bluuebunny/crossref_metadata_2025 huggingface dataset:
1411-P: Dysfunction of Adipose Tissue and Testosterone Deficiency in Men with Type 2 Diabetes Mellitus
Authors: KHRIPUN IRINA A. , VOROBYEV SERGEY V. , BOVA ELENA V.
Published: June 2020

The prevalence of hypogonadism in men with type 2 diabetes mellitus (T2DM) is higher than in population. Though, the function of adipose tissue in men with hypogonadism and T2DM is still unclear.

Aim: To study the function of adipose tissue in men with T2DM and functional hypogonadism.

Materials and Methods: We examined 272 men with T2DM (mean age 53.8±2.7 years). Randomization: 1 group - 148 men with hypogonadism, according to the European Association of Urology criteria 2015; 2 group - 124 patients, not having hypogonadism. The groups were comparable by age and treatment of diabetes. Patients underwent clinical examination, analysis of carbohydrate metabolism and markers of adipose tissue function, such as resistin, leptin, adiponectin. Statistical analysis was carried out using the Mann Whitney U-test.

Results: The analysis demonstrated that hypogonadal patients had a significantly higher body mass index, waist and hip circumferences. Levels of fasting glucose and HbA1c weren’t statistically different in two groups. At the same time, patients with hypogonadism had more pronounced hyperinsulinemia (16,2 [10,5; 30,2] vs. 12,7 [8,4; 21] μU/ml, p=0,002) and insulin resistance, calculated as HOMA-IR (6,2 [3,8; 11,0] vs. 4,6 [2,8; 7,0], p<0,001), compared to eugonadal men. The analysis revealed an increase in leptin (10,8 [7,2; 17,5] vs. 9,2 [5,8; 14,9] ng/ml, p=0,03) and resistin levels (7,5 [2,9; 13,3] vs. 3,8 [1,8; 6,5] ng/ml, p<0,001) in the 1st group compared to the 2nd. Contrary, levels of adiponectin (2,8 [0,5; 5,7] vs. 4,7 [0,8; 7,9] μg/ml, p=0.006) were higher in group 2 compared to the 1st one. Thus, despite the equal fasting glucose and HbA1c levels, men with T deficiency have more pronounced adipose tissue dysfunction compared to eugonadal men having T2DM.

Conclusion: T deficiency leads to adipose tissue dysfunction in men with T2DM.

Disclosure

I.A. Khripun: None. S.V. Vorobyev: None. E.V. Bova: None.

Funding

Russian Science Foundation (14-25-00052)
1428-P: Cardiovascular Outcomes with Dulaglutide vs. Liraglutide
Authors: BOWE ANDY , POONAWALLA INSIYA , TINDAL MICHAEL , MEAH YUNUS A. , SCHWAB PHIL
Published: June 2020

While emerging evidence shows cardiovascular (CV) benefits associated with use of specific glucagon-like peptide-1 (GLP-1) agonists, there is limited data on how outcomes compare between agents in the same drug class. This retrospective cohort study compared once-weekly dulaglutide and once-daily liraglutide on CV outcomes, treatment persistence/discontinuation, healthcare utilization and costs. Using administrative claims data from a large commercial and Medicare Advantage Prescription Drug health plan, new users of liraglutide or dulaglutide from January 2015 to June 2017 were identified. Eligible patients were 19-89 years, with at least 12 months of continuous enrollment pre- and post-index date (i.e., date of first new prescription). Patients who had prescription claims for other GLP-1 agonists were excluded. Propensity score matching (1:1) resulted in 2,245 patients in each treatment arm. The risk of primary composite CV outcome (myocardial infarction [MI] or stroke or mortality) and secondary CV outcome (heart failure [HF] or mortality) was similar across treatment groups, but patients indexed to dulaglutide were less likely to encounter a MI (relative risk [RR] 0.80, P=0.028) or HF (RR 0.81, P=0.001) event. Treatment discontinuation was lower in patients who used dulaglutide vs. liraglutide (57.8% vs. 63.2%, P<0.0001; hazard ratio 0.85, 95% confidence interval 0.79-0.92). The average per-person per-month pharmacy cost was higher for dulaglutide compared to the liraglutide cohort ($1,027 vs. 954, P=0.047). Total and medical costs, inpatient hospitalization stays, emergency department visits and outpatient service visits were similar across cohorts. Despite a lack of significant effect on the study’s composite CV outcomes, this real-world study showed longer treatment persistence with the use of dulaglutide that may be associated with lower MI and HF events. Findings may be useful to providers, especially in the treatment of patients who prefer once-weekly versus once-daily subcutaneous injection.

Disclosure

A. Bowe: Employee; Self; Humana. I. Poonawalla: None. M. Tindal: None. Y.A. Meah: None. P. Schwab: Employee; Self; Humana. Employee; Spouse/Partner; Humana.
1438-P: The Novel Extracellular Matrix Hormone Endotrophin, a Fragment of Collagen Type VI, Is Associated with Diabetes and Is a Risk Factor for Mortality in Elderly Women
Authors: MØLLER ALEXANDRA , RASMUSSEN DANIEL G.K. , KARSDAL MORTEN A. , CHRISTIANSEN CLAUS , STAUNSTRUP LINE M. , BAGER CECILIE L.
Published: June 2020

As a result of the aging population and obesity, diabetes is a major, increasing public health issue approaching global epidemic proportions. It is well known that patients with diabetes have higher levels of inflammation and that the underlying pathology contributes to blood vessel damage resulting in cardiovascular complications. Recently it was suggested that a fragment of collagen type VI (COL VI), released during deposition, is in fact a novel hormone (endotrophin; ETP), suggesting the extracellular matrix (ECM) to be involved in the regulation of type 2 diabetes. In this study, we investigated the association of ETP (measured by the PRO-C6 ELISA) with diabetes and mortality in a large prospective cohort.

