bluuebunny/crossref_metadata_2025 huggingface dataset:
Dietary Education via Teacher–Diabetologist Cooperation
Authors: KANEKO SHIZUKA , ONOGI YUMI , MICHIBATA RYOKO
Published: June 2018

A workforce shortage due to a never before experienced super aged society is coming to Japan. At present, the major producers of society (40-year-olds) are suffering from an increasing incidence of diabetes. Dietary education to S is most important in helping the future labor force develop precautions against life-related diseases before entering the labor force. Student lessons focusing on sugar totals, how to calculate sugar amounts included in beverages, in addition to information on diabetic complications were provided. Problems that occur following severely reduced food intake were also covered. A D provided dietary education to 1100 junior high and high school S on disease development for 3 years in 3 schools. Surveys show, prior to lectures, over 60% of S were aware of health considerations. However, the decision to eat breakfast was not based on the S’ decision. Some breakfast content was inappropriate due to incomplete knowledge. 50%+ were aware of a health to diet link. Of most interest to S was the amount of sugar contained in sugary drinks. After, many refrained from ingestion of these. Surveys found S who had the lesson twice developed their own decision-making ability. 93.7% of S appreciated the knowledge and were pleased to receive knowledge about food intake before suffering disease. They understood why parents said not to take a lot of sugar. 50.1% reviewed food habits, and 82.4% were willing to improve dietary habits. Some students realized they must take personal responsibility for health. 19.3% indicated sharing, or were willing to share, this knowledge with others. Some S asked D to advise other S. It is important after receiving education and tracing from Ds that T become the primary interface with S in the passing on of dietary knowledge and advice. T can more consistently pass on this knowledge on an ongoing basis with a view to putting using the knowledge themselves to personal practical use, and then transferring the skills to future generations. D: diabetologist, T: teachers. S: students. This is a follow-up report.

Disclosure

S. Kaneko: Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Novo Nordisk A/S, Eli Lilly and Company, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma K.K., Sanwa Kagaku Kenkyusho Co., Ltd.. Other Relationship; Self; Elsevier. Speaker's Bureau; Self; Kowa Pharmaceuticals America, Inc., Ono Pharmaceutical Co., Ltd., Astellas Pharma US, Inc., Sanofi, Nippon Boehringer Ingelheim Co. Ltd., AstraZeneca, Sumitomo Dainippon Pharma Co., Ltd.. Speaker's Bureau; Spouse/Partner; Sumitomo Dainippon Pharma Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Otsuka Holdings Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Biogen, Eisai Co., Ltd., Bayer AG, Novartis Pharma K.K., Ono Pharmaceutical Co., Ltd., Nihon Pharmaceutical Co., Ltd., Fujimoto Pharmaceutical Corporation. Y. Onogi: None. R. Michibata: None.
Effects of the Novel Dual GLP-1R/GCGR Agonist SAR425899 on Postprandial Glucose Metabolism in Overweight/Obese Subjects with Type 2 Diabetes
Authors: GOEBEL BRITTA , SCHIAVON MICHELE , VISENTIN ROBERTO , RIZ MICHELA , MAN CHIARA DALLA , COBELLI CLAUDIO , KLABUNDE THOMAS
Published: June 2018

SAR425899 (SAR) is a novel dual glucagon-like peptide-1 receptor/glucagon receptor (GLP-1R/GCGR) agonist. A randomized, double-blind, phase I multiple-ascending-dose study (NCT02411825) in 27 overweight/obese subjects with type 2 diabetes receiving SAR demonstrated decreased body weight with a safety profile comparable with GLP-1R agonists. Here, we report additional analyses of the effect of SAR on key processes in glucose metabolism. Subjects were randomized to receive daily subcutaneous administrations of low-dose SAR (30, 60, 90 µg) or high-dose SAR (60, 120, 180 µg) for 28 days; dose escalation occurred after Days 7 and 14. Mixed meal tests were conducted before treatment (Day −1) and on Days 1 and 28. Oral glucose and C-peptide minimal models were used to quantify metabolic indices of glucose absorption, insulin sensitivity, and β-cell responsiveness. Percent change in area under the curve for rate of meal glucose appearance between 0 and 120 min from Day −1 to Day 28 was −14% and −19% with low- and high-dose SAR, respectively. Change in insulin sensitivity was 104% and 262%, respectively. Change in β-cell function was 127% and 145%, respectively (Table). After 28 days of treatment, SAR improved postprandial glucose control by significantly reducing glucose absorption rate, increasing insulin sensitivity, and enhancing β-cell function.

Disclosure

B. Goebel: Employee; Self; Sanofi. M. Schiavon: None. R. Visentin: None. M. Riz: Employee; Self; Sanofi-Aventis Deutschland GmbH. C. Dalla Man: None. C. Cobelli: Research Support; Self; Sanofi-Aventis. Advisory Panel; Self; Novo Nordisk Inc. T. Klabunde: Employee; Self; Sanofi.
Examining the Association between Treatment Satisfaction and Medication Adherence among Patients with Poorly Controlled Type 2 Diabetes
Authors: EMECHEBE NNADOZIE , AGU NGOZICHUKWUKA , MALMI MARKKU , ZGIBOR JANICE C.
Published: June 2018

