bluuebunny/crossref_metadata_2025 huggingface dataset:
2365-PUB: Can Baseline Hemoglobin A1c Help Guide Treatment with an SGLT2i vs. DPP-4i? A Meta-analysis
Authors: PAGE STEPHANIE O. , MISHRIKY BASEM M. , UHRIG JARROD , SEWELL KERRY , MIAN MUNA R. , POWELL JAMES R. , CUMMINGS DOYLE M.
Published: June 2019

Both sodium glucose cotransporter 2 inhibitors (SGLT2i) and dipeptidyl peptidase 4 inhibitors (DPP-4i) are effective drugs known to reduce hemoglobin A1c (A1c). While some guidelines favor SGLT2i over DPP-4i, there is no clear criteria in choosing between them. Potentially, baseline A1c could be one distinguishing factor. We performed a meta-analysis to explore the efficacy of SGLT2i compared to DPP-4i according to baseline A1c.

We searched MEDLINE, EMBASE, Cochrane CENTRAL, and CINAHL for randomized trials comparing SGLT2i to DPP-4i in type 2 diabetes and reporting a change in A1c stratified by baseline A1c. We pooled trials reporting outcomes based on baseline A1c <8.5% and ≥8.5%. For trials that reported results based on baseline hemoglobin A1c <8%, 8-9%, and >9%, we only used outcomes for baseline hemoglobin A1c <8% and >9% in the main analysis. Our primary outcome was change in A1c. A subgroup analysis was performed to compare both groups.

We included 6 trials. Although there was no significant difference between SGLT2i and DPP-4i when baseline A1c was <8.5%, results significantly favored SGLT2i when baseline A1c was ≥8.5% (MD [95% CI] = 0.04% [-0.09, 0.17] and -0.36% [-0.53, -0.18] respectively). Comparison between the two baseline A1c groups showed a significant difference (p=0.0004).

We conclude that baseline A1c should be considered when considering SGLT2i or DPP-4i. If A1c is ≥8.5%, SGLT2i should be favored over DPP-4i.

Disclosure

S.O. Page: None. B.M. Mishriky: None. J. Uhrig: None. K. Sewell: None. M.R. Mian: None. J.R. Powell: None. D.M. Cummings: None.
2375-PUB: The Need of Women with Type 1 Diabetes for Pregnancy-Related Care in China: An Online Questionnaire Study
Authors: WANG CHAOFAN , LUO SIHUI , ZHENG XUEYING , XIONG SHANSHAN , YAN JINHUA , YANG DAIZHI , QIU LILING , YAO BIN , WENG JIANPING
Published: June 2019

Background: Pregnancy Related Care (PRC) could reduce the risk of adverse pregnancy outcomes in women with type 1 diabetes (T1D). Little was known about the need of them in China. We aimed to identify their need for PRC.

Methods: It was a cross-sectional study on women with T1D by an online questionnaire based on previous in-depth interviews. The questionnaire was advertised via patient community and Wechat. The survey ended when the sample size was reached. The data were analyzed in SPSS 19.0.

Results: The survey was conducted from Dec 26, 2016 to Jan 18, 2018. We received 385 responses from 28 provinces of China. Among them, 72.7% were aged 21∼35; 53.5% with T1D for over 5 years; 84.4% had annual income less than $10,000 and 61.6% spent over 30% income on T1D management; 66.0% and 37.4% were on MDI and CSII, respectively. The results were as below. 1) Current status of PRC: only 23.4% reported HbA1c<6.5%; 33.0% ever got pregnant and 48.4% with adverse pregnancy outcomes; only 12.5% thought they got enough knowledge on PRC; 90.4% had worries for pregnancy, including complications, inheritance of T1D, cost and discrimination; 94.5% were willing to attend PRC program. 2) Doctor-patient relationship: 75.0% went to tertiary hospitals for T1D; 80.5% were satisfied with the doctors; 72.5% reported less than 10 minutes per visit while 76.9% asked for over 10 minutes for better communication; 76.8% gained confidence for pregnancy after visit; 84.2% suggested PRC be provided in a multiple disciplinary team. 3) Social support: 86.2% expressed T1D influenced their decision of marriage and childbearing; 44.9% concealed T1D from their family about T1D and 30.5% didn’t think the family would support the decision of pregnancy; 80.3% longed to share experience among peers and 78.7% were more confident after sharing.

Conclusion: Women with T1D had various unmet need for PRC, but current practice of PRC was lacking in China. The role of professional and social support should be enhanced to relieve their stress on pregnancy.

Disclosure

C. Wang: None. S. Luo: None. X. Zheng: None. S. Xiong: None. J. Yan: None. D. Yang: None. L. Qiu: None. B. Yao: None. J. Weng: None.

Funding

Guangdong Province Science and Technology Program (2018A070701019); National Health and Family Planning Commission of the People's Republic of China (201502011); World Diabetes Foundation (14-921)
2377-PUB: Evaluation of Structure, Documentation, and Treatment Quality of a New Insulin Chart at Departments of Internal Medicine
Authors: KOPANZ JULIA , LICHTENEGGER KATHARINA M. , SENDLHOFER GERALD , SEMLITSCH BARBARA , RIEDL REGINA , PIEBER THOMAS R. , TAX CHRISTA , BRUNNER GERNOT , PLANK JOHANNES
Published: June 2019

Introduction: Insulin charts are the main tool for multidisciplinary documentation of diabetes therapy in the hospital setting. Due to a high heterogeneity of 20 different insulin charts at a tertiary center, a new standardized paper-based insulin chart was developed and implemented at the Departments of Internal Medicine.

Methods: A before-after comparison was performed to evaluate structure, documentation, and treatment quality of a new insulin chart compared to old insulin charts. Structure quality of blank insulin charts was assessed by using questionnaires regarding subjective perception of health care professionals (n=237). To assess documentation and treatment quality a retrospective evaluation of 108 old and 100 new filled-in insulin charts of inpatients receiving insulin therapy by using predefined quality parameters was conducted.

