bluuebunny/crossref_metadata_2025 huggingface dataset:
220-OR: Is There Any Prognostic Value of Diabetes-Associated Autoantibody Levels for Predicting Islet Graft Function in Patients with Long-Standing Type 1 Diabetes Mellitus?
Authors: BACHUL PIOTR J. , GOLEBIEWSKA JUSTYNA E. , ANTIC FILIP , PARA MONICA , BASTO LINDSAY , LUCANDER AARON C. , GOLAB KAROLINA , PEREA LAURENCIA , TIBUDAN MARTIN L. , WANG LING-JIA , THOMAS CELESTE C. , WITKOWSKI PIOTR
Published: June 2019

Introduction: Correlation between increasing titers for GADA, IA-2A, and ZnT8A and graft loss due to recurrent autoimmunity has been reported, but not confirmed in other studies. Here, we assessed the prognostic value of DAA levels for predicting graft function in our cohort of islet transplant recipients.

Methods: Twelve patients with T1DM with hypoglycemic unawareness underwent islet allotransplantation (ITx). Eight of those patients were randomly assigned to receive Reparixin (CXCR1/2 inhibitor) and remaining 4 to placebo in addition to thymoglobulin, tacrolimus and mycophenolate mofetil for immunosuppression. Titers of DAAs were monitored before IT and 0, 7, and 75 days and every 3 months post-operatively.

Results: IA-2A and ZnT8A levels were undetectable prior to and after IT in all 12 T1DM patients at any time points, median follow-up of 56 months (24-66) so had no value in islet monitoring. No difference was observed for trends of GADA titers between 4 patients with long-term insulin independence after IT and the remaining 8 who experienced a decline in islet graft function. Prior to and after IT, GADA levels did not vary between patients receiving Reparixin and placebo with most GADA negative (65% and 50%, respectively). Most patients converted from GADA seronegative to seropositive or increased antibody titers [5/8 (62.5%) and 4/4 (100%), respectively] and converted back to seronegative by 1 year post-transplant and maintained partial or complete islet function over 4 years.

Conclusion: We found no correlation between trends of anti-GAD65 autoantibody levels and IT outcome in our 12-patient cohort. Levels of DAAs targeting IA-2 and ZnT8 were not detectable in all patients prior to and after IT and did not correlate with IT outcome. Differences in immunosuppression and anti-inflammatory regimens and patient characteristics between studies may contribute to inconsistency among reported results.

Disclosure

P.J. Bachul: None. J.E. Golebiewska: None. F. Antic: None. M. Para: None. L. Basto: None. A.C. Lucander: None. K. Golab: None. L. Perea: None. M.L. Tibudan: None. L. Wang: None. C.C. Thomas: None. P. Witkowski: None.

Funding

State of Illinois; Dompé
2206-PUB: Reducing Rates of Hypoglycemic Events through a Multidisciplinary Coordination of Care in a Teaching Hospital in Phoenix, AZ
Authors: CHMELNIK SANDRA , ABDOLLAHI SHAGHAYEGH , NEAL CHANTÉ N. , CAMERON DEBORAH R.
Published: June 2019

The challenge of controlling hyperglycemia and hypoglycemia in hospitalized patients drives cost increase, length of stay, morbidity and mortality. Between 10% of patients on antihyperglycemic agents suffer at least one hypoglycemic event during hospitalization, adding 31% to the overall cost of care. One cause relates to poor coordination of meal delivery and insulin administration. After internal data collection and analysis, the average time between point of care glucose testing (POCT) and insulin administration was 60 minutes. In January 2018, the overall percentage of severe hypoglycemic events (defined as <50 mg/dL) reached 9.1%. A pilot project started at the Medicine-Oncology units in March 2018 to improve coordination between POCT, meal tray delivery and insulin administration. Expected process outcomes were: effective communication between Dietary and Nursing when meal is ordered on-demand, POCT within 30 minutes of meal order and insulin administration within 15 minutes before tray delivery. Also, a branded visual cue was developed as “Insulin tents,” placed on the meal tray, encouraging patients to alert Nursing if medication was needed. Timely insulin coverage was operationalized as within 15 minutes of the first bite due to pharmacokinetics of rapid acting insulin. Our study included adults (≥18 years) admitted to the Medicine-Oncology unit who presented with hyperglycemia. Post intervention POCT data was collected March 2018 to November 2018 and compared to analogous data prior intervention (October 2016 to February 2018). We observed a reduction of hypoglycemic events, from 4.7% pre-intervention to 2.2% post intervention, and 3 months with 0 hypoglycemic events. POCT after patient’s meal order call was successful 52% of the time, and the POCT time improved from expected goal of 30 minutes to 16.6 minutes average. We concluded that the pilot project can reduce hypoglycemic events and improve patient outcomes and costs related to care.

Disclosure

S. Chmelnik: None. S. Abdollahi: None. C.N. Neal: None. D.R. Cameron: None.
2210-PUB: Despite Optimal Use of Angiotensin Receptor Blockers There Exists Substantial Cardiovascular Risk as Suggested by Elevated NT-ProBNP in 259 T2DM Patients
Authors: GUPTA VISHAL , TELI VAISHALI
Published: June 2019

259 T2DM patients with microalbuminuria eUACR >30 irrespective of their A1c, on standard glucose lowering, lipid lowering and ARB (telmisartan TM or valsartan Vs as first line BP lowering therapy until optimal dose was achieved, were followed-up for 2 years. Renal (Cr, eGFR, UACR) and CV (BP, BMI, Lipid profile, hs-CRP) parameters were assessed every 6 months. NT-ProBNP was measured at the end of 2 years. Patients with history of major surgery, coronary intervention, IHD or hospitalization in last 1 year, eGFR <45, hyperkalemia >5.3 were excluded Data was analyzed using PSPP version 1.0.1 and represented as Mean (SD) and paired-t test was used, p-value of 0.05 was considered to be significant.