From 1999-2001, 5855 postmenopausal women with a mean±SD age of 71±6.5 were included in the Prospective Epidemiological Risk Factor study, and visits were planned according to a pre-defined protocol. The diagnoses for diabetes and mortality were extracted from the Danish Health Registries. We measured ETP in serum of 5608 women at baseline (samples collected from 1999-2001). ETP levels were measured in 2016. ETP levels were significantly elevated in women who died (p<0.0001). Additionally, we found that ETP levels were higher in women diagnosed with diabetes prior to baseline visit (n=206) compared to women diagnosed with diabetes after baseline (n=515, p=0.017), that ETP were higher in women with diabetes prior to baseline compared to healthy women (p<0.0001), and a trend of higher levels of ETP in women diagnosed with diabetes after baseline compared to healthy women (p=0.10).

In conclusion, we demonstrate that the hormone ETP, a biomarker also reflecting COL VI deposition, was increased in serum of postmenopausal women with diabetes compared to healthy women. In addition, we show that ETP was associated with mortality, suggesting that turnover of the ECM is very important in metabolic disorders.

Disclosure

A. Møller: None. D.G.K. Rasmussen: Employee; Self; Nordic Bioscience. M.A. Karsdal: Stock/Shareholder; Self; Nordic Bioscience. C. Christiansen: None. L.M. Staunstrup: None. C.L. Bager: None.

Funding

Danish Research Foundation
1444-P: Discordance between Insulin and C-Peptide Is Associated with Liver Function and Ethnicity
Authors: PERKINS CHARLOTTE , CAMPBELL ERIN , CISTOLA DAVID P.
Published: June 2020

Introduction and Hypothesis: Insulin and c-peptide are co-secreted in a 1:1 ratio, but cleared from the blood by different mechanisms. Insulin is cleared by the liver (t1/2 ∼ 4 min), while c-peptide is cleared by the kidney (t1/2∼ 40 min). Thus, differences between steady-state serum insulin and c-peptide may reflect subject-to-subject variation in liver and/or kidney clearance rates.

Specific Aim: In lieu of direct measures of clearance, the aim was to examine the association of insulin/c-peptide residuals with markers of liver and kidney function. Associations were analyzed using cross-sectional data from the 1999-2000 U.S. National Health and Nutrition Examination Survey.

Methods: The inclusion criterion was age ≥ 12, and the exclusion criteria were diabetes, pregnancy, fasting < 8 h, serum creatinine > 2, or missing insulin or c-peptide values, yielding 2,417 subjects. Insulin residuals were calculated as the difference between observed Ln insulin and the predicted value from the regression line for Ln insulin vs. Ln c-peptide.

Results: Insulin residuals were positively correlated with insulin levels (r=0.55, p<0.0001). After adjusting for serum creatinine (kidney function), the association of insulin residuals with other markers was assessed using multiple linear regression. Positive associations were observed with ALT, LDH, CRP and urinary NTx/creatinine, as well as Hispanic ethnicity. Negative associations were observed with age, male gender, white and black race, total serum protein and bilirubin.

Conclusion: Insulin residuals, adjusted for creatinine, are associated with markers of liver dysfunction, inflammation, bone resorption and race/ethnicity. The hepatic clearance rate of insulin is known to be affected by some of these factors. Higher insulin residuals presumably reflect slower hepatic insulin clearance, which promotes hyperinsulinemia. Insulin residuals could be a simple surrogate for assessing differences in insulin clearance. Further studies are warranted.

Disclosure

C. Perkins: None. E. Campbell: None. D.P. Cistola: None.

Funding

National Institutes of Health (R21HL143030)
145-OR: GLP-1 Analogue Effects on Neural Responses to High-Fructose Corn Syrup and Eating Behavior in Obesity
Authors: JOSEPH KELLY , LEVENTHAL JESSICA , HWANG SEUNGJU , KNIGHT MARI-LYNET , SEO DONGJU , LACADIE CHERYL , VAN NAME MICHELLE A. , CAPRIO SONIA , SHERR JENNIFER , TAMBORLANE WILLIAM V. , SINHA RAJITA , JASTREBOFF ANIA M.
Published: June 2020

GLP-1 analogues (GLP-1a) may change sweet food preferences but the neural mechanisms are not fully understood. We studied the effect of GLP-1a on neural responses to drinking high fructose corn syrup (HFCS) using fMRI in 5 lean (LN, BMI 21kg/m2, mean age 21, A1c 5.3%) and 7 obese (OB, BMI 38, age 26, A1c 5.5%) subjects. The OB group had a second fMRI after 3-mos treatment with liraglutide 3.0 mg daily. Food intake was evaluated by dietary recall. At baseline, OB group had increased cerebral blood flow (CBF) in regions implicated in reward/motivation (putamen) and taste perception (insula) vs. LN (p=.05). However, the OB group’s responses to HFCS changed markedly after 3-mos GLP-1a treatment. As shown in the Figure, CBF in OB group increased in regions related to impulse control (anterior cingulate cortex/ventromedial prefrontal cortex), taste perception (insula), and thalamus. It is also noteworthy that CBF did not increase in the reward/motivation region (putamen) during liraglutide treatment. Changes in neural responses to HFCS intake during GLP-1a treatment were accompanied by a 1080 kcal/d decrease in food intake (p<.006), as well as a >50% decrease in daily sugar intake. These preliminary data suggest decreased food and sugar intake induced by GLP-1a may be related to neural mechanisms that promote impulse control while simultaneously suppressing dysregulated reward responses following sugar intake.

Disclosure

K. Joseph: None. J. Leventhal: None. S. Hwang: None. M. Knight: None. D. Seo: None. C. Lacadie: None. M.A. Van Name: None. S. Caprio: None. J. Sherr: Advisory Panel; Self; Bigfoot Biomedical, Cecelia Health. Consultant; Self; Eli Lilly and Company, Lexicon Pharmaceuticals, Inc., Medtronic, Sanofi, T1D Exchange. W.V. Tamborlane: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Novo Nordisk Inc., Sanofi US. Other Relationship; Self; Eisai Inc., MannKind Corporation. R. Sinha: None. A.M. Jastreboff: Consultant; Self; Novo Nordisk Inc., Rhythm Pharmaceuticals.