Adherence to diabetes medications remains an important target for public health intervention, however, approximately 32% of people living with diabetes do not take their medications as they should. We examined the association between treatment satisfaction and medication adherence in people living with type 2 diabetes from the REdesigning MEDication Intensification Effectiveness Study for Diabetes (REMEDIES 4D) study. REMEDIES 4D was a clustered, randomized trial in which certified diabetes educators (CDEs) implemented standardized treatment protocols to intensify treatment for glucose, lipid or blood pressure control. Fifteen practices and their patients were randomized to the intervention or usual care. Eligible participants had uncontrolled HbA1c, blood pressure, or LDLc. The intervention group received diabetes self-management education in addition to treatment intensification, while the usual care group participated in monthly support groups for one year. Medication adherence and treatment satisfaction scores were measured using Morisky medication adherence scale and Medication satisfaction survey respectively. A mixed model was created to account for the cluster randomized design and included covariates for treatment status (intervention vs. usual care group), sociodemographic factors, depression, insulin use, count of comorbidities, polypharmacy, baseline clinical values, adherence score at baseline and treatment satisfaction scores 12 months post-baseline. There were 135 participants in the final study population (mean age of 60 years and 51% female). After controlling for covariates, treatment satisfaction was associated with an increase in adherence to diabetes medications (β=0.34, p=0.02). Ensuring patients with type 2 diabetes are satisfied with their treatment regimen may be a crucial step to improving adherence to diabetes medications.

Disclosure

N. Emechebe: None. N. Agu: None. M. Malmi: None. J.C. Zgibor: None.
Real-World Improvement in Above-Target Estimated A1c with Sequential Use of Professional Flash Continuous Glucose Monitoring for Individuals with Diabetes
Authors: BERGENSTAL RICHARD M. , DUNN TIMOTHY , XU YONGJIN , JANGAM SUJIT , HAYTER GARY
Published: June 2018

Professional flash continuous glucose monitoring using the FreeStyle Libre ProTM system is recently available in the U.S. This is one of the first real-world studies evaluating glucose metrics of sequential monitoring periods using a cross-sectional observational design. Between September 2016 and January 2018, de-identified data from 2,836 users having 2 sequential sensors (at least 5 days each) were divided by the 1st sensor above and below an estimated A1c (eA1c) of 7.5%. Glucose metrics for the two sensors were compared. For those starting above an eA1c of 7.5%, the eA1c reduced from 9.6% to 8.7% (-0.9%, p<0.001), and time in range (70-180 mg/dL) increased from 7.8 to 10.5 h/day (2.7 h/day, p<0.001). Time above 180 mg/dL decreased from 15.7 to 12.5 h/day (-3.2 h/day, p<0.001), while hypoglycemia below 70 mg/dL increased but stayed below 5.0% (29 to 59 minutes/day, 30.1 minutes/day change, p<0.001). For those at an eA1c of 7.5% or lower, eA1c increased but stayed in target (6.4% to 6.9%, 0.5% change, p<0.001), while time below 70 mg/dL reduced by 22%, from 115 to 91 minutes/day (-24.8 minutes/day, p<0.001). Professional glucose monitoring in clinical practice aids in the reduction of hyperglycemia and increased time in range while maintaining minimal hypoglycemia for those with average levels above target. Those with average levels in target benefit by reduced exposure to hypoglycemia.

Disclosure

R.M. Bergenstal: Research Support; Self; Johnson & Johnson Services, Inc.. Consultant; Self; Johnson & Johnson Services, Inc.. Research Support; Self; Abbott. Advisory Panel; Self; Abbott. Research Support; Self; Becton, Dickinson and Company. Consultant; Self; Becton, Dickinson and Company. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., AstraZeneca, Takeda Pharmaceuticals U.S.A., Inc., Dexcom, Inc.. Stock/Shareholder; Self; Merck & Co., Inc.. Research Support; Self; Eli Lilly and Company, Sanofi. Advisory Panel; Self; Sanofi, Roche Pharma. Research Support; Self; Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc.. Research Support; Self; Medtronic. Consultant; Self; Medtronic. Research Support; Self; Hygieia. Advisory Panel; Self; Hygieia, Glooko, Inc.. Research Support; Self; JAEB Center For Health Research, JDRF, National Institute of Diabetes and Digestive and Kidney Diseases. T. Dunn: Employee; Self; Abbott. Y. Xu: Employee; Self; Abbott. S. Jangam: Employee; Self; Abbott. G. Hayter: Employee; Self; Abbott.
Short-Term Aerobic and Interval Training Improves Muscle Mitochondrial Function and Reveals a New Role for an Old Protein
Authors: PARSONS STEPHANIE , PINO MARIA F. , HODGES ANDREW P. , YI FANCHAO , CARNERO ELVIS A. , PRATLEY RICHARD E. , SMITH STEVEN R. , SPARKS LAUREN M.
Published: June 2018

Exercise training has well-documented beneficial effects on skeletal muscle (muscle) mitochondrial function, which can be evaluated from clinical and molecular aspects within the same individual. We evaluated two cohorts at baseline: 1) lean/overweight sedentary (LOS) and 2) lean active (LA), and investigated the effects of three weeks of aerobic training in LOS subjects. All assessments were performed before (PRE) and following (POST) the intervention. In vivo muscle mitochondrial function was assessed by 31P-MRS (ATPmax). Muscle biopsies were performed in the vastus lateralis in the fasted state. Muscle tissue mitochondrial function was quantified via 14C-palmitate oxidation (14C-CO2) assays and high-resolution respirometry (Complex I, Complexes I+II, ETS). Transcriptomic profiles were examined by microarrays combined with in-depth bioinformatics analyses and validated via qRT-PCR. Fiber type and mitochondrial (mt)DNA copy number were quantified via immunohistochemistry and qPCR, respectively. LA subjects had significantly higher VO2peak and muscle mitochondrial function in vivo and in tissue vs. LOS PRE. Three weeks of aerobic training significantly improved muscle mitochondrial function in vivo and in tissue in LOS subjects [to the level of LA subjects] without affecting VO2peak, fiber type nor mitochondrial content. Global transcriptomic analyses revealed downregulation of Tribbles 1 in LOS PRE vs. LA that was confirmed by qRT-PCR in LOS PRE vs. LA. Tribbles 1 mRNA was significantly reduced with training (LOS PRE vs. POST) and inversely related with muscle tissue mitochondrial respiration. Our data identified a novel target related to exercise-induced improvements in muscle mitochondrial function and highlight a potential new role for Tribbles 1 in muscle oxidative capacity.

