bluuebunny/crossref_metadata_2025 huggingface dataset:
1171-P: The Challenges of Implementing a Clinic-Based Peer Support Program for Young People with T1D—The DiaBuddies Study
Authors: COMMISSARIAT PERSIS , OWENS HALEY L. , VOLKENING LISA K. , LAFFEL LORI M.
Published: June 2023

Aim: Many adolescents and young adults (AYAs) with T1D express a desire to meet others with T1D. We designed a pilot peer support program (DiaBuddies) and assessed feasibility of the match process and program implementation.

Methods: Eligible participants (13-25 years old) were recruited and enrolled virtually. After informed consent, participants completed questions about preferred match type (peer vs mentor vs mentee), personal interests, and reasons for entry. Study staff “matched” AYAs 1:1 based on shared interests and mutual preferences on match type. Matches were introduced by email and encouraged to interact using any modality (e.g., text, video, in-person) and frequency they preferred. Study staff did not monitor interactions.

Results: Eighteen AYAs (94% female, 89% non-Hispanic white, age 18.9±6.0, T1D duration 8.5±3.3 years) were enrolled from April-December 2022. Median time between first contact and consent was 14 days (range 4-63). The majority (83%) preferred a same-age peer match. Reasons for participation included: not knowing many people with T1D, wanting to discuss T1D with people who shared their experiences, and feeling eager to give advice and support. Six pairs (n=12) have been matched; median time between consent and match was 40 days (range 25-133). Unmatched participants (n=6) have been waiting a median of 131 days (range 21-196) for a suitable match. During the study, 2 participants expressed disappointment that their match was not responsive to messages, and 5 participants expressed excitement about knowing someone new with T1D.

Conclusion: The DiaBuddies pilot study presented challenges with virtual recruitment and matching AYAs on shared interests. Open-ended questions limited opportunity to match objectively, affecting participant wait time and possibly decreasing enthusiasm. Future programs should incorporate lessons learned by modifying the match process to better facilitate AYAs’ desired type and frequency of peer support.

Disclosure

P.Commissariat: None. H.L.Owens: None. L.K.Volkening: None. L.M.Laffel: Advisory Panel; Medtronic, Lilly Diabetes, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Roche Diagnostics, Provention Bio, Inc., Consultant; Dexcom, Inc., Janssen Pharmaceuticals, Inc., Medscape.

Funding

JDRF; National Institutes of Health (P30DK036836)
1173-P: Maternally Supplemented PQQ Targets Ceramide Metabolism in Offspring to Blunt Developmental Programming of NAFLD
Authors: MANDALA ASHOK , TEAGUE APRIL M. , JANSSEN RACHEL , PATIL NIKHIL , JOSHI ADITYA D. , FRIEDMAN JACOB E. , JONSCHER KAREN R.
Published: June 2023

Maternal obesity is a key risk factor for pediatric nonalcoholic fatty liver disease (NAFLD). Using a mouse model of Western-style diet (WD)-induced maternal obesity, we studied effects of supplementing dams with pyrroloquinoline quinone (PQQ; a potent dietary antioxidant) during gestation and lactation on hepatic lipid metabolism and fibrosis in offspring at postnatal day (PND) 14 and at 16 wks after a 4 wk WD challenge. Maternal PQQ (mWDPQQ) decreased neonatal hepatic triglycerides (30%, P=0.0012) and altered bioactive sphingolipids in adult offspring compared with those exposed to maternal WD (mWD), with no change in weight gain. mWDPQQ increased very long chain ceramides (VLCer; 219%, P=0.0002), associated with protection from fibrosis, concomitant with decreased expression of genes promoting ceramide degradation (Asah2, P=0.0014 and Acer3, P=0.02). Expression of Scd1, a desaturase regulating triglyceride biosynthesis, was attenuated in mWDPQQ offspring at PND14 (P=0.0009) and at 16 wks (P=0.0012), while expression of Elovl3, an enzyme promoting elongation of saturated fatty acids and ceramide production, was increased (P=0.0026). Comparative pathway analysis of RNASeq data showed enrichment of pathways in fatty acid metabolism, hepatic fibrosis and, unexpectedly, signaling through the aryl hydrocarbon receptor (AHR; a ligand-activated transcription factor regulating immune function and hepatoxicity). Chromatin IP in mWDPQQ liver showed increased AHR binding to the Cyp1a1 promoter, its canonical target, as compared with mWD, suggesting AHR signaling may be activated by mWDPQQ. AHR binding to the Scd1 promoter, a known AHR target, was increased, as was binding to Asah2 and Acer3, putative new AHR targets regulating long-chain ceramide degradation. These findings suggest that maternal PQQ has both short and long-term effects on blunting steatosis/fibrosis and promoting VLCer increase through novel AHR targets, protecting offspring from NAFLD.

Disclosure

A.Mandala: None. A.M.Teague: None. R.Janssen: None. N.Patil: None. A.D.Joshi: None. J.E.Friedman: None. K.R.Jonscher: None.

Funding

National Institutes of Health (1R01DK121951)
1176-P: Maternal Hyperglycemia Leads to Distinct Differences in Metabolism and Pancreatic Beta-Cell Function in Male and Female Offspring
Authors: O'HARA STEPHANIE E. , GEMBUS KELLY M. , CLARKE GEORGIA S. , PAGE AMANDA J. , NICHOLAS LISA M.
Published: June 2023

Maternal hyperglycemia is a major risk factor for future T2D risk in the offspring. To better understand T2D pathogenesis in this context, we used a mouse model of hyperglycemia induced by high-fat, high-sugar (HFHS) feeding from before mating through to weaning. This resulted in increased adiposity, reduced insulin sensitivity, hyperinsulinemia and impaired glucose tolerance pre-pregnancy. Pregnancy further worsened the metabolic health of dams resulting in reduced insulin levels in addition to glucose intolerance at gestational day 16. By weaning, HFHS-fed dams had fasting hyperglycemia. Maternal hyperglycemia had no impact on offspring body weight and composition at postnatal day 2. However, male offspring of HFHS-fed dams experienced decelerated postnatal growth in the first 2 weeks of life followed by catch-up growth by weaning. Despite comparable body weight, relative fat mass was increased and relative lean mass decreased from 3 to 8 weeks of age in exposed offspring. In males, this was not linked to changes in food intake and metabolic activity measured at 7 weeks. In contrast, daily energy expenditure was increased in female offspring of hyperglycemic dams. At 8 weeks old, despite normal glucose tolerance and insulin sensitivity, male offspring of HFHS-fed dams were hyperinsulinemic during a glucose tolerance test. In contrast, female offspring had reduced insulin sensitivity and higher plasma insulin concentration at baseline and 45 min. Interestingly, insulin secretion was increased only in islets from male offspring characterised by a marked increase in 1st phase and a trend towards higher 2nd phase secretion. Insulin secretion in response to potassium chloride was also increased in these islets. Thus, our data suggest that there are sex-specific mechanisms contributing to future T2D risk in offspring exposed to maternal hyperglycemia with primary hyperinsulinemia being an early feature in males and insulin resistance in females.