Results: 42.1% used TM and 57.9% used Vs. Average dose of TM 66.76mg (±52.63) and Vs 165.33 (±89.94) Baseline characteristics: 259 patients (females 45.6%, male 54.4%), mean age 61.22 years (±9.50); weight 78.91kg (±15.78), BMI 30.63 (5.81±), DOD 12.9 years (7.52±), SBP 137.09mm (±20.60), DBP 77.54 (±11.31). There was a significant mean reduction observed in HbA1c 1.21% (95% CI 1.02-1.39, p-<0.001), SBP 3.37mm (95% CI 0.66-6.08, p-0.015), TC 14.13mg% (95% CI 8.43-19.83, p <0.001), LDL 10.64mg% (95% CI 5.87-15.41, p <0.001), TG 19.52mg% (95% CI 11.50-27.55, p<0.001), non-HDL 25.31mg% (95% CI 18.95-31.66, p<0.001), Chol remnant 8.25mg% (95% CI 5.27-11.22, p <0.001), UACR 147.5mg% (95% CI 61.27-233.79, p 0.001). There was no significant change seen in weight, BMI, DBP, HDL, Cr, eGFR, potassium. The NT-ProBNP was 166.30 pg/ml (±242.72) remained elevated after 2 years.

Conclusion: Despite optimal use of ARB and reduction in renal (UACR, maintenance of renal function) and CV risk factors there remains a significant risk for future CV mortality as suggested by elevated NT-ProBNP in T2DM with microalbuminuria.

Disclosure

V. Gupta: None. V. Teli: None.
2212-PUB: The Prevalence of Nonalcoholic Fatty Liver Disease Is Increased in Patients with Type 2 Diabetes but Not in Those with Peripheral Artery Disease
Authors: SAELY CHRISTOPH H. , VONBANK ALEXANDER , HEINZLE CHRISTINE , ZANOLIN-PURIN DANIELA , SCHINDEWOLF MARC , BAUMGARTNER IRIS , LARCHER BARBARA , MADER ARTHUR , LEIHERER ANDREAS , MUENDLEIN AXEL , DREXEL HEINZ
Published: June 2019

Nonalcoholic fatty liver disease (NAFLD) is a feature of the metabolic syndrome and is associated with an increased risk of cardiovascular disease. Whether the prevalence of NAFLD is increased independently from the presence of type 2 diabetes (T2DM) in patients with peripheral artery disease (PAD) is unknown and is addressed in the present study. We assessed the prevalence of NAFLD as estimated by the validated fatty liver index in four groups of patients, including 216 who neither had PAD nor T2DM, 56 without PAD but with T2DM, 157 with PAD but without T2DM and 119 with the combination of T2DM and PAD. Both, among patients without PAD and among those with PAD, T2DM was associated with an increased prevalence of NAFLD (71.4 vs. 39.4%; p<0.001 and 70.6 vs. 40.8%; p<0.001, respectively). However, the prevalence of NAFLD neither among those with nor among those without T2DM was significantly associated with the presence of PAD (p=0.783 and p=0.909, respectively). The prevalence of NAFLD was significantly higher in patients with T2DM but without PAD than in PAD patients who did not have diabetes (p<0.001). T2DM after multivariate adjustment remained significantly associated with NAFLD (OR 3.23 [1.77-5.90]; p<0.001). We conclude that the prevalence of NAFLD disease is increased in patients with T2DM but not in those with PAD.

Disclosure

C.H. Saely: None. A. Vonbank: None. C. Heinzle: None. D. Zanolin-Purin: None. M. Schindewolf: None. I. Baumgartner: None. B. Larcher: None. A. Mader: None. A. Leiherer: None. A. Muendlein: None. H. Drexel: None.
2217-PUB: Type 2 Diabetes Is a Strong Predictor for LDL Cholesterol Target Achievement in Patients with Peripheral Artery Disease
Authors: STERNBAUER SIMON , VONBANK ALEXANDER , HEINZLE CHRISTINE , ZANOLIN-PURIN DANIELA , DOPHEIDE JÖRN F. , BAUMGARTNER IRIS , LARCHER BARBARA , MADER ARTHUR , LEIHERER ANDREAS , MUENDLEIN AXEL , DREXEL HEINZ , SAELY CHRISTOPH H.
Published: June 2019

Patients with peripheral artery disease (PAD) are at a very high risk of cardiovascular events and strongly benefit from lowering LDL cholesterol (LDL-C). Current guidelines recommend an LDL-C target of at least <70mg/dl for these patients. PAD patients who also have diabetes are at an extremely high risk of cardiovascular events, and an LDL-C target of <55 mg/dl has been proposed for these patients. Whether the presence of type 2 diabetes (T2DM) affects LDL-C target achievement in PAD patients is unknown and is addressed in the present study. We investigated an unselected consecutive series of 481 patients with sonographically proven PAD, of whom 214 (44.5%) had T2DM. An LDL-C target of <70 mg/dl was met by 26.4% of PAD patients with T2DM and by 9.0% of nondiabetic PAD patients (p<0.001); an LDL-C target <55 mg/dl was met by 11.8% of T2DM patients and by 2.7% of nondiabetic patients (p<0.001). Logistic regression analysis showed that the presence of T2DM was an independent and strong predictor of LDL-C target achievement after multivariate adjustment including age, gender and statin use both for the <70 mg/dl target (OR 3.31 [1.93-5.68]; p<0.001) and for the <55 mg/dl target (OR 4.40 [1.83-10.51]; p<0.001). We conclude that T2DM is a strong and independent predictor of LDL-C target achievement among PAD patients; however, also among PAD patients with T2DM the majority does not even meet the liberal LDL-C target of <70 mg/dl.