Disclosure

S. Parsons: None. M.F. Pino: None. A.P. Hodges: None. F. Yi: None. E.A. Carnero: None. R.E. Pratley: Other Relationship; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eisai Inc., GlaxoSmithKline plc., Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Ligand Pharmaceuticals, Inc., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Inc., Pfizer Inc., Sanofi-Aventis, Takeda Development Center Americas, Inc.. S.R. Smith: None. L.M. Sparks: None.
Relationship of Physical Activity Behavior with Insulin Sensitivity over Five Years after Diagnosis of Type 2 Diabetes
Authors: PESTA DOMINIK , BOBROV PAVEL , ZAHARIA OANA P. , BÓDIS KÁLMÁN , KARUSHEVA YANISLAVA , MARKGRAF DANIEL F. , BURKART VOLKER , MÜSSIG KARSTEN , STRASSBURGER KLAUS , SZENDROEDI JULIA , RODEN MICHAEL
Published: June 2018

Regular physical activity is a key element of lifestyle recommendations for patients with type 2 diabetes (T2D), yet adherence to physical activity (PA) and its association with insulin sensitivity in newly diagnosed T2D is less known.

This study assessed PA behavior during the first year after diagnosis and 5 years later by the validated Baecke questionnaire, which comprises sports-, leisure- and work-related activities, in recent-onset T2D (n=215) and healthy individuals (CON; n=84), adjusted for age, sex and body mass index. Insulin sensitivity was assessed from hyperinsulinemic-euglycemic clamps and maximal oxygen consumption (VO2max) from spiroergometry at baseline and after 5 years.

Patients with T2D had a lower total Baecke (8.1±1.4) and sports index (2.7±0.8) than CON (8.8±1.4; 3.2±0.8; all p<0.05; mean±standard deviation). Compared to CON, VO2max was 28% lower in T2D (p<0.05). Whole-body insulin sensitivity was 41% lower in T2D than in CON (p<0.01). At baseline, sports index correlated positively with insulin sensitivity (T2D r=0.17; CON r=0.32, both p<0.05) and VO2max (T2D r=0.38; CON r=0.32, both p<0.01). Of note, higher PA participation at 5 years after diagnosis associated with decreased body weight (r=-0.30; p<0.01) and improved physical performance (r=0.32; p<0.05) in T2D. Although at 5 years changes in PA did not impact hemoglobin A1c as a parameter for glycemic control, higher PA participation associated positively with changes in whole-body insulin sensitivity in T2D (r=0.26; p<0.05).

In conclusion, lower PA participation contributes to worsening of body weight, physical fitness and insulin resistance in T2D, even during the initial course of disease.

Disclosure

D. Pesta: None. P. Bobrov: None. O.P. Zaharia: None. K. Bódis: None. Y. Karusheva: None. D.F. Markgraf: None. V. Burkart: None. K. Müssig: None. K. Strassburger: None. J. Szendroedi: None. M. Roden: Speaker's Bureau; Self; Boehringer Ingelheim GmbH. Research Support; Self; Boehringer Ingelheim GmbH. Consultant; Self; Poxel SA. Research Support; Self; Danone Nutricia Early Life Nutrition, GlaxoSmithKline plc., Nutricia Advanced Medical Nutrition, Sanofi.
Oral Sodium Nitrite Improves Insulin Sensitivity, Blood Pressure, and Arterial Thickening in Adults with Uncontrolled Hypertension and Metabolic Syndrome
Authors: HUGHAN KARA S. , HELBLING NICOLE L. , ANTHONY STEVEN J. , DELANY JAMES , GOODPASTER BRET H. , GLADWIN MARK
Published: June 2018

Introduction: Although nitrate and nitrite have traditionally been considered to be inert and potentially toxic metabolites of nitric oxide (NO) oxidation, it is now appreciated that both can be recycled to bioactive NO. Recent evidence suggests that the human nitrate-nitrite-NO pathway mediates signaling through NO to reduce blood pressure and endothelial function. The effects of oral nitrite on insulin sensitivity, however, are not known. Therefore, we developed the investigational drug, oral inorganic sodium nitrite, to assess its therapeutic effects.

Methods: Our goal was to examine the effect of 12 weeks of open-label oral sodium nitrite 40 mg three times daily in this pilot study. We employed hyperinsulinemic-euglycemic clamps to assess insulin sensitivity, flow mediated dilation (FMD) to measure endothelial function, and pulse wave velocity (PWV) and carotid intima media thickness (IMT) to measure arterial stiffening and thickening, respectively, in obese adults with metabolic syndrome and uncontrolled hypertension.

Results: Eighteen subjects were recruited with mean age 53 years, BMI 41 kg/m2 and BP 147/88 mmHg and 72% were female. Following 12 weeks of nitrite treatment, systolic (-10 mmHg), diastolic (-13 mmHg) and mean arterial pressures were reduced (-12 mmHg; all p<0.001). Insulin stimulated glucose disposal tended to improve (14%; 7.4±0.7 at baseline to 8.4±0.8 mg/kg/min post, p=0.08) after oral nitrite treatment compared to baseline. Carotid IMT decreased from 0.762±0.02 at baseline to 0.727±0.03 mm post (p<0.01), and FMD and PWV trended towards improvement with oral sodium nitrite treatment. There were no changes in body weight, BMI, fasting glucose, HbA1c or lipids.

Conclusion: Oral sodium nitrite treatment is a promising therapeutic to improve insulin sensitivity, blood pressure and arterial thickening in at-risk obese adults with metabolic syndrome and uncontrolled hypertension.