Results: Patient characteristics from old and new insulin charts were comparable regarding sex (old: 47% vs. new: 42% female), age (71±11 vs. 71±12 years), diabetes type (75% vs. 87% type 2) and HbA1c (62±14 vs. 67±21 mmol/mol). The primary endpoint, the percentage of insulin charts with insulin administration errors, was with 5% significantly better on new insulin charts compared to 77% on old insulin charts (p<0.001). Insulin prescription errors occurred more often on old insulin charts (100% vs. 42%), whereas insulin management errors were rare in both groups (10% vs. 8%). Correct patient identification was rather given on new insulin charts (78% vs. 90%). Both groups had an average of 4±2 good diabetes days. Structure of the new insulin chart was assessed to be more clearly arranged, to give better transparency and to have more space for documentation.

Conclusion: Improvements in structure, documentation, and treatment quality were achieved through implementation of the new insulin chart. However, as some errors still occur, further potential to enhance diabetes inpatient care should be considered.

Disclosure

J. Kopanz: None. K.M. Lichtenegger: None. G. Sendlhofer: None. B. Semlitsch: None. R. Riedl: None. T.R. Pieber: Advisory Panel; Self; ADOCIA, Arecor Limited, AstraZeneca, Novo Nordisk A/S, Sanofi. Speaker's Bureau; Self; Novo Nordisk A/S. C. Tax: None. G. Brunner: None. J. Plank: None.
2378-PUB: Barriers and Facilitators to National Diabetes Prevention Program Engagement by Women of Peak Child-Bearing Age
Authors: HARRISON CAROLINE , PHIMPHASONE-BRADY PHOUTDAVONE , DIORIO BECKY , RITCHIE NATALIE , SAUDER KATHERINE A.
Published: June 2019

Intrauterine exposure to maternal obesity and type 2 diabetes increases chronic disease risks in offspring. The National Diabetes Prevention Program (National DPP) is an evidence-based model for promoting weight loss to prevent diabetes in adults; however, women of peak child-bearing age (18-39 years) do not engage sufficiently, limiting the program’s potential to reduce risks across generations. We assessed participation barriers and facilitators among English- or Spanish-speaking young women who enrolled in the program at an urban safety-net healthcare system. Interviewees included 30 women who enrolled but did not attend (n=10), attended few classes (n=10), or completed the program (n=10). Individual semi-structured interviews explored motivations, challenges, and successes regarding participation and suggestions for improvement. Interviews were analyzed using a grounded hermeneutic approach. Qualitative analysis revealed four primary domains (enrollment, attendance, experience, and suggestions) with multiple sub-themes. Most women were motivated to enroll per concern for health and family. Non-attending and minimally engaged women reported confusion about the program’s aim and relevancy, logistical barriers (scheduling conflicts, lack of childcare or transportation), and lack of connection with fellow participants or coaches. Highly engaged women noted persistent motivation to attend, successful weight loss, and supportive relationships in the program. Taken together, multiple barriers/facilitators arose that may be addressable in future adaptations via enhanced education and motivational support throughout the program, providing childcare and transportation, introducing a mobile app, a more flexible class format, and activities to strengthen group cohesion. Future research is needed to explore strategy implementation and effectiveness, with an ultimate goal of reducing risks prior to initial or subsequent child-bearing.

Disclosure

C. Harrison: Employee; Spouse/Partner; Virta Health Corp. P. Phimphasone-Brady: None. B. DiOrio: None. N. Ritchie: None. K.A. Sauder: None.

Funding

Centers for Disease Control and Prevention
2389-PUB: Development of the Diabetes Clinical Quality Reporting Tool to Assess Diabetes Measures across Primary Care Practices in a Health Network
Authors: PENNOCK JENNIFER , KLEIN BRIAN M. , STEVENS MARY S. , KRAEMER ELLEN
Published: June 2019

Background: Allegheny Health Network Diabetes Support Initiate for Primary Care (AHN DSIPC) developed the Diabetes Clinical Quality Reporting Tool (DCQRT) to assess diabetes measures in primary care practices (practices).

Methods: The data for the DCQRT was accessed via PROC SQL for SAS Enterprise Guide 7.1 from the Clarity Prod Copy of our EPIC Electronic Health Record. The data was shared with practices in aggregated format with Tableau. Patients were attributed to a practice based on primary care provider designation in EPIC. Patients’ data was included if the following criteria were met: in the EPIC diabetes registry; between age 18 to 75; seen in the practice at least once within the report quarter. The DCQRT includes 7 measures shown in the Table. For the A1C measure, we risk tiered patients based on the antidiabetes medication as a surrogate for disease severity. A1C at goal was assigned as follows: no antidiabetes medication<7%; oral antidiabetes medication<7.5%; non-insulin injectable antidiabetes medication<8%; insulin <9%.

Results: See Table.

Table notes: * Performed within the last year# Age 40-75 ^data available in Q4 2016.

Conclusion: The DCQRT allowed assessment of diabetes measures in practices in a health network. The DCQRT has allowed practices to see data in an aggregate form and base quality improvement initiatives.

Disclosure

J. Pennock: None. B.M. Klein: None. M.S. Stevens: None. E. Kraemer: None.

Funding

Richard King Mellon Foundation
2390-PUB: A Diabetes Clinic in the Primary Care Setting: A Quality Improvement Initiative in a Teaching Institution—One-Year Data
Authors: MISHRIKY BASEM M. , POWELL JAMES R. , HOLOMAN CARYL E. , MIAN MUNA R.
Published: June 2019

Diabetes remains one of the most common chronic conditions seen in primary care clinics. While it remains one of the toughest quality measures to fulfill, it is crucial since we are approaching “Pay for Performance” in healthcare that will determine physician re-imbursement rates. We therefore performed this initiative to target patients within the internal medicine clinic at East Carolina University, who have a hemoglobin A1c (A1c) >9% (as this is suggested as a quality measure by Medicare’s Merit-based Incentive Payment System and the National Committee of Quality Assurance).