Disclosure

S.E.O'hara: None. K.M.Gembus: None. G.S.Clarke: None. A.J.Page: None. L.M.Nicholas: None.

Funding

National Health and Medical Research Council of Australia (GNT1092158)
1181-P: Substituting Protein for Fat Lowers Postprandial Glycemic Response in Gestational Diabetes
Authors: ROSENBERG EMILY A. , THAWEETHAI TANAYOTT , JAMES KAITLYN , KELTY ESTELLE , AZEVEDO ROBIN L. , NELSON STACEY , GARRY JAMIE L. , SEELY ELLEN W. , POWE CAMILLE E.
Published: June 2023

Background: Dietary guidelines in gestational diabetes mellitus (GDM) focus on carbohydrate without regard to other macronutrients. We tested the impact of fat and protein on postprandial glycemia in GDM and analyzed whether the physiology underlying GDM influenced this response.

Methods: In a pilot crossover trial, participants ate two isocaloric breakfast meals with the same carbohydrate content and different protein and fat content (High protein meal: 390 kCal, 35 g protein, 9 g fat, 45 g carb, High fat meal: 411 kCal, 15 g protein, 19 g fat, 46 g carb) on subsequent days in a random order. We measured peak postprandial glucose (primary outcome) using continuous glucose monitors. We used homeostatic model assessment to determine if participants had insulin resistant (IR) or insulin deficient (ID) GDM. We used paired t-tests to test if glycemic response to the meals differed and linear regression to test if differential response to meals was influenced by having IR vs ID GDM.

Results: We studied 16 women with diet-controlled GDM (median [IQR] 31 [30-33] weeks’ gestation). Mean [SD] peak glucose after the high fat meal (146 [20] mg/dl) was higher than after the high protein meal (137 [21] mg/dl) (P=0.03), but individuals varied in their differential response to the meals (range: 25 mg/dl higher after high protein meal to 35 mg/dl higher after high fat meal). Median time to peak glucose (IQR) was 72 (63-74) minutes after the high protein meal and 65 (60-73) minutes after the high fat meal (P=0.11). There was no difference in differential glycemic response to the meals in IR (n=8) vs ID (n=4) GDM (P=0.98); age (median [IQR] 36 [33-38] yrs) and BMI (median [IQR] 27 [24-30]) adjustment did not change results (P=0.82).

Conclusion: On average, women with GDM have lower post prandial glucose levels after a high protein meal compared to a high fat meal with equivalent carbohydrate content. This may inform GDM dietary recommendations and motivate research on determinants of individual-level response to macronutrients.

Disclosure

E.A.Rosenberg: None. T.Thaweethai: None. K.James: None. E.Kelty: None. R.L.Azevedo: None. S.Nelson: None. J.L.Garry: None. E.W.Seely: None. C.E.Powe: Consultant; Mediflix, Inc., Other Relationship; Wolters Kluwer Health.

Funding

Robert Wood Johnson Foundation; National Institutes of Health (5F32DK12634302); Endocrine Fellows Foundation
1183-P: Association of Community-Level Social Determinants of Health and Pregestational and Gestational Diabetes
Authors: FIELD CHRISTINE P. , GROBMAN WILLIAM , WU JIQIANG , LYNCH COURTNEY , VENKATESH KARTIK K.
Published: June 2023

Objective: To determine whether community-level adverse social determinants of health are associated with increased risk of pregestational and gestational diabetes (DM, GDM).

Methods: We conducted a secondary analysis from the prospective cohort Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be. We evaluated three community-level exposures using home addresses geocoded at the census-tract level: 1) socioeconomic disadvantage by 2015 Area Deprivation Index (ADI); 2) food insecurity by USDA Food Access Research Atlas; and 3) walkability by EPA National Walkability Score. The outcomes were DM and GDM.

Results: Of 9,155 assessed individuals, 33.6% were in the highest tertile (T3) of ADI, 24.4% lived in a food-insecure community, and 33.7% lived in a less walkable neighborhood; 1.5% (n=137) had DM and 4.2% (n=380) developed GDM. Individuals living in a community in the highest tertile of ADI were more likely to have DM (aOR: 2.49; 95% CI: 1.48, 4.18) and GDM (aOR: 1.49; 95% CI: 1.13, 1.97). Individuals living in a food-insecure community (aOR: 1.49; 95% CI: 1.17, 1.89) and living in a less walkable neighborhood (aOR: 1.29; 95% CI: 1.03, 1.62) were more likely to have GDM, but not DM.

Conclusions: Multiple measures of community-level adverse social determinants of health were associated with an increased risk of developing GDM. Only socioeconomic disadvantage was associated with DM.

Disclosure

C.P.Field: None. W.Grobman: None. J.Wu: None. C.Lynch: None. K.K.Venkatesh: None.

Funding

Eunice Kennedy Shriver National Institute of Child Health and Human Development
1184-P: No Increased Risk of Gestational Diabetes Mellitus (GDM) Diagnosis after COVID-19 Vaccination
Authors: VESCO KIMBERLY K. , DENOBLE ANNA , LIPKIND HEATHER S. , KHARBANDA ELYSE , DESILVA MALINI B. , DALEY MATTHEW F. , GETAHUN DARIOS , ZERBO OUSSENY , NALEWAY ALLISON , JACKSON LISA , WILLIAMS JOSHUA , BOYCE THOMAS G. , FULLER CANDACE , VAZQUEZ BENITEZ GABRIELA
Published: June 2023

Background: Hyperglycemia and possible accelerated onset of de novo diabetes have been reported following COVID-19 vaccination in nonpregnant adults. The objective of this study was to examine the risk of GDM after COVID-19 vaccination in pregnancy.