Disclosure

K.S. Hughan: Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company. N.L. Helbling: None. S.J. Anthony: None. J. DeLany: None. B.H. Goodpaster: None. M. Gladwin: Other Relationship; Self; National Institutes of Health, Globin Solutions, Bayer AG.
Improved Metabolic Flexibility Postbreakfast after Exercise Intervention in People with T2DM
Authors: CARNERO ELVIS A. , BOCK CHRISTOPHER P. , STEPHENS NATALIE , PRATLEY RICHARD E. , SMITH STEVEN R. , SPARKS LAUREN M.
Published: June 2018

Exercise provides many metabolic benefits for people with type 2 diabetes; nevertheless, the ability to switch substrate oxidation from fat to carbohydrate and back, known as metabolic flexibility (MetFlex), in response to prolonged exercise training has not been thoroughly explored.

Purpose: The goal of this analyses was to investigate changes in MetFlex after an exercise intervention. We enrolled healthy sedentary participants with obesity (HSO) and participants with type 2 diabetes (T2DM) in a 10-week aerobic exercise intervention.

Methods: Seventeen participants with T2DM (8 females; 52.9 years; BMI= 36.9 kg/m2 and 9 males; 48.8 years; BMI= 33.3 kg/m2) and seven HSO (5 females; 44.8 years, BMI= 37.6 kg/m2 and 2 males; 46.5 years, BMI= 36.2 kg/m2) completed the intervention. MetFlex was assessed as the respiratory quotient (RQ) kinetic response after ingesting a standard high CHO breakfast during a 24-h energy expenditure measurement in a whole-room respiratory chamber. Briefly, the kinetics between the lowest RQ and highest RQ points were analyzed by a simple linear regression between time (1-minute resolution) and RQ units (RQUnits). Individual data were time-aligned and averaged for each group and moments (PRE and POST intervention), then slopes and intercepts for T2DM vs. HSO groups and PRE vs. POST were compared using a multiple regression model.

Results: At PRE-intervention, HSO group had a significantly lower intercept than T2DM (HSO=0.737 vs. T2DM=0.705; P<0.001) and slower RQ kinetics as demonstrated by a greater slope (HSO=0.00448 RQUnits/min vs. T2DM=0.00332 RQUnits/min; F=18.1, P=0.001). After the exercise intervention only T2DM significantly increased their slope (POST= 0.003944 RQUnits/min; F=6.47, P=0.013).

Conclusions: Our results indicate that participants with diabetes significantly improve MetFlex following a prolonged aerobic exercise intervention.

Disclosure

E.A. Carnero: None. C.P. Bock: None. N. Stephens: None. R.E. Pratley: Other Relationship; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eisai Inc., GlaxoSmithKline plc., Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Ligand Pharmaceuticals, Inc., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Inc., Pfizer Inc., Sanofi-Aventis, Takeda Development Center Americas, Inc.. S.R. Smith: None. L.M. Sparks: None.
Short-Term Interval and Continuous Training Improves Pancreatic ß-Cell Function Adjusted for Skeletal Muscle Insulin Resistance in Adults with Prediabetes
Authors: FRANCOIS MONIQUE E. , EICHNER NATALIE , GILBERTSON NICOLE M. , HEISTON EMILY M. , BARRETT EUGENE , MALIN STEVEN K.
Published: June 2018

Exercise improves pancreatic function in an energy dose-dependent manner. We previously showed that when calories are matched, an acute exercise bout changes glucose-stimulated insulin secretion (GSIS) relative to multi-organ insulin resistance (IR) in an intensity-based manner during the immediate post-exercise period in people with prediabetes. However, the impact of short-term training intensity on ß-cell function is unknown. Thus, we examined the impact of high-intensity interval and moderate-continuous training on GSIS relative to multi-organ IR in adults with prediabetes. Thirty-one adults (Age: 61±8y; BMI: 33±6 kg/m2) with prediabetes according to ADA 75g OGTT and/or HbA1c criteria were randomized to energy-matched interval (INT: 60-min/d alternating 3-min at 90 and 50% HRpeak) or continuous training (CONT: 60-min/d 70% HRpeak) for 2 weeks. Fitness (VO2peak) and body mass were measured before and after, and a 120-min 75g OGTT with blood samples for glucose, insulin, C-peptide and FFA were determined every 30-min. GSIS (C-pep/Glc tAUC0-120min) and ß-cell function (Disposition Index [DI: GSIS/IR]) relative to skeletal muscle (InsulintAUC x GlctAUC), hepatic (HOMA-IR) and adipose (Adipose-IRfasting) IR were calculated. Training increased VO2peak (+1.1±2.1 mL/kg/min), and reduced body mass (-0.6±1.1 kg) and IR (-11±31%), independent of intensity (P<0.05). INT and CONT also decreased GSIS to a similar extent (Interaction: P=0.88). Short-term training improved skeletal muscle DI by ∼24% (P<0.05), but there was no effect on hepatic or adipose DI. Collectively, short-term INT and CONT training improves ß-cell function relative to skeletal muscle, but not hepatic or adipose, IR. These data suggest unique mechanisms regulate glucose metabolism following single vs. habitual physical activity in adults with prediabetes.

