bluuebunny/crossref_metadata_2025 huggingface dataset:
547-P: Impact of the COVID-19 Public Health Emergency on Delivery of the National Diabetes Prevention Program Lifestyle Change Program
Authors: ELY ELIZABETH
Published: June 2023

In January 2020, the Department of Health and Human Services (HHS) declared the COVID-19 pandemic to be a public health emergency (PHE). As a result of this declaration, organizations delivering the National DPP lifestyle change program (LCP) had to decide whether to hold program sessions virtually, in socially distanced spaces, or discontinue (temporarily or permanently). This analysis looks at how CDC-recognized organizations chose to deliver, or not deliver, the LCP during this time. As of data submitted by October 2022, 1,810 organizations had delivered at least one session since 2019, the year leading up to the PHE. At the start of 2020, 1,370 organizations were active: 1,251 in-person, 28 online, 44 distance learning, and 47 combination. The remaining 440 were either approved during the PHE or had gone inactive before the start of it. Of those active at the start of 2020, 219 (16%) had not submitted data on sessions held on or after this time, indicating a pause in delivery. Since the PHE began, 373 new organizations have been approved, 357 of which are still active. Of these new organizations, 241 have been mainly focused on delivery with at least one virtual component. Approval of new organizations in 2020 decreased for those delivering in-person, whereas approval of new online, distance learning, and combination organizations increased by 207%, 158%, and 122%, respectively. Data submitted by in-person organizations in 2020 and 2021 indicated that many of them delivered only virtual sessions during that time, which might explain the large increases in approval of virtual organizations. New enrollment after the start of 2020 among these organizations was 185,596 as of October 2022: 62,217 in in-person organizations, 99,688 in online, 14,859 in distance learning, and 8,832 in combination. As we move out of the PHE, we are mindful of the need to help organizations delivering the LCP adapt to more flexible delivery to accommodate participants’ evolving needs.

Disclosure

E.Ely: None.
55-LB: “Older patients manifest it differently”—HCP Perspectives of People Aging with Type 1 Diabetes
Authors: UDDIN KASHIF , STUCKEY HEATHER L. , HUGHES ALLYSON
Published: June 2023

In the last decade, people with type 1 diabetes (T1D) are living longer due to advancements in diabetes technology. However, there is little research on treating this population. This study examined health care professionals’ (HCPs) experiences in treating older adults with T1D to identify clinical and practical differences. Participants were recruited from T1D Exchange (an online diabetes community) and 11 HCPs (average time in practice: 21.5 years) were interviewed. Interview questions focused on their clinical experiences, challenges that older people experienced, and needs of this aging population that might be different from other age groups. The interviews were recorded, transcribed, independently coded by 2 coders and thematically analyzed. Themes included treatment recommendations for older adults with T1D, diabetes education, post-severe hypoglycemic event recommendations, fear of hypoglycemia, insurance, and polypharmacy. As older adults with diabetes continue to live longer, new recommendations for this age group should be considered. Specifically, treatment recommendations amongst older adults differ in glycemic target goals and HbA1c range. These recommendations are made to combat any severe hypoglycemic episodes prone to this population. There is a greater degree of neurocognitive decline which poses a greater risk for life threatening emergencies, not only in older adults but also older adults with T1D. It is the HCPs duty to prepare this population for the risks of developing certain complications associated with T1D as well as the possible dangers if the more emergent situations are not addressed promptly.

Disclosure

K. Uddin: None. H. L. Stuckey: Consultant; Eli Lilly and Company. A. Hughes: None.
551-P: Healthy Lifestyle Behaviors as Predictors of Initiation of Hemodialysis (HD) in People With and Without Diabetes Mellitus (DM)
Authors: OSAWA TAEKO , FUJIHARA KAZUYA , YAMADA MAYUKO H. , YAGUCHI YUTA , SATO TAKAAKI , KITAZAWA MASARU , MATSUBAYASHI YASUHIRO , YAMADA TAKAHO , KODAMA SATORU , SONE HIROHITO
Published: June 2023

Breslow’s Health Practice Index (HPI) includes recommendations for a healthy lifestyle and is composed of 7 simple lifestyle factors (never smoking, regular physical activity, moderate or no use of alcohol, 7-8 hours sleep regularly, maintaining proper weight, eating breakfast, and not eating between meals). Cardiovascular health metrics (CVHMs), defined by the American Heart Association are composed of lifestyle factors and clinical laboratory values (smoking, weight, physical activity, diet, cholesterol, blood pressure, and blood glucose). To clarify the impact of HPI or CVHMs on incident HD according to DM, we analyzed a nationwide claims-based database of 294,647 people included from 2008-16 (DM- 277,935, DM 16,712). Risk for HD were analyzed according to DM and HPI/CVHMs based on the number of unfavorable lifestyle factors in the HIP and unfavorable lifestyle factors and clinical values in the CVHM (Table). Multivariate Cox regression analysis showed that DM increased the risk of dialysis 5- to 6-fold and DM and CVHMs synergistically increased the risk of HD. Results indicated that factors similar to those used to predict cardiovascular disease would also be useful to predict HD. These approaches might be helpful in clinical practice and patient education.