Methods: Using data from 8 integrated health care systems participating in the Vaccine Safety Datalink, we performed a retrospective analysis among 42,140 pregnancies resulting in livebirth from 1/27/21 -1/25/22. Diagnosis of GDM was defined as two outpatient or one inpatient ICD-10 codes for GDM at or beyond 22 weeks’ gestation. GDM diagnoses were compared between individuals who received one or two COVID-19 vaccine doses prior to 22 weeks’ gestation and those who did not receive a COVID-19 vaccine during pregnancy. We used generalized estimating equations with robust variance and inverse probability weighting to estimate the adjusted relative risk (aRR) and 95% Confidence Interval (CI) of GDM, accounting for baseline differences between vaccinated and unvaccinated individuals.

Results: Of the 42,140 pregnancies, 38% identified as Hispanic, 33% non-Hispanic White, 15.6% non-Hispanic Asian, 8.8% non-Hispanic Black, and 4.4% other or unknown; 25.6% received one or more COVID-19 vaccine doses prior to 22 weeks’ gestation. Individuals who were vaccinated were older (mean age 32.0 ± 4.6 vs 29.5 ± 5.3 years) and more likely to be of non-Hispanic White (37.4% vs 31.7%) or Asian background (25.7% vs 12.1%) than those who were unvaccinated. The rate of GDM was 11.9 per 100 among those who received a COVID-19 vaccine and 10.6 per 100 among those who did not. There was no increased risk of GDM diagnosis associated with receipt of a COVID-19 vaccine during pregnancy, aRR 1.00 (95% CI 0.90-1.10).

Conclusion: Data from this large cohort did not identify an increased risk of GDM associated with receipt of a COVID-19 vaccine prior to 22 weeks’ gestation. These results further support emerging evidence regarding the safety of COVID-19 vaccination in pregnancy.

Disclosure

K.K.Vesco: Research Support; Pfizer Inc. L.Jackson: None. J.Williams: None. T.G.Boyce: None. C.Fuller: Research Support; Pfizer Inc., Johnson & Johnson. G.Vazquez benitez: Research Support; AbbVie Inc., Sanofi. A.Denoble: None. H.S.Lipkind: Other Relationship; Pfizer Inc., Research Support; Centers for Disease Control and Prevention, Patient-Centered Outcomes Research Institute, National Institutes of Health. E.Kharbanda: None. M.B.Desilva: None. M.F.Daley: None. D.Getahun: None. O.Zerbo: None. A.Naleway: None.

Funding

Centers for Disease Control and Prevention (200-2012-53526)
1185-P: Maternal Exposure to Per- and Polyfluoroalkyl Substances and Risk of Adiposity in Offspring at Birth and Early Childhood—A Longitudinal Birth Cohort Study
Authors: YANG AIMIN , TAM CLAUDIA H. , OZAKI RISA , LOWE WILLIAM L. , METZGER BOYD E. , TAM WING H. , WONG CHRIS K. , MA RONALD C.
Published: June 2023

Introduction: Per- and polyfluoroalkyl substances (FPAS) are a class of man-made chemicals that cross the placenta. We examined the associations of maternal exposure to PFAS mixture with risk of adiposity in offspring at birth and childhood.

Methods: In the perspective Hyperglycaemia-and-Adverse-Pregnancy-Outcome (HAPO) study, we measured serum concentrations of six PFAS biomarkers using high-performance LC-MS-MS in 1601 mothers who had joined the Hong Kong centre in 2002-2004 and 922 children at seven years old. We estimated PFAS burden score for each mother and child using concentrations of individual PFAS and exposure patterns of PFAS mixture. Adiposity in the offspring was defined by the ponderal-index (PI) at birth and sum-of-skinfold-thickness in mm at birth and childhood. We used linear regression to estimate associations of maternal exposure to PFAS mixture with adiposity risk.

Results: PFAS burden score in pregnancy was positively associated with PI (β=0.50, 95% CI: 0.02, 0.97) and negatively associated with skinfold thickness (β=-0.61, 95% CI: -0.96, -0.27) in offspring at birth. The correlation of PFAS burden score in mothers and children at seven years old was weak (r=0.07). After adjusting for PFAS burden score of childhood, maternal PFAS burden score was negatively associated with skinfold-thickness in childhood (β=-2.29, 95% CI: -3.97, -0.62). Sex-specific analyses showed similar associations with PI in boys and girls at birth. In contrast, significant negative associations with skinfold thickness were observed in girls but not in boys at childhood.

Conclusions: Maternal exposure to PFAS mixture is independently associated with risk of adiposity in offspring at birth. Its effect on childhood adiposity was apparent only in girls, not boys.

Disclosure

A.Yang: None. C.H.Tam: None. R.Ozaki: None. W.L.Lowe: None. B.E.Metzger: None. W.H.Tam: None. C.K.Wong: None. R.C.Ma: Advisory Panel; AstraZeneca, Merck & Co., Inc., Other Relationship; Bayer Inc., Boehringer-Ingelheim, Research Support; Tricida, Inc., Roche Diagnostics, Novo Nordisk.

Funding

Health and Medical Research Fund (13140761); Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institute of Diabetes and Digestive and Kidney Diseases (R01HD34242, R01HD34243); Research Grants Council of Hong Kong (473408, 471713)
1187-P: Early Pregnancy Hyperglycemia and Glycemic Status at 24–28 Weeks in Indian Women
Authors: HANNAH WESLEY , DEEPA MOHAN , SHIVASHRI CHOCKALINGAM , SAITE HEMAVATHY , RAM UMA , MOHAN ANJANA RANJIT , GHEBREMICHAEL-WELDESELASSIE YONAS , SARAVANAN PONNUSAMY , MOHAN VISWANATHAN
Published: June 2023

Introduction: Early pregnancy hyperglycemia threshold (FPG ≥92mg/dl (≥5.1mmol/l)) suggested by International Association of Diabetes and Pregnancy Study Groups (IADPSG) is debateable. There is no evidence of their glycemic status at 24-28 weeks in Indians.

Aim: To understand the 24-28 weeks glycemic status in women with early pregnancy hyperglycemia.

