bluuebunny/crossref_metadata_2025 huggingface dataset:
9-OR: ADA Presidents’ Select Abstract: Reductions in Management Distress following a Distress Intervention Are Associated with Improved Management and Glycemic Control over Time
Authors: HESSLER DANIELLE M. , FISHER LAWRENCE , MASHARANI UMESH , POLONSKY WILLIAM
Published: June 2020

Objective: To explore mechanisms by which changes in diabetes distress (DD) can lead to reductions in Hemoglobin A1c among adults with type 1 diabetes over time in the context of a distress intervention.

Methods: In a two-arm randomized trial aimed at reducing DD (a DD-focused vs. an education/management intervention), 301 adults with type 1 diabetes [mean ± SD age was 45.1 ±15.0 years, baseline HbA1c 8.80% ± 1.12]. Individuals were assessed at baseline and at 9 month follow-up on DD, behavioral management, HbA1c and frequency of hypoglycemia (blood glucose < 70 mg/dl). Structural equation modeling tested for significant pathways between changes in DD, behavioral measures, and glycemic control; with separate pathways tested for both the education based and affective focused interventions.

Results: Reductions in management distress were associated with fewer missed insulin boluses, increased problem solving skills, increased diabetes knowledge and more frequent adjustments to insulin regimen in relation to diet (all p < .05). In turn, reductions in missed insulin boluses were linked with improved HbA1c; while increases in problem solving and diabetes knowledge were linked with reductions in frequency of hypoglycemia over a 9-month period. SEM model indices indicated good fit (Chi-square p = .01, CFI = .95, RMSEA = .04). An overall stronger set of linkages were noted for the DD-focused vs. the education/management intervention.

Discussion: In the context of an RCT to reduce DD, results point to significant pathways by which changes in Management Distress operate through changes in disease management and knowledge, which, in turn, drive changes in HbA1C and frequency of hypoglycemic episodes. These findings document the mechanisms through which DD is associated with glycemic control in type 1 diabetes and support the importance of integrating disease management with interventions to reduce DD to maximize improvements in glycemic control.

Disclosure

D.M. Hessler: Consultant; Self; Eli Lilly and Company. L. Fisher: None. U. Masharani: None. W. Polonsky: Advisory Panel; Self; Intarcia Therapeutics, Roche Diabetes Care. Consultant; Self; Abbott, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk Inc., Onduo, Sanofi US, Xeris Pharmaceuticals, Inc.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK094863)
903-P: Hydroxyurea Resulting in False Elevation of Continuous Glucose Sensor Values
Authors: TELLEZ SIOBHAN E. , HORNUNG LINDSEY , COURTER JOSHUA D. , ABU-EL-HAIJA MAISAM , NATHAN JAIMIE D. , LAWSON SARAH , ELDER DEBORAH A.
Published: June 2020

Objective: To assess the degree, duration, and mean absolute relative difference (MARD) of false values per continuous glucose monitoring (CGM) systems when hydroxyurea (HU) is administered.

Research Design and Methods: Inpatient glucometer and CGM data from 16 post-total pancreatectomy (TPIAT) patients using Dexcom Professional G4 and 6 patients using Dexcom G6 were analyzed after daily dosing with HU. Timing of HU dosing and up to 2 weeks of sensor and glucometer values were assessed in each patient.

Results: A false elevation (>20 mg/dL) of sensor readings were identified after HU dosing. The greatest discrepancy between glucometer and sensor readings occurred 0.5-2 hours after HU administration [G4 (mean 53 mg/dL, median 44 mg/dL, MARD 0.55), G6 (mean 67 mg/dL, median 72.5 mg/dL, MARD 0.79)]. The sensor and glucometer readings were <20 mg/dL mean and median, MARD 0.14 (G4) and <40mg/dL mean and median, MARD 0.18 (G6), by 6 hours after administration. All other prescribed medications were given multiple times each day and did not result in glucose value discrepancy.

Conclusions: There is a false elevation of sensor glucose readings compared to glucometer values (up to 180 mg/dL (G4), 235 mg/dL (G6)) from 0.5hr to 6hr following HU administration. It is important to counsel a patient using a Dexcom CGM system and HU therapy on this finding and to advise reliance on glucometer testing for accurate glucose assessment up to 6 hours after HU administration.

Disclosure

S.E. Tellez: None. L. Hornung: None. J.D. Courter: None. M. Abu-El-Haija: None. J.D. Nathan: None. S. Lawson: None. D.A. Elder: None.
905-P: Is Continuous Glucose Monitoring Effective? Evidence from Real-World Data
Authors: ZHENG YAGUANG , SIMINERIO LINDA M. , ANTON BONNIE , KRALL JODI T. , BEDNARZ LORI L. , LI DAN , NG JASON
Published: June 2020

Background: Numerous clinical trials have shown the effectiveness of Continuous Glucose Monitoring (CGM) on glycemic control in patients with diabetes; however, real-world evidence of application of CGM is largely lacking. This retrospective study aimed to examine the effects of application of CGM in clinical practice.

Method: Electronic health record (EHR) data from an integrated academic health center’s ambulatory diabetes clinic between May 2014 and May 2019 were used to identify eligible patients diagnosed with diabetes and had used CGM. Diabetes was defined based on ICD-10 Diagnosis Codes. Linear mixed models were used for analysis.

Results: The sample (n=60) was White (86.7%), female (51.7%), with a mean age of 46.9±15.6 years and mean duration of diabetes 19.8±12.4 years. A total of 66.7% of sample had type 1 and 30.0% had type 2 diabetes. The types of CGM were intermittently scanned (51.7%), real-time (36.7%), and passive (11.6%). The HbA1c (%) had a significant reduction after CGM use at 3 months (7.76±1.53) and 6 months (7.76±1.83) compared with 3 months (8.53±1.91) and 6 months (8.62±1.80) before CGM use (p=.002). There were no differences in HbA1c changes by types of CGM (p=.31).

Conclusion: Using EHR data can provide real-world evidence of CGM’s positive impact on glycemic control and on sustained improvement at 6 months. Future research should examine CGM effect gathered from multiple clinics.

