bluuebunny/crossref_metadata_2025 huggingface dataset:
1309-P: Diagnosing Glucose Intolerance in Patients Attending ER in an Acute Hospital in England
Authors: JUDE EDWARD B. , HEALD ADRIAN H. , ANDERSON SIMON G.
Published: June 2024

Introduction and Objective: Type 2 diabetes (T2D) and pre-diabetes (pre-D) are associated with greater risk of cardiovascular disease and mortality. Therefore, early diagnosis of glucose intolerance is important. Patients attending hospital can be screened for diabetes to identify those who will benefit from early treatment and future risk reduction. The aim of this study was to screen people attending Emergency Room (ER), not known to have T2D.

Methods: 3425 individuals (1935 women) were screened for pre-D and T2D using HbA1c at presentation. Demographics, including ethnicity, were also recorded and the Finnish Diabetes Risk Score (FINDRISC) was calculated. Glucose intolerance was defined according to ADA criteria (pre-D: HbA1c 39-47 and T2D: ≥48mmol/mol).

Results: Normal glucose tolerance (NGT) was seen in 1967 people (58.5%), pre-D in 1190 (30.2%) and T2D in 263 (7.8%). Mean (SE) age was: NGT 50.3 (0.32), pre-D 57.4 (0.41) and T2D 57.4 (0.87) years, respectively (P<0.0001). Mean HbA1c: NGT 34.1 (0.1), pre-D 41.5 (0.1), T2D 57.6 (0.3) mmol/mol, respectively (p<0.001). Mean weight and BMI was: NGT 80.5 (0.5), pre-D 82.3 (0.6) and T2D 90.2 (1.6) kg, respectively (p<0.0001) and 28.4 (0.2), 29.2 (0.2) and 31.6 (0.4), respectively (p=0.0001). In a multinomial univariable logistic regression model for each unit increase in FINDRISC score the RRR (95% CI) for pre-D was 1.09 (1.06, 1.11) and for T2D 1.16 (1.11, 1.21). On adjusting for age and sex the RRR was 1.09 (1.08, 1.11) and 1.16 (1.13, 1.20) for pre-D and T2D, respectively (p<0.001). FINDRISC of >20 increased risk for pre-D and T2D 14.2 and 15.4-fold, respectively. South Asians had higher rates of glucose intolerance compared to Caucasians (32.9% vs 22.1%).

Conclusion: Patients attending ER have a high incidence of unknown glucose intolerance. The FINDRSC score may be used to identify those at risk. Use of HbA1c in ER is a practical and effective way of identifying previously unknown pre-D and T2D, leading to prompt implementation of targeted treatment.

Disclosure

E.B. Jude: Speaker's Bureau; AstraZeneca. Research Support; Novo Nordisk. Speaker's Bureau; Lilly Diabetes. Research Support; Abbott. Speaker's Bureau; Sanofi. A.H. Heald: None. S.G. Anderson: None.
1315-P: Pre– and Post–Liver Transplant Diabetes (DM) and Prediabetes (PD), and the Impact on Transplant Outcomes—Results of a Large Single-Center Study
Authors: SCOPELLITI MILENA , VAN STRIJDONCK CATO , GEZICI GIZEM , CARRAI PAOLA , PETRUCCELLI STEFANIA , CATALANO GABRIELE , MARTINELLI CATERINA , BRONZONI JESSICA , PEZZATI DANIELE , TINCANI GIOVANNI , BALZANO EMANUELE , FEMIA FRANCESCA R. , DEL TESTA ROBERTA , PELLUNGRINI ROBERTO , PEDRESCHI DINO , GIANNOTTI FOSCA , MARCHETTI PIERO , GHINOLFI DAVIDE , DE SIMONE PAOLO , MARSELLI LORELLA
Published: June 2024

Introduction & Objective: Discussion is still ongoing on the prevalence and characteristics of DM and PD (IFG and/or IGT) in patients before (pre-Tx) and after (post-Tx) liver transplantation (LT), and the impact on post-Tx outcomes.

Methods: In this single center study we evaluated 1,468 patients [(age: 56±9 yrs; M/F: 1107/361; BMI: 24.4±5.8 Kg/m²; family history of diabetes (FHD): 37%; FPG: 109±36 mg/dl; HbA1c: 35±12 mmol/mol); main indications for LT: 57.7% HCV/HBV-related cirrhosis/HCC, and 27.5% dysmetabolic/esotoxic cirrhosis/HCC)] being waitlisted for LT from brain dead donors.

Results: Based on pre-Tx history, FPG, HbA1c and/or OGTT, 32.5% patients had DM and 21.4% PD, with the remaining 46.1% being normoglycemic (NG). DM and PD patients were older and predominantly males (both p<0.001). Furthermore, DM subjects had higher BMI and FHD than PD and NG (both p<0.050). From this cohort, 1,086 subjects underwent LT, 470 of which reaching a 5-year follow-up. In these latter, patient and graft survival was respectively 84.5% and 84.1%, and the prevalence of DM and PD increased respectively to 49% (p<0.001) and 29% (p=0.053) vs Pre-Tx. To identify pre-Tx factors in NG associated with post-Tx DM, machine learning algorithms (both interpretable and explainable) were used (i.e. decision trees, explainable boosting machines and CatBoost) to assess multivariate correlations. Inspection of the models indicated that pre-Tx FPG, BMI, smoking and eGFR were some of the main factors correlated with post-Tx DM. In addition, duration of pre-Tx DM (p=0.051) and HbA1c (p=0.094) tended to impact on patient survival and/or graft outcome.

Conclusion: This accurate assessment of glycemic status of subjects waitlisted for LT implements previous available data and demonstrates a very high prevalence of DM and PD (> 50%); it also identifies modifiable factors to possibly prevent post-Tx DM; duration of pre-Tx DM and its control could affect post-Tx outcomes.

Disclosure

M. Scopelliti: None. C. Van Strijdonck: None. G. Gezici: None. P. Carrai: None. S. Petruccelli: None. G. Catalano: None. C. Martinelli: None. J. Bronzoni: None. D. Pezzati: None. G. Tincani: None. E. Balzano: None. F.R. Femia: None. R. Del Testa: None. R. Pellungrini: None. D. Pedreschi: None. F. Giannotti: None. P. Marchetti: Speaker's Bureau; Eli Lilly and Company, Novo Nordisk. D. Ghinolfi: None. P. De Simone: None. L. Marselli: None.