Methods: STratification of Risk of Diabetes in Early pregnancy (STRiDE) study, designed to identify the role of HbA1c in early pregnancy on incident GDM, recruited 2703 pregnant women from 7 centres in south India and 566 (20.9%) women had early pregnancy hyperglycemia. Of these 477 women underwent 24-28 weeks screening (OGTT n=150, FPG n=327)

Results: Abnormal glucose values were present in 32.7% of women at 24-28 weeks (high FPG or GDM by OGTT). These women had higher weight, BMI, waist circumference, family history of diabetes, FPG, and HbA1c at booking compared to women who were normoglycaemic. In multiple regression analysis, early pregnancy FPG ≥95mg/dl (5.3mmol/l) was independently associated with abnormal glucose values at 24-28 weeks (aOR: 1.9; 95% CI: 1.3-3.0, p <0.001), adjusted for key covariates.

Conclusion: Majority of women who had early pregnancy hyperglycaemia became normoglycaemic at 24-28 weeks. HAPO study FPG threshold for the adverse outcomes with aOR: 2.0 was ≥95mg/dl. It may be prudent to classify Indian women with this threshold in early pregnancy as abnormal.

Disclosure

W.Hannah: None. M.Deepa: None. C.Shivashri: None. H.Saite: None. U.Ram: None. R.Anjana: None. Y.Ghebremichael-weldeselassie: None. P.Saravanan: Other Relationship; Novo Nordisk, Research Support; Novo Nordisk, Amgen Inc., Abbott. V.Mohan: None.

Funding

Medical Research Council, UK (MR/N006232/1)
1189-P: The Project Wellness Pilot Feasibility Randomized Controlled Trial, a Behavioral Physical Activity Intervention for Gestational Glucose Intolerance and Gestational Diabetes
Authors: EHRLICH SAMANTHA F. , RAND BETHANY G. , ZITE NIKKI , FORTNER KIMBERLY B. , PAUDEL ALISSA M. , CROUTER SCOTT E. , MAPLES JILL M.
Published: June 2023

Introduction: Animal evidence suggests that maternal exercise improves metabolic health in the offspring. The offspring of individuals with gestational glucose intolerance (GGI) or gestational diabetes mellitus (GDM) are at increased risk for large for gestational age, shoulder dystocia, obesity, and diabetes. Maternal physical activity (PA) is indicated for these pregnancies, though PA levels tend to be suboptimal and decline over pregnancy. This pilot feasibility randomized controlled trial explored the effects of a behavioral counseling intervention on late pregnancy maternal PA and neonatal anthropometrics.

Methods: Twenty individuals with GGI or GDM were enrolled. Those randomized to the behavioral PA intervention met weekly with a lifestyle coach via Zoom for at least 5 sessions (10-20 minutes per session). Participants completed surveys and wore ActiGraph CentrePoint PA monitoring devices on their dominant wrist for a 7-day period, at both baseline and follow-up. The TwoRegressions algorithm estimated minute by minute metabolic equivalents of task (METs) for periods in which the devices were worn, and minutes per day at ≥ 3.0 METs, indicative of moderate to vigorous intensity PA (MVPA), were totaled. Neonatal measurements (n = 17) occurred within 3 days of birth.

Results: Those in the PA intervention decreased MVPA less than controls [i.e., -4.0 minutes per day (95% CI -14.5, 6.5) vs. -23.5 minutes per day (95% CI -34.9, -12.1), P = .02]. Neonates born to those in the PA intervention were smaller than control neonates, however no difference attained statistical significance (e.g., weight, neonatal fat mass, total skinfolds). There was the suggestion of significant effect on subscapular skinfold (P = .07).

Conclusion: A behavioral PA counseling intervention mitigated late pregnancy declines in PA in GGI or GDM, and could reduce upper-trunk adiposity in their neonates.

Disclosure

S.F.Ehrlich: None. B.G.Rand: None. N.Zite: Other Relationship; Merck & Co., Inc. K.B.Fortner: Other Relationship; Pfizer Inc. A.M.Paudel: None. S.E.Crouter: None. J.M.Maples: None.

Funding

National Institutes of Health (K01DK105106)
119-LB: Preliminary Accuracy Analysis of a Noninvasive Optical Glucose Sensing Prototype
Authors: GEISER LUKE , MAN COLMAN LEUNG HO , BERGET CARI , GONG CHENGYUE , LIU QIANG , ZHOU XIA , FORLENZA GREGORY P.
Published: June 2023

Background: As the use of CGM in type 1 Diabetes (T1D) becomes more prevalent, it is important to develop less invasive technologies to improve diabetes health outcomes and reduce burden. Optical glucose sensing (OGS) offers a non-invasive option to measure sub-dermal glucose levels by shining a laser beam of light onto the skin. The aim of this study was to gather preliminary data on the accuracy of OGS technology using a prototype device.

Methods: Eighteen adults with T1D (32 ± 11yrs.; 83% white, 17% Latinx) using Dexcom G6 or Libre CGM used an OGS prototype device for 5 days, scanning the palm of their hand up to eight times per day to measure glucose levels. Paired CGM values obtained from Clarity or Libreview CSV files were used for comparison. Outliers due to user-error were removed by leave-one-out cross-validation (20% of values).

Results: Paired CGM and OGS values (n=599) resulted in a MARD of 19% ±13% with 99% of values within the Clarke Error Grid A&B Zones (Figure 1). The % within 15/15, 20/20, or 30/30 were 44%, 59%, and 80%, respectively.

Discussion: OGS may be a promising, non-invasive alternative to current CGM devices on the market. Further research and development of the sensing algorithm is needed to lower the MARD closer to current factory calibrated CGMs. In addition, increased recruitment of people with diabetes who have darker skin tones is needed to evaluate accuracy across all populations.

Disclosure

L. Geiser: None. H. Leung: None. C. Berget: Consultant; Insulet Corporation, Dexcom, Inc. Other Relationship; Tandem Diabetes Care, Inc. C. Gong: None. Q. Liu: None. X. Zhou: None. G. P. Forlenza: Advisory Panel; Medtronic. Research Support; Medtronic, Abbott. Consultant; Dexcom, Inc. Research Support; Dexcom, Inc. Consultant; Insulet Corporation. Research Support; Insulet Corporation. Consultant; Tandem Diabetes Care, Inc. Research Support; Tandem Diabetes Care, Inc. Consultant; Lilly Diabetes.