Disclosure

T.Osawa: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K.Fujihara: None. M.H.Yamada: None. Y.Yaguchi: None. T.Sato: None. M.Kitazawa: None. Y.Matsubayashi: None. T.Yamada: None. S.Kodama: None.
552-P: Disparities in Preventive Reproductive Health Services in Women with Type 1 and Type 2 Diabetes
Authors: TREASURE MADELINE , NOURBAKHSH POURANDOKHT S. , OSUNA-GARCIA ANTONIA , ESTEVES SARA C. , KRANSDORF LISA N. , WISK LAUREN E.
Published: June 2023

About 50% of (~13 million) reproductive aged women with Type I or II diabetes receive any preconception care. Even fewer receive contraceptive counseling, or other vital reproductive health services. This scoping review aimed to explore if reproductive aged women with diabetes receive adequate preventative reproductive health services compared to women without diabetes. A systematic search strategy of the published literature was built and applied in multiple databases (PubMed, Web of Science, Cochrane). Interventional and observational studies describing access to reproductive health services among reproductive-aged women with compared to those without diabetes were included. The Preferred Reporting Items for Scoping Reviews and Meta-Analyses (PRISMA) guidelines were followed. The search strategy identified 6785 unique records. A two reviewer method was used to screen abstracts, with 41 studies identified to be relevant. These studies were separated into the domains of contraception counseling (N=20), cervical cancer screening (N=12), counseling/screening for sexually transmitted infections (N=3), and preconception counseling (N=12). We did not include studies focusing on prenatal care, pregnancy, menstrual irregularities, sexual dysfunction, or breast cancer screening. While a vast amount of literature exists related to diabetes and pregnancy, this scoping review draws attention to the lack of research focused on the reproductive health of women with diabetes prior to pregnancy. The majority of available literature focuses on contraception and preconception management, consistently demonstrating that women with diabetes lack adequate preventative reproductive healthcare compared to their nondiabetic counterparts. Far less evidence exists for sexually transmitted infection risk assessment and screening. It is imperative that future research focus on ways to mitigate disparities in access to reproductive health services for women with diabetes.

Disclosure

M.Treasure: None. P.S.Nourbakhsh: None. A.Osuna-garcia: None. S.C.Esteves: None. L.N.Kransdorf: None. L.E.Wisk: None.
560-P: Examining Characteristics of CDC-Recognized Organizations Delivering the National Diabetes Prevention Program—Full and Full-Plus Recognition
Authors: LLOYD KAYLA R.K. , ELY ELIZABETH
Published: June 2023

Organizations that deliver the National Diabetes Prevention Program (National DPP) lifestyle change program (LCP) can earn CDC-recognition (Pending/ Preliminary/ Full) from the Diabetes Prevention Recognition Program (DPRP). The highest levels of recognition are Full (awarded when risk reduction and eligibility requirements are met) and Full Plus (awarded when retention thresholds are met in addition to achieving Full). As of October 2022, 860 organizations were actively in one of these statuses. The objective of this analysis was to examine the characteristics associated with organizations that achieve the highest levels of recognition.

Examining delivery modes, in-person programs achieved Full/Full Plus at a higher rate than organizations using other delivery modes. Of the organizations eligible to advance (those who submitted data for evaluation), in-person organizations moved into Full/Full Plus at a rate of 65.3%, with distance learning, online, and combination organizations achieving these recognition levels at rates of 53.1%, 56.4%, 46.4%, respectively. While under the COVID-19 public health emergency (PHE), many in-person organizations continued to deliver virtually. Organizations classified as Cooperative Extension Sites or Hospitals/Healthcare Systems/Medical Groups/Physician Practices had the highest rate of advancing to Full or Full Plus, 85.7% and 72.4%, respectively.

On average, organizations in Full Plus enrolled a higher percentage of participants who identified as non-Hispanic or Latino/Black or African American than organizations in Full at 24% and 20%, respectfully. On average, organizations in Full/ Full Plus enrolled similar percentages of men and women. Organizations in Full Plus enrolled a higher percentage of participants aged 65+.

Examining characteristics of organizations provides insight of the recognition trajectory and can shape future support of all recognized organizations.

Disclosure

K.R.K.Lloyd: None. E.Ely: None.
563-P: Outcomes of the Dulce Digital–COVID Aware (DD-CA) Discharge Texting Platform for U.S./Mexico–Border Hispanics with Diabetes
Authors: SPIERLING BAGSIC SAMANTHA R. , PADILLA NEELY OLIVIA M. , SANDOVAL HALEY , BASTIAN ALESSANDRA , BELASCO REBEKAH , ORENDAIN NATALIA , SORIANO EMILY , TALAVERA LAURA , FORTMANN ADDIE L. , PHILIS-TSIMIKAS ATHENA
Published: June 2023

Hispanic individuals are disproportionally impacted by type 2 diabetes (T2D) and COVID-19 compared to non-Hispanic White individuals. Notably, T2D is associated with greater COVID-19 disease severity and mortality; however, with good glucose control, prognosis improves. During the COVID-19 pandemic, N=172 Hispanic patients with T2D hospitalized near the US/Mexico border in California were randomized to receive Dulce Digital-COVID Aware (DD-CA) texting platform or usual care. The DD-CA program provides culturally tailored, educational, and motivational text-messaging related to diabetes management and COVID prevention, remote glucose monitoring, and automated, tailored feedback on behavioral and glucose metrics for 6 months post-discharge. Participants were on average 58 ± 13 years, 52% male, 9.3% COVID+, with a mean BMI of 32.7 ± 8.2 and mean baseline HbA1c of 9.6% ± 2.2%. In unadjusted analyses, DD-CA did not reduce 30- or 90-day hospital readmission rates compared to usual care (28% vs 15%, p = 0.06; and 37% vs 35%, p = 0.9, respectively). Follow up HbA1c completion rates were low; however, HbA1c improvement was significantly greater among those in DD-CA compared to usual care at 3 months (n=56; −2.69% vs. −1.45%, p=0.05), with slight attenuation of effect at 6 months (n=64; −2.03% vs −0.91%, p=0.07). Given the reduction of in-person clinical care and emphasis on staying at home amid the pandemic, DD-CA represented an alternative pathway for delivering diabetes- and COVID-related education and support to high-risk individuals during this time. While the DD-CA intervention did not significantly impact readmission rates, it was effective in achieving a clinically significant, >1% greater improvement in HbA1c relative to usual care post-hospital discharge. Additional analyses will be presented on clinical and patient-reported outcomes.

