bluuebunny/crossref_metadata_2025 huggingface dataset:
1459-P: NMR-Based Metabolomics for the Screening of Sleep-Disordered Breathing in Type 2 Diabetes
Authors: LERTDETKAJORN KHEMAPORN , POUNGSOMBAT PATCHA , KHOOMRUNG SAKDA , PHETCHARABURANIN JUTAROP , HONGTHONG SAKCHAI , KUHAKARN CHUTIMA , SIWASARANOND NANTAPORN , MANODPITIPONG AREESA , NINITPHONG HATAIKARN , SAETUNG SUNEE , ONGPHIPHADHANAKUL BOONSONG , REUTRAKUL VICHAI , REUTRAKUL SIRIMON
Published: June 2020

Sleep-disordered breathing (SDB) is common in type 2 diabetes (T2D). This study aimed to develop a screening tool to detect SDB in T2D.

Method: SDB was screened in 95 patients by an overnight monitor and diagnosed if apnea-hypopnea index ≥ 5. Anthropometric and HbA1c data, and SDB risk by questionnaire were obtained. Quantitative NMR experiment was performed on a Bruker AVANCE 400 Ascend NMR spectrometer. Carr−Purcell−Meiboom−Gill (CPMG) pulse sequence at 310 K was applied to serum samples to enhance signal-to-noise ratio and hence detect low-molecular weight metabolites. Models based on six machine learning methods (e.g., learned vector quantization, stochastic gradient boosting model, support vector machines, decision tree, partial least squares, generalized linear model, and logistic regression) were constructed to predict SDB, tuned with the CARET R package, and evaluated using three repeats of 10-fold cross validation.

Results: Seventy-six patients (80.0%) had SDB. Compared with those without, those with SDB were more likely to be male, have SDB risk, higher BMI and neck circumferences, longer diabetes duration, and higher HbA1c. NMR-based metabolic profiling identified significantly lower levels of branched-chain amino acids (BCAAs) (e.g., L-leucine and L-isoleucine), lactate and threonine metabolites in those with SDB, while level of D-glucose-6 phosphatase was higher than those without SDB. Accuracies for predicting SBD using clinical data alone were ∼80% for each machine learning model. L-leucine and D-glucose-6-phosphatase were identified as being independently associated with SDB using a logistic regression, in addition to clinical factors, with an improved accuracy of 86.3%, and a Cohen’s kappa of 0.429.

Conclusions: Due to its high prevalence, clinical factors alone were not sufficient in predicting SDB in T2D. The discovery of metabolic profiles, including BCAAs and those involved in glucose metabolism, could facilitate a more precise and specific SDB prediction.

Disclosure

K. Lertdetkajorn: None. P. Poungsombat: None. S. Khoomrung: None. J. Phetcharaburanin: None. S. Hongthong: None. C. Kuhakarn: None. N. Siwasaranond: None. A. Manodpitipong: None. H. Ninitphong: Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk Inc., Takeda Pharmaceutical Company Limited. S. Saetung: None. B. Ongphiphadhanakul: None. V. Reutrakul: None. S. Reutrakul: None.

Funding

Endocrine Society of Thailand; Ramathibodi Hospital; Mahidol University; Thailand Center of Excellence for Innovation in Chemistry
1460-P: Type 2 Diabetes Polygenic Score in Addition to Clinical Factors for Prediction of Diabetes Incidence in an Indigenous American Population
Authors: WEDEKIND LAUREN E. , KOBES SAYUKO , HSUEH WEN-CHI , BAIER LESLIE , KNOWLER WILLIAM C. , MAHAJAN ANUBHA , MCCARTHY MARK I. , HANSON ROBERT L.
Published: June 2020

Background: Type 2 diabetes (T2D)-associated variants, derived from genome-wide association studies (GWAS), have largely been reproducible across populations, but there is limited information on how polygenic scores (PS) based on these variants add to clinical factors for predicting diabetes incidence, particularly in non-European populations.

Methods: A longitudinal study of diabetes was conducted in an Indigenous study population native to the Southwestern U.S. At each exam, a 75-g oral glucose tolerance test was administered with measurement of fasting and 2-hour plasma glucose (FPG, 2hPG). Genotypes were available from a GWAS for 2783 participants aged ≥ 20 years without diabetes at baseline, with imputed genotypes based on whole genome sequence data from 296 individuals from the population. PSs for participants were constructed and weighted using genome-wide significant variants in a T2D GWAS meta-analysis in European-descent populations (n=245; Mahajan 2018). Survival analyses were conducted to predict diabetes incidence in 2 models: (1) age, sex, BMI, FPG; (2) age, sex, BMI, FPG, T2D PS. Area under the receiver-operating characteristic curve (AUC) was calculated using a nonparametric method for survival analysis.

Results: 903 cases (32.5%) of diabetes occurred during 25,110 person-years of follow-up. The hazard ratio for T2D PS, controlled for age, sex, BMI and FPG, was 1.27 per SD (P=1.5×10-12). Cumulative incidence at 10 years was 0.076 in the lowest quartile for the prediction score based on clinical factors alone and 0.509 in the highest quartile. For the model including PS, corresponding values were 0.075 and 0.524. AUC was 0.710 for the model with clinical factors alone and 0.721 for the model including T2D PS.

Conclusion: Weighted T2D PSs based on 245 variants were informative in predicting T2D incidence in Indigenous Americans; however, the improvement in prediction beyond clinical factors alone was modest.

Disclosure

L.E. Wedekind: None. S. Kobes: None. W. Hsueh: None. L. Baier: None. W.C. Knowler: None. A. Mahajan: None. M.I. McCarthy: Advisory Panel; Self; Illumina. Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc., Zoe Global Ltd. Employee; Self; Genentech, Inc. Research Support; Self; AbbVie Inc., Merck & Co., Inc., Sanofi-Aventis, Servier, Takeda UK. R.L. Hanson: None.
1468-P: Assessment of Strategies for Identifying Undiagnosed Diabetes Cases in the General Population
Authors: DAURIZ MARCO , BONORA ENZO ,   THE VERONA & PADUA UNDIAGNOSED DIABETES STUDY GROUP
Published: June 2020