Funding

PNRR Project - M4C2-I1.3 PE_00000019 HEAL ITALIA
1316-P: Integration of HCV Screening and Treatment in Patients with Diabetes Mellitus—A Multicenter, Prospective, Quality Improvement Program in Taiwan
Authors: OU HORNG-YIH , LIU CHUN-JEN , WANG CHIH-YUAN
Published: June 2024

Objective: Patients with diabetes exhibit a higher incidence of Hepatitis C virus (HCV) infection, making them a crucial population for targeted HCV screening and micro-elimination. In light of the first published interdisciplinary consensus on managing/screening HCV in diabetic patients, this study aims to evaluate the results and identify effective strategies for incorporating HCV screening and treatment into an existing diabetes care model managed by case managers.

Methods: This is a multicenter prospective program initiated by a diabetes society. Eighteen centers in Taiwan developed strategies to enhance HCV screening and streamline linkage to HCV care in diabetic patients. The performance of each center was assessed based on the number of patients screened and treated with direct-acting antivirals (DAA), HCV micro-elimination achievement, and strategies novelty. The strategies of the top five centers were compared with others to identify key drivers for enhanced HCV screening and care.

Results: Over a median time of 6.1 months, 28,436 patients were screened, and 1,379 (5%) were anti-HCV positive. A total of 333 (22%) patients were positive for HCV RNA, among whom 288 (86%) received DAA. Overall, 27 strategies were adopted, with the following being the most effective: multidisciplinary alignment meetings, incorporating HCV screening into the hospital’s key performance index, nondiabetes/gastroenterology physician participation, physician-assisted screening, automated HCV test slip printing, an alert system for positive anti-HCV result, and fast track to specialist appointments.

Conclusions: This program pioneered the evaluation of the integration of HCV screening and treatment in diabetic patients, providing strategic insights into HCV micro-elimination through efficient patient identification and collaborative HCV management.

Disclosure

H. Ou: Speaker's Bureau; Abbott, AstraZeneca, Boehringer-Ingelheim, Sanofi, Eli Lilly and Company, Takeda Pharmaceutical Company Limited. C. Liu: None. C. Wang: None.
1322-P: Combination of LiverSTAT (LST) and Fibroscan (LSM) Outperforms FIB-4 and LSM for MASLD Advanced Fibrosis (AF) F3F4
Authors: ALKHOURI NAIM , NADEEM RIDA , LEFF PHILLIP , MANTRY PARVEZ , QUIAMBAO RONALD , DUPUY JULIE , MUNTEANU MONA , DE LEDINGHEN VICTOR
Published: June 2024

Background: LiverSTAT (LST) is a new blood test for MASLD stratification.

Aims: To retrospectively compare the efficacy of two combinations in one-step approach with two combinations: LST&LSM versus FIB-4&LSM, for the identification of advanced fibrosis (F3F4) in a multicenter multiethnic meta-dataset of MASLD patients.

Methods: Retrospective data from 5 hepatology centers from MASLD patients that underwent liver biopsy (LB) along with LSM, FIB-4 and LST. Efficiency has been assessed using concordance rates, number needed to screen (NNS) on subject with LB F3F4.

Results: Data from 786 patients (22%US, 39%Asia, 39%EU) was analyzed [age 57.1years, female 54.5%, BMI 31.4, ALT 52U/L]. LB prevalence of F3F4 was 32.8%.In the overall cohort, LB confirmed F3F4 among concordant LST&LSM and FIB-4&LSM, respectively, in 107/142(75%) vs 54/64(84.4%) with a screening efficiency (NNS) of 1.8 vs 2.2; the combination LST&LSM correctly identified twice more F3F4 patients than FIB-4&LSM.In the subgroup with LB≥20mm, LB confirmed F3F4 among concordant LST&LSM and FIB-4&LSM in 43/50(86%) vs 30/33(90%), NNS 1.6 and 1.8, respectively; the combination LST&LSM correctly identified 43% more F3F4 patients than FIB-4&LSM.DFP rate was higher with FIB4-&LSM than with LST&LSM (11.3% vs. 7%).

Conclusion: The combination LST&LSM outperforms FIB-4&LSM for the identification of MASH advanced fibrosis F3F4.

Disclosure

N. Alkhouri: Advisory Panel; Madrigal Pharmaceuticals, Inc., 89bio, Inc. Speaker's Bureau; Alexion Pharmaceuticals, Inc., Gilead Sciences, Inc. Advisory Panel; Altimmune Inc. Consultant; Boehringer-Ingelheim. Advisory Panel; Novo Nordisk. R. Nadeem: None. P. Leff: None. P. Mantry: None. R. Quiambao: Other Relationship; Fibronostics US Inc. J. Dupuy: None. M. Munteanu: Employee; Fibronostics. V. De Ledinghen: Advisory Panel; Fibronostics.
1337-P: Improvement of Visual Acuity May Protect against Cognitive Decline and Cortical Atrophy in Long-Duration Type 1 Diabetes
Authors: SHAH HETAL , DESALVO MATTHEW , HAIDAR ANASTASIA , VISHVA TEJA JANGOLLA SURYA , GREGORY YU MARC , ROQUE REBECCA , ZIEMNIAK NOLAN A. , VIEBRANZ ELIZABETH R. , WU I-HSIEN , FICKWEILER WARD , CHOKSHI TANVI , BILLAH TASHRIF , NING LIPENG , ADAM ATIF , SUN JENNIFER K. , RATHI YOGESH , FEANY MEL B. , KING GEORGE L.
Published: June 2024