Disclosure

S.R.Spierling bagsic: None. A.Philis-tsimikas: Advisory Panel; Dexcom, Inc., Novo Nordisk A/S, Sanofi, Other Relationship; Medtronic, Research Support; Novo Nordisk A/S, Lilly, Viking Therapeutics, NIH − National Institutes of Health. O.M.Padilla neely: None. H.Sandoval: None. A.Bastian: None. R.Belasco: None. N.Orendain: None. E.Soriano: None. L.Talavera: None. A.L.Fortmann: Employee; Dexcom, Inc.

Funding

National Institutes of Health (R01DK112322-05S1)
565-P: A Case of Atypical Diabetes, Monogenic Diabetes
Authors: ATTAH RALUCHUKWU
Published: June 2023

A Case of Atypical Diabetes, Monogenic Diabetes, Monogenic diabetes formerly known as maturity onset diabetes of the young (MODY) is typically diagnosed in younger patients, usually age <25 years. It is a heterogenous disorder and typically accounts for 2-5% of diabetes. Clinical findings tend not to be reliable in determining the underlying etiology, hence patients may be misdiagnosed as type 1 or type 2 diabetes mellitus (DM). Patient is a 42-year-old non-obese male (BMI 21.9) with past medical history of type 2 diabetes mellitus who presented to establish care. He was diagnosed at age 25 with type 2 diabetes. At presentation, he had a hemoglobin A1c of 12.4% and was being managed with metformin, glimepiride and semaglutide by his primarry care physician. He has never been developed diabetes ketoacidosis or been on insulin. Also, his BMI has always been <25. He endorsed an extensive family history of DM but none of them require insulin or are overweight. His father, mother, brother, paternal grandfather and grandmother all have type 2 DM, most mainly diagnosed in their twenties and thirties. Laboratory studies including c-peptide and islet cell autoantibody screen panel were obtained which were low-normal (0.7ng/ml) and negative respectively. Repeat C-peptide was normal at 3.1ng/ml. Given these findings and his extensive family history of DM in non-obese persons, MODY was suspected. Hence genetic testing was done and revealed a heterogenous mutation, ABCC8 Variant in KATPase consistent with MODY12. This variant is typically sulfonylurea responsive. No screening test currently exists for monogenic diabetes. This case demonstrates the misdiagnosis of monogenic diabetes and the need for updated screening guidelines to aid with early diagnosis to prevent the associated comorbidities. Also, early diagnosis will prompt genetic testing in patients off springs and aid in adequate treatment. Finally, the value of a comprehensive history cannot be overemphasized in aiding to make a diagnosis of monogenic diabetes

Disclosure

R.Attah: None.
566-P: SEE-Diabetes in a Different Light—Content Validation of a Patient-Centered Diabetes Self-Management Education Aid for Older Adults
Authors: DEJHANSATHIT SIROJ , NARINDRARANGKURA PLOYPUN , DAY MARGARET A. , BOREN SUZANNE A. , KHAN UZMA Z. , SIMOES EDUARDO J. , KIM MIN
Published: June 2023

Diabetes self-management education and support (DSMES) is a significant component of diabetes care. However, our previous study indicated a lack of patient-centered DSMES during clinic visits. Therefore, we developed a patient-centered DSMES education aid named SEE-Diabetes (Support-Engage-Empower-Diabetes) to facilitate providers and patients in making shared decisions (Figure 1). We aimed to validate the content of SEE-Diabetes by interviewing 11 diabetes patients aged 65 and older, and 8 providers. Participants were asked to evaluate SEE-Diabetes statements incorporated in the Patient Education section by answering focused questions. The participants were asked if the statements were easy to read, helpful, and if they provided additional value to address the concerns, needs, and preferences of older people with diabetes. They were also asked if they would use SEE-Diabetes to improve their diabetes care. Thematic analysis revealed most participants agreed that it was easy to read and understand. Most of them found it very helpful, added value to the clinic note, and would use it to help take care of their diabetes. However, one patient shared it was unnecessary for long-term diabetes patients. Some providers shared concerns about lack of time. Future studies will evaluate the usability and feasibility of SEE-Diabetes as an educational tool in clinical practice.

Disclosure

S.Dejhansathit: None. P.Narindrarangkura: None. M.A.Day: None. S.A.Boren: None. U.Z.Khan: None. E.J.Simoes: None. M.Kim: None.
576-P: Local Muscle Microenvironment, Instead of Training Status, Affects Resting IMTG Turnover
Authors: CHOW LISA S. , BANTLE ANNE , ALVEAR ALISON C. , MASHEK DOUGLAS G. , JENSEN MICHAEL D.
Published: June 2023

Intramyocellular triglyceride (IMTG) level correlates with insulin resistance. Paradoxically, trained humans and obese, sedentary, insulin-resistant humans have high IMTG levels despite discrepant clinical phenotypes. We hypothesize that higher IMTG turnover in trained humans explains this paradox.

Methods: Obese, insulin-resistant subjects [n=47, mean (SD), BMI:36.2 kg/m2(5.7), VO2max 25.4 ml/kg/min (5.7)] and lean trained subjects [n=15, BMI:22.2 kg/m2(1.8), VO2max 55ml/kg/min (10.1)] were fasted overnight. Two muscle biopsies (Bx) were acquired during a pulse-chase experiment using [U-13C]palmitate and [9-2H]palmitate infusions (6 h each), overlapping by 1 hour. Bx#1 was performed during the infusion overlap [last hour of 6 h [U-13C]palmitate infusion, 1 hour after starting [9-2H]palmitate. Bx#2 was performed at study conclusion [last hour of [9-2H]palmitate infusion, 6 hours after stopping [U-13C]palmitate]. Palmitate enrichment and concentration were measured. [9-2H]palmitate IMTG incorporation at Bx#1 and [U-13C] IMTG loss at Bx#2 indicated the interplay between plasma and muscle fatty acids.