Funding

National Science Foundation (ECCS-2037267)
1190-P: Dose-Dependency of Prevention of Cesarean Section and Macrosomia by Glycemic Control—A Meta-analysis
Authors: KODAMA SATORU , YAGYUDA NORIKO , YAMADA TAKAHO , NISHIJIMA KOJI , YOSHIHARA KOSUKE , FUJIHARA KAZUYA , YACHI YOKO , IWANAGA MIDORI , KATO KIMINORI , SONE HIROHITO
Published: June 2023

Observational studies have shown an association of poor glycemic control (GC) with various adverse pregnancy outcomes in patients with diabetes mellitus. To examine whether improving GC reduces risk of maternal/fetal complications, we did a meta-analysis of the quantitative relationship between reductions in glucose levels and individual complication risks. MEDLINE and EMBASE were used to identify randomized controlled trials of the effect of intensified glucose management (i.e., glucose monitoring and/or strict glycemic goals, additional glucose-lowering drugs) on both antepartum glucose levels and incidence of any maternal/fetal complication. Fifty-two eligible trials were retrieved from 2724 articles published until Aug.31, 2022. Focusing on cesarean section (CS) and macrosomia (including large for gestational age if data were unavailable), which are frequent complications, meta-regression analyses indicated that a 1% reduction in HbA1c resulted in a 45% reduction in CS (r=0.59, p=0.002) and a 72% reduction in macrosomia (r=0.43, p=0.005). The intercept (i.e., relative risk at 0 of HbA1c reduction) was almost 1 (1.05 (p=0.46) for CS; 1.02 (p=0.89) for macrosomia) (Figure). In trials of patients with only gestational diabetes, results were unchanged. We conclude that preventing CS and macrosomia depended on the extent to which antenatal cares improved GC.

Disclosure

S.Kodama: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. N.Yagyuda: None. T.Yamada: None. K.Nishijima: None. K.Yoshihara: None. K.Fujihara: None. Y.Yachi: None. M.Iwanaga: None. K.Kato: None.
1191-P: GDM in Twin Pregnancies—Maternal Characteristics and Pregnancy Outcomes
Authors: DAS DEVIKA M. , VELLA ADRIAN , EGAN AOIFE M.
Published: June 2023

The incidence of both gestational diabetes mellitus (GDM) and twin pregnancies have increased over the past two decades. While the same GDM diagnostic criteria and treatment targets are used for singleton and twin pregnancies, data on outcomes for twin pregnancies with GDM are limited. The aim of this retrospective cohort study is to present comprehensive data on maternal characteristics and pregnancy outcomes for individuals with a twin pregnancy who were diagnosed with GDM and attended our center for prenatal care from 2002-22. In total 185 individuals were identified with a mean age of 32 (± 5) years and a mean prepregnancy body mass index of 31.3 (± 7) kg/m2. The majority were dichorionic diamniotic (n=146, 79%), 32 (17%) had a prior diagnosis of GDM and 63 (34%) had prepregnancy fertility treatment. Women underwent universal screening with a 50g glucose challenge test (normal <140mg/dL) and Carpenter and Coustan Criteria were used to diagnose GDM. Pharmacological therapy was required to treat GDM in 68 (37%) cases. Hypertensive disorders of pregnancy were common (n=55, 30%), as was Cesarean delivery (n= 133, 72%). Assessment of pregnancy outcomes (n=370) revealed 360 (97%) livebirths, 8 (2%) stillbirths and 2 (0.6%) neonatal deaths. Among livebirths and neonatal deaths, premature delivery < 37 weeks was recorded in 225 (62.2%) and <34 weeks in 57 (15.7%). Neonatal macrosomia (birthweight >4.0kg) was rare (n=4, 1%), but low birthweight (<2.5kg) occurred in 168 (46%). Neonatal hypoglycemia was documented in 89 (25%) infants. Maternal attendance at the postpartum glucose tolerance test was low (n=47, 25.5%) individuals, and 38 had a subsequent pregnancy with GDM diagnosed in 18 (47%). In summary, the standard GDM diagnostic criteria applied to twin pregnancies identify a maternal cohort at high risk of pregnancy complications and future GDM. Future work should address the optimal nutritional and glycemic goals for this population, particularly considering the high risk of low birthweight and premature neonates.

Disclosure

D.M.Das: None. A.Vella: Advisory Panel; Rezolute, Inc., Consultant; Crinetics Pharmaceuticals, Inc., Hanmi Pharm. Co., Ltd., Zealand Pharma A/S, Other Relationship; Novo Nordisk. A.M.Egan: None.

Funding

National Institutes of Health (DK092721, HD065987)
1192-P: Risk Factors Associated with Preeclampsia in Pregnant Patients with Diabetes
Authors: BRADY MATTHEW , CARTER EBONY B. , PAUL RACHEL , RAGHURAMAN NANDINI , GARR BARRY VALENE , ZHANG FAN , KELLY JEANNIE
Published: June 2023

To determine risk factors associated with pre-eclampsia (PreE) among pregnant patients with diabetes. We performed a case-control study of PreE among pregnant patients with pre-existing and gestational diabetes at a tertiary referral center from 2007-2017. Inclusion criteria were age ≥18 years and English speaking. Lethal anomalies, delivery <23 weeks, and multiple gestations were excluded. Clinical characteristics including advanced maternal age (AMA) ≥35 years old, chronic hypertension (CHTN), diabetes type, insulin use, and HbA1c ≥ 6.5% at any point during pregnancy were compared between groups using univariate regression. A multivariable logistic regression model was used to adjust for potential confounders, including AMA and obesity (BMI ≥30 kg/m2). A total of 503 patients met study criteria: 40 (8.0%) with type 1 DM, 200 (39.8%) with type 2 DM, and 263 (52.3%) with GDM. PreE was diagnosed in 102 (20.3%) patients in the sample. Demographics were similar except patients with PreE were older and more likely to be obese than those without PreE. Compared to patients with diabetes who did not have preE, those with preE were significantly more likely to have type 2 DM (64.7% PreE vs. 33.4% no PreE; aOR 6.78; 95% CI 3.08-14.94), CHTN (60.8% PreE vs. 24.9% no PreE; aOR 7.74; 95% CI 3.63-16.50), insulin use (76.5% PreE vs. 57.5% no PreE; aOR 3.70; 95% CI 1.63-8.42), and HbA1c≥6.5% (PreE 61.8% vs. no PreE 38.2%; aOR 4.49; 95% CI 2.18-9.26). Those with PreE were less likely to have GDM (27.5% PreE vs. 58.6% no PreE; aOR 0.19; 95% CI 0.09-0.41). There was no difference among patients with AMA or type 1 DM. Patients with PreE are more likely to have pregestational diabetes, co-existing CHTN and have worse glycemic control. This finding underscores the importance of glycemic control as a potentially protective factor against PreE.