Cognitive decline is a grave complication in aging people with type 1 diabetes (T1D). We previously reported that compared to individuals without diabetes, those with long-duration T1D, the Joslin “Medalists” cohort, have impaired cognitive function, similar to people with type 2 diabetes (T2D). We further reported that Medalists (n=52), with T1D≥50 years, mean age of 71 years, mean HbA1c of 6.8 %, a good lipid profile and controlled hypertension, had significantly lower brain volumes compared to age-matched controls (n=20) on brain MRI (Alzheimer Disease Neuroimaging Initiative-3 protocol), but no significant differences in neurovascular lesions. In this study, we demonstrate that among Medalists, reduced total and regional brain volumes were cross-sectionally associated (p<0.05) with female sex, worse psychomotor function and visual acuity, longer diabetes duration and higher inflammatory cytokines, but not with glycemic control (HbA1c, continuous glucose monitoring indices, advanced glycation end-products) or history of hypoglycemia. Interestingly, worse cognitive function and lower brain volumes, in addition to diabetic retinopathy, correlated selectively with thinning of the outer retinal nuclear layer (ONL, composed of photoreceptors) as assessed by Optical Coherence Tomography. Mediation analysis showed that psychomotor function mediated 58 % of the association between visual acuity and brain volume, and 44 % of the association between ONL thickness and brain volume. In a longitudinal subset (n=48), where Medalists had 2 or more cognitive visits with an average follow-up time of 4.8 years between visits, worse baseline visual acuity was associated with decline in psychomotor function over 3-5 years of follow-up. These findings suggest that future studies should investigate a potentially novel therapeutic approach of targeting improvement in visual acuity to prevent cognitive decline in people with long-duration T1D.

Disclosure

H. Shah: None. M. Desalvo: None. A. Haidar: None. S. Jangolla: None. M. Yu: None. R. Roque: None. N.A. Ziemniak: None. E.R. Viebranz: None. I. Wu: None. W. Fickweiler: None. T. Chokshi: None. T. Billah: None. L. Ning: None. A. Adam: None. J.K. Sun: Research Support; Optovue, Boehringer-Ingelheim, Novo Nordisk, Roche Pharmaceuticals. Other Relationship; Roche Pharmaceuticals. Research Support; Physical Sciences, Inc, Boston Micromachines. Y. Rathi: None. M.B. Feany: None. G.L. King: None.

Funding

NIH/NIDDK (3P30DK036836-34S1); The Beatson Foundation
1358-P: Diabetes Control and Complications in East India—Three-Year Results of LANDMARC Trial
Authors: RAIS NADEEM , CHOWDHURY SUBHANKAR , KALRA SANJAY , MUKHARJEE SAGARIKA , CHAUDHURY TIRTHANKAR , DAS SAMBIT , SAHA DEBASIS , SHAH SANJAY K. , BHATTACHARYYA SUPRATIK , MENON SHALINI K. , GADEKAR ARVIND , CHODANKAR DEEPA
Published: June 2024

Glycemic control, therapy trends, and diabetes complications, were evaluated in LANDMARC, a prospective observational 3-year study (CTRI/2017/05/008452), of participants with T2D on ≥2 antihyperglycemic medications. This subgroup analysis of 52 sites from East India (Kolkata, Northeast) included 843 participants (mean [SD] baseline [BL] age: 53.1 [9.5] years, T2D duration: 8.7 [6.0] years and A1C: 7.9% [1.7]). At BL, most were insulin-naïve (n=647; 76.7%), mainly on OADs (n=644; 76.4%). At 3 years, 422 (57.5%) participants were on OADs only, while 295 (40.2%) were on insulin + OADs. Biguanides was the most prescribed drug class (BL: 793 [94.1%] and 3-years: 681 [92.8%]). Basal insulin usage increased from BL (n=99; 11.7%) to 3 years (n=213; 29.0%). The mean (SD) A1C, FPG, and PPG decreased by 1.0 (1.6) %, 23.4 (52.9) mg/dL, and 39.2 (82.6) mg/dL, respectively. East India had the highest proportion (53.1%; n=303) of participants with A1C<7% at 3 years. CV death and neuropathy were most common macro and microvascular complications, respectively (Table). Hypertension and dyslipidemia were the most common CV risk factors. An understanding of regional trends in glycemia, therapy, and complications may help strategize future diabetes management practices in India.

Disclosure

N. Rais: None. S. Chowdhury: None. S. Kalra: Speaker's Bureau; Abbott, Bayer Inc., Novo Nordisk, Sanofi. S. Mukharjee: None. T. Chaudhury: None. S. Das: None. D. Saha: None. S.K. Shah: None. S. Bhattacharyya: None. S.K. Menon: Employee; Sanofi. A. Gadekar: None. D. Chodankar: Employee; Sanofi.

Funding

Sanofi
1359-P: Diabetes Control and Complications in North India—Three-Year Results of LANDMARC Trial
Authors: MITHAL AMBRISH , KUMAR WANGNOO SUBHASH , ZARGAR ABDUL H. , CHAWLA RAJEEV , GUPTA MUKULESH , MITTAL VINOD , KHANDELWAL DEEPAK , JULKA SANDEEP , JINDAL SUSHIL , LODHA SAILESH , BANZAL SUBODH S. , MENON SHALINI K. , GADEKAR ARVIND , CHODANKAR DEEPA
Published: June 2024

Glycemic control, therapy trends, and diabetes complications were evaluated in LANDMARC, a prospective observational 3-year study (CTRI/2017/05/008452), having participants with T2D on ≥2 antihyperglycemic medications. This subgroup analysis of 114 sites in North India (Delhi, Jaipur, Lucknow) included 1686 participants (mean [SD] baseline [BL] age: 51.7 [8.8] years, T2D duration: 8.7 [5.5] years and A1C: 8.1% [1.6]). At BL, most were insulin-naïve (n=1332; 79.0%), relying mainly on OADs (n=1324; 78.5%). At 3 years, 1028 (70.1%) participants were on OADs only, while 414 (28.2%) were on insulin + OADs. Biguanides was the most prescribed drug class (BL: 1558 [92.4%] and 3-years: 1313 [89.5%]). Basal insulin usage increased from BL (n=199; 11.8%) to 3 years (n=284; 19.4%). At 3 years, there was a decrease in the mean (SD) A1C by 0.8 (1.7) %, FPG by 17.0 (51.4) mg/dL, and PPG by 19.1 (79.0) mg/dL; and an increase in proportion of those with A1C<7% (BL: 257 [21.2%]; 3 years: 363 [38.6%]). Peripheral vascular disease and neuropathy were most common macrovascular and microvascular complications, respectively (Table). Hypertension and dyslipidemia were the most common CV risk factors reported at 3 years. The highest burden of hypertension was noted in North India. This pivotal understanding of regional trends in glycemia, therapy, and complications may help strategize future diabetes management practices in India.