Results: Palmitate IMTG incorporation positively correlated between measures of IMTG turnover and negatively with insulin sensitivity. No correlation seen for VO2max/BMI.

Conclusion: Muscle-level IMTG measures dictates higher resting IMTG turnover more than training related phenotype.

Disclosure

L.S.Chow: Research Support; Dexcom, Inc. A.Bantle: None. A.C.Alvear: None. D.G.Mashek: None. M.D.Jensen: Other Relationship; Novo Nordisk, Elsevier.

Funding

National Institutes of Health (R01DK098203)
579-P: Exercise Upregulates Extracellular Vesicles (EVs) Proteins Involved in Immunomodulatory and Mitochondrial Pathways in Human Subjects
Authors: VAMVINI MARIA , NIGRO PASQUALE , GOODYEAR LAURIE , MIDDELBEEK ROELAND J.W.
Published: June 2023

Emerging data suggest that single bouts of exercise increase circulating hormones, cytokines, and EVs, and that these circulating factors may play a fundamental role in the beneficial effects of exercise on health. Here, we identify circulating factors in response to both acute exercise and exercise training and determine the effects of nutritional status on these responses. Blood samples were first collected before and immediately after an acute bout of maximal exercise in healthy, lean subjects (N=8, 3M/5F; age=27±2, V̇O2peak=28.4±1.2ml/kg/min). Subjects then completed a 10 wk moderate-intensity aerobic exercise training program (up to 65-70% VO2peak, 4x/week) with the same post-training sample collection. Proteomics (SOMAscan) quantified 1,310 circulating factors. In the untrained state, acute exercise upregulated 196 proteins and after training exercise upregulated only 65 proteins, with 47 proteins simultaneously upregulated in both the untrained and trained state. Interestingly, cellular component analysis showed that 1/3 of these shared proteins are localized in EVs. Next, we determined the baseline effects of exercise training in the fed and fasted state in the absence of acute exercise. Training upregulated 220 and 178 proteins in fed and fasted state, respectively. Exercise training commonly upregulated 120 proteins in the fed and fasted state with 1/3 localized in EVs. Integration using Vesiclepedia of the upregulated proteins in all 4 comparison groups showed 3 upregulated proteins in both acute exercise and training regardless of nutritional status: PPIF, PTPN6, and CLEC1B. These proteins are found in macrophages and neutrophils, and mediate immunomodulatory effects, promote tissue remodeling, and mitochondrial function. As EVs deliver molecules to cells altering their metabolism, they may play an important role in mediating the beneficial effects of exercise and warrant further mechanistic studies.

Disclosure

M.Vamvini: None. P.Nigro: None. L.Goodyear: None. R.J.W.Middelbeek: Research Support; Novo Nordisk.

Funding

Daiichi Sankyo; National Institutes of Health (R01DK099511 to L.G.), (5P30DK36836), (F32DK126432), (K23DK114550 to R.J.W.M.); Joslin Diabetes Center (to M.V.); Boston Area Diabetes Endocrinology Research Center (to R.J.W.M.)
583-P: Prediction of Hypoglycaemia in the 24 Hours after Exercise in Adults with Type 1 Diabetes
Authors: RILSTONE SIAN K. , OLIVER NICK , GODSLAND IAN F. , HILL NEIL E.
Published: June 2023

Background and Aims: Exercise uptake is low in people with type 1 diabetes (T1D), with hypoglycaemia fear cited as the main barrier. We establish factors that predict hypoglycaemia after exercise.

Materials and Methods: People with T1D exercising regularly (minimum 150min/week) recorded the type, timing and duration of exercise, and heart rate, for 80 days using a smartwatch. Participants used Dexcom G6 Continuous Glucose Monitoring throughout. Predictors of hypoglycaemia were analysed.

Results: 24 (8 men), mean (SD) age 35 (11) years, duration of diabetes 14 (7) years, BMI 26 (4.7) kg/m2 and HbA1c of 58 (12) mmol/mol recorded 1454 activities with complete CGM. During the 24 hours after exercise, increasing age and baseline HbA1c increased the risk of experiencing hypoglycaemia <70mg/dL (Age OR 1.028 (95% CI 1.019 - 1.038); HbA1c OR 1.027 (95% CI 1.016 - 1.037)), with similar results at other thresholds. Every additional minute of activity increased exposure to hypoglycaemia <70mg/dL (OR 1.007 (95% CI 1.004-1.010)), 54mg/dL (OR 1.011 (95% CI 1.008-1.014)) and 50mg/dL (OR 1.010 (1.007-1.014)). Exercising in the afternoon reduced the risk of hypoglycaemia at all thresholds (70mg/dL OR 0.766 (95% CI 0.602-0.975), 54mg/dL OR 0.575 (95% CI 0.403-0.820) 50mg/dL OR 0.503 (95% CI 0.330-0.766)) compared to the morning. Females had a reduced risk of hypoglycaemia <70mg/dL compared to males (OR 0.696 (95% CI 0.556-0.871)). Running (OR 2.898 (95% CI 1.958-4.290) and cycling (OR 2.989 (95%CI 2.154 - 4.148)) increased exposure to hypoglycaemia <70mg/dL compared to walking. In multivariate analysis, age (p=0.002), baseline HbA1c (p=0.004), sex (p<0.001), activity type (p<0.001), duration (p=0.009) and timing of exercise (p=0.004) were significant predictors of hypoglycaemia in the 24 hours after exercise.

Conclusion: To empower adults with T1D to avoid hypoglycaemia after exercise, education and support should focus on the timing, duration, and activity type, alongside support to optimise HbA1c.