Disclosure

M.E. Francois: None. N. Eichner: None. N.M. Gilbertson: None. E.M. Heiston: None. E. Barrett: None. S.K. Malin: None.
Two Mechanisms Mediating Enhanced Glucose Tolerance with Regulator of GS Protein 14 Disruption; Increased Exercise Capacity and Increased Brown Adipose Tissue
Authors: OYDANICH MARKO , ZHANG JIE , VATNER DOROTHY E. , VATNER STEPHEN F.
Published: June 2018

The goal of this investigation was to examine glucose tolerance and exercise capacity in the regulator of the G protein signaling 14 knock out (RGS14 KO) mouse. Exercise capacity, which affects glucose tolerance, was improved in the RGS14 KO compared to their wild type littermates (WTL), as reflected by a 64 ± 8%, p<0.05, increase in total distance run on a treadmill. Glucose tolerance was also increased in the RGS14 KO, compared with their WTL, as reflected by a 40 ± 11%, p<0.05, reduction in the area under the glucose curve after administration of 2g of glucose and monitoring blood glucose over the next 3 hours. The insulin tolerance test showed similar improvement in RGS14 KO. The RGS14 KO is also a model of obesity protection, as reflected by 44% less white adipose tissue in the inguinal fat pad, compared with WTL. However, brown adipose tissue (BAT) is increased in the RGS14 KO, as reflected by a 47% increase in the BAT index. To determine if BAT mediated the salutary effects of exercise and glucose tolerance in the RGS14 KO, we simulated a BAT KO, by removing it from the RGS14 KO and transplanting the BAT to their WTL. This resulted in a reversal of phenotype, where the WTL with transplanted BAT behaved like RGS14 KO and the RGS14 KO behaved like WTL; i.e., the WTL with transplanted BAT from RGS14 KO exhibited improved exercise capacity by 36 ± 5%, p<0.05, compared with the RGS14 KO donors. Glucose tolerance showed the same pattern, where WTL with the RGS14 KO BAT transplants exhibited a 39 ± 6% reduction in area under the glucose curve, p<0.05, compared with the RGS14 KO BAT donors. The insulin tolerance test showed similar improvement in the WTL mice with BAT transplant. Thus, there are two mechanisms by which glucose tolerance is enhanced in RGS14 KO: 1. Improved exercise capacity; and 2. Increased BAT, suggesting that either inhibiting RGS14 or increasing BAT would be novel therapeutic approaches to protect against diabetes and obesity.

Disclosure

M. Oydanich: None. J. Zhang: None. D.E. Vatner: None. S.F. Vatner: None.
T2D Users of a Digital Diabetes Management System Experience a Shift from Greater than 180 mg/dL to Normal Glucose Levels with Sustainable Results
Authors: HERSHCOVITZ YIFAT , FENIGER EITAN , DAR SHARON
Published: June 2018

One of the goals of a digital diabetes management system is to improve the patient’s self-management and control of their condition. Blood glucose level reduction and sustainment of lower levels of blood glucose is one of the greatest challenges in managing diabetes. Digital engagement can play a pivotal role in the care of patients with diabetes and other chronical conditions, potentially improving patient’s compliance. The DarioTM Blood Glucose Monitoring System (BGMS) connects physically to a smart mobile device and automatically logs blood glucose measurements into a designated application (App). Data is transmitted to the Dario cloud.

Method: A retrospective data evaluation study was performed on the DarioTM cloud data base. A population of all active type 2 diabetic (T2D) users that took measurements with DarioTM BGMS on average of 20 measurements per month during 2017. The study assessed the ratio of all high blood glucose readings (180-400 mg/dL) and the ratio of all normal blood glucose readings (80-120 mg/dL) in their first month of use to their last month of use during 2017 as recorded in the database.

Results: For 17,156 T2D users activated during 2017 the average ratio of high events (180-400 mg/dL) was reduced by 19.3% (from 28.4% to 22.9% of the entire measurements). While at the same time, the ratio of normal range readings (80-120 mg/dL) was increased in 11.3% (from 25.6% to 28.5% of the entire measurements). The most significant shift occurred after one month of usage (14% decrease) and maintained stability over the following months throughout the full year.

Conclusion: The combination of a glucose meter and an App may promote behavioral modification and enhanced adherence to diabetes management, demonstrating improvement in glycemic outcomes and sustainment for a long period of time.

Disclosure

Y. Hershcovitz: Employee; Self; DarioHealth. E. Feniger: Employee; Self; DarioHealth. S. Dar: Employee; Self; DarioHealth.
Comparison of Effects of Low-Carbohydrate Diet and Calorie-Restricted Diet on Nonalcoholic Fatty Liver Disease in Japanese Patients with Type 2 Diabetes
Authors: NISHIMORI EITA , OGATA SATOSHI , NAKA MOTOJI
Published: June 2018

Background: Nutrition therapies for type 2 diabetes (T2DM) and nonalcoholic fatty liver disease (NAFLD) are recommended for calorie-restricted diet (CRD) in Japan. Recently, the efficacy of low-carbohydrate diet (LCD) has been reported in these diseases. This study aimed to determine the effects of LCD on NAFLD in Japanese patients with T2DM compared with CRD.

Methods: We assigned 28 patients of NAFLD with T2DM in this 3-month prospective open-label randomized comparative trial. They were randomly allocated to either LCD (70-130 g/day of carbohydrate) group (n =14) or CRD (calories of 25 kcal/kg of ideal body weight per day) group (n =14). Abdominal computed tomography (CT) scan evaluated liver fat deposition by the liver-to-spleen attenuation ratio (L/S ratio) and visceral fat accumulation as the visceral fat area (VFA).

Results: The average age of patients at the start was 50 years old, BMI was 31 kg/m2, L/S ratio was 0.7, VFA was 163 cm2. The total intake energy of LCD after 3 months was 1,389 kcal (δ-386 kcal from the start, carbohydrate was 42% of the total energy), CRD was 1,513 kcal (δ-633 kcal, carbohydrate was 54%). Both diets achieved significantly improvement of L/S ratio, VFA, liver transaminase, body weight and HbA1c from baseline within groups after 3 months (P < 0.05). Between the two diets, L/S ratio, liver transaminase, body weight and HbA1c showed a large tendency to improve in LCD, but no significant difference was noted. Significant improvement was observed in VFA of LCD. In the QoL score, "anxiety and dissatisfaction with treatment" was significantly improved in LCD.