The 1st phase involved creating a protocol to identify/contact patients with an A1c >9%. The 2nd phase was to establish a diabetes clinic via a diabetes specialist within the primary care setting with the goal of providing individualized diabetes care for high-risk patients. The 3rd phase was to educate the residents on evidence-based diabetes management through yearly didactic sessions. The 4th phase was to establish a Diabetes Fellow clinic within the primary care clinic. We divided our results according to the level of training of the patients’ primary care provider (attending vs. resident).

On Mar 9, 2017, the clinic protocol identifying/calling patients with A1c >9% was initiated, the first diabetes clinic was on Sep 8, 2017, and the first diabetes fellow clinic was on July 30, 2018. Our initiative resulted in a reduction in the number of patients with A1c >9% in the resident clinic (30% vs. 22.6% vs. 20.9% in Feb 2017, Nov 2017, and Dec 2018 respectively) and the attending clinic (24% vs. 19.3% vs. 17.9% in Feb 2017, Nov 2017, and Dec 2018 respectively). Our clinic’s overall number of patients with A1c >9.0% improved from 21.6% in Nov 2017 to 20.02% in Dec 2018.

Our project has been successful in reducing the percentage of patients with an A1c >9%. Our project also reflects real-time attempts to improve clinic-wide glycemic control while continuously establishing care with new patients in a primary care clinic.

Disclosure

B.M. Mishriky: None. J.R. Powell: None. C.E. Holoman: None. M.R. Mian: None.
2394-PUB: Addressing Diabetes Therapy Inertia during Acute Care Transition
Authors: BROWN ALEXANDER , BELALCAZAR L. MARIA
Published: June 2019

Transition into inpatient care represents a moment of increased metabolic vulnerability for patients with diabetes. There is scant information on diabetes therapeutic inertia during patient acute care transition. We examined the prevalence of therapeutic inertia among internal medicine (IM) residents admitting adults with diabetes on insulin to the hospital, and hypothesized that lack of change in insulin prescribing behavior was associated with decreased knowledge and perceived self-efficacy and that it could be modified by a provider-based multimodal diabetes education intervention (PB-DM-EDI).

Methods: IM inpatient residents were surveyed on perceived self-efficacy and evaluated on insulin therapy knowledge. A PB-DM-EDI including group sessions and on-site one-to-one patient-based teaching addressing knowledge, skills and electronic diabetes order sets and tools (DMOST) use was implemented over 4-months. Insulin regimens were reviewed during a 3-month period prior to and after PB-DM-EDI to screen for therapeutic inertia on admission, defined by the lack of change of pre-admission insulin orders.

Results: We analyzed 51 surveys and 325 patient insulin regimens; 28 surveys and 148 patients prior to PB-DM-EDI and 23 surveys and 177 patients post PB-DM-EDI. Therapeutic inertia was identified in 49.3% and 35.6% of patients before and after PB-DM-EDI, respectively. Surveys revealed low self-efficacy and knowledge relating to insulin therapy; frequent DMOST use was only reported by 50% of residents. PB-DM-EDI increased perceived self-efficacy by 20%, basic knowledge by 5-18%; and self-reported frequent use of DMOST by 15%.

Conclusion: Therapeutic inertia is high among providers caring for patients with diabetes transitioning to the acute care setting and is associated with decreased knowledge and self-efficacy with insulin management. Education interventions that incorporate EMR DMOST may decrease therapeutic inertia, but need to be combined with other strategies to increase their effectiveness.

Disclosure

A. Brown: None. L. Belalcazar: None.
24-LB: Continuous or Transient High Level of Glucose Exposure Differentially Increases Coronary Artery Endothelial Cell Proliferation and Human Colon Cancer Cell Proliferation
Authors: OKADA JUNICHI , OKADA SHUICHI , YAMADA MASANOBU
Published: June 2019

We studied effect of high glucose levels on coronary artery endothelial cell proliferation and human colon cancer cell proliferation. To examine the long-term effect of glucose exposure on cell growth, cells were cultured for 14 days in the absence or presence of 183 mg/dL D-glucose addition in the culture medium. Short effect of elevated glucose levels was examined by addition of 183 mg/dL D-glucose addition in the culture medium for just one hour per day followed by changing the culture to standard medium (5.5 mM D-glucose) during the next 23-hours period. Cell proliferation was estimated by 2,3-Bis (2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carbox-anilide (XTT) assay and phosphor-Erk western blot analysis. We found that coronary artery endothelial cell proliferation was significantly increased in the culture medium with the acute one-hour addition of 183 mg/dL D-glucose compared to the absence or chronic presence of 183 mg/dL D-glucose addition in the culture medium. In contrast, colon cancer cell proliferation was significantly increased in the continuous presence of 183 mg/dL D-glucose addition in the culture medium compared to the acute one-hour addition of glucose. The extent of Erk2 phosphorylation paralleled with the relative changes in cellular proliferation in both cell types. Taken together, these results suggested that continuous or transient high level of glucose exposure differentially effects coronary artery endothelial and human colon cancer cell proliferation.

Disclosure

J. Okada: None. S. Okada: None. M. Yamada: None.
2403-PUB: Predictors of Poor Glycemic Control in a Diabetes Transition Age Cohort at the Johns Hopkins Hospital
Authors: EVERETT ESTELLE M. , LEE JASON T. , SIDHAYE ANIKET
Published: June 2019

Introduction: Transition of care to adult endocrinology is associated with clinical deterioration in young adults with diabetes. We characterized the young adult patient population with diabetes at our institution’s adult endocrinology clinics to identify patients’ characteristics associated with poor glycemic control.

Methods: We completed a retrospective cohort study of patients aged 16-25 with diabetes, whose first visit with an adult endocrinologist at any of 4 sites within our medical system occurred between July 1st, 2011 and June 30th, 2015. The following factors were analyzed: visits with pediatric endocrinology at our center, age, race, ethnicity, gender, social deprivation index, and age of diabetes onset. The primary outcome was mean hemoglobin A1c ≥ 10% in the 2 years after establishing care with adult endocrinology.