Funding

American Diabetes Association (1-18-JDF-003 to A.M.J.)
1454-P: Identifying Maturity-Onset Diabetes of the Young in Electronic Health Records
Authors: SULIEMAN LINA , RAMIREZ ANDREA
Published: June 2020

Maturity onset diabetes of the young (MODY) is a rare cause of diabetes. Most clinical information required to diagnose MODY is difficult to extract from Electronic Health Records (EHR) due to the lack of specific billing code and diagnoses found only in clinical notes. Natural language processing (NLP) can be used to extract information from clinical text and assign labels. In this study, we designed NLP algorithms to scan clinical notes, characterize structured information, and confirmed classification with chart review to develop a reusable process to identify MODY patients in EHR.A de-identified version of the EHR from a large academic medical center was used. We built NLP algorithms to identify notes that mention MODY or MODY 14 genes. We further characterized the relevant mention with context labels), then reviewed charts to confirm MODY cases. We implemented published electronic phenotype algorithms for type 1 diabetes (T1D) and type 2 diabetes (T2D) to identify alternative diagnoses and characterize overlap. Finally, we extracted structured clinical features related to diabetes including frequency of billing codes, outpatient diabetes prescriptions, and laboratory values (A1C, c-peptide, antibody).The total number of notes identified with NLP was 6240 belonging to 959 unique subjects. The notes including negation, affirmation, possible, and family FH were 799, 3407, 1408, and 372 and subjects were 122, 354, and 181, respectively. The MODY count confirmed with review was 354.In MODY cohort, 66% of MODY subjects had T1D codes, 59% had T2D codes, 45% had both T1D and T2D codes, and 20% had no diabetes codes. The number of subjects identified using published algorithms that overlapped the MODY cohort was 26 subjects for T2D and 6 subjects for T1D. On average, MODY subjects had more T1D codes compared to T2D diabetes (59.8 vs. 35.3). The mean A1C of MODY subjects was 7.7 which was lower than for algorithm defined T1D, 8.2. They received lower insulin treatment compared to non-insulin treatment, on average.

Disclosure

L. Sulieman: None. A. Ramirez: None.
1461-P: Liver Fibrosis Is Common in Patients with Type 2 Diabetes Mellitus (T2DM) and Nonalcoholic Fatty Liver Disease (NAFLD)
Authors: LOMONACO ROMINA , FANOUS NADA , KALAVALAPALLI SRILAXMI , TEJERA LAZARO J. , MCCAULEY ALLISON , GODINEZ EDDISON , MANSOUR LYDIA , SHRESTHA SULAV , MARTE JONATHAN S. , FAKHRY JONATHAN , WANG HANNAH , BARB DIANA , BRIL FERNANDO , CUSI KENNETH
Published: June 2020

In 2019, the ADA recommended screening for NASH and liver fibrosis in patients with T2DM and steatosis or elevated ALT. However, the true prevalence of liver fibrosis in unselected patients with T2DM in the United States remains unknown. To this end, we screened patients with T2DM attending either internal medicine (IM), family medicine (FM) or endocrinology (E) clinics unaware of having NAFLD. Screening for fibrosis (1º outcome) was done by vibration-controlled transient elastography (VCTE) and steatosis by controlled attenuation parameter (CAP) (2º outcome). We also measured diagnostic panels of fibrosis (APRI and FIB-4). A liver biopsy was done based on pre-established imaging/panel parameters if suggestive of significant fibrosis (F≥2). A total of 527 patients (IM: 112; FM: 255; E: 160) were recruited (age 60±12; 55% females; 58% non-Hispanic whites, 29% AA, 4% Asian; BMI 33±6 Kg/m2; A1c 7.5±1.7%; AST 22±10 U/L; ALT 24±17 U/L). Only 10% of patients had an ALT >40 IU/L. The prevalence of NAFLD by CAP (≥280 dB/m) was 66% with only 14% having an ALT >40 IU/L. The prevalence of fibrosis was 23% (kPa ≥7.0). In 74% of patients with liver fibrosis AST/ALT were <40 IU/L. Diagnostic panels (APRI, FIB-4) were normal in ∼50% of patients and in the “indeterminate zone” in 36%, highlighting the value of combining them with imaging when screening. Steatosis was similar across E, IM and FM clinics, but F2-3 fibrosis was more common in E than in IM and FM clinics (30 vs. 16 and 21%, respectively; both p<0.05). BMI correlated strongly with steatosis (r = 0.43) and with fibrosis (r = 0.25; both p<0.001), but glycemic control (A1c) did not correlate with either.

In conclusion, NAFLD requires greater awareness among clinicians as there is a high prevalence of undiagnosed liver steatosis and fibrosis in patients with T2DM. An approach based on ALT alone is inadequate, but a combination of diagnostic panels plus imaging is promising and deserves further exploration.

Disclosure

R. Lomonaco: None. N. Fanous: None. S. Kalavalapalli: None. L.J. Tejera: None. A. McCauley: None. E. Godinez: None. L. Mansour: None. S. Shrestha: None. J.S. Marte: None. J. Fakhry: None. H. Wang: None. D. Barb: None. F. Bril: None. K. Cusi: Consultant; Self; Allergan plc., AstraZeneca, Bristol-Myers Squibb, Genentech, Inc., Gilead Sciences, Inc., Merck & Co., Inc. Research Support; Self; Cirius Therapeutics, Echosens, Eli Lilly and Company, Inventiva Pharma, Janssen Pharmaceuticals, Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Poxel SA, Zydus Pharmaceuticals, Inc.