Disclosure

M.Brady: None. E.B.Carter: None. R.Paul: None. N.Raghuraman: Other Relationship; HCFocus. V.Garr barry: None. F.Zhang: None. J.Kelly: None.

Funding

American Diabetes Association (1-19-ACE-02 to E.B.C.)
1196-P: Offspring Being Overweight and Born Preterm Are More Common in Women Treated with Insulin Pump Compared with Multiple Daily Injections—A Large Prospective Cohort Study
Authors: THORIUS IDA H. , HUSEMOEN LISE LOTTE N. , BAASTRUP NORDSBORG RIKKE , CIRIC ALIBEGOVIC AMRA , GALL MARI-ANNE , DAMM PETER , PETERSEN JANNE , MATHIESEN ELISABETH R.
Published: June 2023

Aims: Investigate glycemic control and risk of perinatal complications in women with type 1 diabetes (T1D) treated with insulin pump vs. multiple daily injections (MDI) during pregnancy.

Methods: A secondary analysis of a prospective cohort of 2003 pregnant women. Odds ratios (OR) were estimated by logistic regression in crude and adjusted models for potential confounders.

Results: In total, 723 women were treated with pump and 1280 were treated with MDI. At baseline (gestational weeks 8.6 (IQR: 7-10)) pump users had significant lower mean HbA1c (51.0 (10.2) mmol/mol (6.8 (0.9) %) vs. 54.2 (14.5) mmol/mol (7.1 (1.3) %), P < 0.001), longer diabetes duration (mean (SD) 18.3 (7.8) vs. 14.5 (8.3) years, p < 0.001) and higher prevalence of retinopathy (35.5% vs. 24.8%, p < 0.001). HbA1c in late pregnancy was similar (46.2 (9.4) mmol/mol (6.4 (0.9) %) vs. 46.4 (10.8) mmol/mol (6.4 (1.0) %), P=0.7458). Proportion of offspring being large for gestational age (LGA) was 59.0% (pump) vs. 52.2% (MDI) (adjusted OR 1.33 [95%CI 1.07;1.65], P=0.009) and born preterm 39.6% vs. 32.1% (adjusted OR 1.52 [95%CI 1.23;1.87], P=0.0001) (Table). No statistically significant difference was observed for other endpoints.

Conclusion: Insulin pump treatment in pregnant women with T1D was associated with higher risk of LGA offspring and preterm delivery compared with MDI.

Disclosure

I.H.Thorius: Employee; Novo Nordisk A/S. L.N.Husemoen: Employee; Novo Nordisk A/S, Stock/Shareholder; Novo Nordisk A/S. R.Baastrup nordsborg: Employee; Novo Nordisk A/S, Stock/Shareholder; Novo Nordisk A/S. A.Alibegovic: Employee; Novo Nordisk A/S, Stock/Shareholder; Novo Nordisk A/S. M.Gall: Employee; Novo Nordisk A/S. P.Damm: Other Relationship; Novo Nordisk A/S. J.Petersen: Research Support; Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Vertex Pharmaceuticals Incorporated, Gilead Sciences, Inc. E.R.Mathiesen: Advisory Panel; Novo Nordisk, Research Support; Novo Nordisk, Speaker's Bureau; Novo Nordisk.
1207-P: Gestational Diabetes Mellitus (GDM)—Outcomes for Normal-Weight Individuals
Authors: MOAZZAMI MITRA , VENKATESAN NANDITHA , SANKARAN RAJAGOPALAN KAMALNATH , VELLA ADRIAN , EGAN AOIFE M.
Published: June 2023

Excess body weight is associated with GDM, and BMI ≥ 25kg/m2 is often used as a criterion in risk factor-based screening programs. However, individuals with a normal BMI account for a significant proportion of those diagnosed with GDM (20-60% depending on the population studied), and comparative clinical outcome data are limited. Our aim was to assess pregnancy outcomes for people with GDM and a baseline BMI < 25kg/m2, compared to a reference group with GDM and a BMI of 25-30kg/m2. Included subjects attended our institution for prenatal care from 2018-22 and GDM was diagnosed using universal screening and Carpenter and Coustan criteria. We identified 524 individuals with a BMI < 25kg/m2 and 705 with a BMI 25-30kg/m2. Those with a BMI <25 kg/m2 were younger (22 v 28 years, p<0.001), and a higher proportion identified as Asian (15.5% v 9.22%; p=0.04). Table 1 contains pregnancy outcomes. Those with a BMI <25kg/m2 were less likely to receive pharmacological GDM therapy, but their infants had a higher rate of neonatal ICU admission. Postpartum, those with a BMI <25kg/m2 were less likely to have an oral glucose tolerance test but were at similar risk of glucose intolerance. These findings suggest that normal weight women with GDM may experience higher risk of adverse outcomes compared to their overweight counterparts. These data support universal screening and will be used to inform patients on their risk profile and improve postpartum screening.

Disclosure

M.Moazzami: None. N.Venkatesan: None. K.Sankaran rajagopalan: None. A.Vella: Advisory Panel; Rezolute, Inc., Consultant; Crinetics Pharmaceuticals, Inc., Hanmi Pharm. Co., Ltd., Zealand Pharma A/S, Other Relationship; Novo Nordisk. A.M.Egan: None.

Funding

National Institutes of Health (DK092721, HD065987)
1208-P: Modifiable Risk Factors during Pregnancy in Pregestational Diabetes—A 12-Year Analysis
Authors: RHOU YOON JI J. , WAH CHEUNG N. , PADMANABHAN SUJA
Published: June 2023

Aim: Pregestational diabetes is associated with adverse outcomes. Preconception care is beneficial but unplanned pregnancy is common. We aimed to determine predictors of outcomes and factors modifiable during pregnancy in women with pregestational diabetes.