Results: We identified 264 patients who met inclusion criteria. Our preliminary analysis shows that 107 (40%) had a mean A1c ≥ 10%, which was associated with the following patient characteristics: male gender (OR 1.95 95% CI 1.02-3.74), younger age, with every year placing patient at a 5% increased risk (OR 1.3; 95% CI 1.1-1.5), black race (OR 9.03; 95% CI 3.43-28.2) and being seen in pediatric endocrinology clinic at the same institution (OR 2.34; 95% CI 1.12-4.87). Interestingly, there was no increased risk associated with diabetes type, diagnosis age, ethnicity and area social deprivation tertile.

Conclusion: We found a high prevalence of mean A1c ≥ 10% in our population. Preliminary analysis of data suggests certain patient groups are at high risk of poor control. Additional analysis is needed to determine factors associated with this clinical deterioration. In the future, intervention strategies maybe targeted to high risk populations to improve overall outcomes in our population of young adults with diabetes.

Disclosure

E.M. Everett: None. J.T. Lee: None. A. Sidhaye: None.
2406-PUB: Characterization of Hypoglycemia following New-Onset Diabetes Mellitus Education
Authors: MUSICK TIFFANY S. , MCDONOUGH RYAN
Published: June 2019

Background: Beginning in January 2017, our institution transitioned new-onset diabetes mellitus education to the ambulatory setting for all children 5 years of age and older. During this transition, our education and practice standards were reviewed and updated. Education historically had been provided during a two-day inpatient hospitalization. With the shift to ambulatory education, teaching was spread out to three separate classes in the first month after diagnosis given that the patients were not under direct supervision. Our primary aim was to prevent hypoglycemia at home, so we introduced new standard insulin doses during the education transition. Glargine doses were reduced to 0.2 units/kg (< 5 years), 0.25 units/kg (5-10 years), and 0.3 units/kg (> 10 years) to minimize hypoglycemia risk while preventing DKA. Due to the lower basal insulin, we lowered insulin sensitivity factors (ISF) to 150 for children under 5 years, 75 for 5-10 years, and 50 for children 11 and older. Corrections were given at meal time to prevent stacking of insulin. Initial carbohydrate ratios remained the same.

Methods: We monitored incidence of high-risk events between classes by characterizing the frequency of hypoglycemia less than 70 mg/dL, hypoglycemia less than 50 mg/dL, use of glucagon, and development of ketones/DKA.

Results: From 1/3/2017 to 12/31/2018 there were 451 patients diagnosed with diabetes at our center. Hypoglycemia questionnaires were completed by 320/451 (71%) of patients/families 1 week after diagnosis. Hypoglycemic episodes with BG < 70 mg/dL occurred in 41% of patients and BG < 50 mg/dL occurred in 8% of patients. Only 1 patient required glucagon for a severe hypoglycemic episode. While 22% of patients had ketones, no patients developed DKA after initial diagnosis.

Conclusions: Conservative dosing with glargine, along with more aggressive carbohydrate and correction dosing at meals is safe and effective in preventing severe hypoglycemia and DKA for patients educated in the ambulatory setting.

Disclosure

T.S. Musick: None. R. McDonough: None.
2407-PUB: Glycemic Patterns Derived from Masked Continuous Glucose Monitoring in Adolescents with Type 1 Diabetes on Contemporary Management
Authors: ABRAHAM MARY B. , SMITH GRANT J. , BOCK MARTIN DE , KING BRUCE R. , FAIRCHILD JAN , AMBLER GEOFFREY , CAMERON FERGUS , DAVIS ELIZABETH A. , ONEAL DAVID N. , JONES TIMOTHY
Published: June 2019

Background: There has been a change in the management of type 1 diabetes (T1D) with the availability of continuous glucose monitoring (CGM) systems. In Australia, subsidized CGM is available to patients below the age of 21. A randomized controlled trial (RCT) evaluating hybrid closed loop therapy is currently underway and the baseline data provided an opportunity to analyze the glycemic patterns in patients on contemporary management.

Methods: Adolescents and young adults with T1D and HbA1c <10.5% were eligible. All participants wore masked CGM (Enlite® Sensor 3, Medtronic) for 3 weeks during the run-in period. Glucose data from masked CGM were evaluated for glycemic patterns including sensor glucose (SG), glucose variability, percentage time in range, time in hypoglycemia and hyperglycemia.

Results: Data were analyzed from 100 participants (47M, 53F; pump 80, MDI 20) with (mean±SD) age 14.9±2.7 years, diabetes duration 7.6±0.9 years, HbA1c 7.9±0.9% of which 55% participants were on real-time CGM. The (mean±SD) SG was 9.6±1.6mmol/l with fasting SG of 8.8±1.9mmol/l. The SG coefficient of variation was 41.3±6.04%. The median [IQR] %time in range (3.9 to 10mmol/l) was 55.9 [44.1,62.3]. The %time in hypoglycemia (<3.0 and < 3.9mmol/l) were 1.1[0.3,2.2] and 4.4[2.2,8.6] respectively. The %time in hyperglycemia (>10 and >13.9mmol/l) were 35.5[24.7,45.7] and 14.1[8.1,18.8] respectively.

Conclusion: Majority of adolescents in the trial were on insulin pump therapy with half of them on CGM. The baseline CGM data of these participants provide a snapshot of the glycemic management in patients with T1D on current therapy; especially highlighting the reduced time in hypoglycemia compared to earlier trials. The data can further inform the conduct of future trials.