Disclosure

Y. Zheng: None. L.M. Siminerio: Research Support; Self; Becton, Dickinson and Company. B. Anton: None. J.T. Krall: Research Support; Self; Becton, Dickinson and Company. L.L. Bednarz: Other Relationship; Self; Medtronic, Tandem Diabetes Care. D. Li: None. J. Ng: None.
91-LB: Study of Glycemic Variability and Hypoglycemia Using Continuous Glucose Monitoring in Type 2 Diabetes Mellitus Changed from Basal-Bolus Therapy to Basal-GLP-1RA Therapy
Authors: MIYOSHI ARINA , OBARA SHINJI , WADA NORIO
Published: June 2020

Background and Aims: There are currently nine categories of hypoglycemic drugs and the range of choice is expanding. Insulin is very effective but prone to hypoglycemia. Therefore, it is important to consider changing to drugs that are unlikely to cause hypoglycemia in patients who have stable glycemic status. At the same time, however, it should be noted that inappropriate de-escalation of treatment leads to a worsening of the glycemic situation. Thus, in patients with T2D treated with Basal-Bolus Therapy (BBT) using a small amount of bolus insulin and stable glycemic control, under CGM, we had left basal insulin and switched from all bolus insulin to a weekly GLP-1 RA.

Materials and Methods: The subjects were T2D outpatients who were changed from BBT to Basal-GLP-1 RA Therapy (BGT) under CGM during the period from November 2018 to November 2019. Freestyle Libre Pro was used as CGM in all cases. We analyzed average glucose levels, glycemic variability (%CV), Time Below Range (<70mg/dl), Time In Range (70-180 mg/dl) for 3 days before and after treatment change. A total of 18 patients were included in this study. On average, the patient group was aged 58 years and they had been living with T2D for the past 7.0 years. Their HbA1c was 6.6% and BMI was 25.9 kg/m2. Non-fasting CPR was 2.9 ng/ml. Total daily bolus insulin dose was 12.6 units.

Results: In all cases, bolus insulin was changed to dulaglutide 0.75mg with the same amount of basal insulin. There was no deterioration in mean glucose levels, TBR and TIR (115.4 vs. 105.7 mg/dl, 8.2 vs. 7.5%, 81.4 vs. 87.6%, respectively). %CV (21.1 vs. 15.7%; P = 0.029) and HbA1c (6.6 vs. 6.3%; P = 0.020) were significantly improved.

Conclusion: In T2D with stable glycemic status and maintained endogenous insulin secretion, stepping down from BBT using a small amount of bolus insulin to BGT was able to better manage glycemic level and variability under CGM observation.

Disclosure

A. Miyoshi: None. S. Obara: None. N. Wada: None.
919-P: Comparison of Glycated Haemoglobin with Glycated Albumin as Glycemic Marker in Patients with Iron Deficiency Anaemia: Real-World Evidence from Indian Setting
Authors: THACKER HEMANT , NITEY PRATEEK , MAKKAR BRIJ M. , MAHESHWARI ANUJ
Published: June 2020

Strict glycaemic management is cornerstone of metabolic control. We prospectively compared Glycated Albumin (GA) with Glycated Hemoglobin (HbA1c) for the preciseness as marker for glycemic indicator in T2DM patients presenting with iron deficiency anaemia (n=45). Patients were treated with IV iron therapy (Iron Isomaltoside) without changing the metabolic treatment protocol. Table summarises the progressive change over baseline, two and four weeks in Hemoglobin (Hb), FPG, HbA1c and GA. 25 patients (56%) were females; mean age was 52.1 ± 10.74 years. Hb was negatively correlated with HbA1c (r = - 0.001; p = 0.99 NS) and positively corelated with GA (r = 0.29; p = 0.44 NS). Mean (±SD) percentage difference in the target and achieved values of HbA1c (6.5%) and GA (<18%) was 6 (±3.6) and -19 (±10), respectively. All the patients achieved glycemic targets when assessed with GA in contrast to none achieving HbA1c targets. The (GA/HbA1c) ratio did not ranged widely (range 0.75), mean 2.1 (±0.27, 95% CI 1.9 to 2.3). HbA1c values may be misleading, whereas GA, which is independent of anemia would be a precise monthly glycemic indicator than HbA1c to evaluate the glycemic control and fluctuations, in patients with anaemia to achieve strict and early glycemic control and further optimise the treatment. The results need corroboration with larger studies.

Disclosure

H. Thacker: None. P. Nitey: None. B.M. Makkar: Advisory Panel; Self; Abbott, AstraZeneca, Biocon, Boehringer Ingelheim Pharmaceuticals, Inc., Eris Lifesciences, Novartis AG, Novo Nordisk Inc., Sanofi, USV Private Limited. Speaker’s Bureau; Self; Janssen Pharmaceuticals, Inc. A. Maheshwari: None.
93-OR: Low Maternal Insulin Sensitivity Associates with DNA-Related Functions in Human First-Trimester Trophoblast
Authors: BANDRES-MERIZ JULIA , HOCH DENISE , HONEDER SOPHIE , MAJALI-MARTINEZ ALEJANDRO , HERRERA EMILIO , SCHITTMAYER MATTHIAS , BIRNER-GRUENBERGER RUTH , DESOYE GERNOT
Published: June 2020

In first trimester (FT) of pregnancy the human placenta is rapidly growing making it sensitive to environmental influence. We hypothesized that the altered intrauterine milieu associated with maternal obesity modifies placental proteome and function. We used maternal BMI and leptin as measures of obesity and adiposity, characterized the glucose-insulin axis (glucose, C-peptide, insulin sensitivity (ISHOMA)) and quantified fatty acids (GC) in maternal fasted serum (n=123-323). Among those, only higher C-peptide levels and lower ISHOMA were associated with obesity. Subsequent untargeted proteomics (LC-MS/MS, qTOF Bruker maXis ETD II) in FT placentas (weeks 5-6 p.m.) from lean (n=11) and obese (n=11) women and Principal Component Analysis clustered the samples in two groups. Only ISHOMA differed between both clusters (ISHOMA cluster 1: median 0.95, IQR 0.69-1.17; ISHOMA cluster 2: median 0.57, IQR 0.20 - 1.00, P<0.05). Comparing proteomic profiles between ISHOMA groups (separated by median ISHOMA 0.61) identified 86 proteins enriched in the low ISHOMA cluster (P<0.05, FDR 0.05). Biological processes (KEGG pathway analysis) enriched in this group were related to DNA replication and cell cycle (FDR<0.001). Members of the MCM family, involved in DNA damage response and cell cycle arrest, associated with low ISHOMA. This suggested trophoblast growth related processes depend on ISHOMA. Semi-quantitative in-situ analysis found decreased trophoblast proliferation (Ki67, n=22, Δ -33.4%, p<0.05) and increased apoptosis (TUNEL assay, n=22, 5.6 fold, p<0.05) in the low ISHOMA group. These differences were related to an increased DNA damage (𝛄;;H2AX, n=12, 6.9 fold, p<0.001). We conclude that low ISHOMA associated with maternal obesity in FT of pregnancy induces placental proteome changes related to DNA metabolism. This might alter trophoblast, i.e., placental, growth early in pregnancy, which is known to associate with fetal growth and birth weight.