Conclusions: Our findings suggest that LCD may be as effective as CRD in improving fatty liver in Japanese patients of NAFLD with T2DM, and that LCD may be less burdensome on patients than CRD.

Disclosure

E. Nishimori: None. S. Ogata: None. M. Naka: None.
Evaluation of Dietary Intakes of Macronutrients in Adults with Different A1c Levels
Authors: KELLY OWEN , KROK-SCHOEN JESSICA L. , LUO MENGHUA , TAYLOR CHRISTOPHER A.
Published: June 2018

Nutritional modification is a key consideration for the management of diabetes. Characterization of dietary habits among adults with diabetes may help focus dietary behavior changes. Dietary intakes and hemoglobin A1c data from the 2005-2014 National Health and Nutrition Examination Survey (NHANES) were evaluated to assess differences in meal and snacking macronutrient patterns by A1c levels. Data from 20,2adults ≥ 30 years were categorized into the following groups using A1c values: <5.7% (nondiabetes, n= 12,949); 5.7-6.4% (prediabetes, n=4,892); 6.5-6.9% (controlled diabetes, n=768); and ≥7%, (poorly controlled diabetes, n=1,597). Dietary intakes were assessed via a 24 hour dietary recall. Eating occasions were defined by the participant. Data analyses were weighted to create a nationally representative sample. Overall, the mean energy intakes were higher in the nondiabetes group by up to 264 kcal. Mean protein, carbohydrate and fat intakes were also higher in the nondiabetes group. Intakes for energy and macronutrients were similar across all groups at breakfast and dinner, however, at lunch and for all snacks combined, those without diabetes had higher intakes. Intakes of added sugars at eating occasions were also higher in the nondiabetes group and snacks contributed the most for all groups. The daily total number of carb choices for the nondiabetes, prediabetes and both diabetes groups were 17, 16, 15 and 15, respectively. For all groups, dinner was the largest meal and accounted for the highest carb choice values. Despite the overall reduction in energy and macronutrient intakes in those with elevated A1c, indicating they may be making perceived positive dietary behavior changes, all the groups diets are low in quality per Healthy Eating Index. There may need to be a greater focus on changing macronutrient quality, especially carbohydrates, when developing individualized medical nutrition therapy for people with diabetes or prediabetes.

Disclosure

O. Kelly: Employee; Self; Abbott. Employee; Spouse/Partner; Abbott. J.L. Krok-Schoen: None. M. Luo: Employee; Self; Abbott. C.A. Taylor: None.
Impact of the ENHANCED (diEtitiaNs Helping pAtieNts CarE for Diabetes) Trial on Optimal Care Outcomes in Adults with Type 2 Diabetes
Authors: BENSON GRETCHEN , SIDEBOTTOM ABBEY , HAYES JOY , BOUCHER JACKIE L. , VACQUIER MARC , MIEDEMA MICHAEL D. , SILLAH ARTHUR , VANWORMER JEFFREY
Published: June 2018

Background: Clinical care for type 2 diabetes has improved, but remains suboptimal. Collaborative, team-based models that maximize the skills of different disciplines may improve care for type 2 diabetes, but few have been tested using rigorous research designs.

Objective: We investigated the effectiveness of a registered dietitian nutritionist-led (RDN) telemedicine program vs. usual care on type 2 diabetes optimal care goals, including A1C, blood pressure, tobacco use, and appropriate statin and aspirin use. For participants randomly assigned to the intervention group, RDNs utilized an approved treatment protocol to initiate/titrate therapies for blood glucose, hypertension and lipids, in addition to providing medical nutrition therapy. Outcomes were compared between the intervention vs. usual care group over one year.

Design: A randomized control trial design was used that included 118 adults with type 2 diabetes who were receiving care at two rural primary care clinics. Participants were randomized (March-December 2016) to usual (clinical) care or an intervention group that included usual care plus monthly RDN-led telemedicine visits for one year.

Results: Mixed model regression was used to examine outcomes between baseline and one year follow-up. Modest, but significantly greater improvement was observed for the intervention group in the number of optimal care measures met at follow-up, 3.7 compared to 3.2 among controls (p=.017) after adjusting for baseline. Among individual optimal care measures, the intervention group had a significantly greater increase in medication use, with 2.5 and 2.2 higher odds (compared to controls) of taking a statin and aspirin as appropriate, respectively.

Conclusions: The ENHANCED study care model, which utilized RDNs to initiate and titrate medications, modestly improved type 2 diabetes care outcomes for adults.

Disclosure

G. Benson: None. A. Sidebottom: None. J. Hayes: None. J.L. Boucher: None. M. Vacquier: None. M.D. Miedema: None. A. Sillah: None. J. VanWormer: None.
Digital Dietitian—Pilot Study of a Novel Smartphone Application
Authors: FARFAN CHRISTIAN C. , AXELROD CEARA , FRASE DONNA L. , MACKENZIE ANDREW , HAROUSH GAL , CASTORINO KRISTIN
Published: June 2018

Objective: There is a global need for individualized dietician education for the management and prevention of diabetes. Dietician consultation achieves better outcomes than primary care guidance alone, but long-term diet counseling to support sustained change is costly. Smartphones have provided new, scalable methods for achieving and maintaining lifestyle changes. The primary aim of this study was to determine whether the dietary recommendations made by a Digital Dietician were comparable to those made by a registered dietician in terms of safety, practicality, nutrition, health, and calorie control. A secondary aim was to determine the usefulness of the Digital Dietician to help individuals achieve lifestyle changes.

Methods: Two dieticians analyzed nearly 2,000 dietary recommendations given by the app over 4 months. A five point scale was assigned to each of the following categories: safety, practicality, nutrition, health, and calorie control. In addition, we also measured participant engagement with the app, changes in body weight over time, and participant reported results of their experience with the app.