The rising tide of diabetes (DM) calls for strategies applicable at large scale to anticipate diagnosis at the earliest disease stages. However, no conclusive evidence exists on the most effective DM screening program. We tested whether random capillary blood glucose (RCBG), a validated DM risk questionnaire (FINDRISC), or both, may be applied as universal screening strategy in a 4-year (2015-18) multi-center study involving all individuals presenting to the information desks during the World Diabetes Day and similar initiatives in two metropolitan areas of Northern Italy. In case of high FINDRISC scores (>14 points) and/or RCGB levels suggestive for DM (≥200 mg/dL within 2h after last meal/sugar drink;≥150 mg/dL within 2-5h; ≥125 mg/dL, >5h), people were invited to the Diabetes Center (DC) for laboratory confirmation by fasting plasma glucose and A1c. The FINDRISC was also advertised on newspapers and flyers in squares, hospitals and pharmacies of both cities. Overall, 62,827 flyers were distributed and ∼400.000 inhabitants were exposed to the advertisements. Eventually, 154 individuals reporting high FINDRISC scores presented for a laboratory check and diagnosis was confirmed in 18 (11.7%). Among 8,563 individuals undergoing RCBG, 341 (4%) had glucose levels suggestive for DM; 86 had a laboratory check and DM was confirmed in 36 (41.9%). In addition to RCBG, 3,351 subjects also completed the FINDRISC and 480 (14.3%) reported high scores. Of them, 397 (82.7%) presented to the DC and 40 (10.1%) had diagnosis confirmed. In 30 individuals, both FINDRISC and RCBG were suggestive for DM and diagnosis was confirmed in 17/27 subjects eventually presented to the DC (63.0%). These data suggest that RCBG outperforms FINDRISC to identify unknown DM. The simultaneous presence of FINDRISC and RCBG suggestive for DM appears even more effective. Poor adherence to laboratory check in high-risk cases calls for initiatives to raise public awareness on the deleterious concequences of untreated DM.

Disclosure

M. Dauriz: None. E. Bonora: Advisory Panel; Self; Lilly Diabetes, Novartis AG, Sanofi. Speaker’s Bureau; Self; Abbott, Lilly Diabetes, Novo Nordisk A/S, Sanofi.

Funding

Italian Ministry of Health (RF-2011-02350193)
1469-P: OGTT-Based, Very Simple, Disposition Index (OGTT-DI) and Beta-Cell Function Index (OGTT-B) Proposed
Authors: SHINDE SURESH N. , SHINDE RITUPARNA S. , JOSHI ASHWINI S.
Published: June 2020

Two new indexes of DI and BCF, parallel to HOMA basal indexes, based on analysis of 1313 individuals subjected to 75 Gm OGTT are proposed. Glucose and insulin Area Under Curve (AUC) values were calculated using trapezoidal rule. OGTT Insulin Secretion (Isec) was calculated using ’AUCins/AUCglu’ and insulin sensitivity (Isen) by using ’(1/(AUCins * AUCglu)’ formula which was derived by omitting basal values from Matsuda Index. Calculation of Disposition Index (OGTT-DI) i.e., ISec*ISen, was found proportional to ’1/(AUCglu)^2’, as the ’AUCins’ values in denominator and numerator were cross-cancelled. Considering other non-insulin dependent glucose disposal variables as ’constant’, a new index of BCF function, OGTT-B, was defined and derived using ’(OGTT-DI Test/OGTT-DI Normal) * 100’ formula. This resulted in a final equation as ’[{(AUCglu normal) ^2/(AUCglu-test) ^2} * 100]’. Normal AUCglu, a population specific variable, was determined from 10 normoglycemic non-obese individuals and was ’241’. Fourteen categories of dysglycemia were defined based on glucose, insulin, HOMA-IR and Matsuda index. When compared, OGTT-DI showed more consistent linear relationship to evolving dysglycemia categories than other BCF indexes such as HOMA-DI, oral-DI and ISSI-2. (Figure below). Being independent of Insulin and BMI levels, OGTT-DI and OGTT-B are simple and low cost BCF indexes which will be useful in staging and managing dysglycemia.

Disclosure

S.N. Shinde: None. R.S. Shinde: None. A.S. Joshi: None.
1473-P: Evaluation of Insulin Resistance in Healthy Nonobese Asian Indians Using TyG (Triglyceride-Glucose) Index and Its Comparison with HOMA-IR
Authors: SHARMA CHARU , ARORA MANISHA , GUPTA DEEPAK , MAKKAR BRIJ M.
Published: June 2020

Background: Insulin resistance(IR) is a key determinant of CV Risk and is highly prevalent in Asian Indians. However, there is limited data on IR in healthy non-obese individuals. Quantification of IR in clinical practice is a challenge and HOMA IR is the commonly used method. Triglyceride-Glucose(TyG) Index, a simple method for measuring IR, is not much used in clinical practice. This study assessed the prevalence of IR using TyG index in comparison to HOMA-IR in healthy non-obese Indians.

Aims and Objectives: 1. To assess the prevalence of IR using TyG index in healthy non-obese individuals 2. To assess TyG (Triglyceride-Glucose Index)Index as a measure of IR in comparison to HOMA IR.

Methodology: A total of 170 healthy non-obese individuals visiting for routine health checks were recruited in the study. Relevant anthropometric and laboratory parameters were recorded. IR was calculated using TyG index and HOMA IR using following formulae: TyG = ln (Triglycerides in mg/dL x Glucose in mg/dL/2)8 IRHOMA = (I0 × G0)/405 (I0 -fasting insulin in mIU/L, G0-fasting glucose in mg/dL)1 IR was defined as HOMA-IR >2.8 or TyG index >4.65. Prevalence of IR in the study population was calculated using both and compared.

Results: Mean age of study population was 43.45±15.72 years and 55% were males. Average BMI was 22.09± 2.29 Kg/m². Systolic and diastolic BP were 117.29±7.90 and 72.12±8.37 mmHg respectively. Mean fasting blood glucose was 92.79±6.92 mg/dL, mean triglycerides 107.48 ± 28.95 mg/dL and fasting serum insulin was 11.42 ± 8.53 μU/ml. Prevalence of IR defined by TyG index was 44% as compared to 34% by HOMA IR. There was a strong correlation between TyG index and HOMA IR(p=0.006). TyG index had a high negative predictive value (74%).

Conclusions: Prevalence of IR in healthy Indians is high and affects more than a third of healthy non-obese individuals. TyG index appears to be a better tool for evaluation of IR in clinical practice and has a strong correlation with HOMA IR.