Disclosure

J. Bandres-Meriz: None. D. Hoch: None. S. Honeder: None. A. Majali-Martinez: None. E. Herrera: None. M. Schittmayer: None. R. Birner-Gruenberger: None. G. Desoye: None.
935-P: Effect of CTRB1/2 RS7202877 (T>G) Polymorphism on Weight Loss Response to Liraglutide Treatment in Greek People with Type 2 Diabetes
Authors: KYRIAZOU ANGELIKI V. , KYRIAKIDOU ARTEMIS , KOUFAKIS THEOCHARIS , VASILOPOULOS YIANNIS , AVRAMIDIS IAKOVOS , BALTAGIANNIS STEFANOS , MANTHOU ELENI , GOULIS DIMITRIOS G. , ZEBEKAKIS PANTELIS , KOTSA KALLIOPI
Published: June 2020

Previous studies have demonstrated an association between gene polymorphisms and weight loss response to GLP-1 RA therapy. We aimed to evaluate the role of rs7202877 (T>G) polymorphism in CTRB1/2 gene in weight loss response to liraglutide among Greek people with T2D. 116 adults with T2D (51% female, mean BMI 35.4±6.4 kg/m2, mean age 68.3±10.9 years), who had been on treatment with liraglutide for at least 6 months were genotyped for the rs7202877 polymorphism, using real-time PCR. Responders were defined as subjects who lost 3% or more of their baseline weight, whereas non-responders those who lost less than 3% of their initial weight after 3 or 6 months of liraglutide administration. 77 (66%) individuals were classified as responders and 39 (34%) as non-responders. 97 (84%) patients were homozygous for the wild type rs7202877 T allele (TT) and 19 (16%) patients carried one polymorphic G allele (TG). The probability of being weight loss responder was increased by 12%, when carrying the G allele; however, the result did not achieve significance (OR:1.12, 95% 0.4, 3.2, P=0.84). In the response group, weight was reduced by 5.9 kg (95% CI: -6.9, -4.9, P<0.0001) and by 6.4 kg (95% CI: -8, -4.9, P<0.0001) from baseline to 3 and 6 months, respectively. More non-responders were treated with a combination of oral agents and insulin at baseline, compared to responders (OR: 0.25, 95% CI: 0.07, 0.84, P=0.008). Both responders and non-responders exhibited a reduction in HbA1c during the study (-0.9%, P<0.0001 and -0.5%, P=0.008, respectively). The probability of being a weight loss responder was decreased by 26% for every 10 kg increase in baseline weight (adjusted for baseline HbA1c OR: 0.97, 95% CI: 0.95, 0.99, P=0.027). Our findings do not suggest a role of CTRB1/2rs7202877 polymorphism in affecting weight loss response to liraglutide in Greek people with T2D. In contrast, lower baseline body weight might be related to better weight control following treatment with liraglutide.

Disclosure

A.V. Kyriazou: Research Support; Self; Novo Nordisk A/S. A. Kyriakidou: None. T. Koufakis: None. Y. Vasilopoulos: None. I. Avramidis: None. S. Baltagiannis: None. E. Manthou: None. D.G. Goulis: None. P. Zebekakis: None. K. Kotsa: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Sanofi-Aventis, Takeda Pharmaceutical Company Limited. Speaker’s Bureau; Self; Menarini Group. Other Relationship; Self; Novo Nordisk Inc.

Funding

Novo Nordisk (91220)
950-P: Efficacy and Safety of Once-Weekly Dulaglutide Added to Titrated Insulin Glargine, Prandial Insulin, and Oral Agents in Obese Asian T2 Diabetes (T2D) Patients: One Year Real-World Evidence from India
Authors: NIGAM ANANT
Published: June 2020

Objective: To assess the effect of the addition of a weekly GLP-1 Receptor Agonist, injection Dulaglutide (DU) 1.5mg in obese T2D patients, sub-optimally controlled on titrated basal insulin Glargine (iGL), prandial insulin (iP), metformin and glimepiride (SU).

Methods: We retrospectively observed the impact of addition of DU in 167 patients with HbA1c ≥ 8% for ≥ 16 weeks (wk), all on titrated iGL and also on metformin (n=156; 1.5-2g/d), SU (n=101; 3-4mg/d) and iP (n=75; 10-14 units/d). End points were changes in (i) HbA1c (ii) body weight (iii) doses of iGL and iP (iv) dose of SU at wk 16, 32 and 52. Adverse events and side effects of the combination of DU and iGL were noted.

Results: One hundred sixty-seven patients (89M/78F, age 50±4.5 years, wt.82.8±1.4 kg, BMI 30.1±2.1kg/m2, eGFR 78±4mL/min./1.73m2, 10.3±1.1 years duration of T2D) met the inclusion criteria. After addition of DU, HbA1c was - 1.23% [8.24±0.3 to 7.01±0.2, P<0.0001] at wk 16 in 74 % patients, which decreased to 6.9±0.3% (P=0.1586) in 16% at wk 32, but rose to 7.1±0.1% (P=0.1885) in 10% at wk 42-52. At wk 16, weight was - 2.3 kg (82.8±1.4 to 80.5±1.6, P<0.0001) in 78% patients with a further loss of 1.1±0.7 kg (P<0.0001) in 12% by wk 32, but was stable in others until wk 52. Dose of iGL was - 11.1 units (41.3±10.2 to 30.2±9.1, P=0.0381) in 65% subjects by wk 32, was stable in 28% but rose by 4.1±0.01 units (P=0.0078) in 7% by wk 52. Dose of iP was -5.9±0.03 units (12.5±0.3 to 6.6±0.2, P=0.9700) in 31% patients. Dose of SU had to be reduced by 60% in 75% patients and had to be stopped in others because of minor hypoglycemia. No major hypoglycemia occurred. Side effects with DU were nausea (16.5%), vomiting (15.9%) and diarrhea (6.8%), but none had to stop therapy.