Funding

Echosens
1467-P: Retinal Vascular Biomarkers in Diabetic Peripheral Neuropathy
Authors: BURGE MARK R. , SOLIZ PETER , BENSON JEREMY , JOSHI VINAYAK
Published: June 2020

Purpose: Studies have shown that individuals with retinal blood vessel abnormalities often present with other biomarkers associated with diabetic peripheral neuropathy (DPN). Existing software requires extensive manual intervention to measure structures in the retinal vasculature (e.g., arterial caliber, artery/vein ratios, fractals, etc.) for the purpose of studying the relationship of these structures to DPN. The goal of this study was to demonstrate an artificial intelligence (AI) software system for determining DPN risk based on retinal vascular abnormalities. Our approach circumvented the need to explicitly measure vessel characteristics by using AI as applied to a state-of-the-art methodology known as “convolutional neural networks” (CNN) to characterize the retinal vascular structures. CNNs have been demonstrated to be effective in a number of medical applications. This study is the first time CNNs have been used to extract retinal vascular features for DPN risk assessment.

Methods: From a database of 25,000 cases previously labeled as healthy (controls), unaffected diabetes (DM), or DPN, we have identified 331 cases that fit the requirements for this study. Controls (N=103) had monofilament and vibration tests to confirm normal peripheral nerve function. DM patients (N=163) were classified based on their medical records and monofilament and vibration tests. DPN patients (N=65) were confirmed by clinical examination and their medical record. With these cases, an AI classifier was trained to identify individuals with DPN biomarkers based on spatial features extracted from the retinal abnormalities.

Results: 80% of cohort data were used for training and 20% was used for testing. The resulting AI tool demonstrated 95% specificity and 78% sensitivity when using the clinical exam as the reference standard.

Conclusions: AI-based CNN analysis of retinal vascular features show promise for identifying subjects with DPN and reduced human manipulation and measurement of tedious vessel geometries.

Disclosure

M.R. Burge: None. P. Soliz: None. J. Benson: None. V. Joshi: None.

Funding

National Institutes of Health (DK104578)
1474-P: Association between Low Birth Weight and ß-Cell Function in Adults without Diabetes from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
Authors: BRANDA JULIA I. , PITITTO BIANCA ALMEIDA , BENSENOR ISABELA M. , LOTUFO PAULO A. , GOUVEA F.G. VIVOLO SANDRA ROBERTA
Published: June 2020

Based on the fetal origins of diseases hypothesis, adverse intrauterine environment - reflected by low birth weight (LBW) - has been linked to insulin resistance and type 2 diabetes later in life. Whether β cell function reduction could be detected even in middle-aged adults is less investigated. We examined the association of LBW with β cell function and insulin sensitivity. This is a cross-sectional analysis of 2634 ELSA-Brasil participants aged between 34 and 59 years. Exclusion criteria were diabetes, glomerular filtration rate <60 ml/min/m2, thyroid dysfunction, liver disease, BMI <18.5 kg/m2 and macrosomia. Participants were stratified according to LBW defined as <2.5 kg and their clinical data were compared. HOMA-IR, HOMA-β, HOMA-adiponectin, TyG index and QUICKI were calculated. Associations of LBW with β cell function and insulin sensitivity indexes were tested using multiple linear regression including adjustments suggested by Directed Acyclic Graphs. The sample (47.0±6.3 years) was composed of 58% of women and 9% had LBW. Subjects with LBW had lower mean body weight at age 20 but similar current BMI than the normal weight born ones. In average, cardiometabolic risk profile as well as indexes of β cell function and insulin sensitivity were within normal ranges. Lower median HOMA-β values in the subset with LBW did not differ statistically from normal birth weight ones. In regression analysis, log-transformed HOMA-β - but not with the other indexes - was associated with LBW (p=0.016) independent of sex, skin color, prematurity and family history of diabetes. The association between HOMA-β and LBW suggests that decrease in insulin secretion may occur in healthy middle-aged adults. Our data are coherent with a relatively reduced β cell mass in low weight born subjects that could contribute to the risk of glucose metabolism disturbances.

Disclosure

J.I. Branda: None. B. Almeida Pititto: None. I.M. Bensenor: None. P.A. Lotufo: None. S.F.G. Vivolo: None.

Funding

Fundação de Amparo à Pesquisa do Estado de São Paulo - FAPESP; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES); CNPq - National Research Council
1479-P: Regional Variations in Chronic Kidney Disease Prevalence among Patients with or without Type 2 Diabetes (RADAR) in the U.S.
Authors: FENG XUE , FAREJ RYAN , XIA FANG , GAISER ANDREW S. , KONG SHELDON , ELLIOTT JAY , LINDEMANN STEFANIE , SINGH RAKESH
Published: June 2020

Introduction: Type 2 diabetes (T2D) represents the leading cause of Chronic Kidney Disease (CKD) worldwide. While variation in T2D prevalence in the U.S. is well established, regional variation in the prevalence of CKD in patients with or without (w/o) T2D is less well characterized and may inform targeted implementation of risk-reducing interventions.

Objective: We explored regional variations in the prevalence of CKD in patients with or w/o T2D in the U.S.

Method: Data from January 1, 2013 through December 31, 2017 from an employer-based claims database (MarketScan) was used for this analysis. Continuously enrolled patients aged ≥18 years diagnosed with CKD with or w/o T2D were identified using International Classification of Disease diagnosis codes. We estimated overall CKD, CKD+T2D, and CKD w/o T2D prevalence for each year from 2013 to 2017. Geo-mapping was used to visualize the prevalence of CKD. Univariate and differential local indicators for spatial analyses (LISA) were performed to describe the geographic differences of CKD prevalence.

Results: The overall prevalence of CKD doubled from 1.50% in 2013 to 3.11% in 2017. Within the CKD population, 46.3% had T2D in 2017. The prevalence of CKD+T2D increased from 0.70% in 2013 to 1.44% in 2017. From 2013 to 2017, low-low clusters from univariate LISA were consistently observed in the Northwest regions (e.g., MT, WY) (P<0.05), indicating the consistently low prevalence of CKD in these areas. High-high clusters from differential LISA, which implied the clusters of increasing CKD prevalence, were found in the Southeast regions (e.g., FL, MS) (P<0.05).