Results: The overall composite score of the application’s recommendations was 17.9 out of 25 (higher scores indicate better recommendations). Recommendations scored most highly in the safety category, averaging 4.92 out of 5 points (SD ± 0.35), followed by practicality (4.00 ± 1.39), health (3.29 ± 1.09), and nutrition (3.± 1.13), with calorie control receiving the lowest scores (2.65 ± 1.35). Participants indicated that the app helped them achieve their health goals, and we observed an average weight loss of 0.31 pounds per week while the app was being used.

Conclusion: The recommendations given by the app were comparable to those of a dietician. The app also appears to have helped participants set and achieve their health goals. While there is certainly room for improvement, this and other nutrition applications for mobile devices have an exciting potential and offer a framework for evaluation.

Disclosure

C.C. Farfan: None. C. Axelrod: None. D.L. Frase: None. A. Mackenzie: Stock/Shareholder; Self; Johnson & Johnson Services, Inc.. G. Haroush: None. K. Castorino: None.
Impact of the No-Carrageenan Diet on Glucose Tolerance and Insulin Resistance in Adults with Prediabetes
Authors: TOBACMAN JOANNE K.
Published: June 2018

Previous animal and cell-based studies indicated that exposure to the common food additive carrageenan impaired glucose tolerance and increased insulin resistance. Carrageenan is widely used in processed foods to improve solubility, but predictably causes inflammation, which contributes to insulin resistance by inhibition of insulin signaling. To test if removal of carrageenan from the diet could reduce insulin resistance, we initiated a double-blinded, controlled feeding study in individuals with prediabetes, defined by Hemoglobin A1c values of 5.7%-6.4%. All procedures were approved by the University of Illinois at Chicago IRB. Participants were provided study diets for 12 weeks, which either contained or did not contain carrageenan, and had similar composition of protein, carbohydrate, and fat. An additional group was comprised of individuals who participated in study tests, but ate their usual diet. Subjects on study diets picked up their food weekly at UIC and had blood tests, including 2h glucose tolerance tests performed at entry, 6, and 12 weeks. Inflammatory parameters, including fecal calprotectin, were measured at entry and conclusion. Preliminary study results from 17 participants indicate that the carrageenan-free diet was associated with significant decline in hemoglobin A1c (p=0.004, unpaired t-test, two-tailed), HOMA-IR (homeostatic model for insulin resistance) score (p=0.0064), insulin resistance (p=0.02), and leukocyte phospho-serine IRS-1 (p=0.003) and NF-kappaB, compared to study participants on the control study diet or their regular diet. Study findings indicate significant decline in insulin resistance by removal of carrageenan from the diet. Additional studies of inflammatory parameters, immune cell subsets, and fecal microbiome are pending.

Disclosure

J.K. Tobacman: None.
Carnosine Supplementation Improves Serum Resistin Concentrations in Overweight or Obese but Otherwise Healthy Sedentary Adults—Results From Randomised Controlled Trial
Authors: DE COURTEN BARBORA , UKROPEC JOZEF , MOUSA AYA , UKROPCOVA BARBARA , ALDINI GIANCARLO , BAYE ESTIFANOS
Published: June 2018

Adipokines play an important role in the regulation of glucose metabolism. We have previously shown that carnosine supplementation in overweight or obese nondiabetic individuals improved glucose metabolism but did not change adiponectin levels, however its effect on other adipokines has not been investigated. We aimed to determine the effect of carnosine supplementation on serum adipsin, resistin and leptin concentrations in these individuals. Twenty-two overweight or obese otherwise healthy adults were randomly assigned to receive either 2g of carnosine (n=13) or identically looking placebo (n=9) for 12 weeks. Serum adipsin, leptin and resistin were analysed using a bead-based multiplex assay (LEGENDPlex™, BioLegend, CA). Carnosine supplementation decreased serum resistin concentrations compared to placebo (mean change from baseline: -35 ± 83 carnosine vs. 35 ± 55 ng/ml placebo, p=0.04). There was a trend for a reduction in serum leptin concentrations after carnosine supplementation (-76 ± 165 ng/ml carnosine vs. 20 ± 28 ng/ml placebo, p=0.06). Change in leptin and resistin were inversely related to change in concentrations of urinary carnosine (r =-0.72, p = 0.0002; r= -0.67, p=0.0009, respectively), carnosine-propanal (r= -0.56, p=0.005; r= -0.63, p=0.001, respectively) and carnosine-propanol (r=-0.61, p=0.002; r = -0.60, p=0.002, respectively). There were no differences between groups in change in adipsin concentrations (both p<0.1). Our findings suggest that carnosine supplementation may normalise some but not all serum adipokine concentrations involved in glucose metabolism in overweight and obese individuals. Further clinical trials with larger samples are needed to confirm these results.

Disclosure

B. de Courten: None. J. Ukropec: None. A. Mousa: None. B. Ukropcova: None. G. Aldini: None. E. Baye: None.
Protein-Restricted Diet Is Effective in Decreasing Glycemia, HbA1c, and Cholesterol in Type 2 Diabetic Subjects by the Activation of the GCN2 Pathway
Authors: FERRAZ RAFAEL C. , BERALDO REBECA A. , GOMES PATRICIA , FOSS MILTON C. , FOSS-FREITAS MARIA CRISTINA
Published: June 2018