Methods: Retrospective analysis of pregnancies complicated by pregestational diabetes at a tertiary center from 2010–2022. Baseline characteristics, longitudinal glycemic, weight and microvascular complication assessment per trimester, and outcomes were collected and binary logistic regression performed.

Results: Of 445 pregnancies, 116 (25%) had type 1 diabetes. Mean age was 32.6 ± 5.8 years with prepregnancy BMI 30.0 ± 7.0 kg/m2. The cohort was diverse with 315 (71%) of non-Caucasian ethnicity and 141 (32%) in the most disadvantaged socioeconomic quintile. Planned pregnancy comprised 147 (43%). Women with type 1 compared to type 2 diabetes had increased preeclampsia (28 [26%] vs 48 [15%], p=0.02), preterm (46 [39%] vs 66 [20%], p<0.001), large for gestational age (LGA) (57 [49%] vs 82 [25%], p<0.001), neonatal hypoglycemia (53 [46%] vs 117 [37%], p=0.047), respiratory distress (47 [42%] vs 65 [20%], p<0.001) and neonatal intensive care admission (NICU) (48 [41%] vs 84 [26%], p=0.003). Small for gestational age was more common in type 2 diabetes (5 [4%] vs 32 [10%], p=0.045). Adjusting for diabetes type and baseline features, HbA1c>6.5% in 1st and >6% in 2nd and 3rd trimesters and >15% insulin decrease in 3rd trimester were associated with preeclampsia, 3rd trimester HbA1c>6% an independent predictor (OR 4.7) irrespective of 1st trimester HbA1c. Excessive gestational weight gain (GWG) (OR 3.4) and 3rd trimester HbA1c>6% (OR 3.6), irrespective of 1st trimester HbA1c, were independent predictors of LGA. Third trimester HbA1c>6% was associated with NICU (OR 3.7). Conclusion: Type 1 and 2 diabetes have distinct risk profiles for adverse outcomes. Early and late pregnancy glycemic control and GWG are modifiable targets during pregnancy.

Disclosure

Y.J.Rhou: None. N.Cheung: None. S.Padmanabhan: None.
121-LB: Effect of Using the mySugr App on Glycemic Control in T1D patients—A Real-World Analysis from Mexico
Authors: VULCANO CRISTINA , MIKULSKI HEATHER , MITTER MICHAEL , RUCH BERNHARD
Published: June 2023

Objectives: Describe Mexican patients with T1DM and find out if blood glucose (BG) testing frequency impacts glycemic targets (mean BG & estimated HbA1c [eHbA1c]).

Methods: Included mySugr users with a self-reported diagnosis of T1DM and had at least 2 BG logs in at least 14 days (G2D14) in the month prior to their first log entry. G2D14 is the lowest adherence needed to calculate eHbA1c. Users were stratified as low (G2D14 + G3D14) and high testing (G4D14 + G5D14). Subgroup analysis according to baseline eHbA1c was performed. Using a logistic regression model, an exploratory analysis to identify factors associated with BG decrease was also considered.

Results: 118,210 users (13% T1DM) were considered. Users in the highest testing subgroup (G5D14; n=276) in the first month before mySugr usage had a significantly lower baseline eHbA1c (-0.8 %; p < 0.01) compared with users in the lowest category (G2D14; n=254). For all users in the group G2D14 or above, eHbA1c decreased from baseline (1 mo. prior to mySugr usage) and stayed below baseline levels for the entire period of 5 mo. (n=253; mean differences: -0.3% at the first month of mySugr usage, -0.2% at the fourth month of mySugr usage; both changes significantly different from 0 with p < 0.05). No statistically significant difference in eHbA1c between the logging subgroups after 4 months of mySugr use was found. Nevertheless, high logging users with baseline eHbA1c > 8% had a non-significant higher reduction. In the logistic regression model, the factor with the strongest association with BG decrease was the baseline mean BG (log OR: 2.4).

Conclusion: in our RwD setting, the use of mySugr was associated with reduced eHbA1c. Baseline BG was statistically associated with BG reduction intensity. Although no significant difference in eHbA1c improvement between the high and low logging groups was found during mySugr usage, the baseline analysis suggests that users with increased logging had significantly better glycemic control before starting mySugr.

Disclosure

C. Vulcano: Employee; Roche Diabetes Care. H. Mikulski: Employee; Roche Diabetes Care. M. Mitter: Employee; Roche Diabetes Care. B. Ruch: Employee; Roche Diabetes Care.
1210-P: Associations of Community-Level Social Determinants of Health and Hypertensive Disorders of Pregnancy
Authors: CAROLINE BANK TRACY , GROBMAN WILLIAM , WU JIQIANG , LYNCH COURTNEY , VENKATESH KARTIK K.
Published: June 2023

Objective: To determine whether community-level social determinants of health are associated with hypertensive disorders of pregnancy (HDP).

Methods: This is a secondary analysis from the prospective Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be. We evaluated three community-level exposures using home addresses geocoded at the census-tract level: 1) socioeconomic disadvantage by the 2015 Area Deprivation Index (ADI); 2) food insecurity by the USDA Food Access Research Atlas; and 3) less walkability by the EPA National Walkability Score. The outcome was new onset HDP. Poisson regression was used to estimate adjusted relative risks (aRR).

Results: Of 9,062 individuals, 33.6% were in the highest tertile of ADI, 24.5% lived with food insecurity, and 66.3% lived in a less walkable neighborhood. 13.0% were diagnosed with HDP. Individuals living in a community with higher socioeconomic disadvantage, (aRR T2: 1.26; 95% CI: 1.10, 1.44; and T3: 1.19; 95% CI: 1.02, 1.38), food insecurity (aRR: 1.15; 95% CI: 1.02, 1.29), and less walkability (aRR: 1.21; 95 CI: 1.07, 1.36) were at higher risk of developing HDP compared with those who did not.

Conclusions: Community-level social determinants of health, including socioeconomic disadvantage, food insecurity, and low walkability, were associated with increased risk of HDP among nulliparous individuals.