Disclosure

M.B. Abraham: None. G.J. Smith: None. M. de Bock: None. B.R. King: None. J. Fairchild: None. G. Ambler: None. F. Cameron: None. E.A. Davis: None. D.N. ONeal: None. T. Jones: Research Support; Self; Dexcom, Inc., Medtronic MiniMed, Inc. Speaker's Bureau; Self; Eli Lilly and Company, Roche Diabetes Care.
241-LB: Identification of Novel and Population-Specific Signals for Type 2 Diabetes in Large-Scale Study of Hispanic/Latino Individuals
Authors: PETTY LAUREN E. , BELOW JENNIFER E. ,   DIAMANTE HISPANIC/LATINO CONSORTIUM
Published: June 2019

Hispanic/Latino populations are both disproportionately burdened by type 2 diabetes (T2D) and drastically less studied compared to non-Hispanic whites. We present results of the final data freeze of the DIAMANTE Hispanic/Latino Consortium, comprising the largest genome-wide meta-analysis and transcriptome-wide association study of T2D in a Hispanic/Latino population and including a total of 13,151 T2D cases and 21,511 controls. We identified a novel locus in an intronic region of BACE1 for T2D adjusted for body mass index, which has previously been linked to gestational diabetes susceptibility, but never before to T2D. We also identified two variants in known loci with evidence (p <1x10-5) of a residual effect after adjusting for the closest known variant, suggesting that these may be population-specific effects due to H/L linkage disequilibrium structure. We used S-PrediXcan to compute the association of tissue-specific imputed expression for 48 tissues with T2D, revealing novel associations with ten genes and replicating six known genes. These novel genes include three genes previously associated with blood pressure traits: MOV10, ST7L, and WNT2B, as well as two genes previously associated with adiposity, measured by waist and hip circumference: MOV10 and WNT2B. Three novel genes have compelling evidence due to known roles of their biological pathways, including PTCH1, in the hedgehog pathway, which is known to play a role in pancreas development, ST7L, which is a miR-24 target and previous studies have indicated that miR-24 is elevated in diabetes, and WNT2B, part of the WNT signaling pathway, which is known to be involved in glucose homeostasis. These results demonstrate that genetic study of T2D in H/L populations can both help prevent a major health disparity through inclusion of this henceforth overlooked population and can also enable further discovery.

Disclosure

L.E. Petty: None. J.E. Below: None.
2412-PUB: Demographics of Women with Gestational Diabetes Attending a Diabetes and Pregnancy Clinic: 2000-2002, 2010-2012, and 2014-2016
Authors: KHANNA PARUL , ANUKAM KINGSLEY , CHOW LINDSEY , BRYDGES EVAN , LIU SELINA L. , MAHON JEFFREY , JOY TISHA R. , MCMANUS RUTH M.
Published: June 2019

Background: Numbers of women attending Diabetes and Pregnancy Clinics (DPC) are increasing. Potential reasons include: obesity; fertility intervention access; diagnostic changes for gestational diabetes (GDM). The DPC in London Ontario sees all pregnant women with diabetes within the catchment area with stable clinic structure and procedures. Longitudinal characteristics of GDM women were documented for demographic insights.

Methods: DPC pregnancy charts were assessed for 2000-2002, 2010-2012 and 2014-2016. Data were abstracted for: age; weight, infertility interventions; GDM diagnostic method. Continuous results were analyzed by one-way analysis of variance (ANOVA), non-parametric results by Chi-square testing; p≤ 0.05 signifying significance.

Conclusions: Over the study interval, women with a GDM diagnosis increased 240%. The change may be related to obesity; changes to GDM diagnostic criteria and week of testing; but not late pregnancy weight gain or use of fertility interventions.

Disclosure

P. Khanna: None. K. Anukam: None. L. Chow: None. E. Brydges: None. S.L. Liu: Consultant; Self; Novo Nordisk Inc., Sanofi. Research Support; Self; Physicians' Services Inc. Foundation. J. Mahon: None. T.R. Joy: Speaker's Bureau; Self; Amgen Inc., Novo Nordisk Inc., Sanofi. Other Relationship; Self; Amgen Inc., AstraZeneca, Novo Nordisk Inc. R.M. McManus: None.
2413-PUB: Demographics of Women with Type 1 Diabetes Attending a Diabetes and Pregnancy Clinic, 2000-2002, 2010-2012, and 2014-2016
Authors: KHANNA PARUL , ANUKAM KINGSLEY , CHOW LINDSEY , BRYDGES EVAN , LIU SELINA L. , MAHON JEFFREY , JOY TISHA R. , MCMANUS RUTH M.
Published: June 2019

Background: The numbers of women attending Diabetes and Pregnancy Clinics (DPC) are increasing. Some of the increase may reflect obesity effects on GDM prevalence, but changes in numbers and characteristics of women with type 1 diabetes (T1DM) are unknown. The DPC in London Ontario sees all pregnant women with diabetes within the catchment area with stable clinic structures and procedures. Longitudinal characteristics of women with T1DM were documented for demographic insights.

Methods: DPC pregnancy charts were assessed for 2000-2002, 2010-2012 and 2014-2016. Data were abstracted for: age; weight, A1C and medication use. Continuous results were analyzed by one-way analysis of variance (ANOVA); non-parametric results by Chi-square testing; p≤ 0.05 signifying significance.

Conclusions: Clinic numbers of pregnant women with T1DM increased non-significantly over the study timeline while pump usage rose concurrent with access to government funding. A1C values fell 0.5% from first to last visit in all time periods. A1C values at first visit rose over the time periods suggesting women with less optimal glucose control were conceiving pregnancies.