Disclosure

A. Mithal: Other Relationship; Sanofi. S. Wangnoo: None. A.H. Zargar: None. R. Chawla: None. M. Gupta: None. V. Mittal: None. D. Khandelwal: None. S. Julka: Other Relationship; Sanofi, Eli Lilly and Company, Novo Nordisk, USV Private Limited. S. Jindal: None. S. Lodha: None. S.S. Banzal: None. S.K. Menon: Employee; Sanofi. A. Gadekar: None. D. Chodankar: Employee; Sanofi.

Funding

Sanofi
1364-P: Racial and Ethnic Disparities in COVID-19 Outcomes among Dialysis Patients with Diabetes
Authors: CONWAY REBECCA B. , QUANDELACY TALIA , HU MING , WANG YUEDONG , KOTANKO PETER
Published: June 2024

Hemodialysis patients w/ COVID-19 have fatality rates higher than the general population. Racial minorities in the U.S. bear a disproportionate burden of diabetes and dialysis and were the hardest hit by COVID-19. Whether the impacts of COVID-19 and its outcomes on those receiving dialysis vary by race are unknown. To determine racial differences in COVID-19 infection, hospitalization, and mortality in dialysis patients w/ diabetes, we followed 114,881 in-center hemodialysis patients w/diabetes (AIAN; Asian; Black/African American: AA; Hispanic; Native Hawaiian/Other Pacific Islander: NH; Non-Hispanic White: NHW) from January 2020 to March 2022 for risk of COVID-19 infection, hospitalization, and mortality. ORs and 95% CIs were calculated, adjusting for demographic characteristics, vaccination status, vintage, and lab data. During follow-up, the cumulative incidence of COVID-19 was 26%; 34% of the population was hospitalized and 12% died. Infection rates were highest in AIAN and lowest in Asian patients: AIAN: 30%; Hispanic: 26%; NH: 22.4%; AA: 21.5; NHW: 19.8; Asian: 15.3. Risk of infection was higher in Hispanic (OR=1.36, 1.22-1.52), but lower in Asian (OR=0.69, 95% CI=0.53-0.89) patients compared to NHWs. Though Asian patients had lower infection risks, they had marginally higher hospitalization risk (OR=1.45, 95% CI=0.94-2.26; p=0.09) compared to NHW. NH were at a marginally 45% lower risk of hospitalization (OR=0.55, 95% CI =0.28-1.01; p=0.07). AA (OR=0.66, 95% CI=0.53-0.83) and Hispanic infected patients (OR=0.64, 95% CI=0.48-0.84) were at lower risk of mortality compared to NHW. Despite lower COVID-19 infection risk, US Asian dialysis patients w/ diabetes are at increased hospitalization risk when infected, whereas AIAN patients though at increased infection risk are at lower risk of hospitalization. AA and Hispanic patients are at lower risk of death. Understanding reasons for these differences may provide clues to increasing survival for dialysis patients w/ diabetes.

Disclosure

R.B. Conway: None. T. Quandelacy: None. M. Hu: None. Y. Wang: None. P. Kotanko: Other Relationship; Fresenius Medical Care.
1366-P: Cardiovascular Complications (Myocardial Infarction, Stroke, and End-Stage Renal Disease) and Mortality in Youth-Onset Type 1 and Type 2 Diabetes Based on National Health Insurance Service (NHIS) Data
Authors: KIM SUNGEUN , HAN KYUNGDO , CHO WON-KYOUNG
Published: June 2024

Background: In South Korea, little is known regarding the mortality and the occurrence of related cardiovascular complications in youth-onset diabetes.

Methods: Based on Korean National Health Insurance Service-National Sample Cohort database from 2006 to 2020, data of patients with type 1 (T1DM) and type 2 diabetes (T2DM) who were aged ≤30 were collected. Mortality and incidence of cardiovascular complications (myocardial infarction [MI], stroke and end-stage renal disease [ESRD]) in T1DM and T2DM were compared to the general population of the cohort.

Results: The total population was 513,633. Patients with T1DM and T2DM were 413 and 1,250, respectively. After adjusting for sex, age and income, the odds ratios (ORs) of MI were 8.71 (95% confidence interval [CI], 3.25-23.31) for T1DM and 7.81 (95% CI, 4.38-13.94) for T2DM. The ORs of stroke were 5.95 (95% CI, 2.23-15.91) for T1DM and 4.72 (95% CI, 2.59-8.60) for T2DM. The ORs of ESRD were 144.05 (95% CI, 89.00-233.15) for T1DM and 28.20 (95% CI, 15.69-50.66) for T2DM. The mortality risks in patients with T1DM (5.16; 95% CI, 2.77-9.61) and T2DM (5.18; 95% CI, 3.65-7.36 for T2DM) were significantly higher than the control group. The morality risk for T2DM aged < 20 (14.00; 95% CI, 5.82-33.69) was predominantly higher than other subgroups in T1DM and T2DM.

Conclusion: In South Korea, patients with youth-onset diabetes had a high risk of cardiovascular complications, particularly more pronounced in patients with T1DM for ESRD. Both types of diabetes were associated with notably increased mortality risk compare to the general population.

Disclosure

S. Kim: None. K. Han: None. W. Cho: None.

Funding

Catholic Medical Center Research Foundation
1368-P: Early-Life Adversity, Indicated by Difference between Observed and Genetically Predicted Height, and Risks of Diabetes and 48 Related Diseases
Authors: ZHANG YANBO , LI YANG , XUE XIAONAN , WANG TAO , MOON JEE-YOUNG , ISASI CARMEN R. , ROHAN THOMAS , QI QIBIN
Published: June 2024

Introduction & Objective: Early-life adversity contributes significantly to global disease burden but lacks objective measures. Given height is determined by genetic and early environmental factors, we aimed to assess early-life conditions by the difference between observed and genetically predicted height (i.e., residual height) and to examine its associations with risks of diabetes and related diseases.

Methods: Among 407366 UK Biobank participants, we calculated genetically predicted height by fitting age- and sex-specific linear regression models regressing observed height on a polygenic score of 9863 height-related SNPs (Fig A). Outcomes were obtained via disease registry (median follow-up=12.5 years).

Results: Residual height was correlated with favorable early-life indicators (Fig B). Shorter residual height (comparing <-2 SD to ≥2 SD away from the mean) was associated with higher risks of diabetes (HR 1.19, 95% CI 1.00-1.41), CVD (1.26, 1.10-1.45), psychiatric/neurological, digestive, musculoskeletal, and other diseases (HR range 1.13-1.25), and mortality (1.38, 1.23-1.55). Among 49 individual diseases, shorter residual height was associated with higher risks for 27 diseases (Fig C).