Conclusion: Weekly DU when added to iGL, provides statistically significant glycemic control with weight loss, reduced hypoglycemia risk and insulin doses. This combination therapy is well tolerated.

Disclosure

A. Nigam: Advisory Panel; Self; Intas Pharmaceuticals Ltd., Lupin Pharmaceuticals, Inc., Sun Pharmaceutical Industries Ltd., Torrent Pharmaceuticals, USV Private Limited. Speaker’s Bureau; Self; AstraZeneca, Biocon, Cipla Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Sanofi.
957-P: Efficacy of Oral Semaglutide According to Background Medication: An Exploratory Subgroup Analysis of the PIONEER Trial Program
Authors: BUSE JOHN B. , CROWLEY MATTHEW , ERIKSSON JAN W. , GISLUM METTE , HERTZ CHRISTIN L. , KAISER MARCEL , NIELSEN ANNE MOELLER , HALUZIK MARTIN
Published: June 2020

The global PIONEER program investigated the efficacy and safety of the first oral glucagon-like peptide-1 receptor agonist, oral semaglutide. Across PIONEER trials, patients with type 2 diabetes (T2D) were randomized to once-daily oral semaglutide (3, 7, 14 mg or flexibly dosed) or comparator. The present exploratory subgroup analysis evaluated the effect of background medications on glycated hemoglobin (HbA1c) and body weight (BW) reductions at the end of trial (week 26, 52 or 78) in five PIONEER trials (3-5, 7-8). Data were analyzed from patients who received oral semaglutide or comparator (sitagliptin, liraglutide or placebo) based on background medication received: metformin, sulfonylurea, sodium-glucose co-transporter 2 inhibitor, insulin or combinations. Baseline characteristics were generally similar across subgroups. Reductions in HbA1c and BW were greater for oral semaglutide vs. comparators (except liraglutide, with similar HbA1c reductions), regardless of background medication (Table). In general, there were no statistically significant interactions between treatment and subgroups. Estimated treatment differences were consistent within each trial and background medication subgroups. These findings support the use of oral semaglutide across a broad population of patients with T2D in combination with other commonly used glucose-lowering agents.

Disclosure

J.B. Buse: Consultant; Self; Cirius Therapeutics, CSL Behring, Neurimmune. Research Support; Self; American Diabetes Association, National Institutes of Health, Novo Nordisk A/S, Patient-Centered Outcomes Research Institute, Sanofi, Tolerion, Inc., vTv Therapeutics. Stock/Shareholder; Self; Mellitus Health, Pendulum Therapeutics, PhaseBio Pharmaceuticals, Inc., Stability Health. Other Relationship; Self; ADOCIA, AstraZeneca, Dance Biopharm Holdings, Inc., Eli Lilly and Company, MannKind Corporation, NovaTarg Therapeutics, Novo Nordisk A/S, Senseonics, Inc, vTv Therapeutics, Zafgen, Inc. M. Crowley: None. J.W. Eriksson: Advisory Panel; Self; Novo Nordisk A/S. Research Support; Self; AstraZeneca, Novo Nordisk A/S. M. Gislum: Employee; Self; Novo Nordisk A/S. C.L. Hertz: Employee; Self; Novo Nordisk A/S. M. Kaiser: Advisory Panel; Self; Merck Sharp & Dohme Corp., Novo Nordisk A/S. Speaker’s Bureau; Self; AstraZeneca, Lilly Diabetes. A. Moeller Nielsen: Employee; Self; Novo Nordisk A/S. M. Haluzik: Advisory Panel; Self; Lilly Diabetes, Sanofi. Consultant; Self; Ethicon US, LLC. Speaker’s Bureau; Self; AstraZeneca, Mundipharma International, Novartis AG, Novo Nordisk A/S.

Funding

Novo Nordisk A/S
96-LB: Diabeloop Closed-Loop System Allows Patients with Type 1 Diabetes (T1D) to Significantly Improve Their Glycemic Control in Real-Life Situation, without Serious Adverse Events: A 6-Month Follow-Up
Authors: AMADOU CORALIE , FRANC SYLVIA , BENHAMOU PIERRE Y. , LABLANCHE SANDRINE , HUNEKER ERIK , CHARPENTIER GUILLAUME , PENFORNIS ALFRED
Published: June 2020

Objective: Previous trials demonstrated an improvement of glycemic control with the single hormone closed-loop system Diabeloop DBLG1. Therefore, efficacy assessment of this system in real life situation is eagerly awaited. A preliminary analysis of glucose TIR (time-in-range) after a mean of 20 weeks of follow-up was previously communicated. The aim of this report is to present results of TIR and HbA1c after 6-month of follow-up.

Methods: After a run-in period with G6 sensor and usual pump, 25 patients with T1D in Corbeil-Essonne and Grenoble diabetes centers (France) were provided with the commercial setting of DBLG1 System (G6 sensor and Kaleido pump). They were taught to manage it during a one to five days hospitalization. Data on system parameters and glycemic control were collected from a cloud platform. We present here the results of TIR and HbA1c after 6 months of follow-up.

Results: Mean age of patients was 43 years (25-72) with a mean duration of diabetes of 19 years (2-43). All patients were already insulin pump users and 76% of patients were women. The run-in period lasted an average of 7 days (4-15). The mean HbA1c and TIR 70-180 mg/dL before DBLG1 System initiation were respectively 7.9% (5.6 to 8.5 %) [63mmol/mol, 38 to 69 mmol/mol] and 53% (21 to 85%). One patient decided to stop using the system after 2 months due to repeated system disconnections and was therefore excluded from the 6-months analysis. After a mean follow-up of 6 months, mean HbA1c decreased from 7.9% to 7.1% [63 to 54 mmol/mol] (p< 0.001*) and TIR 70-180 mg/dL increased from a mean of 53 to 67% (p<0.0001*). Moreover, TIR < 70 mg/dL decreased from a mean of 2.4 to 1.3% (p = 0.03*). No adverse event was reported. Closed loop was in functional mode for 85% of time. Conclusions: The DBLG1 System confirms its ability to significantly improve glycemic control in real life situation without serious adverse events.