Disclosure

S. Sternbauer: None. A. Vonbank: None. C. Heinzle: None. D. Zanolin-Purin: None. J.F. Dopheide: None. I. Baumgartner: None. B. Larcher: None. A. Mader: None. A. Leiherer: None. A. Muendlein: None. H. Drexel: None. C.H. Saely: None.
223-LB: Beta-Cell Function but Not Insulin Sensitivity Is Impaired in Nondiabetic Cystic Fibrosis Adults Assessed with the Oral Minimal Model Method
Authors: SCHIAVON MICHELE , TOFFOLO GIANNA MARIA , COBELLI CLAUDIO , NAIR K. SREEKUMARAN , MORAN ANTOINETTE
Published: June 2019

Insulin deficiency in cystic fibrosis (CF) is the primary cause of impaired glucose tolerance and diabetes. However, along with insulin deficiency, insulin sensitivity may also play an important role. Herein we aimed to quantify insulin action and secretion in nondiabetic CF adults in comparison with healthy controls after an oral glucose tolerance test (OGTT) with the oral minimal model method. Sixteen nondiabetic CF (7F; age=22±2 y; BMI=22±2 kg/m2; BW=66±10 kg) and seven healthy adults (3F; age=22±2 y; BMI=22±2 kg/m2; BW=66±9 kg) underwent an OGTT. Plasma glucose, insulin and C-peptide were measured for 5 h. The oral glucose and C-peptide minimal models were used to quantify indices of glucose absorption, insulin sensitivity, β-cell responsiveness and disposition index.

Insulin sensitivity was similar (mean±SE; p-value from two-sample t-test) in CF and healthy (23±3 and 16±3 10-4 dL/kg/min per uU/mL; NS), while percentage of glucose absorbed within the first two hours was significantly higher in CF (70±3 vs. 53±4 %; p<0.005). In contrast, β-cell responsiveness was significantly reduced in CF (42±4 vs. 118±16 10-9 min-1) due to a reduction both in the dynamic (320±45 vs. 1316±172 10-9; p<0.005) and static (42±4 vs. 118±16 10-9 min-1; p<0.005) component. The delay in the static component was also higher, but not significantly, in CF (15±4 vs. 8±3 min; NS). As a consequence, the disposition index was significantly reduced in CF (1659±423 vs. 3303±426 10-14 dL/kg/min2 per pmol/L; p<0.05). Of note, no difference in incremental Area Under Curve (0-5 h) of glucose (6186±884 vs. 3680±1113 mg/dL*min; NS), insulin (4901±559 vs. 8577±2032 uU/mL*min; NS) and C-peptide (331±33 vs. 349±82 nmol/L*min; NS) in CF vs. healthy was observed.

In conclusion, the oral minimal model method showed that abnormal glucose tolerance in our cohort of CF patients is due to an impaired β-cell function, while insulin action is similar and glucose absorption is higher.

Disclosure

M. Schiavon: None. G.M. Toffolo: None. C. Cobelli: None. K. Nair: None. A. Moran: Other Relationship; Self; Novo Nordisk Inc.

Funding

National Institutes of Health (R01DK101402); National Center for Advancing Translational Sciences (UL1-TR-000114)
2234-PUB: A Risk Prediction Model for End-Stage Renal Disease in Patients with Type 2 Diabetes Mellitus
Authors: GEBA DANIELA , CORDOVA JEANINE M. , SHETTY SHARASH , WILLIAMS BRENT
Published: June 2019

End-stage renal disease (ESRD) is the most severe form of chronic kidney disease (CKD) and requires dialysis or renal transplant for survival. ESRD affects more than 600,000 individuals in the United States and over 40% of cases are diabetes-related. Results from recent clinical trials consistently showed that sodium-glucose cotransporter-2 (SGLT2) inhibitors improve renal outcomes among patients with type 2 diabetes mellitus (T2DM). Cost considerations, however, emphasize the need for designing cost-effective strategies to use the medicine in this class for ESRD prevention. Therefore, the goal of this project was to develop a risk prediction model that would help identify T2DM patients at high risk to develop ESRD. The study is based on a retrospective cohort of patients with T2DM who received health care services at a large, integrated healthcare system for at least two years between 2001 and 2016. Cox regression was used to identify the strongest predictors of ESRD among 93 candidate predictors (e.g., medical history, laboratory tests) obtained from the electronic medical records. The “high-risk” group included the highest risk 10% of patients according to the final model predictors. The study sample included 58,428 patients with a mean age of 61 years. Of these, 6350 (11%) had CKD at baseline. During a mean follow-up of 6.8 years, 2208 (3.8%) patients were diagnosed with ESRD. Estimated event rates were 0.4% at 1 year and 2.7% at 5 years. The corresponding rates for the high-risk group were 2.8% and 15.1%. The predictors of ESRD included in the final model were: blood urea nitrogen, CKD, albumin, pulse pressure, hemoglobin A1c, anemia, glomerular filtration rate, and preexisting diabetes (vs. newly diagnosed) (c-statistic: 0.706). The proposed risk prediction model for ESRD demonstrates strong predictive capabilities. Applied in clinical settings, the model could help clinicians identify T2DM patients most likely to benefit from SGLT2 inhibitors to prevent or delay progression to ESRD.

Disclosure

D. Geba: None. J.M. Cordova: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. S. Shetty: None. B. Williams: None.
2238-PUB: Small-Fiber Neuropathy Is Prevalent in Diabetes with Albuminuria
Authors: OH TAE JUNG , KANG SUNYOUNG , CHOI SUNGHEE , JANG HAK CHUL
Published: June 2019

Diabetic neuropathy is one of microvascular complications of diabetes. Among many types of diabetic neuropathy small-fiber neuropathy is believed to be the earliest sign of nerve dysfunction. Albuminuria, the other microvascular complication, is common and precedes renal dysfunction in diabetes and the early detection of these two complications is important. In this study, we investigated whether the small-fiber nerve dysfunction would be prevalent in subjects with diabetes and albuminuria. If so, we could discover a common etiology of these two conditions. We enrolled adult type 2 diabetes (n = 311) and measured their feet electrochemical skin conductance (ESC) by SUDOSCAN, and albumin to creatinine ratio (ACR) using random urine samples. The subjects were categorized according to their albuminuria status: no albuminuria, newly detected albuminuria, and persistent albuminuria. We defined small-fiber neuropathy if the feet ESC levels were less than 60 uS. Mean ages of subjects were 57.9 years and 58.8% were male. Among them, 13.5% and 20.6% of subjects had newly detected and persistent albuminuria, respectively. Mean ESC levels were decreased in subjects with albuminuria than those without albuminuria. In addition, more subjects had small-fiber neuropathy in albuminuria groups than normal counterpart (47.6% vs. 56.3% vs. 26.8% in newly detected albuminuria, persistent albuminuria, and no albuminuria groups, respectively, P <0.001). Feet ESC levels were negatively correlated with ACR and it can detect the presence of albuminuria with 58.5% of sensitivity and 70.2% of specificity. The feet ESC levels were independently associated with albuminuria after adjusting for diabetes duration, HbA1c, systolic blood pressure, triglyceride, and LDL-cholesterol.