Conclusion: Shorter residual height, a potential early-life adversity indicator, was associated with higher risks of diabetes and related diseases.

Disclosure

Y. Zhang: None. Y. Li: None. X. Xue: None. T. Wang: None. J. Moon: None. C.R. Isasi: None. T. Rohan: None. Q. Qi: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK119268, R01DK120870, and R01DK126698), National Heart, Lung, and Blood Institute (R01HL060712), and National Institute on Aging (1RF1AG077639).
1390-P: Access to Telehealth and Changes in Diabetes Care Patterns during the Pandemic
Authors: OVIEDO SOFIA A. , GANDER JENNIFER C. , MCDONALD BENNETT , ALI MOHAMMED K. , HARDING JESSICA L.
Published: June 2024

Objective: To investigate the impact of the COVID-19 pandemic on telehealth utilization and adherence to annual diabetes care guidelines and risk factor management among people with diabetes.

Research Design and Methods: We included all adults (≥18 years) with prevalent diabetes as of January 1, 2018, who were continuously enrolled at Kaiser Permanente Georgia (KPGA) through December 31, 2021 (n=22,854). We defined pre (2018-2019) and during COVID-19 (2020-2021) periods. Logistic generalized estimating equations (GEE) were used to assess the within-subject change in screening adherence (blood pressure (BP), HbA1c, cholesterol, creatinine, urine-albumin-creatinine ratio, eye and foot exam) pre and during COVID-19 among telehealth users (i.e., at least one telehealth visits per period) and non-telehealth users. Linear GEE similarly compared mean lab measurements pre vs. during COVID-19, stratified by telehealth use.

Results: The proportion of telehealth users increased from 38.7% to 91.5% pre vs. during COVID-19. During the pandemic, adherence to all annual screenings declined but the decline was significantly less in telehealth (range: 1.6% for foot exams to 12.4% for BP) vs. non telehealth users (range: 1.9% for foot exams to 40.7% for BP). Average HbA1c, BP, creatinine, and UACR worsened during (vs. pre) COVID-19, while LDL cholesterol improved, and this effect was greater in non-telehealth users.

Conclusion: The proportion of people with diabetes meeting guideline recommended screenings decreased during the pandemic, coinciding with worsening glucose, kidney, and (some) cardiovascular risk profiles, and was more severe for non-telehealth users. Follow-up is needed to assess the long-term implications and the role of telehealth use in addressing these care gaps.

Disclosure

S.A. Oviedo: None. J.C. Gander: None. B. McDonald: None. M.K. Ali: Advisory Panel; Eli Lilly and Company. J.L. Harding: None.

Funding

Supported by a Georgia Center for Diabetes Translation Research Pilot Award; National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (P30DK111024)
1391-P: Prevalence of Barriers to Preventive Care among U.S. Adults of Multiple Races Eligible for Type 2 Diabetes Screening
Authors: KOYAMA ALAIN , ONUFRAK STEPHEN J. , XU FANG , BULLARD KAI M. , SAELEE RYAN , MIYAMOTO YOSHIHISA , PAPALII MICHELLE , PAVKOV MEDA E.
Published: June 2024

Introduction: While much research exists on racial and ethnic disparities in access to preventive care, less is known in persons of multiple races. We described prevalence of barriers to preventive care in US adults, by subgroups of multiple races.

Methods: Using the Behavioral Risk Factor Surveillance System (2013-2022), we conducted a pooled cross-sectional study of 3,301,491 US adults (≥18 years) eligible for type 2 diabetes screening. Among adults reporting a single race or ethnicity and subgroups of multiple races, we estimated the prevalence of: being uninsured, not having a primary care doctor, healthcare cost concerns in the past 12 months, and no physical exam in the past 12 months.

Results: Prevalence of preventive care barriers were heterogenous among all groups. For most subgroups of multiple races, prevalence was within that of the component single race groups. Healthcare cost concerns were more prevalent in adults self-identified as both American Indian/Alaska Native and White than those who reported either racial group alone, while adults self-identified as both Asian and Pacific Islander showed the opposite pattern.

Conclusions: Heterogeneity in the prevalence of barriers to preventive care among subgroups of multiple races highlights the possible need to properly identify these subgroups and for culturally sensitive approaches for type 2 diabetes prevention.

Disclosure

A. Koyama: None. S.J. Onufrak: None. F. Xu: None. K.M. Bullard: None. R. Saelee: None. Y. Miyamoto: None. M. Papalii: None. M.E. Pavkov: None.
141-OR: Cardioprotective Effect of Empagliflozin and Modification of Sirtuins and Their Noncoding RNAs Regulators in Patients with Myocardial Infarction
Authors: NOWAK ANNA , WICIK ZOFIA , EYILETEN CEREN , AHMADOVA SARA , SILLER-MATULA JOLANTA , VON LEWINSKI DIRK , SOURIJ HARALD , POSTULA MAREK
Published: June 2024

Introduction: Studies have demonstrated direct cardio-protective effect of SGLT2 inhibitors, but the mechanism of action is unclear. We hypothesize that cardioprotective effects of SGLT2 inhibitors are due to increased expressions of Sirtuins and their regulator-miRNAs.

Method: We conducted in silico prediction analysis using a computational approach. We identified/ranked the most promising ncRNAs associated with sirtuin pathways and SGLT2. We identified top miRNAs by preparing a gene list of all SIRT genes, 1st and 2nd level SGLT2 interactors, and genes involved in inflammation, fibrosis, oxidative stress, hypoxia-ischemia, MI and HF based on DisGeNet database. We validated our findings through qRT-PCR using selected plasma samples (empagliflozin/placebo=24/24; baseline, 26-weeks after treatment) collected from the double-blinded EMMY clinical trial (NCT03087773).