Disclosure

C. Sharma: None. M. Arora: None. D. Gupta: 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.
1477-P: Clinical Utility of a Noninvasive Metabolic Approach in Assessing the Prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH) in Type 2 Diabetes
Authors: BELLIDO VIRGINIA , MARTÍNEZ-ARRANZ IBON , GOICOLEA IGNACIO , AMOR ANTONIO J. , PI JAVIER , PÉREZ ANTONIO , ESPIGA JAVIER , MONTALBAN CORAL , MAYO REBECA , GAZTAMBIDE SONIA
Published: June 2020

Aims: We aimed to assess the utility of validated metabolomic-based non-invasive tests to estimate the prevalence of liver disease in overweight/obese T2DM patients.

Materials and Methods: A total of 97 T2DM patients with HbA1c <7% and BMI >25 kg/m2 were recruited. Patients underwent routine lab, liver ultrasound and FibroScan. OWLiver® Care test and OWLiver® test were measured (two serum-based, BMI-dependent lipidomic tests that discriminate between normal liver and NAFLD, and between isolated steatosis and NASH, respectively).

Results: Based on results from ultrasound and FibroScan, patients were divided into four groups (Table). The prevalence of NAFLD and NASH was 86.4% and 31.1%, respectively. Severe fibrosis (F2-F4) was found in 22.9% and cirrhosis (F4) in 12.2%. OWLiver® Care test classified correctly 95% of patients with NAFLD (AUC 0.929). It showed high sensitivity (95%) and high accuracy (80%). OWLiver® test showed high consistency with the results of ultrasound and FibroScan, classifying correctly 90% of the samples of patients with NASH.

Conclusions: The prevalence of NAFLD and NASH is high in overweight/obese T2DM patients. OWLiver® Care test and OWLiver® test can be good tools for early detection of NAFLD and NASH, respectively, in routine clinical practice.

Disclosure

V. Bellido: None. I. Martínez-Arranz: Employee; Self; OWL Metabolomics. I. Goicolea: None. A. Amor: None. J. Pi: None. A. Pérez: None. J. Espiga: Consultant; Self; Novo Nordisk A/S. C. Montalban: None. R. Mayo: Employee; Self; OWL Metabolomics. S. Gaztambide: None.
1483-P: Reproducibility of a Novel Classification of Type 2 Diabetes Patients into Subgroups (Clusters) at a Reference Center in Brazil: Differences in Body Composition Analyses
Authors: DANTAS ISABEL , BANDEIRA FRANCISCO
Published: June 2020

Objectives and Methods: To stratify type 2 diabetes (T2DM) patients into subgroups (clusters) according to clinical and laboratory data from 80 adults including body composition analyses by Dual X-ray absorptiometry (DXA) and multi-frequency bio-electrical impedance (BIA).

Results: Four subgroups were identified. Cluster 1: Severe insulin deficiency (recruited by C-peptide <0.8 ng/ml): 17.5% of patients; age 62.57 ± 8.23 ​​years, diabetes duration 17.07 ± 7.60 years (longer than the other clusters; p <0.001), BMI 22.68 ± 1.95 kg/m2 (lower than the other clusters; p<0.001), HbA1c 9.64 ± 1.30% (higher than the other clusters; p <0.001), HOMA2-IR 0.68 ± 0.14. Cluster 2: Severe insulin resistance (recruited by the presence of metabolic syndrome): 35.0% of patients; age 58.32 ± 5.94 years, diabetes duration 8.50 ± 5.07 years, BMI: 26.39 ± 2.38 kg/m2, HbA1c 7.53 ± 0.96%, HOMA2-IR 3.10 ± 0.43(higher than the other clusters; p <0.001). Cluster 3: Obesity-related (recruited by BMI > 30 kg/m2): 21.25 % of patients; age 59.76 ± 8.86 years, diabetes duration 8.35 ± 3.97 years, BMI: 35.95 ± 4.51 kg/m2 (higher than the other clusters; p <0.001), HbA1c 7.33 ± 1.04%, HOMA2-IR 1.77 ± 0.48. Cluster 4: Age-related (recruited by age > 65 years): 26.25% of patients; age 72.38 ± 5.06 years (older than the other clusters; p <0.001); diabetes duration 4.90 ± 2.81 years, BMI 27.21 ± 1.76 kg/m2, HbA1c 6.91 ± 0.69%; HOMA2-IR: 0.99 ± 0.47. Although significantly younger cluster 1 patients had significantly lower values for lean mass parameters by both DXA and BIA in comparison with cluster 4: Fat Free Mass Index (BIA)/Apendicular Skeletal Mass index (DXA) (16.39 kg/m2/6.66 kg/m2; p <0.001 vs. 17.19 kg/m2/7.31 kg/m2; p <0.001).

Conclusion: Our data demonstrated the heterogeneity of T2DM presentation in adults with marked differences between them. Insulinopenic diabetes had more sarcopenia than age-related diabetes.

Disclosure

I. Dantas: None. F. Bandeira: None.
1485-P: Difference between Comprehensive Physical Fitness Age and Calendar Age Is a Potent Predictor of Incident Metabolic Syndrome (MetS)
Authors: SATO TAKAAKI , FUJIHARA KAZUYA , YAMADA MAYUKO H. , YAGUCHI YUTA , KITAZAWA MASARU , MATSUBAYASHI YASUHIRO , IWANAGA MIDORI , YAMADA TAKAHO , KATO KIMINORI , SONE HIROHITO
Published: June 2020

Although grip strength, single-leg balance and trunk flexibility each are reportedly predictive of type 2 diabetes and atherosclerosis, little is known about the impact of comprehensive physical fitness adjusted by age on these cardiovascular risks. Thus, we developed a new index of comprehensive physical fitness standardized by age (e.g., the physical fitness index (PFI)) and examined its relevance to incident MetS in Japanese. Analyzed were 8,041 non-MetS persons (5291 men) aged 22 to 86 y who underwent the physical fitness tests cited above yearly for 4 y. MetS was defined according to Japanese guidelines. Participants were stratified yearly by sex and age (≤39, 40-49, 50-59, 60-69, 70≤), and an equation was developed using the above 3 tests by principal component analysis. We defined PFI as the difference between physical fitness age and calendar age. Discrete-time logit models were used to examine the influence of PFI on the incidence of MetS. MetS occurred in 355 persons. PFI was negatively correlated with MetS incidence. In multivariate analysis, comparison of the high PFI group with the moderate and low PFI groups showed a 1.38 (95% CI 1.01-1.88) fold and 1.98 fold (1.45-2.71) increased risk, respectively. The PFI could be used as a non-invasive and simple screening tool for those at high cardiometabolic risk, which is independent of calendar age in a Japanese population.