Disclosure

C. Amadou: None. S. Franc: Consultant; Self; Diabeloop SA. P.Y. Benhamou: Consultant; Self; Abbott, Diabeloop SA, Eli Lilly and Company, Insulet Corporation, Novo Nordisk Inc., Sanofi. S. Lablanche: None. E. Huneker: Stock/Shareholder; Self; Diabeloop SA. G. Charpentier: Board Member; Self; Diabeloop SA. A. Penfornis: None.
965-P: Real-World Evidence of the Effect on Glycemic Control with Relatively Simultaneous vs. Sequential Initiation of Basal Insulin and GLP-1 Receptor Agonists
Authors: ROSENSTOCK JULIO , AMPUDIA BLASCO FRANCISCO JAVIER , LUBWAMA ROBERT , PENG XUEJUN V. , BOSS ANDERS H. , SHI LIZHENG , FONSECA VIVIAN
Published: June 2020

Injectable therapy initiation in T2D is often delayed. This retrospective cohort study evaluated the impact of the timing of initiating both basal insulin and GLP-1 RA in people with uncontrolled T2D (HbA1c ≥9 %) on OADs within 12 months (Optum Humedica database of electronic medical records and claims; 1/1/2011 to 6/30/2017). Study cohorts were defined by the days between initiating the first and second injectable: cohort A ≤30 (simultaneous); B 31-90; C 91-180; D 181-270; E 271-360 (sequential). Endpoints: proportion achieving HbA1c <7 % or <8 % and achieving ≥1 % or ≥2 % reduction in HbA1c at 6 and 12 months after initiating the second injectable. Baseline characteristics (N=6339): mean ± SD age 54 ± 11 years; HbA1c 10.7 ± 1.5 %; weight 108 ± 25 kg; 47% male. Despite slightly higher baseline HbA1c, cohort A had the best glycemic outcomes at 6 and 12 months for all 4 endpoints, followed by cohort B, then no difference between C, D and E (Table). Cohorts C, D and E were significantly less likely to achieve HbA1c <7 % than cohort A (hazard ratios [95% CI]: 0.62 [0.53-0.72]; 0.62 [0.53-0.72]; 0.63 [0.54-0.73]), but cohort B was not (0.87 [0.76-1.01]).

In summary, despite higher baseline HbA1c, addition of a second injectable agent within 90 days of the first led to significantly better glycemic control at 12 months than postponing addition to later in the year in uncontrolled T2D.

Disclosure

J. Rosenstock: Research Support; Self; AstraZeneca, Bristol-Myers Squibb, Genentech, Inc., GlaxoSmithKline plc., Lexicon Pharmaceuticals, Inc., Oramed Pharmaceuticals, PegBio Co., Ltd., Pfizer Inc., REMD Biotherapeutics. Other Relationship; Self; Applied Therapeutics, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Intarcia Therapeutics, Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi. F. Ampudia Blasco: None. R. Lubwama: Employee; Self; Sanofi US. X.V. Peng: Employee; Self; Sanofi. A.H. Boss: Employee; Self; Sanofi. Stock/Shareholder; Self; Novo Nordisk Inc., Sanofi. L. Shi: None. V. Fonseca: Consultant; Self; Abbott, Asahi Kasei Corporation, AstraZeneca, Bayer Inc., Novo Nordisk Inc., Sanofi. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Stock/Shareholder; Self; Amgen, Bravo4health.

Funding

Sanofi
966-P: Effect of Baseline ß-Cell Function on Treatment Response to Exenatide in Patients with Newly Diagnosed Type 2 Diabetes
Authors: WANG CHAOFAN , XU WEN , DENG HONGRONG , LIN BEISI , LV JING , ZENG LONGYI , YAO BIN , WENG JIANPING
Published: June 2020

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) improve glycemic control mainly by enhancing glucose-dependent insulin secretion. Yet patients may have different responses when treated with GLP-1 RAs. This study investigated whether the baseline β-cell function affects the treatment response to exenatide in patients with newly diagnosed T2D.

Methods: In the CONFIDENCE study, 110 patients with newly diagnosed T2D completed 48-week exenatide treatment. Glucose and insulin during fixed breakfast were measured at baseline and 48 weeks. This post-hoc analysis evaluated the effect of baseline β-cell function represented by the disposition index (DI) on treatment response to exenatide.

Results: The 110 patients were 49.6±10 years old, with the baseline HbA1c of 8.0±1.0% and BMI of 25.9±3.0kg/m2. As shown in Table 1, patients with the lowest tertile DI had the highest HbA1c, FPG, PPG and the worst insulin resistance at baseline. After adjusting for the baseline values, the improvements of glycemic control were similar among all tertiles groups, regardless of baseline DI. The effects of lowering weight or BMI were comparable in all groups on the basis of the balanced baseline values.

Conclusion: In newly diagnosed T2D who have relatively good residual β-cell function, DI at baseline may not predict the treatment response to exenatide both on glycemic control and weight reduction.

Disclosure

C. Wang: None. W. Xu: None. H. Deng: None. B. Lin: None. J. Lv: None. L. Zeng: None. B. Yao: None. J. Weng: None.

Funding

National Natural Science Foundation of China (81770821 to W.X.); National Key Research and Development Program of China (2016YFC1304801); Eli Lilly and Company
968-P: Long-Term Quantitative and Qualitative Effect of Dulaglutide in Type 2 Diabetes Patients
Authors: KOUTSOVASILIS ANASTASIOS , SOTIROPOULOS ALEXIOS , PAPPA MARIA , PEPPAS THEODOROS
Published: June 2020

Background: Dulaglutide is a once-weekly glucagon-like peptide-1 receptor agonist GLP-1.

Aim: The aim of the study was to investigate dulaglutide’s quantitative and qualitative long-term effects in type 2 diabetes patients with unsatisfactory glycemic control.

Material and Methods: 310 patients under treatment with dulaglutide were included in the study. Parameters of glycemic control (HbA1c, Fasting Blood Glucose -FBG) and cardiovascular risk factors (weight, body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, LDL, HDL, and triglycerides) were recorded, while treatment satisfaction was evaluated with the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Follow up period was 52±2 weeks with assessment of study’s parameters at 12 ±2 weeks and 24±2 weeks. All the data were collected for 254 patients.