Disclosure

S.K.Rilstone: None. N.Oliver: Advisory Panel; Dexcom, Inc., Medtronic, Roche Diabetes Care, Research Support; Dexcom, Inc., Medtronic. I.F.Godsland: None. N.E.Hill: Research Support; Dexcom, Inc.
584-P: Similar Variability in Pre- and Post-exercise Glucose Levels between Morning-Fasted and Afternoon-Fed Resistance Exercise in Adults with Type 1 Diabetes
Authors: MCCLURE REID , NITZ CORBIN J. , YARDLEY JANE E.
Published: June 2023

Background: Exercise increases longevity and decreases the incidence/progression of diabetes-related complications for those with type 1 diabetes (T1D), but it complicates blood glucose management. Understanding variability in blood glucose response to exercise may help guide choices of exercise strategies for people with T1D. Our primary objective was to compare the variability in capillary glucose (CG) response to morning, fasted resistance exercise (AMre), to afternoon post-prandial exercise (PMre). We hypothesized that CG responses would be less variable during morning fasted RE.

Methods: Seven participants [4F/3M; mean (SD): age = 29.1 (11.3) yrs; diabetes duration = 19.4 (6.7) yrs; HbA1c = 7.5 (0.7)%] completed a standardized resistance exercise protocol (3 sets of 8 repetitions of seven exercises involving all major muscle groups with 90 seconds between sets) three times in the morning (~7am) while in a fasted state and three times in the afternoon (~5pm) in a fed state. Sessions were performed in a random order with at least 48 hrs between sessions. Participants aimed for close consistency in the timing of the sessions, any associated meals (PMre only) and related insulin adjustments. To determine the intra-individual variability in CG response during AMre and PMre, as well as subsequent 30-minute recovery periods, we performed paired t-tests of the within-participant SD of the change in CG.

Results: From the beginning to the end of RE, mean within-participant SD of CG change was 1.2 (0.5) and 1.9 (1.2) mmol/L during AMre and PMre respectively (p=0.08), and 1.2 (0.4) and 1.2 (1.2) mmol/L during subsequent 30-minute recovery periods (p=0.98).

Conclusion: For adults with T1D the variability in CG response may be similar between AMre and PMre. More data are needed to clarify these effects.

Disclosure

R.Mcclure: None. C.J.Nitz: None. J.E.Yardley: Speaker's Bureau; Dexcom, Inc., Abbott.

Funding

LifeScan
585-P: Lactate Kinetics in Type 1 Diabetes—A 1-13C Lactate Study
Authors: ROMERES DAVIDE , RUCHI FNU , YADAV YOGESH , COBELLI CLAUDIO , BASU ANANDA , BASU RITA
Published: June 2023

Lactate kinetics in individuals with type 1 diabetes (T1D) has not been assessed quantitatively. Defining lactate kinetics in T1D under steady state condition is vital for estimating non-steady state lactate turnover. We studied 5 T1D and 7 nondiabetic (ND) anthropometrically matched participants during [1-13C]-sodium-lactate bolus injection in the resting, overnight fasted state. A two-compartment model with loss only from the peripheral compartment reliably described [1-13C]-lactate kinetics. Volume of distribution of the accessible compartment, V1, was similar between T1D and ND groups (40.32±21.08 vs. 47.64±33.32 mL/kg, p=0.76) thus concordant to plasma volume (~40 ml/kg). The irreversible loss from the peripheral compartment was impaired in T1D vs ND (0.08±0.03 vs. 0.13±0.03 min−1, p=0.03); rate of lactate appearance (12.4±5.2 vs. 18.5±9.6 µmol/kg/min, p=0.34), disappearance (12.7±5.2 vs. 18.8±9.7 µmol/kg/min, p=0.34) and lactate clearance (15.9±4.7 vs. 21.9±7.8 mL/kg/min, p=0.20) were numerically but not statistically lower in T1D vs. ND individuals. To conclude, we have defined lactate kinetics under resting, overnight fasted state in T1D and ND subjects. While the volume of distribution was similar in both groups, irreversible loss from the peripheral compartment was lower in T1D subjects. Further studies are needed to better define lactate kinetics during exercise in individuals with and without T1D.

Disclosure

D.Romeres: None. F.Ruchi: None. Y.Yadav: None. C.Cobelli: None. A.Basu: None. R.Basu: Consultant; Sparrow Pharmaceuticals Inc, Research Support; Abbott Diabetes, AstraZeneca.

Funding

National Institutes of Health (DK29953 to R.B.), (DK85516 to A.B.)
587-P: AS160 Expression, but Not AS160 Serine-588, Threonine-642, and Serine-704 Phosphorylation, Is Essential for Elevated Insulin-Stimulated Glucose Uptake by Skeletal Muscle from Female Rats after Acute Exercise
Authors: WANG HAIYAN , ZHENG AMY , ARIAS EDWARD B. , KWAK SEONGEUN , PAN XIUFANG , YUE YONGPING , DUAN DONGSHENG , CARTEE GREGORY D.
Published: June 2023

One exercise bout can substantially enhance subsequent insulin-stimulated glucose uptake (ISGU) in skeletal muscle. Evidence suggests that the insulin signaling protein Akt Substrate of 160 kDa (AS160; also known as TBC1D4) may be involved in this outcome. Supporting this idea, we recently reported that in male rats, AS160 expression was essential for increased postexercise-ISGU (PEX-ISGU). Furthermore, AS160 phosphorylation on Ser588, Thr642, and Ser704 was required for a portion (~45%) of the elevated PEX-ISGU. We now use the same approach to test AS160’s role in elevated PEX-ISGU in female rats. The initial experiment tested if AS160 is essential for exercise effects on ISGU by studying wildtype (WT) and AS160-kockout (AS160-KO) rats. The next experiment used AS160-KO rats together with an adeno-associated virus (AAV) approach to determine if AAV-delivery of WT-AS160 could restore the exercise benefit on ISGU. The final experiment employed AS160-KO rats and AAV-delivery of either WT-AS160 or AS160 mutated to prevent phosphorylation of key sites (Ser588, Thr642, and Ser704) to evaluate the requirement of phosphorylation on these sites for improved PEX-ISGU. The results from the first two experiments using female rats were very similar to our earlier findings with male rats: 1) AS160 expression was essential for increase PEX-ISGU; and 2) restoring muscle AS160 expression of AS160-KO rats rescued exercise’s ability to improve ISGU. However, in contrast to the results in male rats, preventing AS160 phosphorylation on Ser588, Thr642, and Ser704 did not diminish the magnitude of elevated PEX-ISGU in female rats. Future research will be required to elucidate the mechanisms underlying the sexual dimorphism with regard to the role of AS160 phosphorylation in elevated PEX-ISGU.