Results: Our in silico analysis identified six miRNAs; miR-34a-5p, miR-27a-3p, miR-302a-3p, miR-146a-5p, miR-182-5p and miR-124-3p, which target the highest number of SIRT1-7 genes, SGLT2 and first-level SGLT2 interactors. qRT-PCR analysis showed that after 26 weeks of treatment, patients taking empagliflozin had significantly higher expression of miR-214 (p=0,015), miR-34a (p<0,001), miR-146a (p<0,001), miR-182-5p (p<0,001) and SIRT2 (p=0,005) compared to baseline. We also found that patients taking empagliflozin had significantly higher expression of SIRT6 (p=0,036), and significantly lower expression of miR-214 (p=0,007) and miR-302a-3p (p=0,042) compared to placebo.

Conclusion: Our in silico analysis for the first time predicted the interaction network between ncRNAs and HF-related genes in the context of the SGLT2-sirtuin axis. We showed based on our prediction, empagliflozin, an SGLT2 inhibitor, can demonstrate cardioprotective effects via SIRT2 and SIRT6 and their ncRNA regulators axis.

Disclosure

A. Nowak: None. Z. Wicik: None. C. Eyileten: None. S. Ahmadova: None. J. Siller-Matula: None. D. von Lewinski: Speaker's Bureau; AstraZeneca. Research Support; Novo Nordisk. H. Sourij: Advisory Panel; Amarin Corporation. Speaker's Bureau; Amgen Inc., Amarin Corporation, Bayer Inc. Advisory Panel; Boehringer-Ingelheim. Speaker's Bureau; Boehringer-Ingelheim. Research Support; Boehringer-Ingelheim. Advisory Panel; Eli Lilly and Company. Research Support; Eli Lilly and Company. Speaker's Bureau; Eli Lilly and Company. Advisory Panel; Novartis AG. Speaker's Bureau; Novartis AG. Advisory Panel; Novo Nordisk. Research Support; Novo Nordisk. Speaker's Bureau; Novo Nordisk. Research Support; Sanofi. Speaker's Bureau; Sanofi. Consultant; K:Businesscom. M. Postula: None.

Funding

Polish National Scientific Centre (2022/45/N/NZ7/02461); Polish Medical Research Agency (2019/ABM/01/00037)
1413-P: Youth-Onset Diabetes—Who Is Missed by EHR-Based Surveillance
Authors: BELLATORRE ANNA , BURGETT SHAWNA , ANDERSON THERESA , CONWAY REBECCA B. , SHIFERAW BETHELHEM A. , DABELEA DANA , CRUME TESSA L.
Published: June 2024

Background: Efficient population-level surveillance of youth-onset diabetes is essential for public health planning. Early surveillance approaches predated the use of electronic health records (EHR) and required manual chart reviews of all potential cases. Approaches utilizing EHR data present the potential for significant gains in cost efficiency, but the degree of precision remains unclear.

Objective: Identify characteristics of diabetes patients <20 years in Colorado who were missed or misclassified by an EHR algorithm compared with patients identified by a traditional approach including manual chart review.

Methods: We compared incident diabetes patients diagnosed in 2014-2018 in Colorado by SEARCH for Diabetes in Youth and ascertained using manual chart review to determine diabetes status, type, and date of diagnosis to those identified by date of first diabetes diagnosis per EHR data extracts. Both approaches used similar and multiple case sources (networks of providers and hospitals) designed to cover all of Colorado.

Results: SEARCH ascertained 2206 patients with incident diabetes in 2014-2018. The EHR-based algorithm correctly identified incident diabetes status for 81% with 8.7% not identified as a diabetes case, and 10.3% assigned the wrong incident year. Patients missed or misclassified by the algorithm were more likely to have type 2 diabetes (36.1% incorrect or missing) or other diabetes types (36.4% incorrect or missing), to identify as Hispanic of any race (24.0% incorrect or missing) or other race (45.5% incorrect or missing) or were first identified by SEARCH at sources that did not use EHRs (75.8% incorrect or missing).

Conclusion: Algorithmic misclassification from EHR system data using date of first diagnosis may be more profound for minority race/ethnic groups and those without type 1 diabetes. Improved understanding of who is missed or misclassified by such approaches may assist with bias correction efforts to provide valid, generalizable estimates of the diagnosed diabetes population.

Disclosure

A. Bellatorre: None. S. Burgett: None. T. Anderson: None. R.B. Conway: None. B.A. Shiferaw: None. D. Dabelea: None. T.L. Crume: None.

Funding

Centers for Disease Control and Prevention and National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (U18DP006139)
1416-P: Unveiling the Risk Factor Landscape for Global Type 2 Diabetes Burden in Adults—An Attribution Analysis from 1990 to 2050
Authors: HUANG YUE , WANG JINGXUAN , ZHONG VICTOR W.
Published: June 2024

Introduction & Objective: The lack of assessing risk factor contributions to the rising burden of type 2 diabetes (T2D) across various subpopulations hinders targeted interventions. We conducted a subgroup-focused analysis to evaluate the contributions of different risk factors to the T2D burden.

Methods: Utilizing the Global Burden of Disease study (GBD) 2019, we analyzed the disability-adjusted life-years (DALYs) for T2D due to 15 risk factors in adults (aged 25+ years) globally and by sex, age, Socio-demographic Index (SDI) and GBD region, from 1990 to 2019. Additionally, we assessed future trends of these risk factors through 2050.

Results: High BMI emerged as the top one risk factor in all subpopulations, accounting for over 60% of T2D-related DALYs in 2019, and the DALYs rates due to high BMI were projected to double by 2050. In 2019, males were more affected by smoking and diet high in red meat, while females by secondhand smoke and household air pollution. The related DALYs burden due to specific risk factors escalated with age, except for high BMI and smoking which peaked in the 60-74 age group. Notable regional disparities were observed, with diet high in processed meat ranking second in high SDI regions, instead of household air pollution in low SDI regions (Figure 1).

Conclusion: Targeted actions are required to address the varying risk factors for the T2D burden across subpopulations.