Disclosure

T. Sato: None. K. Fujihara: None. M.H. Yamada: None. Y. Yaguchi: None. M. Kitazawa: None. Y. Matsubayashi: None. M. Iwanaga: None. T. Yamada: None. K. Kato: None. H. Sone: Research Support; Self; Kyowa Hakko Kirin Co., Ltd., Novartis AG, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co.
149-LB: Reluctant to Lose Control: Older Patients’ A1C Goals Lower than ADA Guidelines
Authors: CUI MICHAEL , NATHAN AVIVA , MILES CRISTY , PRESS VALERIE G. , PUSINELLI MARIKO , ZHU MENGQI , ALI RABIA , SCALES KAMILAH , HUANG ELBERT
Published: June 2020

Older adults (≥65 years) represent >40% of patients living with diabetes. Multiple practice guidelines call for stratifying risk factor goals based on health status. “My Diabetes GOAL” is an intervention designed to introduce ADA guidelines to patients and to collaborate with them on setting glycemic goals.

Participants ≥ 65 years, with type 2 DM, and an active patient portal account (MyChart) were randomized to a 6 month intervention (n=42) or delayed start control arm. Intervention patients completed a MyChart survey to elicit health status to identify ADA goals and initial self-reported A1C goals. A diabetes nurse spoke with patients to review and potentially revise goals. We compared patients’ 1) baseline A1C, 2) self-reported A1C and 3) revised A1C goals, versus ADA guidelines.

Among 42 intervention patients, ADA A1C goals were <7.5% for 24, <8.0% for 13, and <8.5% for 5 patients. Most (35/42) patients self-reported an A1C goal, among whom 66% (23/35) self-reported A1C goals >0.5% lower than the ADA A1C goals. There were no statistically significant differences in baseline A1C, self-reported A1C, or revised A1C across patients with different ADA A1C goals (Figure 1).

Older patients’ personal A1C goals were more aggressive than ADA guidelines and did not alter with nurse intervention. The results suggest that older patients with diabetes are anchored to lower A1C goals, and find more lenient A1C goals difficult to choose.

Disclosure

M. Cui: None. A. Nathan: None. C. Miles: None. V.G. Press: Consultant; Self; Humana, Vizient Inc. M. Pusinelli: None. M. Zhu: None. R. Ali: None. K. Scales: None. E. Huang: None.
1493-P: The Impact of Adverse Social Determinants on Health Care Utilization and Expenditures among U.S. Adults with DKD
Authors: OZIEH MUKOSO N. , GARACCI EMMA , WALKER REBEKAH J. , EGEDE LEONARD E.
Published: June 2020

Introduction: This study examined whether adverse social determinants of health (SDOH) are associated with higher health care utilization and out of pocket (OOP) expenditures in U.S. adults with diabetic kidney disease (DKD).

Methods: Data from 458 adults with self-reported DKD age ≥50 from the Health and Retirement Study 2008-2012 was analyzed. Primary outcomes were number of hospital overnight stays (HOS), number of physician visits (PV) and OOP expenditures. Primary independent variables were nine adverse SDOH factors clustered around three SDOH domains: psychosocial (depression, perceived social support and discrimination); financial hardship (difficulty paying bills, food insecurity, medication cost non-adherence); neighborhood (neighborhood social cohesion, social participation and physical disorder). Two variables were created, a continuous 0-9 and a categorical variable of 0, 1-2, 3+. We used negative binomial regression and marginalized two-part models to determine the impact of adverse SDOH on outcomes.

Results: In the unadjusted model, compared to adults with no adverse SDOH, adults with 3+ adverse SDOH had 3% lower likelihood of PV (95%CI 0.72-1.29), 75% (95%CI 1.10-2.79) and 87% (95%CI 1.31-2.65) higher likelihood of HOS and OOP expenditures respectively. In the adjusted model, having 3+ adverse SDOH was not significantly associated with PV (Ratio 0.94 95%CI 0.69-1.29) or HOS (Ratio 1.53 95%CI 0.93-2.49) but was associated with a 2-fold higher likelihood of OOP expenditures (95% CI 1.60-3.31). Adverse neighborhood factors were associated with 63% higher likelihood of HOS (adjusted 95% CI 1.19-2.24) and financial hardship factors were associated with 85% higher likelihood of OOP expenditures (adjusted 95% CI 1.42-2.41).

Conclusions: Our findings suggest having 3+ adverse SDOH especially financial hardship impacts OOP expenditures in adults with DKD. Interventions targeting adults with 3+ adverse SDOH may significantly decrease OOP expenditures in DKD.

Disclosure

M.N. Ozieh: None. E. Garacci: None. R.J. Walker: None. L.E. Egede: None.

Funding

American Diabetes Association (1-19-JDF-075 to R.J.W.); Advancing Healthier Wisconsin/Clinical and Translational Science (UL1TR001436, KL2TR001438); National Institutes of Health (K24DK093699, R01DK118038, R01DK120861, R01MD013826)
15-LB: Ready-to-Use Glucagon for the Prevention of Exercise-Induced Hypoglycemia during Aerobic Exercise
Authors: ARONSON RONNIE , RIDDELL MICHAEL , JUNAIDI MOHAMMED K. , CLOSE NICOLE C. , SEQUEIRA DAVID J.
Published: June 2020

Objective: A novel ready-to-use liquid stable glucagon (RTUG; Xeris Pharmaceuticals) was evaluated for safety and efficacy in the prevention of exercise induced hypoglycemia (EIH) during and after moderate-to-high intensity aerobic exercise.

Method: A Phase 2 randomized, placebo-controlled, double-blind, clinical research center (CRC) crossover stage, followed by a 12-week 3-arm parallel Outpatient stage, enrolled 48 adults with type 1 diabetes using an insulin pump. In the outpatient stage, subjects were assigned to RTUG 150 μg plus 50% basal insulin pump reduction, or RTUG 150 μg with no insulin change, or to placebo. Blood glucose was measured by blood glucose meter before, during, and after moderate-to-high intensity, aerobic exercise to evaluate the incidence and severity of hypoglycemia. Continuous glucose monitors were utilized in the CRC and Outpatient stage.