Conclusion: This study provides real-world evidence of regional variations in CKD prevalence in the U.S. Additionally, this study identified lower CKD prevalence than previously cited in the literature, which may indicate major under-coding in the employer-based claims database. Further characterization of CKD patients with or w/o T2D could help understand these variations.

Disclosure

X. Feng: None. R. Farej: Employee; Self; Bayer U.S. F. Xia: None. A.S. Gaiser: None. S. Kong: None. J. Elliott: None. S. Lindemann: None. R. Singh: None.
148-LB: Timely Administration of Rapid-Acting Insulin in Hospitalized Children with Diabetes: A Quality Improvement Project
Authors: ENG LIANE , DUHAME DANIELLE , UNDERLAND LISA
Published: June 2020

Background: The preferred management of insulin-dependent diabetes (IDDM) for pediatric patients includes rapid-acting insulin analogs administered at mealtimes in conjunction with carbohydrate counting. Hospitalized children with IDDM are dependent on hospital personnel to administer rapid-acting insulin, which should occur within 15-30 minutes of the onset of eating. Delays in insulin administration can result in hyperglycemia, poor patient satisfaction, and inappropriate insulin regimen adjustments. At the Children’s Hospital at Montefiore (CHAM), we found that rapid-acting insulin is administered within 15 minutes of glucose check at breakfast time in only 18% of patients, and within 30 minutes of glucose check in only 40% of patients.

Methods: We formed a multi-disciplinary team and used process mapping to identify barriers to timely insulin administration and implement interventions. We studied the time to rapid-acting insulin administration at breakfast for children with IDDM admitted to the 6th floor of CHAM from November 2018 to present before and after PDSA cycles, which have included nurse and resident education in carbohydrate counting, standardization of diabetes menus to include carbohydrate content, and standardization of communication method between nurses and residents.

Results: As of December 2019, median time from blood sugar check to rapid-acting insulin administration at breakfast improved from 32.5 minutes at baseline to 26 minutes. The percentage of children with IDDM who receive rapid-acting insulin within 15 minutes of blood sugar check has not changed, but the percentage of children who receive rapid-acting insulin within 30 minutes of blood sugar check improved from 40% at baseline to 60%.

Conclusions: Timely administration of rapid-acting insulin to hospitalized children with IDDM is a complex process involving coordination of care by multiple providers, and can be improved upon with a multidisciplinary team approach.

Disclosure

L. Eng: None. D. Duhame: None. L. Underland: None.
1480-P: Increased Particle Size of Triglyceride Remnant Lipoproteins, but Not Plasma Concentration or Lipid Content, Boost Risk Prediction of Incident Type 2 Diabetes
Authors: CARVALHO LUIZ SERGIO F. , BENSENOR ISABELA M. , LOTUFO PAULO A. , SPOSITO ANDREI C.
Published: June 2020

Importance: Predicting the risk of type 2 diabetes (T2DM) accurately allow allocation of resources to preventive strategies. Besides fasting blood triglycerides (TG) are highly predictive for T2DM, TG remnant lipoproteins (TRL) translate more accurately physiopathological events that underlie progression to T2DM such as pancreatic steatosis and inflammation.

Objective: We hypothesized TRL-related factors could improve risk prediction for T2DM.

Methods: Regression models were used to predict 4-year risk of incident T2DM, starting with clinical characteristics and metabolic syndrome traits (age, sex, parental history of diabetes, hypertension, waist circumference, HbA1c, blood TG, hsCRP and HDL-C), adding TRL-related measurements, including TRL plasma concentration, particle size, cholesterol and TG content. TRL features were derived from NMR spectroscopy. Discrimination was assessed with area under the ROC curves (AUROCs).

Results: Among 13,628 individuals (1,132 new T2DM cases during follow-up) we generated a 10-variable model with AUROC 0.890 (95%CI: 0.868-0.911). This was reproduced in a subset cohort of 4,466 individuals (353 new cases of T2DM) who had available sNMR, with AUROC 0.891 (95%CI: 0.870-0.913). TRL-related markers in general did not improve predictive capacity for T2DM, but only TRL particle size (TRLZ) increased AUROC particularly in individuals with Hba1c<5.8% at baseline. In this subgroup, AUROC increased from 0.792 (95% CI: 0.764-0.813 - model without TRLZ) to 0.844 (95% CI: 0.802-0.869 - model with TRLZ) (p-value for the diff in AUCs = 0.00013). Further analyses showed that, in prediabetic individuals at baseline, TRLZ is highly correlated with obesity, insulin resistance and inflammatory activity, and less important in individuals with Hba1c<5.8%.

Conclusions: TRL particle size improve predictive capacity for T2DM, particularly in non-prediabetic individuals.

Disclosure

L.F. Carvalho: None. I.M. Bensenor: None. P.A. Lotufo: None. A.C. Sposito: None.

Funding

Brazilian Ministry of Health; Brazilian Ministry of Science, Technology and Innovation; Brazilian National Council for Scientific and Technological Development
1487-P: Increased Identification of NASH among Diabetic and Nondiabetic Patients through Machine Learning in Real-World Settings
Authors: DOCHERTY MATT , TIETZ ANDREAS , REGNIER STEPHANE A. , BALP MARIA-MAGDALENA , CAPKUN GORANA , LOEFFLER JUERGEN , PEDROSA MARCOS , SCHATTENBERG JÖRN M.
Published: June 2020

Background: Nonalcoholic fatty liver disease (NAFLD) and its progressive form nonalcoholic steatohepatitis (NASH) are under recognized due to low awareness and lack of specific symptoms. Machine learning techniques allow the creation of algorithms derived from large databases with many interacting features to predict outcomes of interest. The objective of this study was to estimate the patients who might have NASH in electronic health records (EHR) using a NASH machine learning model (NASHmap).

