% lacked adequate transportation, and 4.3% experienced unstable housing; 23.5% had one, 5.1% had two, and 0.9% had three unmet social needs. Mean (SD) CES-D score was 14.3 (11.9), which is below the cutoff score of 16 for risk of depression. Compared to YYA with no unmet social needs, those with 1 and 2-3 unmet social needs had depressive symptom scores 5.9 and 15.9 points higher, respectively (p<0.0001 for both exposure values), after adjusting for age, sex, race/ethnicity, diabetes duration, clinic site, parental education, and household income. Social needs among YYA with T1D are confluent and are jointly and cumulatively associated with depressive symptoms. Future studies should investigate the impact of alleviating unmet social needs on depressive symptomatology among YYA with T1D.

Disclosure

A. D. Brown: None. S. M. Marcovina: None. A. D. Liese: None. J. A. Mendoza: None. E. A. Frongillo: None. K. Flory: None. B. A. Reboussin: None. E. T. Jensen: None. L. M. Dolan: None. A. Bellatorre: None. F. Malik: None.

Funding

National Institutes of Health (R01DK117461, T32GM081740)