Result: Of the 48 subjects, 45 subjects (93.8%) completed multiple exercise sessions and have entered the ongoing outpatient stage. On average, subjects were 37 (±11.2) years old with an average BMI of 26.7 (±4.6), 52.1% male and 81.3% white. In the CRC stage, the placebo group experienced more EIH (16.7% vs. 2.1%), had 7-times higher glucose tablet utilization during and after exercise, resulting in more post-exercise hyperglycemia (blood glucose >250 mg/dL). To date, no SAEs have occurred, and RTUG 150 μg caused no edema, erythema, nor injection site reactions.

Conclusion: RTUG 150 μg maintained euglycemia during prolonged, continuous, intense aerobic exercise. In the CRC stage, RTUG was more effective than insulin reduction alone, to prevent EIH, and may result in less post-exercise hyperglycemia than ingestion of carbohydrate. Data from the ongoing Outpatient stage may support the use of RTUG to prevent EIH during and after aerobic exercise in real-world settings.

Disclosure

R. Aronson: Consultant; Self; AstraZeneca, Becton, Dickinson and Company, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Gilead Sciences, Inc., HTL Strefa, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi. Research Support; Self; AstraZeneca, Bausch Health, Bayer Inc., Becton, Dickinson and Company, Boehringer Ingelheim (Canada) Ltd., Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Janssen Pharmaceuticals, Inc., Kowa Company, Ltd., Medpace, Novo Nordisk Inc., Sanofi, Tandem Diabetes Care, Xeris Pharmaceuticals, Inc., Zealand Pharma A/S. M. Riddell: Advisory Panel; Self; Zucara Therapeutics Inc. Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc., Insulet Corporation. Speaker’s Bureau; Self; Medtronic, Novo Nordisk A/S. M.K. Junaidi: Employee; Self; Xeris Pharmaceuticals, Inc. N.C. Close: Employee; Self; EmpiriStat, Inc. D.J. Sequeira: Employee; Self; Xeris Pharmaceuticals, Inc.
1502-P: Trends in Cause-Specific Mortality in Those with and without Diabetes in the UK
Authors: PEARSON-STUTTARD JONATHAN , CHENG YILING J. , VAMOS ESZTER P. , BENNETT JAMES E. , CROSS AMANDA J. , EZZATI MAJID , GREGG ED
Published: June 2020

Background: Increased longevity and reductions in diabetes(DM) complication rates have altered patterns of DM-related mortality in several countries. It is unclear whether this diversification of mortality has occurred in the UK.

Methods: With linked hospital and mortality data from 320,613 adults aged 26 - 91 from the 1998-2018 UK Clinical Practice Research Datalink, we used discrete Poisson regression to estimate death rates and proportional mortality from all causes, vascular diseases, cancers, and other (non vascular, non cancer) causes in DM patients. We compared this to age and sex matched individuals without DM.

Findings: From 1998-2018 all-cause death rates per 100 person-years declined by 36% in individuals with DM (4.42 (4.37-4.48) to 2.82 (2.79-2.85)). There were substantial reductions (57%, 1.84 (1.80-1.88) to 0.80 (0.78-0.81)) in vascular, moderate reductions in ’other’ (31%, 1.77 (1.73-1.80) to 1.21(1.19-1.23)), and minor reductions in cancer (8%, 0.92(0.89-0.94) to 0.84(0.82-0.86)) death rates. Within the ’other’ category, exceptions included increases in dementia (468%) and liver disease (86%) with static respiratory and accident death rates. These differential rates of decline resulted in increases in the proportion of all deaths due to cancer (20% to 29%) and ’other’ causes (39% to 43%). Rates of decline in all-cause and cancer mortality were greatest among young (<55 years) and middle aged (55-75 years), whereas those >75 years had no reduction in cancer mortality. All cause death rates also declined substantially among the non-DM population (from 2.78 (2.75-2.82) to 1.77 (1.75-1.79)/100 PYs) and across all major cause groupings.

Conclusions: Reductions in vascular mortality in patients with DM have not been matched by improvements in cancer mortality, while death rates for specific ’other’ causes (dementia and liver) have increased. This reflects a diversification of DM-related mortality with profound implications for management and prevention of DM.

Disclosure

J. Pearson-Stuttard: Advisory Panel; Self; Novo Nordisk A/S. Consultant; Self; DnaNudge Ltd. Y.J. Cheng: None. E.P. Vamos: None. J.E. Bennett: None. A.J. Cross: None. M. Ezzati: Consultant; Self; Prudential, Scor, Third Bridge. Research Support; Self; AstraZeneca Youth Health Programme. E. Gregg: None.

Funding

UK Wellcome Trust
1505-P: Lower Extremity Amputation Trends among People with Diabetes in a Large Urban Environment
Authors: CHATHA KIRAN K. , WALSH BRAD , FONTAINE JAVIER LA , BOWEN MICHAEL E. , MENEGHINI LUIGI
Published: June 2020

Non-traumatic lower extremity amputations (NLEAs) are a major complication for individuals with poorly controlled diabetes. We sought to identify trends for diabetic NLEAs in Dallas County between 2015 (4th quarter) to 2019 (3rdquarter) by using hospitalization data available from Dallas-Fort Worth Hospital Council Educational and Research Foundation and the CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Per BRFSS, the prevalence of diabetes in Dallas County is 11.7% with a mean (±SD) age of 53±19.1 years, and 56% male, 27% Hispanic, 35% black and 30% non-Hispanic white. The age-adjusted NLEA rates per 1,000 in this population of adults with diabetes increased 18.1% between 2015 and 2019 (incomplete years annualized), with men experiencing higher NLEA rates than women. There was a significant decrease in age-adjusted rates of all NLEAs in women from 2017 and 2018, reflecting prior reports at the national level. The age-adjusted rates for major NLEAs decreased in all age groups except ages 75+ between 2018 and 2019 with a concomitant increase in minor NLEAs; this had been preceded by a steady increase in rates of all NLEAs up to 2018. Of relevance is that starting in 2018 the proportion of major to minor NLEAs has been decreasing steadily.

In conclusion, we note a fall in NLEA rates in the last year of observation with the added benefit of a relative fall in major compared to minor NLEAs in patients with diabetes.