Results: Patients’ age was 60.23±10.21 years. A reduction of HbA1c was during the follow-up period. HbA1c was reduced from the baseline at the 3, 6 and 12 month monitoring times (8.0±1.31 vs. 7.0.9±0.9 vs. 6.97±1.1, vs. 6.77±0.9) p<0.0001). Bodyweight was also reduced during the same monitoring times (96.30 ±20.24 vs. 92.41±18.52 vs. 90.04±18.77, vs. 89.49±18.27, p=0.001). Statistically significant change on waist circumference (p=0.010). A statistically significant reduction was noticed on LDL (p=0.022), triglycerides (p=0.016) while the improvement on HDL was not significant (p=0.108). There was a reduction of the systolic blood pressure (p=0.088) and of the diastolic blood pressure (p=0.114). Treatment satisfaction was improved as evaluated via DTSQ on both Group A (p = 0.026)

Conclusion: The long-term use of dulaglutide leads to a significant reduction of HbA1c and to significant improvement of cardiovascular risk factors from the first three months of dulaglutide’s use. All these parameters are showing a steady improvement during the first twelve months of dulaglutide’s use in type 2 diabetes with an unsatisfactory glycemic control.

Disclosure

A. Koutsovasilis: None. A. Sotiropoulos: None. M. Pappa: None. T. Peppas: None.
The Association Between Age of Onset of Type 2 Diabetes with Long-term Risk of End Stage Kidney Disease: A National Registry Study
Authors: Morton Jedidiah I , Liew Danny , McDonald Stephen P , Shaw Jonathan E , Magliano Dianna J
Published: June 2020

Objective: The long-term risk of end-stage kidney disease (ESKD) in type 2
diabetes is poorly described, as is the effect that younger age of diabetes
onset has on this risk. Therefore, we aimed to estimate the effect of age of
onset on the cumulative incidence of ESKD from onset of type 2 diabetes.

Research Design and Methods: This study included 1,113,201 people with
type 2 diabetes registered on the Australian National Diabetes Services Scheme
(NDSS) followed from 2002 until 2013. The NDSS was linked to the Australia and
New Zealand Dialysis and Transplant Registry and the Australian National Death
Index.

Results: Between 2002 and 2013, there
were 7,592 incident cases of ESKD during 7,839,075 person-years of follow up. In
the first 10-15 years following onset of diabetes, the incidence of ESKD was
highest in those with an older age of onset of diabetes, whereas over longer
durations of diabetes the incidence of ESKD became higher in those with
younger-onset diabetes. After 40 years of diabetes, the cumulative incidence of
ESKD was 11.8% and 9.3% in those diagnosed with diabetes aged 10-29 and 30-39
years, respectively. When death from ESKD without renal replacement therapy was
included, incidence of ESKD remained higher in older onset diabetes for the
initial 20 years, with no clear effect of age thereafter.

Conclusions: The long-term risk of ESKD in type 2 diabetes is high,
which disproportionately affects those with younger-onset of diabetes as they
are more likely to survive to longer diabetes durations.
HUBUNGAN DIMENSI KUALITAS PELAYANAN DENGAN MINAT KUNJUNGAN ULANG PASIEN DI INSTALASI RAWAT JALAN RUMAH SAKIT UMUM KABUPATEN TANGERANG TAHUN 2019
Authors: Rahmiati Rahmiati , Temesveri Nauri Anggita
Published: June 2020

Minat kunjungan ulang pasien menjadi sangat penting untuk mempertahankan eksistensi rumah sakit. Kualitas pelayanan yang baik akan memberikan kepuasan pelanggan, sehingga mempengaruhi pengambilan keputusan minat kunjungan ulang bagi pasien. RSU Kabupaten Tangerang mengalami penurunan jumlah kunjungan pasien pada tahun 2017 dan tahun 2018 sebanyak 10.11%. Hal tersebut juga berdampak pada target kunjungan pasien yang tidak tercapai dalam Rencana Bisnis dan Anggaran Pertahun rumah sakit. Tujuan penelitian ini adalah untuk mengetahui hubungan persepsi pada dimensi kualitas pelayanan dengan minat kunjungan ulang pasien di instalasi rawat jalan Rumah Sakit Umum Kabupaten Tangerang. Jenis penelitian menggunakan desain potong lintang. Sampel dalam penelitian sebanyak 106 pasien lama. Analisis data menggunakan uji chi-square. Hasil penelitian menunjukan bahwa lima dimensi kualitas pelayanan terdiri dari bukti fisik, kehandalan,daya tanggap, jaminan, dan empati tidak berhubungan dengan minat kunjungan ulang pasien (p-value > 0.05).
PERTUMBUHAN DAN HASIL TIGA VARIETAS KEDELAI DI GAWANGAN DENGAN PEMOTONGAN UJUNG PELEPAH KELAPA SAWIT
Authors: Effendy Iqbal , Novianto Novianto , Utami Dia
Published: June 2020

Oil palm plantations in Indonesia are the largest one in the world, reaching 12.3 million hectares, around 46% are smallholders with very low productivity couse  income of oil palm farmers is very low. One effort to take over the problems is to develop an intercroping pattern of soybean- oilpalm  by trimming  the tips of the midribs of oil palm plants on thewider side of interspace of palm stand rows, to increase light interception accepted by soy bean  plant surfaces. This study used a randomized block design (RBD) arranged in factorial 4x3 with three replications. The first treatment is cutting the edge of the oil palm midrib, namely P1 = 50 cm, P2 = 100 cm, P3 =  150 cm. The second treatment was low light intensity tolerant soybean varieties, namely: V1 = Dena 1, V2 = Anjasmoro and V3 = Detam 1. Other actions were carried out according to generally accepted standards. To see the effect of treatment carried out the F test at the level of 5%, and continued with the HSD test at the level of 5% to see the difference among treatments. The results showed that a hope of developing soybean plants as intercrops, although statistically did not show a significant difference. FFB results were not significantly affected by the act of  trimming the midrib as 150 cm.
Vuosipäiväjournalismi historian tulkitsijana ja nykyisyyden muokkaajana: Kehysanalyyttinen tutkimus EU:n historiaa käsittelevistä vuosipäiväjutuista kolmessa suomalaisessa päivälehdessä
Authors: Ikäheimo Hannu-Pekka , Seuri Olli
Published: June 2020