Methods: NASHmap is a predictive extreme gradient boosting model built and validated in two databases in the USA. The model has a test area under the curve of 0.82 and 0.76 in the training and validation database, respectively. It uses 14 features, ranked by importance: HbA1c, AST, ALT, total protein, AST/ALT, BMI, triglycerides, height, platelets, WBC, hematocrit, albumin, hypertension, and gender. The model was applied to a cohort of patients in Optum EHR meeting predefined inclusion (e.g., common NASH comorbidities) and exclusion criteria (e.g., any other liver disease) and had the 14 features available.

Results: Out of 86 million (M) patients in the Optum EHR, 14M met the inclusion and exclusion criteria and 3M had all 14 features. Among them ∼23,000 patients had a diagnosis of NASH or NAFLD based on ICD codes with 73% having type 2 diabetes (T2D), 65% female and 28% above 65 years. For the patients with no recorded NASH diagnoses, 56% had T2D, 54% were female and 46% were above 65 years. Among the 3M patients, NASHmap predicted ∼902,000 as potentially having NASH and among them 70% had T2D, 52% were female and 43% were above 65 years; median HbA1c was 7.1 for diabetics and 5.8 for nondiabetics.

Conclusion: High-performing machine learning models can be used to alert on patients likely to have NASH. In clinical practice, this could help physicians to identify patients at risk and direct them to appropriate diagnostic and therapeutic interventions.

Disclosure

M. Docherty: Consultant; Self; Novartis Pharmaceuticals Corporation. A. Tietz: Employee; Self; Novartis AG. Stock/Shareholder; Self; Novartis AG. S.A. Regnier: Employee; Self; Novartis AG. Stock/Shareholder; Self; Novartis AG. M. Balp: Employee; Self; Novartis AG. G. Capkun: Employee; Self; Novartis AG. J. Loeffler: Employee; Self; Novartis Pharmaceuticals Corporation. Stock/Shareholder; Self; Novartis Pharmaceuticals Corporation. M. Pedrosa: Employee; Self; Novartis AG. J.M. Schattenberg: Consultant; Self; GENFIT, Gilead Sciences, Inc., Intercept Pharmaceuticals, Inc., Novartis Pharmaceuticals Corporation, Pfizer Inc., Roche Foundation.
1488-P: Closing the Racial/Ethnic Disparity Gap in Kidney Failure from Diabetes in the United States, 2000-2016
Authors: BURROWS NILKA RIOS , ZHANG YAN , HORA ISRAEL A. , PAVKOV MEDA E. , IMPERATORE GIUSEPPINA
Published: June 2020

Diabetes-related end-stage kidney disease (ESKD-D) disproportionately affects U.S. racial/ethnic minority populations compared with whites. With the recent plateau in diabetes prevalence, we assessed ESKD-D trends by race/ethnicity to determine if disparity gaps have changed. From the U.S. Renal Data System, we obtained the number of adults (whites, blacks, Hispanics, Asians, and Native Americans [NAs]) aged ≥18 years with newly treated ESKD-D (with diabetes listed as primary cause) between 2000 and 2016. ESKD-D incidence rates by race/ethnicity were calculated using Census population estimates and age-adjusted to the 2000 U.S. standard population. Average annual percentage change (AAPC) in rates was estimated using joinpoint regression. From 2000 to 2016, the age-adjusted ESKD-D rates decreased by 53% for NAs (66.7 to 31.2 per 100,000, AAPC= -4.5%, p<0.001); by 33% for Hispanics (50.0 to 33.3, AAPC= -2.1%, p<0.001); by 20% for blacks (56.2 to 44.7, AAPC= -1.6%, p=0.02), did not change for Asians, and increased by 10% for whites (15.4 to 17.0, AAPC= 0.6%, p=0.01) (Figure). ESKD-D incidence declined for NAs, Hispanics, and blacks, narrowing the gap with whites, with NAs having the largest decline. However, in 2016, ESKD-D incidence rates in NAs, Hispanics, and blacks were about 2.0-2.5 times higher than whites. Continued efforts might be considered to sustain and improve ESKD-D trends in these populations.

Disclosure

N. Burrows: None. Y. Zhang: None. I.A. Hora: None. M.E. Pavkov: None. G. Imperatore: None.
1494-P: Prevalence and Incidence of Chronic Kidney Disease among Patients Newly Diagnosed with Type 2 Diabetes
Authors: AN JAEJIN , NICHOLS GREGORY A. , QIAN LEI , LI ZHUOXIN , MUNIS MERCEDES A. , WEI RONG , HARRISON TERESA , WEISS TRACEY , RAJPATHAK SWAPNIL , REYNOLDS KRISTI
Published: June 2020

Patients with type 2 diabetes (T2D) are at increased risk of chronic kidney disease (CKD) or end-stage renal disease (ESRD). We estimated the prevalence and incidence of CKD/ESRD among adults with incident T2D within a U.S. integrated healthcare system.

Incident T2D between 2003-2014 was identified based on a validated algorithm. CKD was defined as eGFR <60 ml/min/1.73m2 on ≥2 occasions 90 days apart and ESRD as initiation of chronic dialysis or renal transplant. Prevalence of CKD/ESRD was evaluated for the 2 years prior and 6 months after T2D diagnosis (index). Incidence of CKD/ESRD was evaluated from 6 months after index through 2018. Multivariable Cox proportional hazards models were used to study factors associated with CKD incidence.

We identified 135,199 incident T2D [mean age 58 years, 48% women, 36% White, 35% Hispanic, 12% Black, 13% Asian]. Median follow up was 6 years. Prevalence of CKD and ESRD was 12.3% and 0.2%, respectively. Median (IQR) eGFR closest to index was 86 (70-101) ml/min/1.73m2. The CKD/ESRD incidence rates decreased for recent diagnoses (2-year CKD incidence: 35.4 vs. 16.6 per 1000 person-years for those diagnosed in 2003-2004 vs. 2013-2014) (Table). Older age, white race, lower eGFR, higher A1c, and hypertension were associated with increased CKD incidence.

Though incidence rates are improving, a significant proportion of patients had reduced eGFR including CKD/ESRD at diagnosis.