Disclosure

K.K. Chatha: None. B. Walsh: None. J. La Fontaine: None. M.E. Bowen: None. L. Meneghini: Advisory Panel; Self; Novo Nordisk Inc., Sanofi US. Consultant; Self; Applied Therapeutics, Sanofi US.
1508-P: Predicting Stress Hyperglycemia in Patients without Diabetes Admitted to the Hospital
Authors: MENDEZ CARLOS E. , WALKER REBEKAH J. , LU KAIWEI , DAWSON APRILL Z. , EGEDE LEONARD E.
Published: June 2020

Stress hyperglycemia (SH) is associated with poor clinical outcomes in hospitalized patients. Delays in recognizing SH impact timing of treatment, however, the best way to identify those at risk is unclear. We assessed the value of a validated diabetes risk test, the Cambridge Risk Score (CRS), to predict SH in patients admitted to the hospital compared to using undiagnosed diabetes and prediabetes based on HbA1c. Adults admitted without diabetes or use of diabetes medication to medical and surgical services of an academic hospital over 4 years was analyzed. Patients with at least one measurement of blood glucose ≥ 140mg/dL during the stay were identified as having SH. CRS was calculated using age, sex, BMI, family history of diabetes, smoking status, and use of antihypertensives or steroids. Prediabetes was defined based on HbA1c 5.7-6.4 and undiagnosed diabetes was defined as HbA1c >=6.5 without ICD code of diabetes in the medical record. Multivariate regression was used to assess the association between CRS, prediabetes and undiagnosed diabetes, and risk of SH controlling for relevant covariates. 5,535 adults met inclusion criteria, 25.9% developed SH. CRS as a continuous variable was significantly associated with risk of SH after adjustment (OR 2.25, 1.84 - 2.74). Prediabetes was significantly associated with risk of SH after adjustment (OR 1.31, 1.13-1.51). However, undiagnosed diabetes was not significantly associated with SH, but many individuals were missing A1c measures which could have influenced results.

In conclusion results of this study suggest CRS risk stratification and early assessment for prediabetes may allow early identification of individuals at risk for SH.

Disclosure

C.E. Mendez: Advisory Panel; Self; Monarch Medical Technologies. R.J. Walker: None. K. Lu: None. A.Z. Dawson: None. L.E. Egede: None.
151-OR: Radiologic Evidence that Hypothalamic Tissue Is Abnormal in Adults with Obesity and Type 2 Diabetes or Impaired Glucose Homeostasis
Authors: ROSENBAUM JENNIFER L. , SEWAYBRICKER LETICIA E. , CHANDRASEKARAN SUCHITRA , DE LEON MARY ROSALYNN , WEBB MARY , MELHORN SUSAN J. , SCHUR ELLEN
Published: June 2020

Gliosis, a cellular response to injury in neural tissue, is linked to diet-induced obesity in rodent models. Growing evidence also implicates reactive gliosis and inflammation of the mediobasal hypothalamus (MBH) as a potential mechanism connecting obesity to insulin resistance. We tested for radiologic evidence of MBH gliosis in humans in relation to impaired glucose homeostasis and type 2 diabetes (T2D), independent of obesity.

Adults with obesity and 1) T2D not on insulin (N=17), 2) impaired glucose tolerance (IGT; N=21), or 3) normal glucose tolerance (NGT; N=29) by OGTT underwent magnetic resonance imaging to measure mean bilateral T2 relaxation time (ms) in the MBH and 3 control regions. Longer T2 relaxation time is a marker of gliosis.

Groups were matched for race, sex, BMI and % body fat (P=0.99), but age differed (T2D 54 ± 8 y, IGT 46 ± 11 y, NGT 45 ± 12 y; P=0.02). Group differences in T2 relaxation time varied by brain region (interaction: chi2(6) = 65, P<0.0001, adjusted for sex and age). Bonferroni-corrected post-tests confirmed that MBH, but not control region, T2 relaxation times were longer in T2D (180 ± 26 ms) than IGT (160 ± 26 ms, P<0.0001) or NGT (152 ± 17 ms, P<0.0001) groups. Among all 67 subjects, fasting glucose, 2-hr post-glucose, and hemoglobin A1c values were each positively associated with MBH, but not control region, T2 relaxation times (interactions by region all P< 0.0001, MBH all P< 0.0001, control regions all NS). Among the 50 subjects without T2D, interactions remained significant (all P<0.0001), and greater 2-hr post-glucose and hemoglobin A1c were associated with longer MBH T2 relaxation times (β = 0.22 ms, P<0.0001 and β = 14.8 ms, P=0.002, respectively) whereas a trend was present for fasting glucose concentrations (β = 0.38 ms, P=0.06).

These data provide novel evidence that the degree of inflammation and gliosis in glucose-regulating areas of the brain is related to impaired glucose homeostasis and T2D in adults with obesity.

Disclosure

J.L. Rosenbaum: None. L.E. Sewaybricker: None. S. Chandrasekaran: None. M. De Leon: None. M. Webb: None. S.J. Melhorn: None. E. Schur: None.

Funding

American Diabetes Association (1-17-ICTS-085 to E.S.)
1514-P: Suboptimal Glycemic Control and High Prevalence of Diabetes Complications in Adults with Type 1 Diabetes (T1D) in the SAGE Study
Authors: RENARD ERIC , BOSNYAK ZSOLT , LAUAND FELIPE , POZZILLI PAOLO , IKEGAMI HIROSHI , KESAVADEV JOTHYDEV , VIANNA ANDRE G.
Published: June 2020

Poor glycemic control is a risk factor for many diabetes-related complications, but global real-world data on diabetes management in adults with T1D is limited. SAGE was a multinational, observational, cross-sectional study to describe glycemic control of participants aged ≥26 years with T1D for ≥1 year.

Of 3858 participants from 17 countries, 54.6% were female, with mean (standard deviation [SD]) age 47.4 (14.0) years, T1D duration 20.7 (12.6) years, and age at T1D onset 26.7 (14.4) years. Childhood-onset T1D was most common (48%) in the 26-44 years age group. Mean (SD) HbA1c was 7.95 (1.42) % (63.4 [15.6] mmol/mol), and similar across predefined age groups (Table). Only 20.9% of participants reached their individualized HbA1c target. Prevalence of microvascular complications was 36-63%, increasing with age and duration of diabetes. Incidence of diabetic ketoacidosis was similar in all age groups and consistent with previous reports.

SAGE shows that the prevalence of microvascular complications remains high, affecting over half of the study population aged ≥65 years, and is more prevalent in those with a longer duration of diabetes.