Tässä artikkelissa analysoidaan, miten kolme suomalaista päivälehteä esittävät EU:n historiaa ja Suomen EU-historiaa. Aihetta lähestytään tärkeitä merkkipäiviä – Rooman sopimuksen solmiminen, Suomen EU-jäsenyys, Suomen Emu-jäsenyys – käsittelevän vuosipäiväjournalismin kautta. Aineisto kattaa vuodet 1995–2019. EU:ta koskevien vuosipäiväjuttujen kehysanalyysistä ja sisällönanalyysistä käy ilmi, että suomalaisilla sanomalehdillä, toimittajilla ja poliittisella eliitillä on vahvasti jaettu käsitys EU:n historiallisesta ja poliittisesta merkityksestä. EU nähdään menestystarinana, eikä merkkejä konsensuksen murtumisesta näy edes 2000-luvulla kumuloituvien kriisien keskellä. Määrällisessä kehysanalyysissä arvopainotus näkyy normaalisti journalismissa vähän esiintyvän moraalikehyksen yleisyytenä. Se myös vankistaa kuvaa vuosipäiväjournalismista erityisenä kerronnan lajinaan. Tutkittujen lehtien perusteella Euroopan integraatioon liittyvillä vuosipäivillä on vakiintunut asema suomalaisessa journalismissa. Aineistosta on kuitenkin havaittavissa kaksi erilaista juonnetta: Euroopan unionin historia esitetään harmonisena, kun taas vasta 1990-luvulta alkavaan Suomen EU-historiaan liittyy myös ristiriitoja ja poliittisia jännitteitä. Mitä kauempana tapahtumat ovat (maantieteellisesti, ajallisesti ja kulttuurisesti), sitä ristiriidattomampana ne sanomalehdessä esitetään.
Síndrome da apneia e hipopneia obstrutiva do sono e principais comorbidades associadas
Authors: De Souza Francinete Silva , Carmo Alípio , Toledo Mercedes , Rodrigues Francisco Sandro Menezes , Fonseca Fernando Luis Affonso , Gehrke Flávia De Sousa
Published: June 2020

O estudo pretendeu avaliar a fisiopatologia correlacionada, as diferenças de sexo e as comorbidades associadas à síndrome da apneia e hipopneia obstrutiva do sono. Trata-se de uma revisão de literatura realizada a partir dos dados obtidos pesquisas com as palavras-chaves “Síndrome de Apneia e Hipopneia do Sono”, “Fisiopatologia”, “Fatores de Risco”, “Comorbidades e Sexo” nas plataformas digitais SciELO, PubMed, DESC Bireme e Google Acadêmico no período de 2008 a 2018. O sono é dividido em sono Rapid Eye Movement e sono Non-Rapid Eye Movement. A síndrome da apneia e hipopneia do sono é observada pelo ronco e caracterizada pela obstrução total (apneia) ou parcial (hipopneia) das vias aéreas superiores, que leva ao colapso e à dessaturação da oxi-hemoglobina e, consequentemente, causa hipóxia. Os índices de apneia e hipopneia são diagnosticados pela polissonografia e classificam o distúrbio em leve, moderado ou grave. A síndrome da apneia e hipopneia do sono apresenta-se frequentemente associada à obesidade e a doenças cardiovasculares, sendo principalmente observada em homens. A síndrome é considerada um problema de saúde pública mundial e envolve uma equipe multidisciplinar para o tratamento farmacológico ou não farmacológico. Dentre as principais comorbidades verificadas estão obesidade, hipertensão, arritmias e diabetes Mellitus tipo 2.
O coro, a musa e as estrelas: estudo do Fr. 5 Page de Álcman
Authors: Aubert Eduardo Henrik
Published: June 2020

Este artigo propõe-se a investigar o fr. 5 Page, de Álcman, frequentemente lido como se consistisse em uma cosmogonia arcaica. Por meio de um exame dos lemmata conservados, em diálogo com os demais fragmentos supérstites de Álcman e com o comentário em que os referidos lemmata estão inseridos, propomos uma nova interpretação do poema. O resultado é uma reaproximação entre essa composição e os partênios do poeta.
O Núcleo de Cultura Clássica e a Sociedade Brasileira de Estudos Clássicos
Authors: Pompeu Ana Maria César
Published: June 2020

Apresentamos o Núcleo de Cultura Clássica, vinculado ao Departamento de Letras Estrangeiras do Centro de Humanidades da Universidade Federal do Ceará, Grupo de Pesquisa do diretório do CNPq, Grupo de Pesquisa da Sociedade Brasileira de Estudos Clássicos e Programa de Extensão da Universidade Federal do Ceará.
PENGARUH JENIS PELARUT PADA EKSTRAKSI MENGGUNAKAN GELOMBANG ULTRASONIK TERHADAP AKTIVITAS ANTIOKSIDAN EKSTRAK KULIT BUAH LEMON (Citrus limon (Linn.) Burm F.)
Authors: Verdiana Melia , Widarta I Wayan Rai , Permana I Dewa Gede Mayun
Published: June 2020

This study aims to determine the effect of solvent types on antioxidant activity of lemon peel (Citrus limon (Linn.) Burm F.) extract and to obtain the right solvent types with the highest antioxidant activity of lemon peel extract. The experimental design used in this research  was a completely randomized design with the treatment of solvent types (aquades, acetone 70%, ethanol 70% and methanol 70%). The treatment  was repeated four times to obtain 16 units of the experiment. Data were analyzed with analysis of variance (ANOVA) and followed by Duncan test. The result showed that the best treatment was obtained extract with ethanol 70% solvent with antioxidant activity was 52.72% and the IC50  value 471.33 mg/L, followed by yield was 37.68%, vitamin C was 227.90 mg AAE/g extract and total flavonoid was 7.14 mg QE/g extract.
PENGARUH PERBANDINGAN TERIGU DENGAN TEPUNG KECAMBAH JAGUNG (Zea mays L.) TERHADAP KARAKTERISTIK FLAKES
Authors: Utama I Dewa Gede Dwi Agastia , Wisaniyasa Ni Wayan , Widarta I Wayan Rai
Published: June 2020