In conclusion, small-fiber neuropathy was more prevalent in diabetes with albuminuria compared to diabetes without albuminuria. The small-fiber neuropathy might be an independent risk factor for diabetic nephropathy.

Disclosure

T. Oh: None. S. Kang: None. S. Choi: None. H. Jang: None.
2249-PUB: Current Practices and Gaps in Management of Dyslipidemia in Indian Participants with Type 2 Diabetes Mellitus (T2DM) in Alignment with American Association of Clinical Endocrinologists (AACE) Guidelines in LEADD (Learning with Experts to Advance Diabetes
Authors: UNNIKRISHNAN AMBIKA GOPALAKRISHNAN , DAS ASHOK KUMAR , SABOO BANSHI D. , KALRA SANJAY , AYYAR VAGEESH , TIWASKAR MANGESH HARIHAR
Published: June 2019

Background: Dyslipidemia is a common co-morbid condition in participants with T2DM. AACE guidelines advocate moderate to high intensity statins in T2DM unless contraindicated.

Objective: Assess evaluation practices and treatment patterns for dyslipidemia with statin intensity usage in the T2DM population as per AACE guidelines.

Methods: Sub-analysis of prospective, cross sectional, observational LEADD study in T2DM participants, conducted at 226 sites Participants stratified basis risk status and mean LDL was compared to recommended LDL levels as per AACE guidelines. “n”=number of participants analyzed for each parameter.

Results: Total of 4002 participants were evaluated and had mean (±SD) LDL - C levels of 117.7 ± 37.66 mg/dl. AACE Risk stratification with available data (n = 3538/4002) of participants was conducted on stratification 0.3% (n = 11/3538) participants were in high risk, 87.0% (n = 3077/3538) in very high risk and 12.7% (450/3538) in extreme risk category. Mean(±SD) LDL - C was 116.8 (± 36.41), 118.1 (±38.04) and 118.4 (± 41.39) mg/dl as against goal of <100, <70 and <55mg/dl for high risk, very high risk and extreme risk groups. 77.5% (n = 1523/1964) participants evaluated for dyslipidemia received Rosuvastatin. Percentage participants not on LDL- C goal were 54.54%, 89.88% and 94.77% in high risk, very high risk and extreme risk. 87.44% (n = 1962/2244), and 77.69% (n = 282/363 in very high risk and extreme risk group did not receive moderate to high intensity statin as recommended by AACE.

Conclusion: AACE guidelines adherence for evaluation and management of diabetic dyslipidemia is sub-optimal in study population. Although population falling in very high to extreme risk, they were not treated with moderate to high intensity statins. Reasons for these findings require further research.

Disclosure

A. Unnikrishnan: Other Relationship; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Dr. Reddys Laboratories, Eli Lilly and Company, Eris Pharmaceuticals, Ipca Laboratories Ltd., MSD, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Sanofi. A.K. Das: None. B.D. Saboo: None. S. Kalra: None. V. Ayyar: None. M.H. Tiwaskar: None.

Funding

Diabetes Care India; Dr. Reddy's Laboratories
2250-PUB: Fatty Acid Composition and Diabetic Kidney Disease in Type 2 Diabetes
Authors: KAWAI MIKI , ETO RUMA , AYAKO FUCHIGAMI , SATO GENKI , HIJIKATA MAI , YAMASHITA KAORU , ICHIJO TAKAMASA , HIGA MARIKO
Published: June 2019

Aim: Elevated saturated fatty acid (SFA) and decreased polyunsaturated fatty acid (PUFA) levels, especially n-3 PUFAs levels are important in the development of obesity and metabolic syndrome, but there are few accounts of the relationship between fatty acid composition and diabetic kidney disease. We investigated whether serum fatty acid composition, especially SFA and PUFA, are associated with urine albumin excretion (UAE) and estimated glomerular filtration rate (eGFR) in obese type 2 diabetic patients.

Research Design and Method: The subjects were 85 patients (age: 60.3±13.9 years old, 47 male and 38 female) who were not taking EPA agents. They were divided into two groups, i.e., Obese group (n=54) with a BMI of more than 25 kg/m2 and non-Obese group (n=31) with a BMI below 25 kg/m2. Serum levels of fatty acids were measured by gas chromatography.

Results: In the Obese group, the serum levels of palmitic acids and stearic acids, which belong to SFA, and dihomo-gamma-linolenic acid (DGLA), which is an n-6 PUFA, were significantly higher than those in the non-Obese group. No significant differences were seen in the serum levels of n-3 PUFA. UAE in the Obese group was 218.8±88.9 mg/gCr, which tended to be higher than that in the non-Obese group (135.9±49.0 mg/gCr), but there were no significant differences in eGFR between the two groups. The serum levels of palmitic acids, stearic acids, and DGLA showed significant positive correlations with UAE and eGFR in the Obese group, while no significant correlation was seen in the non-Obese group. Palmitic acids and DGLA were correlated with serum adiponectin and leptin levels.

Conclusion: These results suggest that an excessive lipid intake may play an important role in the development of not only obesity but also diabetic kidney disease. The high levels of blood SFA and n-6 PUFA might contribute to the diabetic kidney disease progression via hyperfiltration and inflammatory effects in type 2 diabetes patients with obesity.