Disclosure

E. Renard: Board Member; Self; Abbott, Insulet Corporation, Novo Nordisk A/S, Roche Diabetes Care. Consultant; Self; Air Liquide, Eli Lilly and Company, Sanofi. Research Support; Self; Dexcom, Inc., Tandem Diabetes Care. Z. Bosnyak: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. F. Lauand: Employee; Self; Sanofi. P. Pozzilli: Advisory Panel; Self; Abbott, AstraZeneca, Eli Lilly and Company. Research Support; Self; Medtronic, Sanofi. H. Ikegami: None. J. Kesavadev: Speaker’s Bureau; Self; Biocon, Novo Nordisk Inc., Sanofi-Aventis. A.G. Vianna: Board Member; Self; Abbott, Medtronic, Novo Nordisk A/S. Research Support; Self; Sanofi. Speaker’s Bureau; Self; Lilly Diabetes.

Funding

Sanofi
1517-P: Characteristics and Burden of Macro, Micro, and Normoalbuminuria in Patients with Type 2 Diabetes (T2D)
Authors: BLONDE LAWRENCE , WILK ALAN , BOGDANOV ALINA , VASEY JOE , KALLENBACH LEE , DURKIN MICHAEL
Published: June 2020

Individuals with T2D and diabetic nephropathy are at higher risk for adverse cardiovascular events. This study compared patient characteristics and disease burden by severity of albuminuria (normoalbuminuria [NOR], microalbuminuria [MIU], macroalbuminuria [MAU]) among T2D patients tested for albuminuria and initiating new diabetes pharmacotherapy not dispensed in the prior 6 months.

From a U.S. database of linked electronic health records and insurance claims, we identified adults with T2D initiating a new DPP-4, GLP-1, or sulfonylurea between June 2016 and June 2019 (index event), with a lab value for urinary albumin: creatinine ratio (UACR) or albumin excretion rate (AER). Albuminuria was defined as NOR if UACR (in mg/g) or AER (in mg/day) <30, MIU if 30≤UACR/AER≤300, and MAU if 300<UACR/AER<5,000. Baseline characteristics and healthcare resource utilization for 6 months pre-index were compared among cohorts.

Patients with an available UACR/AER value (n=127,405) represented ∼12% of adult T2D therapy initiators. Severity of albuminuria was NOR (54.9%), MIU (37.0%), and MAU (8.1%). As severity increased, the percentage of patients with baseline cardiovascular conditions and medications and with baseline hospitalizations also increased (Table). More research is needed into the unique needs of the T2D with MAU population.

Disclosure

L. Blonde: Advisory Panel; Self; AstraZeneca, Gilead Sciences, Inc. Consultant; Self; Merck & Co., Inc., Novo Nordisk A/S, Sanofi. Research Support; Self; Janssen Scientific Affairs, LLC., Novo Nordisk A/S, Sanofi. Speaker’s Bureau; Self; Janssen Pharmaceuticals, Inc., Sanofi. A. Wilk: Employee; Self; Veradigm. A. Bogdanov: None. J. Vasey: None. L. Kallenbach: None. M. Durkin: Employee; Self; Janssen Scientific Affairs, LLC.

Funding

Janssen Scientific Affairs, LLC
152-OR: Postabsorptive Splanchnic and Leg Glucagon Metabolism in Healthy Subjects: Use of 13C 15N Glucagon
Authors: RUCHI FNU , YADAV YOGESH R. , ROMERES DAVIDE , SAWLEH SAFIA , BENSON LINDA M. , JOHNSON KENNETH L. , MAN CHIARA DALLA , COBELLI CLAUDIO , MCCORMICK DANIEL J. , WILKINS LUKE R. , BASU RITA , BASU ANANDA
Published: June 2020

Glucagon metabolism in humans is poorly understood and is currently under active investigation. We have recently developed a novel isotope dilution method using nonradioactive, stable human glucagon (Phe 6 13C9, 15N; Phe 22 13C9, 15N) tracer to measure glucagon turnover. In this study we combined this method with organ catheterization technique to estimate splanchnic and leg glucagon extraction and uptake. We present data from the first 6 healthy subjects (age 25±3.6 yrs; BMI 26.7±4.5 kg/m2; fasting glucose 4.6±0.5 mM; HbA1c 5.1±0.3%) completed thus far. After IRB approval and informed consent, subjects were admitted in the morning after an overnight fast to Interventional Radiology, where catheters were placed in the right femoral artery and vein under local anesthesia with aseptic precautions. Under fluoroscopic guidance, a hepatic venous catheter was positioned through the femoral vein. Glucagon tracer was infused intravenously and Indocyanine Green infused via the femoral artery sheath to measure splanchnic and femoral plasma flows. Plasma samples were collected periodically from femoral artery, femoral vein and hepatic vein for concentrations of glucagon tracer (Tandem Mass Spectrometry), glucagon, glucose and Indocyanine Green (Spectrophotometry) concentrations. Fractional splanchnic glucagon extraction was 24.0±12.5 % while total splanchnic glucagon uptake was 214.3±56.1 ng/kg total body weight/min. Net splanchnic glucagon balance was -34.4±10.0 ng/kg total body weight/min implying net splanchnic glucagon production. Fractional leg glucagon extraction was 13.5±3.8% while total leg glucagon uptake was 53.0±21.2 pg/kg total body weight/min. To the best of our knowledge, these initial data provide the first direct assessment of regional glucagon metabolism in healthy humans in the post absorptive fasting state.

Disclosure

F. Ruchi: None. Y.R. Yadav: None. D. Romeres: None. S. Sawleh: None. L.M. Benson: None. K.L. Johnson: None. C. Dalla Man: Research Support; Self; Sanofi-Aventis Deutschland GmbH. C. Cobelli: None. D.J. McCormick: None. L.R. Wilkins: None. R. Basu: Consultant; Self; GENFIT. Research Support; Self; AstraZeneca. A. Basu: Consultant; Spouse/Partner; GENFIT. Research Support; Spouse/Partner; AstraZeneca.