Disclosure

P. Khanna: None. K. Anukam: None. L. Chow: None. E. Brydges: None. S.L. Liu: Consultant; Self; Novo Nordisk Inc., Sanofi. Research Support; Self; Physicians' Services Inc. Foundation. J. Mahon: None. T.R. Joy: Speaker's Bureau; Self; Amgen Inc., Novo Nordisk Inc., Sanofi. Other Relationship; Self; Amgen Inc., AstraZeneca, Novo Nordisk Inc. R.M. McManus: None.
2422-PUB: Short-Chain Acylcarnitines as Early Predictors of Gestational Diabetes in Mexican Population
Authors: RAZO-AZAMAR MELISSA , NAMBO-VENEGAS RAFAEL , DELGADILLO-VELAZQUEZ JAIME , PALACIOS-GONZALEZ BERENICE
Published: June 2019

Gestational diabetes (GD) represents the main metabolic alteration during pregnancy affecting 17% of pregnancies in Mexico. The clinical relevance of this pathology is the short and long-term complications such as obesity, diabetes, and hypertension; that affect mother and child. GD is often diagnosed between weeks 24 to 28 of gestation through an oral glucose tolerance test. The aim of the present study was to identify early pregnancy metabolites (under 18 weeks of gestation) present on women who were diagnosed with GD; in order, to generate an early prediction model to identify those women who will later be diagnosed with GD. We used targeted metabolomics (11 amino acids and 39 acylcarnitines) to select early serum biomarkers with the most predictive power to identify women who will later be diagnosed with GD on a Mexican cohort of pregnant women. We assessed 79 pregnant women, which 66 underwent a normal pregnancy and 13 were diagnosed with GD under the IADPSG criteria. Random forest analyses were performed to assess the contribution and association of the metabolites identified to the development of GD. We developed a model that included two short-chain acylcarnitines (namely AC4 and AC5:1) that allowed an AUC of 0.904 (0.843-0.965, 95 CI) for classification of gestational diabetes. This model allows the identification of women on early stages of pregnancy that will be diagnosed with gestational diabetes between weeks 24 to 28 of gestation. However, additional studies in a large sample of pregnant women are required.

Disclosure

M. Razo-Azamar: None. R. Nambo-Venegas: None. J. Delgadillo-Velazquez: None. B. Palacios-Gonzalez: None.
2426-PUB: Circulating WBC, RBC, and Hemoglobin Level in Relation to Metabolic Syndrome and Incident Prediabetes in a Biracial Cohort of Normoglycemic Subjects with Parental Type 2 Diabetes
Authors: ABUTINEH IMAN , UMEKWE NKIRU A. , ARIGANJOYE FOLABI , DAGOGO-JACK SAMUEL
Published: June 2019

Objective: We assessed the relationships among blood cell counts, metabolic syndrome (MetS), and prediabetes risk in a biracial cohort of African Americans (AA) and European Americans (EA) with parental type 2 diabetes mellitus (T2DM).

Methods: We studied 603 normoglycemic subjects (264 EA, 339 AA), mean (+SD) age 46.14 ± 10.58 y and BMI 31.1 + 7.30 kg/m2. Each subject underwent clinical examination and OGTT. Blood specimens were analyzed for RBC, WBC and differentials, and lipids. MetS markers were identified using NCEP cut-offs for waist, blood pressure, HDL cholesterol and triglyceride (TG) levels.

Results: Total WBC count correlated positively with waist circumference (P=<0.001), TG (P=0.018) and fasting plasma glucose (FPG) (P=0.023) and inversely with HDL level (P=0.005), as did segmented neutrophil and monocyte counts. RBC count also correlated positively with waist (P= 0.0002), TG (P= 0.0004), FPG (P=0.035) and WBC count (P=0.0016) and inversely with HDL cholesterol level (P=<0.0001). Hemoglobin (Hb) and hematocrit (Hct), both strongly reflecting RBC count (r=0.75, P=0.0001), mirrored the association with MetS markers seen with RBC. Among 372 subjects followed longitudinally for 5 y, baseline MetS markers, absolute eosinophil and basophil counts, and Hb significantly predicted progression to prediabetes. After adjustment for age and BMI, logistic regression odds ratio [95% CI] for incident prediabetes was 1.37[1.094-1.633], P=0.0045 for MetS; 1.21[1.037-1.405], P=0.015 for Hb; 1.006[1.002-1.011], P=0.0093 for absolute basophil count; and 1.003[1.000-1.005], P=0.0237 for absolute eosinophil count.

Conclusions: The known association between cardiometabolic risk and WBC extends to RBC count as well. Moreover, Hb level, eosinophil and basophil counts specifically predict increased risk of prediabetes, probably via proinflammatory and iron-related mechanisms.

Disclosure

I. Abutineh: None. N.A. Umekwe: None. F. Ariganjoye: None. S. Dagogo-Jack: Board Member; Self; Jana Care Inc. Consultant; Self; Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Sanofi-Aventis. Research Support; Self; AstraZeneca, Novo Nordisk Inc. Stock/Shareholder; Self; Dance Biopharm Holdings Inc.

Funding

National Institutes of Health
2428-PUB: Circulating microRNAs Are Associated with Latino Ancestry but Not Prediabetes
Authors: FLOWERS ELENA , LAZO-DE-LA-VEGA-MONROY MARIA-LUISA , SUCHER ANATOL , AOUIZERAT BRADLEY , KANAYA ALKA M.
Published: June 2019

Introduction: Circulating microRNAs (miRs) may be predictive biomarkers to identify individuals at risk for type 2 diabetes (T2D). Latinos are at particular high risk for T2D, and the reasons are entirely known.

Methods: We compared expression of circulating miRs between 66 individuals who self-identified with Latino ancestry in the United States (n=21) and native Mexicans living in or near Leon, Mexico (n=45), who had prediabetes (n=36) or normal glycemic status (n=30). Expression of three miRs (i.e., miR-126, miR-146a, miR-15) associated with risk for T2D in other race/ethnic groups was measured using quantitative polymerase chain reaction.

Results: All miRs were strongly correlated (r2>0.7, p<0.05 for all). MiR-146a and miR-15 were increased in U.S. Latinos compared to native Mexicans, (p<0.05 for both). There were no significant differences in expression of any miR associated with prediabetes compared to normal glycemic status. There were no significant interactions between geographic region and miRs in logistic regression models for prediabetes. In a logistic regression model for prediabetes that only included common covariates (i.e., age, sex, body mass index (BMI)), and no miRs, BMI was the only significant predictor (p<0.05), and there was a significant interaction between BMI and geographic region (p<0.05). We tested associations between miRs and common covariates. MiR-146a was correlated with BMI (r2=0.3, p<0.05). When miR-146a was added to a model for prediabetes, the relationship between BMI and prediabetes was no longer significant. There was no significant interaction between miR-146a and geographic region.