Disclosure

T.Bank: None. W.Grobman: None. J.Wu: None. C.Lynch: None. K.K.Venkatesh: None.
1221-P: Hypoglycemia in Nursing Home Residents Often Co-occurs with Hyperglycemia
Authors: LEE ALEXANDRA K. , SHI YING , LEE SEI J.
Published: June 2023

During the transitional period following admission to a nursing home (NH), the primary diabetes management goal is to avoid hypoglycemia and hyperglycemia. However, the frequency and severity of hypo- and hyper-glycemic episodes in this population are unclear. Using the Veterans Affairs NH electronic health records, we examined Veterans aged ≥65 years with diabetes, insulin use, and a NH stay ≥7 days from 1 Jan 2016 to 30 Sept 2019. From fingerstick glucose values from Days 1 through 7, we calculated the proportion of Veterans with Level 1 (<70mg/dL) and Level 2 (<54mg/dL) hypoglycemia and with hyperglycemia ≥250mg/dL (recommended upper limit for NH residents) and severe hyperglycemia ≥400mg/dL. Of 12,031 Veterans, mean age was 74.4, 98% were male, 17% were Black and 77% were White. During Days 1-7 of NH stay, the majority (51%) had only hyperglycemia >250mg/dL. Almost one-third (30%) had neither hypo- nor hyper-glycemia, 6% had only hypoglycemia <70mg/dL, and 13% had both hypo- and hyper-glycemia. Among Veterans with Level 1 hypoglycemia, over two-thirds also had hyperglycemia >250mg/dL, and only one-third had Level 2 hypoglycemia. Of Veterans with hyperglycemia ≥250mg/dL, only 16% had hyperglycemia ≥400mg/dL. In conclusion, most hypoglycemia in NH residents using insulin is mild (54-69mg/dL) and often co-occurs with hyperglycemia ≥250mg/dL, suggesting any deintensification in response to hypoglycemia should be coupled with monitoring for worsening hyperglycemia. Future research is needed to determine whether hypoglycemia 54-70mg/dL or hyperglycemia 250-400mg/dL is associated with adverse outcomes in NH residents.

Disclosure

A.K.Lee: Other Relationship; GRAIL (acquired by Illumina in 2021). Y.Shi: None. S.J.Lee: None.

Funding

National Institutes of Health
1222-P: An Examination of Frailty as Measured via Deficit Accumulation in African American Adults with Diabetes and Prediabetes
Authors: SIMPSON FELICIA , BERTONI ALAIN
Published: June 2023

Type 2 diabetes increases the accumulation of health deficits and has been described to be connected to accelerated biological aging. We utilized a frailty index (FI) in African Americans with prediabetes and diabetes modeled after the deficit accumulation index approach used in the Action for Health in Diabetes (Look AHEAD) Trial. This metric of frailty is comprised of 32 functional, behavioral, and clinical characteristics using the Jackson Heart Study (JHS) public access dataset. JSH is a large, community-based, observational study investigating the causes of cardiovascular disease (CVD) in 5301 African-Americans from Jackson, MS. Our study included 1339 adults aged 40-84 with prediabetes and diabetes who had over 12 years of follow-up for incident CVD events. Obese individuals, older individuals, those with poorer diabetes control, and hypertension had significantly higher mean FI scores than those without these characteristics. Approximately 34% of this sample was frail and 66% not frail. Compared with non-frail participants, stroke, heart failure, and coronary heart disease incidence of frail participants were increased. Frailty was an independent predictor of 12-year stroke (adjusted hazard ratio (HR): 6.84; 95% confidence interval (CI): 3.09 to 15.12), heart failure (adjusted HR: 3.00; 95% CI: 1.77 to 5.09), and coronary heart disease (adjusted HR: 2.48; 95% CI: 1.44 to 4.15) after adjusting for age and gender. Frailty is prevalent among African Americans with diabetes and prediabetes and is a predictor cardiovascular outcome. Frail adults with diabetics have an even higher risk of CVD, compared to non-frail adults with diabetes.

Disclosure

F.Simpson: None. A.Bertoni: None.
1224-P: Glucagon Secretion Increases with Age in People with Type 2 Diabetes
Authors: KANEKO SHIZUKA , MOTOHASHI KAZUYA , UEBA YOKO , TOKUMOTO SHINSUKE
Published: June 2023

It has been shown that the decline in the number of pancreatic beta cells and the insulin-secreting capacity of individual pancreatic beta cells progressively decreases with age, and this functional decline is accelerated by the addition of hyperglycemia. While, glucagon (GCG) is elevated in diabetes, and elevated GCG not only increases blood glucose levels (GLUs), but also decreases muscle mass due to protein metabolism leading to decrease in muscle glucose uptake, making blood glucose control more difficult. However, there are no reports yet regarding to age-related changes in GCG secretion. In this study, we analyze the age-related changes in GCG secretion in people with type 2 diabetes (T2D) after insulin treatment to remove glucose toxicity. A retrospective analysis was performed on people with T2D hospitalized for a period of 5 years from December 2017 in whom a test meal load (carbohydrate 75.5-70g, protein 8.5g, fat 28.5g) was performed before and after insulin treatment, and GLUs and GCG were measured. Insulin (IRI) and/or C-peptide (CPR) were also measured. A total of 121 patients (70 males, age 64.2 ± 11.6 years) were included in the analysis. After insulin treatment, GCG secretion was almost all lower than before treatment. GCG secretion increased with age (P=0.014). Insulinogenic Index decreased with age (R=-0.286 P=0.004), and IRI/GLU and CPR/GLU at 120 minutes after the test meal load also decreased with age (R=-0.314 P=0.001, R=-0.324 P=0.001). We confirmed that there is an increase in GCG secretion with aging in people with T2D. This might be one of the reasons for the decrease in muscle mass and physical activity in elderly people with T2D. Further studies are needed to expand the number including people with normal glucose and impaired glucose tolerance. Acknowledgments:The Cookie Testing Study Group provided support.

Disclosure

S.Kaneko: Advisory Panel; Lilly Diabetes, Speaker's Bureau; AstraZeneca, Novo Nordisk, Sumitomo Dainippon Pharma Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Lilly Diabetes, Bayer Inc., Kowa Company, Ltd., Kyowa Kirin Co., Ltd. K.Motohashi: None. Y.Ueba: None. S.Tokumoto: None.

Funding

Cookie Testing Study Group