Disclosure

M. Kawai: None. R. Eto: None. F. Ayako: None. G. Sato: None. M. Hijikata: None. K. Yamashita: None. T. Ichijo: None. M. Higa: None.
226-OR: The Lipoprotein Insulin Resistance Index Is a Measure of Hepatic and Total Insulin Resistance: The Federal Women's Study
Authors: CRAVALHO CELESTE K. , MEYERS ABBY G. , MABUNDO LILIAN , SUMNER ANNE E. , CHUNG STEPHANIE T.
Published: June 2019

The lipoprotein insulin resistance index (LPIR) is an emerging biomarker that correlates with peripheral insulin resistance (IR) derived from a composite score of 6 nuclear magnetic resonance (NMR) lipoprotein (LP) parameters. However, its ability to reflect hepatic and total body IR in women of African descent, who have low-normal triglyceride-rich LP particles, is unclear. Our objectives were to compare LPIR in black (BW) and white (WW) women and determine the association with insulin sensitivity index (SI), hepatic insulin sensitivity index (HISI), and hepatic and visceral fat content. In 127 federally employed women without diabetes (78 BW and 49 WW; age 44±10 (24-62y); BMI 30.2±5.7 (20.3-45.2 kg/m2); mean±SD (range)), LPIR was derived, SI was calculated by the minimal model, basal HISI using stable isotopes and hepatic and visceral fat measured by proton NMR. LPIR was lower in BW (18 (8-37) vs. 26 (14-41), median (IQR), P=0.04) but there was no difference by race in the correlation coefficients of LPIR with SI (r=-0.5), HISI (r=-0.6), hepatic fat (r=0.5), visceral fat (r=0.6), all P<0.01. Compared to the 1st quartile, the 4th quartile of LPIR was associated with lower hepatic and total IR, and higher hepatic and visceral fat (Table). Overall, the LPIR index was a strong correlate of hepatic and total IR and may be a useful index for identifying individuals who are at risk for diabetes.

Disclosure

C.K. Cravalho: None. A.G. Meyers: None. L. Mabundo: None. A.E. Sumner: None. S.T. Chung: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases
227-LB: Sociodemographic and Lifestyle Factors Associated with Long-Term Weight Change among Low-Income Blacks and Whites
Authors: YANG JAE JEONG , SHU XIAO-OU , YU DANXIA
Published: June 2019

Objective: American adults gain on average 1-2 lb/year. Sociodemographic and lifestyle factors have been shown to influence body weight. This influence has not yet been well characterized among blacks and low-income Americans, who are at high risk for obesity and related diseases.

Methods: Included in the study were 12,261 blacks and 6,307 whites, 40-69 years old, who participate in the Southern Community Cohort Study, had no history of diabetes, cardiovascular disease, or cancer, and reported ≥2 body weight measures, one at baseline and another during follow-up. Mixed model was used to evaluate 5-year weight change in relation to baseline factors and changes in factors during follow-up. Analyses were conducted among all subjects and stratified by sex and race and baseline obesity status. Differences in 5-year weight change>1 lb with FDR-p<0.10 were considered significant.

Results: During follow-up (median: 6 years; range: 0.5-15 years), participants gained 2.5 lb/year. After mutual adjustments, greater 5-year weight gain was seen among men (+1.61 lb) than women and associated with getting married (+1.67 lb), quitting smoking (+4.72 lb), and transition to menopause (+1.98 lb). The association for marital status change was most evident among white men (+5.80 lb) and the association for quitting smoking was most evident among subjects with baseline BMI>35 (+8.95 lb). Diet and other lifestyle factors (e.g., physical activity) overall contributed modestly to 5-year weight change in this population, although associations were observed for per serving increase in greens and beans among white women (-4.61 lb) and dairy among white men (+3.30 lb) and Healthy Eating Index among subjects with BMI>35 (-2.02 lb per 10 points increase).

Conclusion: Changes in smoking, marriage, and menopause status contribute to body weight change among low-income Americans. Certain dietary factors are also related to weight change, but the association may vary by sex, race, and obesity status.

Disclosure

J. Yang: None. X. Shu: None. D. Yu: None.
2274-PUB: Glycemic Index and Response of Plant-Based Nutritional Supplement and Its Subjective Satiety in Indian Adults
Authors: MOHAN VISWANATHAN , PARTHASARTHY VIJAYALAKSHMI , JEEVAN R. GANESH , VISWANATHAN GOPINATH , VASUDEVAN KAVITHA , NAGAMUTHU GAYATHRI , RAJAGOPAL GAYATHRI , KARTHIKEYAN PARKAVI , SHANMUGAM SHOBANA , ANJANA RANJIT MOHAN , UNNIKRISHNAN RANJIT , VASUDEVAN SUDHA , TOPPO ARCHANA , MEHTA SUYOG , ACHARYA SHIVANI A. , BHOITE RACHANA MAHESH
Published: June 2019

Background: The major nutritional challenges faced by individuals with diabetes in South Asia is adhering to dietary advocacy and providing optimal nutrition with adequate protein and dietary fibre as they usually consume very high carbohydrate diet. This is particularly a concern in vegetarians.

Aim: The objective of the study was to assess the Glycemic Index (GI) and Glycemic Response (GR) of two different flavors of a plant based nutritional supplement specially designed with high protein and fibre. The subjective satiety was also assessed.

Methods: In all, fifteen overweight/obese subjects aged 18-45 years were recruited. After overnight fasting, blood samples were drawn at -5 and 0 minutes. Test and reference food providing available carbohydrates of 25g each was consumed by the participants. The capillary blood samples were drawn at 15, 30, 45, 60, 90 and 120 minutes. Participants underwent 3 days of reference food testing and 1 day of test food test in random order with 2 days of wash out period. The GI was assessed using validated ISO, 2010 protocol. Satiety index was measured using Visual Analog Scale (VAS). The dietary intake of the subjects for previous day and the test day was measured by 24-hour dietary recall. The Incremental Area Under the Curve (IAUC) was calculated using the trapezoid rule. The study was registered in the clinical trial registry of India, CTRI/2018/04/012979.