Conclusions: Our study failed to validate associations between miRs and prediabetes observed in other racial groups, but we did identify differences in expression levels associated with geographic region. Further studies are needed to determine which miRs are widely associated with risk for T2D across racial groups versus miRs that identify unique risk within a racial subgroup.

Disclosure

E. Flowers: None. M. Lazo-de-la-Vega-Monroy: None. A. Sucher: None. B. Aouizerat: None. A.M. Kanaya: None.

Funding

University of California Institute for Mexico and the United States; El Consejo Nacional de Ciencia y Tecnología
2432-PUB: Predictors of Imminent Glycemic Worsening in Adults with Screen-Detected Diabetes
Authors: AGUIRRE REBECCA S. , HANNON TAMARA S. , CONSIDINE ROBERT , KIRKMAN M. SUE , MATHER KIEREN J.
Published: June 2019

Reliable clinical indicators of near-term risk of worsening glycemia in type 2 diabetes (T2D) could help guide individual-level interventions. Here we analyzed data from the Early Diabetes Intervention Program (EDIP) to identify predictors of near-term glycemic progression. EDIP evaluated progression of fasting blood glucose (FBG) above 140 mg/dl on consecutive quarterly measurements in individuals with screen-detected T2D and FBG below 140 at study entry (age 52.6 + 11.5 years, 41.9% male, mean entry FBG 121±14 mg/dL; mean 2-hour OGTT glucose 236±30; mean HbA1C 6.4+0.57%). We investigated accessible clinical parameters (weight, glycemia, lipids, and insulin levels) as potential near-term predictors of progression, evaluating absolute levels and yearly changes preceding progression. Variables were evaluated individually in age/sex/race-adjusted analyses and in combination in multivariable Cox progression models. Change over the preceding 1 year in fasting glucose, but not in weight or insulin levels, was predictive of glycemic progression in the subsequent year in adjusted univariate analyses (p<0.03). In multivariable modeling, the FBG concentration (hazard ratio HR 1.14) and the antecedent 1-year change in FBG (HR 0.90) were the strongest predictors of progression, and both retained significance in multivariable models including all specified variables (p< 0.0001). Adding changes in fasting insulin, HOMA-IR, or oral disposition index to the modeling did not change this result. There was a significant correlation between current FBG and the antecedent 1-year change (r=0.587; p<0.01), highlighting that change in FBG was contributing in part via its effect on current FBG. In the EDIP study population with screen-detected T2D, current FBG and antecedent 1-year change in FBG were the best predictors of upcoming glycemic worsening. These data underscore the value of serially monitoring fasting glucose, and suggest a similar monitoring paradigm should be evaluated in prediabetes.

Disclosure

R.S. Aguirre: None. T.S. Hannon: Advisory Panel; Self; Eli Lilly and Company. R. Considine: None. M. Kirkman: Research Support; Self; Bayer AG, Novo Nordisk A/S, Theracos, Inc. K.J. Mather: Advisory Panel; Self; Roche Diabetes Care. Research Support; Self; Abbott, Merck & Co., Inc., Novo Nordisk A/S, Sanofi.
2434-PUB: Comparison of Diabetes Prevalence and Severity between Chinese and Non-Chinese Populations in New York City
Authors: LIU GEORGE , GEORGE JOHN D. , SHARP JAMES W. , HU ANTHONY , CHANG TA-MIN
Published: June 2019

Diabetes mellitus (DM) is the 7th leading cause of death in the U.S. in 2015. According to Center of Disease Control (CDC), prevalence of DM has increased in recent years affecting 9.4% of U.S. population and 12.5% of New York City (NYC) population in 2015. Increased DM prevalence is a worldwide trend associated with increasing age of the population.

Aim: To determine prevalence and severity of diabetes/prediabetics in NYC Chinese population in comparison with those of non-Chinese patients.

Methods: We obtained and analyze HMO A1C data of 276,854 Chinese (age 18-98 with median of 51 years, 55% female, 45% male, representing the largest population studies) and non-Chinese sampling population in NYC from January 2015 to October 2018 using BioReference Lab. Patients (57,612 Chinese, 49,548 non-Chinese) classified as prediabetics with A1C between 5.7-6.4% upon initial A1C test had follow-up test after management according to CDC Prediabetic management protocol.

Results: Of 197,487 Chinese who had A1C test indicated prevalence of 18.5% diabetes, 45.6% of prediabetic and 35.6% nondiabetics. The male group had a higher incidence of diabetes than females (21% vs. 16.5%). Among 1,341,054 non-Chinese clients, there were 51.6% nondiabetics, 31.4% prediabetics and 18.0% diabetes. The severity of diabetes with respect to A1C data in 36,596 Chinese were 6.5-7.4, 57%; 7.5-9.0, 27%; >9.0, 16% whereas in 241,180 non-Chinese they were 44%, 29% and 28%, respectively. Among Chinese prediabetics, 30% reversed to nondiabetics and 5.7% progressed to diabetic categories, whereas among non-Chinese prediabetics, 25.8% reverse to nondiabetics and 11.1% progressed to diabetics during the study time.

Conclusion: Prevalence of diabetes in NYC population is higher than that found in 2015. More severe diabetes with higher A1C levels was found in non-Chinese than Chinese patients. The NYC Chinese had higher incidence of prediabetics but had better management outcome than non-Chinese community.

Disclosure

G. Liu: None. J.D. George: None. J.W. Sharp: None. A. Hu: None. T. Chang: None.
2442-PUB: Religion and Religiosity Are Associated with Hyperglycemia in Adults without Diabetes in Northern Israel
Authors: BASHKIN AMIR , SHEHADEH MONA , YAACOVY RONIT , NODELMAN MARINA , ZUR ANITA , BARHOUM MASAD
Published: June 2019

Background: Northern Israel is characterized by a multi-ethnic population. We looked for differences in the risk factors for hyperglycemia in Jews, Muslims and Druze without diabetes.