Disclosure

Y. Huang: None. J. Wang: None. V.W. Zhong: None.

Funding

National Natural Science Foundation of China (82373551)
1419-P: The Effect of Remnant Cholesterol on Pathophysiology of Metabolic Dysfunction–Associated Steatotic Liver
Authors: MIYAKE TERUKI , FURUKAWA SHINYA , MATSUURA BUNZO , YOSHIDA OSAMU , KANAMOTO AYUMI , MIYAZAKI MASUMI , SHIOMI AKIHITO , NAKAGUCHI HIRONOBU , HIROOKA MASASHI , ABE MASANORI , HIASA YOICHI
Published: June 2024

Insulin resistance is associated with the inactivation of lipoprotein lipase and elevated levels of remnant lipoproteins, including remnant cholesterol (Rem-C). On the other hand, insulin resistance is the risk factor for progression of MASLD, and might induces cirrhosis, hepatocellular caricinoma, and liver-related death. Additionally, DM, high Rem-C level, and MASLD are risk factors for cardiovascular disease (CVD), and these three pathologies may be closely related. However, the correlation between REM-C levels and the pathophysiology of MASLD remains unclear. The present study aimed to elucidate the relationship between serum REM-C levels and the histological finding of MAFLD. We assessed 222 patients (94 men and 128 women; age 20-80 years) who were diagnosed with NAFLD by liver biopsy with available medical history, physical examination, and biochemical measurement data. Serum ester-type cholesterol and free cholesterol contents in the remnant lipoproteins were measured using an enzymatic method. The relationship between serum Rem-C levels and histological findings was analyzed. Serum Rem-C levels were significantly higher in patients with NAFLD activity score (NAS) 5-8,>66% steatosis grade, lobular inflammation with ≥ 5 foci, and many cells/prominent ballooning cells than in patients with NAS 1-4, < 33% steatosis grade, lobular inflammation with < 2 foci, and few ballooning cells. While univariate analysis revealed no significant association between Rem-C levels and advanced fibrosis, a significant association between Rem-C levels and NAS was evident. The relationship remained significant in multivariate analysis adjusted for confounders.

In conclusion, high serum Rem-C levels were associated with high NAS but not with fibrosis stage. Controlling serum Rem-C level may help alleviate NAFLD.

Disclosure

T. Miyake: None. S. Furukawa: Speaker's Bureau; Lilly Diabetes, Novo Nordisk, Mitsubishi Tanabe Pharma Corporation. B. Matsuura: None. O. Yoshida: None. A. Kanamoto: None. M. Miyazaki: None. A. Shiomi: None. H. Nakaguchi: None. M. Hirooka: None. M. Abe: None. Y. Hiasa: None.
1421-P: Neighborhood Vulnerability and Diabetes Prevention Program Referrals in a Bronx Health System
Authors: DIAZ KATELYN , STEPHENSON-HUNTER CARA , CHAMBERS EARLE
Published: June 2024

Research on the determinants of Diabetes Prevention Programs (DPP) referral typically focuses on individual-level factors like patient and provider characteristics, neglecting neighborhood context. We aim to examine neighborhood environment vulnerability as a factor influencing likelihood of referral to a health system DPP in the Bronx, NY.

NEVI is a neighborhood vulnerability index based on composite measures reflecting 4 primary neighborhood-level domains (demographic, economic, residential, and health status) measured at the census tract-level. High and low NEVI was determined by a median split (median=0.48; range: 0.19-0.58). This study used an observational cross-sectional design and recorded patient demographic, anthropometric, and DPP referral data from the electronic health records. Eligibility was based on hemoglobin A1c (HbA1c) between 5.7-6.4 and body mass index (BMI) ≥25 (​​kg/m2), a NYC residential address, and seen for a PCP visit between January 2018 and February 2020. The association between NEVI and DPP referral was examined using logistic regression, adjusted for age, sex, insurance type, preferred language, HbA1c (mg/dL), and BMI.

Of 9,319 eligible patients, 66% were female, 78% were Hispanic or non-Hispanic Black, and the mean age was 53 years (SD: 13.9 years). Of referred patients, approximately 18% (n=851) have a higher NEVI while 12% (n=542) have a lower NEVI (p=2.2e-16). In the adjusted analysis, higher odds of referral were observed for patients residing in high NEVI neighborhoods than low NEVI neighborhoods (OR=1.50, 95% CI, 1.28-1.65).

We show a 50% higher likelihood of DPP referral among patients who reside in a high-vulnerability neighborhood. The reasons contributing referrals to DPP are likely multifactoral, including individual patient characteristics and PCP characteristics (e.g. knowledge & discretion). Our study highlights the importance of neighborhood-level context as a potential factor influencing PCP referrals to DPP.

Disclosure

K. Diaz: None. C. Stephenson-Hunter: None. E. Chambers: None.

Funding

National Institutes of Health (DK121896-04S1)
1425-P: Determinants of Cost-Related Medication Nonadherence in Adults with Diabetes in the United States, 2015 to 2018
Authors: WU CHIEH-CHEN , WENG YUNG-CHING , ISLAM MOHAIMENUL
Published: June 2024

Introduction & Objectives: Cost-related medication nonadherence (CRN) can lead to serious consequences including diabetic complications and increased mortality. The aim of this study was to identify the factors influencing CRN among diabetic patients and assess their relative contributions in explaining the occurrence of CRN.

Methods: This study leveraged four years of nationally representative data in the United States with diabetes from the 2015 - 2018 National Health Interview Survey (NHIS). Adult participants (≥18 years) with skipped doses to save money, took less medication to save money, or delayed filling a prescription to save money were considered to have experienced CRN. Logistic regression was applied to identify factors independently associated with CRN.

Results: Of the 12990 adult individuals with diabetes, 9.96% (weighted 4.4 million) of those adults reported CRN. Lack of insurance (OR: 4.32, 95%CI:3.16 - 5.92), education (OR: 1.38, 95%CI: 1.03 - 1.84), current smoking (OR: 1.77, 95%CI:1.39 - 2.26), obesity (OR: 1.53, 95%CI:1.12 - 2.10), female sex (OR: 1.47, 95%CI: 1.21 - 1.79), asthma (OR:1.25, 95%CI: 1.05 - 1.48), and insulin use (OR: 1.45, 95%CI: 1.19 - 1.76) were associated with higher odds of CRN among adult patients with diabetes. Non-Hispanic Black individuals were less likely to be adherent compared with White individuals (OR: 1.07; 95% CI: 0.83 - 1.36).

Conclusion: This cross-sectional study reveals that 1 in 10 diabetic individuals report nonadherence due to cost-related issues. Addressing financial barriers and enhancing healthcare accessibility, especially in marginalized communities, can potentially mitigate CRN and improve overall health outcomes.