Results: The GI and GR of both flavors of the supplement was categorized as low GI. The GI and GR of Flavor 1 was 27.3±4.8 and 16.4 ±2.6 (Mean ± SEM) respectively. For Flavor 2 the GI and GR was 36.7±4.4 and 25.7 ± 2.3 (Mean ± SEM). For Flavor 1, 60% of participants reported feeling hungry only after 3 hours, showing good satiety.

Conclusion: The plant based high fibre high protein supplement, along with regular meal could help in reducing the postprandial glycemic response and improve satiety.

Disclosure

V. Mohan: None. V. Parthasarthy: None. R. Jeevan: None. G. Viswanathan: None. K. Vasudevan: None. G. Nagamuthu: None. G. Rajagopal: None. P. Karthikeyan: None. S. Shanmugam: None. R. Anjana: None. R. Unnikrishnan: None. S. Vasudevan: None. A. Toppo: Employee; Self; Dr. Reddys Laboratories. S. Mehta: Employee; Self; Dr. Reddys Laboratories. S.A. Acharya: Employee; Self; Dr. Reddys Laboratories. R.M. Bhoite: Employee; Self; Dr. Reddys Laboratories.
2282-PUB: Differences in Child Psychosocial Functioning According to Diabetes and Weight Status
Authors: GUSEMAN EMILY H. , ENGLERT MARIA K. , WHIPPS JONATHON , SCHULZE MEGHAN , BEVERLY ELIZABETH A.
Published: June 2019

Children with diabetes may be expected to experience greater psychosocial difficulty than children without chronic diseases, however less is known about how this varies according to weight status.

Purpose: The purpose of this study was to evaluate differences in child psychosocial functioning among children with type 1 diabetes (T1D) in comparison to children with overweight and obesity.

Methods: Parents of children age 2-17 years were invited to participate in this online survey study. Parents reported child demographics, chronic disease diagnoses, body size, and completed the parent version of the 35-item Pediatric Symptom Checklist (PSC). Children were classified into 4 groups based on diagnosis of T1D, and then according to BMI percentile. ANOVA was used to compare PSC total score and internalizing, externalizing, and attention subscales between groups. Multiple regression was used to examine the contribution of T1D diagnosis, age, gender, and BMI percentile to PSC total score.

Results: A total of 133 children were included in the analysis (mean age 9.7 + 3.1 years, 48.9% girls). PSC total score was highest among children with T1D (54.25 + 17.9) followed by children with obesity (48.1 + 16.6), comparison (46.6 + 12.4), and overweight children (43.8 + 14.0); however, these differences did not reach statistical significance. Comparison children demonstrated higher externalizing and internalizing subscale scores than did overweight children, while the highest attention subscale score was found among children with obesity. The strongest predictor of PSC total score was T1D (unstandardized B = 9.4; p=0.03).

Discussion: No differences were found in psychosocial functioning among this sample. Trends in the data suggest that the presence of T1D, and potentially obesity, may be associated with worse psychosocial functioning among children. However, additional studies are needed to confirm.

Disclosure

E.H. Guseman: None. M.K. Englert: None. J. Whipps: None. M. Schulze: None. E.A. Beverly: None.
2288-PUB: Capturing the Emotional Burden of Gestational Diabetes
Authors: HARDING ANNA-JANE , MCGILL MARGARET , GAULD AMANDA , PECH CHRISTINE M. , O'CONNOR DANIEL , CONSTANTINO MARIA I. , ROSS GLYNIS P. , WU TED , WONG JENCIA
Published: June 2019

Gestational diabetes (GDM) is increasingly common and the burden to healthcare services is well recognized. Less understood is the emotional burden associated with a diagnosis of GDM, from the women’s perspective. A qualitative study of women attending the Royal Prince Alfred Hospital, Sydney Antenatal Diabetes Service was undertaken during a 14-week period in 2018. Women were invited to complete an anonymous questionnaire which asked, “How do you feel about the diagnosis of Gestational Diabetes?” Women were included in the study at three time points, i) newly diagnosed with GDM ii) at 36 weeks gestation and iii) at 3-month follow-up post-delivery. Responses were received from 189 women; 121, 32 and 36 at diagnosis, 36 weeks and post-delivery time points respectively. Their free text responses were transcribed and a thematic analysis of content was undertaken. Results were visualized using a word cloud and tag cloud generator (www.wordclouds.com) with font size representing the prominence or frequency of words expressed. As demonstrated by the images generated, the predominant feelings expressed at diagnosis were ‘worried,’ ‘disappointed,’ ‘upset,’ ‘sad’ and ‘anxious.’ These negative emotions prevailed irrespective of previous GDM experience and maternal age. At 36 weeks the predominant feelings expressed were ‘frustrated,’ ‘disappointed,’ ‘worried,’ ‘upset’ and ‘anxious.’ The primary emotion expressed in diet treated women was ‘anxious’ and in insulin treated women ‘worried.’ Post-delivery, the predominant words were ‘relieved,’ ‘supported’ and ‘anxious.’

In conclusion, there was a high prevalence of negative emotion expressed by women with GDM at diagnosis which persisted throughout pregnancy and, for many, into the postnatal period. Clinicians need to be mindful of this high emotional burden with the aim to better support women with GDM and reduce associated distress.

Disclosure

A. Harding: None. M. McGill: None. A. Gauld: None. C.M. Pech: None. D. O'Connor: None. M.I. Constantino: None. G.P. Ross: Other Relationship; Self; Roche Diabetes Care Australia. T. Wu: Advisory Panel; Self; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk A/S, Sanofi. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. J. Wong: Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; AstraZeneca, Lilly Diabetes.
2303-PUB: Efficacy of Dulaglutide (DU) as First Injectable Option for Patients with Type 2 Diabetes (T2D): A Post Hoc Pooled Analysis
Authors: PATEL HIREN , MUNIR KASHIF M. , SUTHERLAND SINDEE S. , KONIG MANIGE
Published: June 2019

Background: ADA-EASD consensus report recommends using GLP-1RAs including DU as 1st injectable therapy prior to basal insulin in most patients with T2D not at their glycemic goals after oral antidiabetic medications (OADs).

Objective To assess the glycemic efficacy of DU 1.5 mg in patients with T2D when added on background of commonly used OAD regimens.