Methods: Adult visitors to our Medical Center without known diabetes were included in the study. A point-of-care (POC) capillary blood glucose level with institutional glucometer and a seated blood pressure were measured and additional data were collected from an interview. We excluded people with hypoglycemic drug usage, acute disease, glucocorticoid usage, pregnancy and capillary blood glucose in the diabetes range. The blood glucose levels were divided according to last caloric intake to postprandial (4 hours or less) or pre-prandial (more than 4 hours). Hyperglycemia was defined as pre-prandial blood glucose level ≥100 mg/dl or postprandial glucose level ≥140 mg/dl. High systolic blood pressure was defined as ≥140 mm Hg. Backward stepwise logistic regression was used to identify the factors independently associated with hyperglycemia.

Results: A total of 1062 Jews, 419 Muslims and 341 Druze were included in the analysis. 57% of Muslims, 44% of Jews and 34% of Druze reported that they are religious. Compare to Jews, Muslims had increased risk for hyperglycemia (OR 1.73, 95% CI 1.22-2.43, p=0.002) and Druze had no significant difference. After adjusting for sex, high systolic blood pressure and fewer than 12 years of education, age was a significant risk factor for hyperglycemia in all three religions and obesity was an independent risk factor for Druze (OR 2.45, 95% CI 1.28-4.69, p=0.07) and Muslims (OR 2.25, 95% CI 1.31-3.86). Only religious Muslims had an independently lower risk for hyperglycemia than non-religious Muslims (OR 0.5, 95% CI 0.29-0.86, p=0.012).

Conclusion: Religion and religiosity are independently associated with hyperglycemia in people without diabetes. Muslims in north Israel have increased risk for hyperglycemia compared to Jews but this risk is lower in religious people.

Disclosure

A. Bashkin: None. M. Shehadeh: None. R. Yaacovy: None. M. Nodelman: None. A. Zur: None. M. Barhoum: None.
2449-PUB: Sex-Specific Associations between Diabetic Status and Cognitive Performance
Authors: VISARIA AAYUSH , AMOROSA LOUIS F.
Published: June 2019

Background: We studied cognitive performance in prediabetes (PD) and diabetes mellitus (DM) in males and females.

Methods: A population of 1,895 males and 2,249 non-pregnant females aged 20-59 with data on the Symbol Digit Substitution Test (SDST) and DM status and no history of stroke, depression, or recreational drug use were included in this secondary analysis of NHANES III (1988-1994). Diabetic status, as determined by FPG, in mg/dl, was categorized into Normal (70-99), PD (100-125), and DM (≥126 or HbA1c > 6.5% or medication use). Cognitive performance was measured using a computer-based SDST, commonly used to assess frontal lobe-related functions. Multivariate linear regression models were run using an inverse transformed SDST score (digits/90 sec) and adjusted for confounders and study design in 3 additive models listed in Table 1.

Results: The mean (SE) SDST score (in digits/90 sec) was 36.9 (0.3) for females and 35.2 (0.3) for males. DM males matched, on average, 4.02 fewer digits than normals. This association did not hold after adjustment in Model 2 and 3. PD males, however, significantly matched 1.16 fewer digits than normals even after adjustment. Although PD and DM females also had lower SDST scores compared to normals, the difference lost significance after adjustment.

Conclusion: PD and DM did poorer on SDST than normals. Males seem to be more affected cognitively by impaired glucose tolerance than females.

Disclosure

A. Visaria: None. L.F. Amorosa: None.
2452-PUB: Use of Controlled Transient Elastography (VCTETM) Evaluation in a Clinical Research Clinic to Assess Degree of Liver Fibrosis and Steatosis in a Largely Hispanic Population
Authors: MORA PABLO F. , CAMACHO ALLISON S. , ADAMS-HUET BEVERLEY
Published: June 2019

The aim of this study was to describe a population referred as potential research study candidates for diabetes, obesity and nonalcoholic Fatty Liver Disease (NAFLD). NAFLD is now the leading cause of cirrhosis, ahead of viral hepatitis and alcohol-related liver disease and is associated with type 2 diabetes, dyslipidemia and obesity. The clinical challenge is how to screen these subjects to determine the degree of fibrosis and steatosis, ideally with a non-invasive procedure and to complement it with the traditional clinical and biochemical markers for NAFLD. We utilized Controlled Transient Elastography (VCTETM) measurements performed with a Fibroscan® (Echosens) to produce a minimum of ten acquired measurements with a median liver stiffness (fibrosis) measured in kPa with IQR/Median percentage and a CAP ultrasound attenuation rate (steatosis) value measured in dB/m. Patients were evaluated from December 2017 to December 2018 with a consent form obtained prior to the examination and IRB approval for the analysis of the data. A total of 198 individuals had a complete, valid Fibroscan® report, median age 52. 54% were females with a majority of them (67%)identified as of Hispanic ethnicity. The median (IQR) kPa score was 5.8 (4.5-7.9), QR/Mean percentage 11.9% (7.8-16.9)and CAP attenuation rate of 320 (282-352) dB/m. The percentage of individuals who had an elevated kPa over 7.5 (identified as F2) was 27% and CAP attenuation score over 290 was 71%, with 24% of them had both an elevated kPa and CAP scores identifying the presence of both fibrosis and steatosis. We conclude that in a population of primarily Hispanic individuals, we detected a high rate of clinically significant fibrosis and steatosis suggesting a high prevalence of NAFLD in these high-risk group and emphasize the role of non-invasive testing of individuals with T2DM, obesity and metabolic syndrome.

Disclosure

P.F. Mora: Consultant; Self; Novo Nordisk Inc. Speaker's Bureau; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., MannKind Corporation, Merck & Co., Inc., Novo Nordisk Inc., Valeritas, Inc. A.S. Camacho: None. B. Adams-Huet: None.