Disclosure

H.Wang: None. A.Zheng: None. E.B.Arias: None. S.Kwak: None. X.Pan: None. Y.Yue: None. D.Duan: None. G.D.Cartee: None.

Funding

National Institutes of Health (R01DK071771)
59-LB: Patient-to-Peer Education—An Unconventional Prescription for Teens with Type 1 Diabetes
Authors: PACK RICHARD , ARONSON LAUREN N. , VYAS NEHA V. , PIERCE JESSICA
Published: June 2023

Introduction: Type 1 diabetes (T1D) is a chronic condition affecting nearly 200,000 youths in the US with increasing incidence. There is often decreased adherence to therapy in adolescents because of challenges in managing T1D combined with social and metabolic changes. Therefore, addressing the individual and social factors affecting treatment is essential in teens with T1D. To date, scant research exists on how to improve patient’s self-care in the context of their relationships to peers without T1D.

Objectives: We aimed to test feasibility of a brief socio-educational intervention designed to improve patient perceived social support, diabetes self-care behaviors, and glycemic levels among teens with T1D.

Methods: A medical student encouraged participants to 1) develop a SMART goal for improving self-care of T1D, 2) recruit peers without T1D to help achieve the goal, and 3) educate peers on the goal’s importance to their health. Participants were surveyed prior to goalsetting and 3-4 months post-intervention to assess social support, self-care, self-efficacy, and intervention acceptability; measures of glycemia were also gathered from the EMR. Thematic analysis of participant goals and plans with peers was performed.

Results: All 13 participants who attended an info meeting consented to join the study; 8 completed study surveys. On average, there was a 0.9% decrease in HbA1c among the small cohort. Survey results reflect participants were satisfied with the intervention and were more interested in working with others to care for their T1D. Thematic analysis revealed teens primarily wanted assistance, reminders, and encouragement from peers for completing their T1D self-care goals.

Conclusions: This intervention is a potentially low cost and feasible tool that may improve teens with T1Ds’ perceived social support, diabetes knowledge, treatment adherence, and overall health. More research into the effects of encouraging positive patient-peer interactions is warranted.

Disclosure

R. Pack: None. L. N. Aronson: None. N. V. Vyas: None. J. Pierce: None.
598-P: No Relationship between Sedentary Behavior Patterns and Peak Oxygen Consumption (VO2peak) among Overweight Individuals With and Without Type 2 Diabetes
Authors: WHIPPLE MARY O. , PINTO ANA J. , RAFFERTY DEIRDRE , SCALZO REBECCA L. , ABUSHAMAT LAYLA , SCHAUER IRENE E. , HUEBSCHMANN AMY G. , CLARK ETHAN , REGENSTEINER JUDITH G. , REUSCH JANE E.B.
Published: June 2023

Background: Sedentary behavior (SB) has negative effects on health, even in the context of achieving physical activity (PA) guidelines. It is unclear how total volume and patterns of accumulation of SB may vary among overweight/obese adults with and without uncomplicated type 2 diabetes (T2D) and whether SB is related to aerobic capacity.

Purpose: To examine SB patterns and their relationship to estimated peak oxygen consumption (VO2peak) among adults with uncomplicated T2D and overweight controls.

Methods: This was a secondary analysis of baseline data from VA-MIXED (NCT03419195), a trial in physically inactive, overweight/obese adults aged 30-55 with and without T2D. Daily pattern of PA/SB was assessed via activPAL for 7 days. Participants completed a cycle ergometer graded exercise test to measure maximal workload. VO2peak was estimated using the American College of Sports Medicine metabolic equation. Pearson correlation, two-sample t-tests, and multiple linear regression analyses were used to examine relationships between variables overall and by T2D status.

Results: Baseline data were available for 21 participants (8 T2D, 13 overweight controls), mean (SD) age 43.3 (7.6) yrs, BMI 34.6 (5.6) kg/m2. Participants were sedentary (11.7 [2.2] h/day). There were no differences in step count; stepping, standing, or sedentary time; sit-to-stand transitions, and time in SB bouts ≥1 hour by T2D status (all p>0.11). Correlations between SB variables and VO2peak were not significant (all p>0.20). The relationship between total SB and VO2peak did not change when T2D status was included in the model (β −2.22, p=0.39).

Discussion: Objectively measured SB patterns were similar between overweight controls and adults with uncomplicated T2D and did not correlate with VO2peak. Future studies should examine these variables in larger cohorts and evaluate if SB patterns are associated with variability in response to exercise.

Disclosure

M.O.Whipple: None. J.E.B.Reusch: Advisory Panel; Medtronic. A.J.Pinto: None. D.Rafferty: None. R.L.Scalzo: None. L.Abushamat: None. I.E.Schauer: None. A.G.Huebschmann: None. E.Clark: None. J.G.Regensteiner: None.