This study aims to determine the effect of wheat flour ratio with corn sprouts flour on the characteristics of flakes produced and the exact composition of wheat flour with corn sprouts flour that is able to produce flakes with the best characteristics. The experimental design used was Completely Randomized Design with treatment factor that is the comparative treatment of flour with corn sprouts flour which consist of 5 levels: 50%:50%; 40%:60%; 30%:70%; 20%:80%; 10%:90%. The treatment was repeated 3 times to obtain 15 units of experiment. The data obtained were analyzed by variance and if the treatment had an effect on the observed variable then continued with Duncan test. The comparison of wheat flour with corn sprout flour significantly affected water content, ash content, fat content, protein content, carbohydrate content, coarse fiber content, tensile strength, color (hedonic test), aroma (hedonic test), texture (hedonic test and scoring ), taste (hedonic test) as well as overall acceptance (hedonic test) flakes. Comparison of 30% wheat flour : 70% corn sprouts flour produces flakes with the best characteristics, namely: water content was 2.94%, ash content was 2.99%, fat content was 11.60%, protein content was 14.40%, carbohydrate content was 68.08%, crude fiber content was 6.25%, tensile strength was 4.24 N, color liked, aroma some liked, texture crispy and liked, taste liked and overall acceptance liked.
PEMANFAATAN ANGKAK SEBAGAI PEWARNA ALAMI DAN ANTIOKSIDAN PADA SOSIS IKAN KEMBUNG (Rastrelliger kanagurta L.)
Authors: Pandiangan Justicia Febi Estermaria , Putra I Nengah Kencana , Pratiwi I Desak Putu Kartika
Published: June 2020

This research was conducted to identify the effect of adding angkak on the color, antioxidant content, change the number of TBA sausage for six days of storage, sensory’s characteristic of mackerel fish sausage, and to identify the right percentage to adds angkak can improve the color, antioxidant content, and change the number of TBA for six days of storage, and sensory’s characterisctic of mackerel fish sausage. The experimental design used was a completely randomized design (CRD). Treatment factor was consist of six concentrations: 0%, 0,5%, 1%, 1,5%, 2%, and 2,5%. Each treatment had three replications so that obtained 18 units of trial. Observations were made on intensity of colour, antioxidant capacity, number of TBA, and organoleptic characteristics (hedonic test and scoring test). Data were analyzed by One-Way Analysis of Variance at level of 1% and 5% and continued by Duncan. The addition of angkak has affected very significant on color intensity, antioxidant capacity, number of TBA, color, taste, and overall acceptance, also significant on texture of mackerel fish sausage. On the others hand, it has not affected on flavor of mackerel fish sausage. The right concentration is obtained from the use of 1 % angkak. It has L*’s score 31,71; a*’s score 21,10; b*’s score 21,13; antioxidant capacity 53,37 mg GAEAC/kg; number of TBA for the 6th day 0,31 g malonaldehide/kg, color rather faded red and rather liked, flavor rather liked, texture liked, taste bitter weak and liked, and overall acceptance liked.
DAYA HAMBAT EKSTRAK BUAH ANDALIMAN (Zanthoxylum acanthopodium DC) DALAM ETIL ASETAT TERHADAP PERTUMBUHAN Escherichia coli
Authors: Sitanggang Fitri Maria Clarensia , Duniaji Agus Selamet , Pratiwi I Desak Putu Kartika
Published: June 2020

This study aims to determine the Minimum Inhibitory Consentration (MIC) of andaliman fruit extract (Zanthoxylum acanthopodium DC) in ethyl acetate against the growth of Escherichia coli bacteria. The design of this study used an experimental method with 10 extract concentrations for MIC testing, namely 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90% and 100% with 2 repetitions so that they were obtained 20 experimental units. The variables observed were the formation of clear zones, namely the inhibition produced by the presence of antimicrobial activity from andaliman fruit extract in ethyl acetate against the growth of Escherichia coli. Data from research results are presented in the form of tables, figure and discussed descriptively. Andaliman fruit extracts in ethyl acetate have varying inhibitory forces, namely at the concentrations of concentrations of 10% to 20% was 0.65 mm to 3.15 mm with weak inhibition categories, concentrations of 30% to 50% was 5.25 mm to 6, 60 mm in the moderate inhibition category and concentrations of 60% to 100% showed strong inhibition categories with inhibition diameters of 7.20 mm to 9.60 mm. Minimum Inhibitory Concentration (MIC) for the growth of Escherichia coli was at the concentration of 60% with a clear zone diameter of 7.2 mm with a strong category.

 

 

Keywords : Andaliman fruit, Escherichia coli, antibacterial.
Analisis Pangsa Pasar Beberapa Merek Produk Minuman Susu Fermentasi dalam Kemasan dengan Metode Rantai Markov di Lingkungan Kampus Universitas Udayana
Authors: Az-zahra Keisa , Wiranatha A. A. P. A. Suryawan , Wrasiati Luh Putu
Published: June 2020

The objectives of this research were to determine the consumer characteristics of fermented milk products, analysis market share of several packaged fermented milk brands at this time until next five years ahead and determine the long-term market balance at Udayana University. The data used in the study was primary data collected through a questionnaire, for analysis this research was using the markov chain method by software QM 5.3. The result of the characteristics consumers of fermented milk were dominated by women with an average age 21-25 years old and mostly profession are students, with an average spending money for snacks/drinks was Rp 100,000-300,000/month with an average consumption of fermented milk 2-3 times/week. The reason of respondents consuming fermented milk was because of the taste was so special and respondents also get the information from advertisements on television, respondents usually buy the products from supermarkets on their own initiative by planning them first. The result of the research market share analysis was Yakult brand always leads market share, in the 2019 the Yakult brand was 55%, Cimory 30%, Calpico 8%, Vitacharm 4% and other brands 3%. in 2020 there was an increase for Yakult to 56%, a decrease for Cimory 29.5%, Calpico 7.5%, Vitacharm 3.9% and other brands rising to 3.1%. In 2021 only for Yakult change to 56.1% and Vitacharm 3.8%. In 2022 all brands were still in the same percentage but in 2023 Yakult change to 56.2% and Vitacharm 3.7%. The market share will reach stable conditions where the market share of each brand was Calpico 7.0%, Cimory 25.7%, Vitacharm 3.4% and Yakult 60.6% and other brands 3.3%.

Keywords: fermented milk, market share, markov chain method