Funding

National Institutes of Health (R01DK029953 to R.B.), (R01DK085516 to A.B.), (DK059637, DK020593)
1522-P: High Incidence of Hospital-Onset Clostridium Difficile Infection in Diabetic Foot Syndrome Patients: Data from a Single Tertiary Diabetes Care Clinic in Poland
Authors: HOHENDORFF JERZY , SERAFIN MARIA , WITEK PRZEMYSLAW W. , BORYS SEBASTIAN , KATRA BARBARA , MALECKI MACIEJ
Published: June 2020

Diabetic Foot Syndrome (DFS) commonly occurs with infected ulceration and is associated with a high rate of amputation and excessive mortality. Antibiotic therapy increases the risk of Clostridium difficile infection (CDI). The mean CDI rate in European hospitals is 7.0 cases (country range 0.7-28.7) per 10 000 patient-bed days (PBD). The risk of hospital-acquired CDI (HA-CDI) among patients with diabetes mellitus (DM) and DFS may be much higher than in the general hospitalized population. The aim of the study is to define the incidence of HA-CDI in patients with DM and DFS. We performed a retrospective analysis using 2018 data from a tertiary diabetes care hospital which provides medical care mostly to patients with diabetes, including those admitted from the emergency department. We included patients with CDI confirmed by positive test result for toxins A/B. In 2018, CDI occurred in 22 cases, including 9 in patients with DFS. Overall, the CDI incidence rate was 21.6 cases per 10 000 PBD. The rate was much higher among patients with DFS than among patients department-wide (IRR: 3.73, 95% CI: 1.59-8.71). Prior to testing for toxins A/B, antibiotics were used in all DM patients with DFS who developed HA-CDI (9/9) and in 83.8% (109/130) DFS cases not complicated by CDI. Patients with DFS and CDI were characterized by lower mean BMI (28.3±0.4 vs. 30.3±0.6 kg/m2, p=0.01) than patients with DFS and without CDI. Between these two groups, no statistically significant differences were found in sex (male: 96/130 vs. 6/9, p=0.70), median age at hospitalization (65.0 (57.0-70.0) vs. 62.0 (52.0-67.0) yrs., p=0.30), HbA1c (68.3 (42.1-80.3) vs. 60.7 (49.7-78.1) mmol/mol, p=0.93) and eGFR (78.0 (62.0-93.0) vs. 84.5 (54.0-97.0) ml/min/1,73m2, p=0.91). Our results showed that DM patients with DFS had a higher risk of CDI than patients department-wide.

Disclosure

J. Hohendorff: None. M. Serafin: None. P.W. Witek: None. S. Borys: None. B. Katra: None. M. Malecki: None.
1528-P: Blood Level of Alpha-1 Antitrypsin in the Course of Acute Myocardial Infarction in Diabetic Patients: A Possible Clinical Significance
Authors: KHATIB SAID Y.
Published: June 2020

Introduction: Alpha-1 antitrypsin (A1AT) is known to protect lung tissue from damage. Such protection is extended to myocardial tissues during myocardial ischemia/infarction.

Objective: The aim of the study was to determine the time course of A1AT levels in the plasma of myocardial infarction patients over 96 hours and compare it with healthy individuals.

Methods: Blood samples were collected from patients (n=40, age 58 ± 11 yrs, males 29 and females 11), at 1, 4, 24, 48 and 96 hrs after confirmed diagnosis and admission to King Salman Cardiac Center in King Fahad Medical City, Riyadh, Saudi Arabia. IRB approval and consent was signed by all patients. The patients were divided into diabetics (n=19) and nondiabetic (21). Blood samples were collected in purple top tubes containing EDTA to prevent blood coagulation and immediately centrifuged at 6000 rpm at 4 C for 20 min. Plasma was decanted and stored at - 20 C until analyzed. AlAT was determined in plasma using Eliza kits (abcam, USA). Control blood samples were collected from 20 healthy individuals (age 46±10 yrs.

Results: A1AT were significantly less in MI patients (1025±77 ug/ml at 96 hrs, P<001, n=40) compared to (1655±128 ug/ml, n=20) (mean ±SEM) in controls. Those patients in whom the decrease in A1AT was greater than 50 % of control values, they did not survive and deceased (673+71 ug/ml, approx 40%, n=3). The decrease was significantly greater in nondiabetic patients as compared to diabetics. A1AT after an MI attack was comparable in hypertensive and non-hypertensive and in STEMI and Non-STEMI patients.

Conclusion: A1AT seem to be important in providing some protection to myocardial cells during an MI attack. A1AT levels seem to drop following an MI attack. The drop is larger in nondiabetic as compared to diabetics. In those patients in whom the level of A1AT drops to more than 50 % of normal values they are less likely to survive the MI attack. More studies are needed to confirm the above findings.

Disclosure

S.Y. Khatib: None.

Funding

King Fahad Medical City Research Center (016-2018)
1530-P: Metabolic Characteristics in Chinese Sarcopenia Patients with Type 2 Diabetes
Authors: HE QINGHUA , GUO LIXIN
Published: June 2020

Objective: To evaluate glucose metabolism characteristics in middle-aged and elderly sarcopenia patients with type 2 diabetes.

Methods: Data were collected from a multicenter, cross-sectional survey study. Eligible patients aged 50 years or older with a previous diagnosis of type 2 diabetes were recruited from the endocrinology department of nine different hospitals in Beijing, China. All participants were grouped into a probable sarcopenia group with low muscle strength and a nonsarcopenia group with normal muscle strength according to the recommendations from EWGSOP2 (2018). Body composition, glucose metabolism, laboratory and nutritional index were compared between two groups.

Results: A total of 1125 diabetic participants were included, with 405 in probable sarcopenia group and 720 in nonsarcopenia control group. Compared to the controls, the probable sarcopenia participants were older and had lower waist-to-hip ratio and BMI, higher fasting plasma glucose level and glycosylated hemoglobin (HbA1c), decreased estimated glomerular filtration rate, and lower bone mineral content, basal metabolic rate, fatless upper arm circumference, appendicular skeletal muscle mass index (ASMI) and muscle quality in both men and women. The prevalence of low muscle mass was obviously elevated in probable sarcopenia group in both sexes (men: 11.0% vs. 25.4%, women: 6.8% vs. 19.1%). Multivariable logistic regression analysis showed that aged, male sex, low BMI, increased HbA1c, diabetic nephropathy and decreased serum albumin level were risk factors associated with low muscle strength in diabetes patients.

Conclusions: Sarcopenic diabetic patients were older and had lower BMI, worse nutritional status and glucose metabolism, decreased renal function and reduced muscle quality and mass with a greater likelihood of osteoporosis. Clinically, diabetic aged patients should receive an assessment on muscle strength and muscle quality to optimize their treatment program.

Disclosure

Q. He: None. L. Guo: None.