Methods: Patients from 7 Phase-3 trials where DU 1.5 mg was added to OADs were pooled and categorized based on OAD regimens into the following categories; Metformin (MET), sulfonylurea (SU), MET + SU, MET + Pioglitazone, MET + SGLT2i. DU 0.75 mg was assessed in only 5 studies and hence not included in this analysis. Change from baseline in HbA1c, fasting serum glucose and body weight, % patients with HbA1c <7%, GI adverse events and hypoglycemia were assessed.

Results: Table 1 summarizes the glycemic and weight outcomes of DU at baseline and after 6 months for different OAD categories. HbA1c reduction of -1.3 to -1.6% and weight change of -0.8 to -2.9 kg was seen when DU was added to different OADs. Nausea, vomiting and diarrhea were reported by 10-35%, 4-19% and 6-28% patients respectively. Severe hypoglycemia occurred in 1 patient in MET+SU group.

Conclusion: In patients with T2D on different OAD regimens and requiring an additional glycemic control, DU demonstrated clinically meaningful glycemic control making it an effective first injectable option.

Disclosure

H. Patel: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. K.M. Munir: None. S.S. Sutherland: Other Relationship; Self; Eli Lilly and Company. M. Konig: Employee; Self; Eli Lilly and Company, Eli Lilly and Company.
2304-PUB: Liraglutide also Has Favorable Effects on Body Composition without Decrease in Lean Body
Authors: KANEKO SHIZUKA , UEDA YOUHEI , TAHARA YUMIKO
Published: June 2019

Background/Objective: It has been known that liraglutide GLP-1 therapy produces a decrease in body weight with a concurrent decrease in appetite. However, we felt it was important to investigate this phenomenon more deeply in order to ascertain whether there were effects an leanness or body fat, especially visceral fat which may induce atherosclerosis.

Method: We conducted an observation study to investigate the effect of liraglutide therapy (n=53), a GLP-1RAg, on body composition in patients during hospitalization. These results were compared with those obtained from insulin therapy (n=130). Diet therapy (ideal BW x 27 kcal/day including <25% fat and >55% carbohydrate) and exercise therapy after every meal were provided. Body weight changes, body composition (i.e., lean body mass and % body fat) and were analyzed.

Result: We found the body weights of subjects receiving liraglutide decreased by 2.4 ± 2.0. However, for insulin therapy, subjects body weight only decreased by 1.6 ± 2.1 kg (p < 0.05). In addition, lean body mass in the liraglutide and insulin groups showed no significant changes from the first day of therapy. However, regarding visceral fat area (VFA), we found that patients undergoing liraglutide and insulin therapy tended to experience a decrease (101±152.4 vs. 113±171.7 cm2).

Conclusion: Our study showed the administration of liraglutide reduced visceral fat, but not lean body mass. In addition, we found that diet and exercise therapy mostly contribute to decrease in visceral fat regardless of the medication.

Disclosure

S. Kaneko: Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Mitsubishi Tanabe Pharma Corporation, Novo Nordisk Inc., Sumitomo Dainippon Pharma Co., Ltd. Y. Ueda: None. Y. Tahara: None.
2318-PUB: Patient Experience after Using a Medtronic Enhanced Hybrid Closed-Loop System
Authors: SADEGHZADEH MAHTA
Published: June 2019

Objective: The prototype enhanced hybrid closed-loop (E-HCL) system has iterative changes from the current HCL system that include automated correction boluses to address hyperglycemia and improved usability. User experience with this system was qualitatively assessed after a 1-week supervised hotel phase and 3-week at-home phase.

Method: Twelve adults (median age 48 [39-57] years and HbA1c 6.8% [6.2-7.2%]) with type 1 diabetes were asked to complete a Medtronic-developed survey (5-point scale) after completing a hotel and at-home phase of E-HCL system use. In addition, they were interviewed for an hour after completing the study.

Result: After completion of both phases, 100% of respondents rated the E-HCL system 5.0±0.0, the best therapy they have ever been on, all rated their overall satisfaction as extremely satisfied or very satisfied (4.8±0.4) with a net promoter score (NPS) of 100%. Reasons for high satisfaction were improved overall time in range, reduced highs after meals, increased time in Auto Mode, and reduced daily effort required to manage diabetes. All participants stated that they trusted the system to take care of their glucose and that it significantly increased their flexibility and confidence in taking care of their diabetes.

Conclusion: All users reported a high level of satisfaction with the prototype E-HCL system and believed it improved their outcomes while reducing their day to day effort in managing diabetes.

Disclosure

M. Sadeghzadeh: Employee; Self; Medtronic.
2327-PUB: Real-World Patient-Reported Outcomes (PROs) with Insulin Glargine 300 U/ml (Gla-300) in Basal Bolus-Treated People with Type 2 Diabetes (T2DM): The MAGE Study
Authors: VERHAEGEN ANN A. , SCHEEN ANDRÉ , ALEXANDRE KATHY C. , BRUHWYLER JACQUES , COLIN IDES M.
Published: June 2019

Fear of hypoglycemia and treatment satisfaction both influence therapy adherence. MAGE was a 6-month multicenter, prospective, single-arm, observational study with a 6-month extension conducted in Belgium, mainly assessing patient satisfaction with Gla-300 in people ≥18 years, with T2DM for ≥1 year, HbA1c 7.0-10.0%, receiving a basal-bolus insulin regimen for ≥6 months ± oral antidiabetic therapy, and naïve to Gla-300. Primary objective: change of ≥2 points in Diabetes Treatment Satisfaction Questionnaire Status Version (DTSQs) total score (TS) from baseline (BL) to month 6. Secondary objectives included change in: HbA1c, other DTSQs scores, and hypoglycemia fear scale II (HFS-II). The intent-to-treat population comprised 87 patients (Table). Primary endpoint was achieved; DTSQs TS increased by 2.80 (SD: 5.46; p<0.0001; Table). Significant decreases were seen in total HFS-II scores and worry/behavior subscales (all p<0.05). There was no change from BL in HbA1c (p>0.05); however, more patients reached HbA1c <7% at month 12 versus BL (11.5% vs. 0%). Hypoglycemia occurred at a mean (SD) 34.97 (48.28) events per patient-year.