Disclosure

J. An: Research Support; Self; Merck & Co., Inc., Novartis AG. G.A. Nichols: Research Support; Self; Boehringer Ingelheim International GmbH, Bristol-Myers Squibb, Merck & Co., Inc. L. Qian: None. Z. Li: None. M.A. Munis: None. R. Wei: None. T. Harrison: None. T. Weiss: Employee; Self; Merck & Co., Inc. S. Rajpathak: Employee; Self; Menarini Group. K. Reynolds: Research Support; Self; CSL Behring, Merck & Co., Inc., National Institutes of Health, Novartis Pharmaceuticals Corporation.
150-LB: Moving the Needle on the High-Risk T1D Panel: Lessons from the T1D Exchange Quality Improvement Collaborative (T1DX-QI)
Authors: RIOLES NICOLE , BUNKER CASSANDRA , CLEMENTS MARK A. , GALLAGHER KATHRYN , GARRITY ASHLEY , JONES NANA-HAWA , KAMBOJ MANMOHAN K. , MAJIDI SHIDEH , PRAHALAD PRIYA , SONABEND RONA Y. , THIVENER KATIE , EBEKOZIEN OSAGIE
Published: June 2020

There is an increased risk of complications among “high risk” patients (having elevated HbA1c scores). Social, racial, and economic factors contribute to the difficulty in reducing HbA1c. The T1DX-QI is a type 1 diabetes learning health system with over 10 endocrinology centers working collaboratively on the goal of improving outcomes for people with type 1 diabetes. The program is coordinated by the T1D Exchange in Boston, MA.

“High-risk” patients are defined as having two clinic visits in the preceding 12 months and two HbA1cs above 9%. Centers shared data monthly with the coordinating office which used statistical process control charts to evaluate the effectiveness of the interventions. (Figure 1).

This abstract describes how 10 centers used QI principles and interventions to reduce the proportion of high-risk patients. Successful efforts include: utilizing a patient navigator, workflow redesign, developing insulin pump and CGM education classes, depression screening, and addressing social determinants of health.

The Collaborative set a goal to decrease percentage of high risk patients by 5% from baseline and made a significant 3% improvement; data is projected to meet goal by June 2020. Six of 10 centers met the goal, impacting over 200 patients. Continued efforts are needed to expand interventions to additional sites to reduce the number of high-risk patients.

Disclosure

N. Rioles: None. C. Bunker: None. M.A. Clements: Consultant; Self; Glooko, Inc. Other Relationship; Self; Glooko, Inc. K. Gallagher: None. A. Garrity: None. N. Jones: None. M.K. Kamboj: Research Support; Self; Type 1 Diabetes TrialNet, Unitio, Inc. S. Majidi: Advisory Panel; Self; Companion Medical. P. Prahalad: None. R.Y. Sonabend: None. K. Thivener: None. O. Ebekozien: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
1504-P: Is Dry Eye a Biomarker for Diabetes?
Authors: MOMEN DONIA , WU GLORIA , LAU CHAP-KAY K. , WONG JONATHAN , HAN JACQUELINE
Published: June 2020

Background: Meibomian gland (MG) loss plays a role in dry eye. DM patients often complain of dry eyes. Infrared (IR) photography can image MGs in DM pts.

Purpose: To study Meibomian Glands in DM patients with dry eye.

Methods: A chart review (2017-2020) of T2DM pts and non-DM pts with Dry Eye was performed. IR imaging (820nm) and Corneal Topography (CT) was performed. T2DM Inclusion Criteria: HbA1c of >6.6%. Control Inclusion Criteria: non-DM pts, HbA1c labs. Inclusion Criteria for T2DM and Controls: 1) Vision 20/15 - 20/80; 2) IR imaging; 3) % loss of MG per eye, then averaged; 4) CT per eye, then averaged. Exclusion Criteria: eye surgery, medication eye drops, <18yrs old, >90yrs old.

Results: n=100 pts, Avg=58.4 yrs (sd=15.2, range 23-89 yrs). DM: n=50 pts, Male=25, Female=25, Avg=64.2 yrs (sd=11.7, range 36-85 yrs). Control: n=50 pts, Male=20, Female=30, Avg=52.6 yrs (sd=16.2, range 23-89 yrs). Visual Acuity Avg: DM: OD=20/20 OS=20/25, Control: OD=20/40 OS=20/40. CT Avg: DM=45.34 Diopters (D), Control=43.87 D (p<0.0001, t-test). MG % loss: DM=51.54%, Control=11.29% (p<0.0001, t-test). Of the 50 DM pts, 31 with HbA1c > 6.6% had an avg loss of 60% of their MGs, compared to all Controls with HbA1c < 5.7% had an avg loss of 12%, (p=0.0001, t-test).

Conclusion: This small pilot study is the first to document Meibomian Gland loss in DM pts vs. HbA1c levels. Meibomian Gland loss may be a possible biomarker for DM. Infrared imaging may be useful for future evaluation of Meibomian Glands and diabetes.

Disclosure

D. Momen: None. G. Wu: None. C.K. Lau: None. J. Wong: None. J. Han: None.
1534-P: Protein Intake below the Individual Recommendation Is Associated with Lower Physical Functioning among Adults with Diabetes: 2005-2016, NHANES
Authors: THOMAS SARA , FANELLI STEPHANIE M. , KELLY OWEN , KROK-SCHOEN JESSICA L. , TAYLOR CHRISTOPHER A.
Published: June 2020