Dietary restriction increases lifespan across the evolutionary spectrum and decreases metabolic disease risk in mammals. It has been shown that amino acid restriction is sufficient to promote some of the beneficial effects of dietary restriction in rodents. This phenomenon is dependent on GCN2 (general control nonderepressible 2), a kinase activated by amino acid restriction that controls protein synthesis and stress response. Our results show that treatment of type 2 diabetic subjects on a protein restriction diet for 4 weeks exhibited a 61% reduction in fasting glucose levels and a 14% decrease in Hb1Ac. These patients had a 32% reduction in Total Cholesterol with a 33% decrease in LDL. We noticed a reduction of 4.5% of body weight, with a decrease of 11% of fat mass and maintenance of lean mass. In addition, all subjects had systemic blood pressure normalization, with a decrease of 23% in systolic pressure and 44% in diastolic pressure. In order to understand in detail the action of protein restriction we evaluated the gene expression in the subcutaneous adipose tissue of these individuals. We observed the activation of GCN2 expression (p=0.0394) and consequently the activation of ATF4 (Activating transcription factor 4) and CHOP (C/EBP homologous protein) (p=0.0360 and p=0.0011 respectively). This findings suggesting that in fact, protein restricted diet affects the GCN2 pathway in humans, modulating the energy metabolism and enabling glycemic and lipidemic control.

Disclosure

R.C. Ferraz: None. R.A. Beraldo: None. P. Gomes: None. M.C. Foss: None. M. Foss-Freitas: None.
High Prevalence of Distress among Patients with Type 2 Diabetes (T2DM)—A Hospital-Based, Cross-Sectional Study from South India
Authors: SANKAR PRASANTH , SASIKUMAR PRIYANKA , MEDAYIL RITUNA , JACOB RITTIN , SASIDHARAN SARANYA
Published: June 2018

Background: Diabetes distress (DD) refers to unique, often hidden emotional burdens and worries, distinct from clinical depression, that are part of the spectrum of patient experience when managing diabetes.

Aim: To assess DD and its association with various parameters in patients with T2DM.

Methodology: A cross sectional study was done on 262 out-patients with T2DM in a multispecialty hospital in South India. DD was measured by DDS-17, a 17-item self-reported DD scale used with subscales in 4 domains - Emotional burden (EB), Physician, Regimen and Interpersonal distress. Overall score < 2.0 was little or no distress, 2.0-2.9 moderate, ≥3.0 was high distress. Data was analysed using SPSS version 11.5.

Results: Mean age of participants was 59.7 ± 9.1 years. Females constituted 71.8%. BMI was ≤ 25kg/m2 in 32.8%. Duration of diabetes was < 10 years in 42%. Insulin was used by 45%. Mean HbA1c was 8.7±1.7%. Prevalence of DD was 27.9%, with moderate distress in 22.1% and high distress in 5.7%. Mean total DD score was 1.67± 0.59. Mean for EB, physician-related, regimen-related and interpersonal distress were (2.1 ± 1.02), (1.09 ± 0.33), (1.92 ± 0.89), (1.30± 0.76) respectively. Total DD had significant association with BMI (p=0.04), duration of T2DM (p=0.04), HbA1c (p=0.01), neuropathy (p=0.002) and nephropathy (p=0.008). EB, considered most important domain, was associated with duration of T2DM (p=0.02), insulin use (p=0.002), neuropathy (p<0.001), nephropathy (p=0.008), high HbA1c levels (p=0.001), ASCVD in females (p<0.001). Regimen related distress was more in those with high HbA1c (p=0.001) and smokers (p=0.04).

Discussion: The study, first of its kind from South India, identifies high prevalence of DD in this population Assessment of DD should be integrated into patients’ self-care plan. Patients become more involved in managing diabetes if their specific emotional distress are taken care of, and have a better sense of social care, health control and self-efficacy.

Disclosure

P. Sankar: None. P. Sasikumar: None. R. Medayil: None. R. Jacob: None. S. Sasidharan: None.
Economic Evaluation of Group Medical Visits for Adults with Diabetes in Community Health Centers
Authors: WAN WEN , STAAB ERIN M. , HAM SANDRA A. , CAMPBELL AMANDA , SCHAEFER CYNTHIA T. , QUINN MICHAEL T. , BAIG ARSHIYA
Published: June 2018

Background: Diabetes group visits (GVs) - shared appointments that incorporate medical care, diabetes self-management education, social support, and goal-setting - were recently examined in a network of U.S. community health centers (HCs) and found to improve glucose control and diabetes-related quality of life.

Objective: To evaluate the economic impact of group visits (GV) in adults with diabetes in HCs.

Methods: In a pilot prospective matched case-control trial, we implemented 6 monthly GV sessions in 5 HCs and compared intervention patients (n=49) to control patients receiving usual care within the same HCs (n=72). We conducted patient chart reviews to obtain healthcare utilization data for the prior 6 months, at baseline, 6, and 12 months and collected monthly logs of HC expenses and staff time spent on activities related to GVs, including training, planning, implementation, and evaluation. Total costs included HCs’ expenses and activities and patients’ healthcare use over one year. Wilcoxon rank-sum tests, generalized linear models, and modified Park tests were used to compare the healthcare use and cost data.

Results: Despite each HC spending $17,342 on average (or $1770 per-patient) for the GV preparation and implementation, the per-patient annual total costs were not different between the groups (GV: $3,982 vs. control: $4,287, p=0.73). Most of the benefits were due to GV patients having fewer hospitalizations (p=0.08) and fewer primary care visits that occurred outside the trial (p=0.01). After excluding the staff training costs (mean $7,962 per HC), the GV group had significantly lower total costs ($3,169) than the control group (p <0.01).

Conclusions: The diabetes group visits in health centers improved patients’ healthcare quality without increasing overall healthcare costs. In subsequent GV sessions, excluding the need for staff training, group visits may be cost saving. Future studies should assess the cost-effectiveness of group visits.

Disclosure

W. Wan: None. E.M. Staab: None. S.A. Ham: None. A. Campbell: None. C.T. Schaefer: None. M.T. Quinn: None. A. Baig: None.