Funding

American Diabetes Association (1-21-CMF-003 to L.A.); National Institutes of Health (P50CA244688, P30DK116073, UL1TR001082, R01AG066562, R01DK124344, K12HD057022); Ludeman Family Center for Women’s Health Research; U.S. Department of Veterans Affairs (BX004533, BX002046, CX001532)
599-P: The Effects of Cardiac Rehabilitation and Exercise Training in Hospital among Patients of Diabetic Cardiovascular Disease with Sarcopenic Obesity
Authors: KAYAMA YOSUKE
Published: June 2023

Background: The patients of type 2 diabetes have known to have a higher chance of having Sarcopenic obesity, in which the increase of body fat and the decrease of extremity muscles is observed. A high level of lower-limb muscle has been known to associated with a lower risk of cardiovascular mortality in patients with cardiovascular diseases. The effects of cardiac rehabilitation (CR) on the patients of diabetic cardiovascular disease with sarcopenic obesity has not been well known. The aim of this study was to examined the change of body compositions and of lower-limb muscle strength between diabetic (DM) and nondiabetic (Non-DM) cardiovascular disease patients during CR.

Methods: A total of 82 male patients were assigned to the study who discharged from the acute-phase treatments for ischemic heart disease (IHD) or heart failure (HF) (DM group; n=33, Non-DM group; n=49). The body compositions and the lower-limb muscle strength were evaluated before and after CR twice a week for 5 months and analyzed retrospectively.

Results and Conclusions: The DM group before performing the CR showed significant increase in body fat and decrease in lower-limb muscle strength, compared with the non-DM group (p<0.05). The effects of increasing lower-limb muscle strength after CR were observed in both DM and non-DM groups (n,c). Moreover, HF patients had weaker lower-limb muscle strength before CR than IHD patients (p<0.05) and it was even weaker among the DM. However, after CR, the increasing effects of lower-limb muscle tended to be stronger in the DM group. These data showed that the patients with diabetic cardiovascular disease with sarcopenic obesity have a chance to have increase of the lower-limb muscle strength after CR as well as that of nondiabetic cardiovascular disease. A lower-limb muscle might be a new scale and a therapeutic target in patients with cardiovascular disease.

Disclosure

Y. Kayama: None.
6-LB: GPR119 Agonist PRM A Increases Glucagon Response to Hypoglycemia in Rats
Authors: KWOK DAVID W.K. , ALEXANDER DIANE , BEELEY NIGEL R.A. , KELLEY DAVID
Published: June 2023

Glucagon (Gcg) is crucial in the counter-regulatory response (CRR) to hypoglycemia yet this is severely impaired in T1D. This pathophysiology was recognized 50 years ago, but only recently have drug targets emerged to amplify Gcg CRR in T1D. One promising target is the receptor GPR119, expressed in gut endocrine cells and pancreatic islets with highest expression on α-cells, 10-fold greater than on β-cells. In the current study, a GPR119 agonist (PRM A) was given by oral gavage at doses of 3, 10 and 30 mg per kg (mpk), to rats (Sprague-Dawley, groups of 8) two hours prior to induction of hypoglycemia by an insulin tolerance test (ITT), using a dose of 1.25 Units per kg, given by intra-peritoneal injection at t=0 min. A vehicle-treated (V) control and a positive comparator group, given the GPR119 agonist MBX-2982 (10 mpk) were also studied. MBX-2982 is currently being used in a clinical trial to assess its effect on Gcg CRR in volunteers with T1D challenged with a hypoglycemic clamp. In rats in the current study, severe hypoglycemia was induced during the ITT; blood glucose nadir was achieved by 60 min in association with peak insulin ≥ 100 µU/ml. Glucose and insulin were similar across groups. The healthy V rats mounted a normal Gcg CRR, with a peak value of 26±10 pM, 5-fold above baseline. Pre-treatment with PRM A significantly amplified Gcg CRR relative to V (to 86±17, 79±18, and 85±12 pM; at 3, 10, and 30 mpk; p<0.0001 vs V). The Gcg AUC during the ITT was nearly 50% greater with all doses of PRM A (p<0.05 vs V) and the peak Gcg CRR was shifted earlier (p<0.01 vs V). MBX-2982 pre-treated rats, relative to V, trended to a higher peak (49±14 vs 26±10 pM) and AUC Gcg (7292±2039 vs 6855±1306 pM*h), but neither difference was significant, whereas the differences for PRM A were strongly significant for time and treatment.

In summary, PRM A, a potent GPR119 agonist, tripled peak Gcg CRR during an ITT in healthy rats, affirming that the target of GPR119 holds promise as a novel means to mitigate the dangerous risk of hypoglycemia for individuals with T1D.

Disclosure

D. W. K. Kwok: None. D. Alexander: None. N. R. A. Beeley: None. D. Kelley: Consultant; Pramana Pharmaceuticals, Inc, Kallyope.

Funding

Pramana Pharmaceuticals Inc.
60-OR: A Pilot Study Evaluating an Insulin and Pramlintide Fully Closed-Loop Delivery System
Authors: ODABASSIAN MADISON , TSOUKAS MICHAEL , COHEN ELISA , PASQUA MELISSA-ROSINA , RUTKOWSKI JOANNA , HAIDAR AHMAD
Published: June 2023