Adequate protein intakes are important for preventing and treating sarcopenia. Age-related sarcopenia is associated with altered physical functioning, and hyperglycemia is associated with an increased risk for sarcopenia, possibly due to increased muscle loss related to metabolic changes. Impairments in physical functioning may be manifested as falls, fractures, and limited mobility. Therefore, this study examined the differences in physical functioning in U.S. adults by glycemic status and protein intake. Data were examined from 23,487 non-institutionalized adults, aged 31 years and older, from the 2005-2016 National Health and Nutrition Examination Survey (NHANES). Hemoglobin A1c (%) was used to classify glycemic status: nondiabetes (<5.7%); prediabetes (5.7-6.4%); diabetes (≥6.5%). Dietary data were collected using 24-hour dietary recalls. Participants were further categorized by mean individual protein intake as either ’met’ or ’did not meet’ the protein recommendation of 0.8 g/kg/d. NHANES questionnaire data containing 19 discrete physical tasks were used to assess functional limitations. For those without diabetes, 35.9% had protein intakes below 0.8 g/kg/d while 46.8% of adults with prediabetes and 51.3% of adults with diabetes had protein intakes below 0.8 g/kg/d. Adults with diabetes had more functional limitations than those without, and even more if below the protein recommendation. Likewise, adults who consumed < 0.8 g/kg/d protein had more functional limitations, regardless of glycemic status. The most common physical limitation reported across all glycemic groups was stooping, crouching, and kneeling; and 52% of adults with diabetes who did not meet the protein recommendation reported this specific limitation. Assessment of dietary protein intakes are encouraged for adults, especially those with diabetes, to encourage optimal physical functioning and prevent sarcopenia.

Disclosure

S. Thomas: Employee; Self; Abbott. S.M. Fanelli: None. O. Kelly: Employee; Self; Abbott. Employee; Spouse/Partner; Abbott. J.L. Krok-Schoen: None. C.A. Taylor: Research Support; Self; Abbott Laboratories.

Funding

Abbott Nutrition
1535-P: Associations between Eating Patterns and Meeting ABC Goals among U.S. Adults with Diagnosed Diabetes
Authors: SIEGEL KAREN R. , BULLARD KAI M. , SAYDAH SHARON , MERCADO CARLA , ALI MOHAMMED K. , ALBRIGHT ANN L. , IMPERATORE GIUSEPPINA
Published: June 2020

Nutrition is important for individuals with diabetes (DM), as healthful eating patterns may help to attain individual glycemic, blood pressure (BP), and lipid goals (ABC goals) and to delay or prevent complications. Using data from 2,805 non-pregnant adults aged ≥20 years with self-reported diagnosed DM and complete data on diet (one day of 24-hour recall), A1c, BP, and non-HDL cholesterol in the National Health and Nutrition Examination Surveys 2007-2016, we examined associations between five American Diabetes Association-recommended eating patterns and meeting ABC goals. Adjusting for age, sex, race/ethnicity and daily calorie intake, we used logistic regression to calculate the proportion of individuals meeting ABC goals (defined as A1c<8%, BP <140/90 mmHg, non-HDL cholesterol <130 mg/dL, and meeting all three), as well as prevalence ratios, by adherence to each eating pattern. Overall, following a Mediterranean-style diet or a low-fat diet was significantly associated with meeting A1c. Following a vegetarian diet was significantly associated with meeting BP goal. Following a Mediterranean-style diet was also significantly associated with meeting all ABC goals. These results suggest that improved nutrition among adults with DM may help with meeting treatment goals, and that overall healthy eating patterns may be as important for meeting goals than diets that focus on a single macronutrient.

Disclosure

K.R. Siegel: None. K.M. Bullard: None. S. Saydah: None. C. Mercado: None. M.K. Ali: Research Support; Self; Merck & Co., Inc. A.L. Albright: None. G. Imperatore: None.
1540-P: Paternal Obesity Is Associated with Offspring Obestatin Levels in Young Participants of the Nutritionists’ Health Study
Authors: FREITAS RENATA G. , VASQUES ANA CAROLINA J. , RIBEIRO FRANCIELI B. , SOLAR ISABELA , BARBOSA MARINA G. , HANADA ALFREDO S. , VALENTE ANGÉLICA M. , ALMEIDA-PITITTO BIANCA , NETO BRUNO G. , FERREIRA-VIVOLO SANDRA ROBERTA G.
Published: June 2020

Discovery of adipose-produced cytokines and gut hormones has improved the understanding obesity-related mechanisms. The developmental origins of diseases theory also helped to explain the obesity risk in adults exposed to adverse intrauterine environment. In contrast to maternal conditions, the role of paternal characteristics for outcomes has been less investigated. Whether paternal adiposity is associated with obesity biomarkers in adults prior to the development of metabolic disturbances is unknown. This cross-sectional analysis included 124 women (28±5yrs) who participated in the NutriHS baseline. Early life events questionnaire, anthropometry, DXA-determined body composition and blood sample were obtained. Associations of paternal BMI with outcomes were tested by multiple linear regression, using the minimal sufficient adjustments (pre-gestational maternal, paternal education levels and current family income) suggested by Directed Acyclic Graphs. Participants had mean BMI of 25±5 kg/m2 (49% were overweight but metabolically healthy). Blood pressure and biochemical values were within the normal range. Mean obestatin and visfatin levels were 58.9±22.2 mg/dl and 18.8±8.1 mg/dl, respectively; these values did not differ between subsets with BMI <25 and ≥25 kg/m2. Pre-gestational maternal BMI was correlated to paternal BMI (r=0.344, p=0.001) and 11.3% of mothers and 39.0% of fathers were overweight/obese. In linear regression model, offspring obestatin levels was inversely associated with paternal BMI (β=-0.22, p=0.049). No significant association was observed with visfatin levels. The inverse association of paternal BMI with offspring obestatin levels in healthy women raises a possibility of being a marker of protection against obesity-related disturbances in adulthood. Further analyses of the NutriHS cohort should investigate this hypothesis.

Disclosure

R.G. Freitas: None. A.J. Vasques: None. F.B. Ribeiro: None. I. Solar: None. M.G. Barbosa: None. A.S. Hanada: None. A.M. Valente: None. B. Almeida-Pititto: None. B.G. Neto: None. S.G. Ferreira-Vivolo: None.

Funding

Fundação de Amparo à Pesquisa do Estado de São Paulo (2018/11433-9); Fundação de Amparo à Pesquisa do Estado de São Paulo (2018/11401-0)