Disclosure

C. Wu: None. Y. Weng: None. M. Islam: None.
143-OR: A1C Change after Initiating Continuous Glucose Monitoring (CGM) for People with Diabetes in a Large U.S. Managed Health Care Plan
Authors: NORMAN GREGORY J. , FERNANDES JOAQUIM , NEMLEKAR POORVA , LUPTON LAURA , BERK ALEXANDRA
Published: June 2024

Background: National guidelines stipulate lifestyle and glycemic management for diabetes care. However, diabetes control remains inadequate for many people. CGM devices can improve detection and awareness of dysglycemia. Examining glycemic changes related to real-world CGM use can inform clinical and policy decisions about implementing this technology.

Methods: This was a retrospective observational study of medical claims data from Aetna’s fully insured member population. The index date was the first claim for CGM from 1/1/2019 through 12/31/2021. A1c was measured in the 3m prior to the index date and during the follow-up period. Patients were classified as having T1D or T2D based on ICD10 codes.

Results: A cohort of 7,814 patients (25% T1D, mean age = 58, 43% Medicare insured, 46% female, 56% white) met the inclusion criteria. A subset (n = 1,127) had A1c measures at baseline and in the last 3m of follow-up. Across all patient groups, A1c at baseline was > 8.0 with statistically significant reductions at end of follow-up (Table). Analysis of all available A1c measures indicated reductions occurred primarily in the first 3m of CGM initiation and were sustained over the 12m.

Conclusion: CGM was associated with clinically meaningful and sustained reductions in A1c for patients with T1D and T2D, suggesting a population approach to CGM use for all patients with diabetes may be warranted.

Disclosure

G.J. Norman: Employee; Dexcom, Inc. J. Fernandes: Employee; CVS Caremark. Research Support; Dexcom, Inc., Pfizer Inc., Novo Nordisk, Sage Pharmaceuticals, Becton, Dickinson and Company, Aetion, Inc., Boehringer-Ingelheim. P. Nemlekar: Employee; Dexcom, Inc. L. Lupton: Employee; CVS Health. A. Berk: Employee; CVS Caremark.
1432-P: Identifying Prediabetes Phenotypes and Their Associations with Clinical Outcomes—Findings from the Center for Cardiometabolic Risk Reduction in South Asia (CARRS) Study
Authors: JAGANNATHAN RAM , KONDAL DIMPLE , TIWARI PRADEEP K. , GUJRAL UNJALI , MOHAN ANJANA RANJIT , DEEPA MOHAN , WALIA GAGANDEEP K. , SENGUPTA SHANTANU , PANDEY RAJESH , RADHA VENKATESAN , ALI MOHAMMED K. , SUN YAN , PRABHAKARAN DORAIRAJ , TANDON NIKHIL , MOHAN VISWANATHAN , VENKAT NARAYAN K M
Published: June 2024

Background: Current definitions of prediabetes fail to capture the heterogeneity of the type 2 diabetes (T2D) pathophysiology. We aim to identify clusters of prediabetes among South Asians and explore their associations with diabetes incidence and overall mortality.

Methods: Data from individuals with prediabetes based on the ADA criteria in the CARRS study were clustered using the k-means approach based on age, BMI, HbA1c, HOMA-B, and HOMA-IR. T2D incidence (based on the ADA criteria) and all-cause mortality were assessed using Cox proportional hazards models.

Results: Two distinct prediabetes phenotypes emerged: insulin resistant (35.8%) and insulin-deficient (64.2%). Among 5,794 individuals (normal glucose tolerance (NGT): 2,882; prediabetes: 2,912), over a median follow-up of 11 years, 487 individuals developed T2D, and 212 individuals died. Both insulin resistant and insulin deficient prediabetes phenotypes were associated with T2D incidence compared to NGT, but only insulin-deficient phenotype showed increased mortality risk (Table).

Conclusion: Two-thirds of South Asians with prediabetes exhibit insulin deficient phenotype, contributing to 74% of diabetes incidence and associated with increased mortality. This data could guide precision prevention interventions based on diabetes pathophysiology.

Disclosure

R. Jagannathan: None. D. Kondal: None. P.K. Tiwari: None. U. Gujral: None. R. Anjana: None. M. Deepa: None. G.K. Walia: None. S. Sengupta: None. R. Pandey: None. V. Radha: None. M.K. Ali: Advisory Panel; Eli Lilly and Company. Y. Sun: None. D. Prabhakaran: None. N. Tandon: None. V. Mohan: None. K. Narayan: None.

Funding

The CARRS study has been funded with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health (HHSN2682009900026C, P01HL154996)
1433-P: Longitudinal Association between Smoking and Key Diabetes and Cardiovascular Biomarkers among American Indians with Diabetes
Authors: LI CHAO
Published: June 2024

Introduction & Objective: American Indian (AIs) have been disproportionately burdened by diabetes. AI adults are twice as likely to have diabetes compared to Whites. However, there is limited research that has been focused on the longitudinal and quantitative relationship between smoking and diabetes among AIs. This study is aimed to evaluate the long-term relationship among smoking and key cardiovascular and diabetes biomarkers among AIs with diabetes.

Methods: This study uses existing data from the Strong Health Study (SHS), which is an on-going and multi-centered cohort study of cardiovascular disease and its risk factors among AIs. Original SHS participants with diabetes and who completed at least 1 follow up assessment are included in this study. The overall sample size is 1359. The exposure of interest is smoking, e.g., numbers of cigarettes smoked per day. The outcome variables are Hemoglobin A1C (HbA1c), fasting glucose (FG), 2-h glucose (2-h FG) and serum lipids including low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG) and total cholesterol (TC). Mixed models are performed to assess the longitudinal relationship.

Results: This study consists of 831 females and 528 males, and the average age is 57.6. Initial numbers of cigarettes smoked per day is positively associated with HbA1c (Relative Risk (RR)=1.02, p<0.05) after adjusting for age, gender, education, marital status, diabetes treatment, physical activity, and waist hip ratio. Similar significant longitudinal associations are observed between numbers of cigarettes smoked per day and TG (RR=8.32, p<0.05) and TC (RR=1.53, p<0.05), and numbers of cigarettes smoked per day is negatively related with HDL (RR=0.84, p<0.05) over time. There is no significant association between numbers of cigarettes smoked per day and FG and LDL levels.

Conclusion: Smoking has significant longitudinal adverse effects on HbA1c, TG, TC and HDL among AIs with diabetes.

Disclosure

C. Li: None.

Funding

American Diabetes Association (AWD-231969)