We conducted a randomized, controlled, pilot study to eliminate carbohydrate counting (CC) in adults with type 1 diabetes using an automated insulin (insulin aspart and faster aspart) and pramlintide dual-pump fully closed-loop delivery system. The interventions included 5 arms (n = 11, 8 F, A1C 7.4%) and participants underwent 14 hours of outpatient, free-living, supervised interventions of (i) faster aspart with CC, (ii) faster aspart and pramlintide at a 1u:8µg ratio without CC, and (iii) faster aspart and pramlintide (1:10) without CC (iv) insulin aspart and pramlintide (1:8) without CC, and (v) insulin aspart and pramlintide (1:10) without CC. One participant opted out of the two insulin aspart and pramlintide arms. Prior to each dual-hormone intervention, participants had a 2-4-day drug dose-escalation period. P-values are not reported as this is an underpowered pilot study. During the faster aspart and pramlintide interventions, the mean time in target range (70-180 mg/dL) was 69% (24%) and 77% (13%) with the 1:8 and 1:10 ratios, respectively. During the aspart and pramlintide interventions, the time in range was 71% (15%) and 77% (11%) with the 1:8 and 1:10 ratios, respectively. Compared to the control arm where time in range was 72% (26%), both the insulin aspart and faster aspart arms with the 1:10 ratio provided numerical improvements to time in range. The median time spent below 54mg/dL with each respective ratio was 1.3% (0, 4.5), 0.6% (0, 2.4) on the aspart arms and 0.0% in the faster aspart and control arms. The mean total insulin used throughout the interventions was 38.2 (23.5) units on the control arm, 31.8 (18.4) and 32.5 (17.5) on the faster aspart 1:8 and 1:10 respectively, and 36.6 (26.9) and 32.2 (23.5) on the insulin aspart 1:8 and 1:10 arms respectively. This pilot study suggests that our fully automated dual-hormone delivery system has the potential to alleviate carbohydrate counting without degrading time in the target range; and it will be investigated in a larger subsequent study.

Disclosure

M.Odabassian: None. M.Tsoukas: Speaker's Bureau; Novo Nordisk Canada Inc., Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Janssen Scientific Affairs, LLC, AstraZeneca, Sanofi. E.Cohen: None. M.Pasqua: None. J.Rutkowski: None. A.Haidar: Consultant; Eli Lilly and Company, Other Relationship; Bigfoot Biomedical, Inc., Research Support; Adocia, Dexcom, Inc., Tandem Diabetes Care, Inc.
600-P: Higher Hydration Status Is Indicative of Better Glucose Tolerance
Authors: APAFLO JEHU , LABADAH JOSHUA , NARVAEZ GABRIEL , ROCHA VICTORIA M. , MOSSAYEBI ALI , BAJPEYI SUDIP
Published: June 2023

Introduction: Water intake is an important dietary behavior to replace high-caloric beverages and to enhance metabolic health. Type 2 diabetes is a metabolic disorder that has been shown to be more prevalent in Hispanics, a population shown to consume relatively less water compared to non-Hispanic Whites. The underlying cause of type 2 diabetes is insulin resistance, characterized by hyperglycemia and impaired glycemic control. However, whether a relationship exists between dehydration and the development of diabetes remains to be elucidated.

Purpose: To evaluate if hydration status indicates glucose tolerance among a dominant Mexican American population.

Methods: Sixty-one participants without diabetes (Age: 26.5 ± 9.1 years; BMI: 27.5 ± 6.0 kg/m2) participated in the study. Fasting blood glucose level was determined, and a 2-hour glucose tolerance test was performed following the ingestion of a 75g glucose drink. Blood glucose concentration levels were determined at 15−, 30−, 60−, 90−, and 120-minute time intervals post ingestion and glucose area under the curve was analyzed as well. Blood works were performed to determine blood urea nitrogen (BUN) and creatinine concentrations. Hydration status was estimated using the ratio of BUN to creatinine values.

Results: Hydration status measured by BUN/Creatinine was positively associated with glucose intolerance measured at 15−, 30−, 60−, and 90-minute post glucose load and by glucose area under the curve (r=0.33; r=0.43; r=0.37; r=0.27; and r=0.41 respectively; p<0.05).

Conclusion: Adequate fluid consumption should be encouraged for glycemic control, especially among people with high diabetes risks.

Disclosure

J.Apaflo: None. J.Labadah: None. G.Narvaez: None. V.M.Rocha: None. A.Mossayebi: None. S.Bajpeyi: None.
601-P: Heterogeneity in Postprandial Glucose Response to Specific Carbohydrates and Mitigation with Premeal Fat, Fiber, or Protein
Authors: METWALLY AHMED A. , PERELMAN DALIA , EHLERT BENJAMIN W. , WU YUE , CELLI ALESSANDRA , BEJIKIAN CAROLINE , PARK HEYJUN , MCLAUGHLIN TRACEY , SNYDER MICHAEL
Published: June 2023

Glycemic responses to foods are determined by total carbohydrates, glycemic index, and addition of fat, fiber, and protein. Interindividual variability in these responses are not well characterized. We propose that postprandial glucose response (PPGR) exhibits variability between individuals with regard to 1) “worst” or most glucose elevating food; 2) degree of mitigation by fat, fiber, or protein. Forty participants, healthy or with prediabetes, were given a repeated series of 7 standardized food challenges with the same amount of carbohydrates but varying in source (rice, bread, potatoes, pasta, berries, grapes, and beans) while wearing a CGM. We summarized PPGR and constructed a typical response to each food challenge. Rice exhibited the highest peak value and potatoes had the longest return to baseline time. However, cluster analysis revealed heterogeneity in PPGR indicating that the “worst” food differed between individuals. Participants were then pretreated with potential mitigators (fat, protein, or fiber) before a standardized food challenge. Cluster analysis revealed heterogeneity of mitigator effect between individuals and foods, and within individuals. Results indicate that diets can be individualized with regard to both carbohydrate choice and addition of fat, protein, or fiber to optimize metabolic health.

Disclosure

A.A.Metwally: Employee; Google LLC, Stock/Shareholder; Google LLC. D.Perelman: Advisory Panel; January, Inc. B.W.Ehlert: None. Y.Wu: None. A.Celli: None. C.Bejikian: None. H.Park: None. T.Mclaughlin: Board Member; January, Inc., Research Support; Merck & Co., Inc., Stock/Shareholder; Eiger Bio. M.Snyder: Advisory Panel; Genapsys, Jupiter, Neuvivo, Swaza, Mitrix, Other Relationship; Personalis, QBio, January, Inc., Fodsel, Filtricine, Protos, RTHM, Iollo, Marble Therapeutics, Mirvie, SensOmics.

Funding

Stanford Precision Health and Integrated Diagnostics Center (5R01DK110186)