Treatment satisfaction and fear of hypoglycemia significantly improved after switching to Gla-300 in people with T2DM on basal-bolus insulin therapy in a real-life setting.

Disclosure

A.A. Verhaegen: Advisory Panel; Self; Amgen Inc., AstraZeneca, Boehringer Ingelheim International GmbH, Lilly Diabetes, Merck & Co., Inc., Sanofi. Speaker's Bureau; Self; Mylan, Novo Nordisk Inc. A. Scheen: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, Janssen, Merck Sharp & Dohme, Novartis, Novo Nordisk, Sanofi, Servier. Research Support; Self; AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, Janssen, Merck Sharp & Dohme, Novartis, Novo Nordisk, Sanofi, Servier. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, Janssen, Merck Sharp & Dohme, Novartis, Novo Nordisk, Sanofi, Servier. K.C. Alexandre: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. J. Bruhwyler: Other Relationship; Self; Sanofi. I.M. Colin: None.

Funding

Sanofi
233-LB: Depressive Symptom Trajectories among Youth and Young Adults with Type 1 Diabetes
Authors: SUTHERLAND MELANIE W. , LOHMAN MATTHEW , REBOUSSIN BETH A. , FLORY KATE , BROWN MONIQUE J. , CORATHERS SARAH , BELLATORRE ANNA , LAWRENCE JEAN M. , YI-FRAZIER JOYCE , PIHOKER CATHERINE , LIESE ANGELA D.
Published: June 2019

Purpose: To characterize the burden of depressive symptoms over time in youth and young adults (YYA) with type 1 diabetes (T1D) by identifying subgroups that have similar trajectories of depressive symptoms and assessing baseline demographic predictors of these trajectories.

Methods: YYA diagnosed with T1D between 2002-2005, ages 10.0 to 20.6 years, who were enrolled in the SEARCH for Diabetes in Youth Study baseline were included (n = 879, 47.6% female, 76.3% non-Hispanic white). Participants provided a baseline and at least one follow-up measure of depressive symptoms using the Center for Epidemiologic Studies - Depression (CES-D) scale over a five-year period. Group-based trajectory modeling was used to assign individuals to the most likely depressive symptom trajectory class, and multinomial logistic regression was used to assess predictors of trajectories. Depressive symptoms were interpreted based on established CES-D cut-offs for adolescents: minimal (0-15), mild (16-23), and moderate/severe (24-60).

Results: Five depressive symptom trajectory classes were identified: little to no symptoms (63.2%), persistent minimal (22.2%), increasing from mild to moderate (4.6%), decreasing from mild to minimal (6.7%), and chronic moderate (3.3%). There were no significant differences in age at baseline among the groups. Significant demographic predictors of trajectories included sex, race/ethnicity, parental education, family income, and health insurance status. For example, the increasing mild to moderate trajectory had a greater proportion of Hispanic participants, public health insurance, and lower parental education compared to the little to no symptoms trajectory.

Conclusion: Among YYA with T1D, unique trajectories of depressive symptoms show meaningful differences in demographic characteristics. These results provide insight into the identification of high-risk groups and potential target populations for prevention of chronic depressive symptoms.

Disclosure

M.W. Sutherland: None. M. Lohman: None. B.A. Reboussin: None. K. Flory: None. M.J. Brown: None. S. Corathers: None. A. Bellatorre: None. J.M. Lawrence: None. J. Yi-Frazier: None. C. Pihoker: None. A.D. Liese: None.

Funding

University of South Carolina
2340-PUB: Success of Online CME at Improving the Clinical Knowledge and Confidence in Using SGLT1/SGLT2 Inhibitors in T1D Management
Authors: LARKIN AMY , LACOUTURE MICHAEL , LE ANNE
Published: June 2019

Introduction: New data continue to emerge related to safety and efficacy of emerging SGLT1 and 2 inhibitors. We sought to assess the effect of online education designed to improve the knowledge and confidence of primary care physicians (PCPs), diabetologists and endocrinologists (D/Es), and nurses/nurse practitioners (NPs) in emerging therapies for diabetes management.

Methods: The education consisted of a 30-minute continuing medical education (CME)-certified roundtable discussion among 3 expert faculty. A 3-question knowledge and 1-question confidence linked pre-/post-assessment study design with McNemar’s chi-squared test (5% significance level, P <.05) assessed educational effect. The activity launched September 26, 2018 and data collected through October 5, 2018.

Results: Improvements were demonstrated by all specialties (PCP N=324, D/E N=104, nurse/NP N=1519): 24% more PCPs (P<.0001), 20% more D/Es (P=.0032), and 4% more nurses/NPs (P=.0251) correctly identified the mechanism of action of dual SGLT1/SGLT2 inhibitors. 38% of PCPs, 27% of D/Es, and 28% of NPs reported increased confidence in the treatment of type 1 diabetes with non-insulin therapies, specifically SGLT type 1 and SGLT type 2 inhibition. Continued knowledge gaps were identified for all specialties: 72% of PCPs, 65% of D/Es, and 66% of nurses/NPs failed to recognize safety and efficacy data for an emerging dual SGLT1/SGLT2 inhibitors. 40% of PCPs, 17% of D/Es, and 55% of nurses/NPs incorrectly identified a candidate for dual SGLT1/SGLT2 therapy 45% of PCPs, 32% of D/Es, and 69% of nurses/NPs failed to recognize the mechanism of action of dual SGLT1/SGLT2 inhibitors.

Conclusion: This study demonstrates the success of an online CME-certified roundtable discussion on improving clinical knowledge and confidence of PCPs, D/Es, and nurses/NPs related to dual SGLT1/SGLT2 inhibitors when treating patients with T1D. Continued knowledge gaps were identified for future education.

Disclosure

A. Larkin: None. M. LaCouture: None. A. Le: None.

Funding

Sanofi U.S.; Lexicon Pharmaceuticals