bluuebunny/crossref_metadata_2025 huggingface dataset:
2247-PUB: Shared Education Visits for Adolescents with Type 1 Diabetes
Authors: WILKES MEREDITH , MURPHY TAYLOR , ALUF ANNA , SPERBER DANA , SHERRY AMELIA , SETHURAM SWATHI , CHOLEVA LAURYN , RAPAPORT ROBERT
Published: June 2020

Introduction: Deterioration in glycemic control often occurs during adolescence in children with type 1 diabetes (T1D). Shared appointments have been shown to improve quality of life scores and treatment adherence in children with chronic illnesses.

Objective: To examine the impact of combined individual visits and shared education appointments in adolescents with T1D on diabetes control, self-management, and diabetes related distress.

Methods: Adolescents ages 11-19y with T1D for over 1y and poor control/adherence defined by HbA1C > 9%, 2 or more DKA episodes in the past year or 2 missed appointments were enrolled in a 6 month DKA prevention program consisting of monthly individual visits followed by an hour long shared education visit. HbA1C levels were obtained every 3 mo. Participants completed a diabetes distress score (DDS) and diabetes self-management questionnaire (DMSQ) prior to participation and at the 6th visit. Participants were followed for an additional 6 months after completion of the program. Those who attended 2 or more session were included in the analysis.

Results: Ten adolescents (8 female, average age 13.9 y, diabetes duration from 1-11 y, average A1C 10.6% SD 2.0) were enrolled. None of the 10 participants had DKA during the program. There was no statistically significant change in A1C. No changes were noted in the DDS; however there was improvement in dietary control on DMSQ from 4.0 to 5.7 (p value 0.058). Six attended 5 or more of the sessions. Those 6 participants had a decrease in average A1C by 0.3% over 6 mo with no DKA episodes within 6 mo of completion. The 4 participants who attended 2-4 sessions had an increase in average A1C of 0.85% over the same period and 3 had DKA episodes within 6 mo after completion.

Conclusions: Shared education visits may be a valuable approach to the care of adolescents with diabetes. No episodes of DKA and no significant changes in glycemic control were noted in 6 mo; however larger long-term studies are needed to explore whether continued shared visits can improve glycemic control.

Disclosure

M. Wilkes: None. T. Murphy: None. A. Aluf: None. D. Sperber: None. A. Sherry: None. S. Sethuram: None. L. Choleva: None. R. Rapaport: None.
2263-PUB: Consideration of Insulin Resistance Improves HbA1c-Based Type 2 Diabetes Risk Assessment
Authors: MEIGS JAMES B. , PORNEALA BIANCA C. , LEONG AARON , SHIFFMAN DOV , DEVLIN JAMES , MCPHAUL MICHAEL J.
Published: June 2020

Background: T2D risk assessment is typically based on fasting glucose (FG) and HbA1c levels. We tested the hypothesis that HbA1c-based T2D risk assessment is improved by also considering another physiological axis, insulin resistance (IR), assessed using a fasting insulin (FI) homeostasis model (HOMA-IR).

Methods: We followed 2,205 white individuals from the Framingham Heart Study without T2D (medication use or FG >=126 mg/dL) at baseline for a mean of 16 years. We used age-sex adjusted regression to model incident T2D as a function of baseline HbA1c and IR tertile of HOMA-IR (FI x FG/22.5).

Results: Of 266 incident T2D cases, 205 (77%) were in HOMA-IR tertile 3, and of these, 135 (66% of 205) had HbA1c <5.7 (Table). Individuals in HOMA-IR tertile 3 had 16-year T2D CI rates of 20-35%. Both HbA1c and IR were independently associated with elevated incident T2D risk. We saw similar patterns in the 1,583 individuals with baseline FG <100 mg/dL.

Conclusion: HbA1c and fasting insulin are commonly available clinical diagnostic tests. Combined consideration of high levels of both identifies the great majority of white individuals at highly increased risk for future T2D.

Disclosure

J.B. Meigs: Consultant; Self; Quest Diagnostics. B.C. Porneala: None. A. Leong: None. D. Shiffman: Employee; Self; Quest Diagnostics. J. Devlin: Employee; Self; Quest Diagnostics. M.J. McPhaul: Employee; Self; Quest Diagnostics.
227-OR: The Effect of Dietary Fiber in Combination with Metformin Therapy in Type 2 Diabetes
Authors: TRAMONTANA FLAVIA , MADDALONI ERNESTO , GRECI SARA , DEFEUDIS GIUSEPPE , STROLLO ROCKY , POZZILLI PAOLO , NAPOLI NICOLA
Published: June 2020

Background: The efficacy of increasing dietary fiber intake (DFI) to ameliorate glycemic control in patients with type 2 diabetes (T2D) is still controversial. In this randomized open-label comparator-controlled study we tested the effect of high-fiber diet and fiber supplement on glycemic control in patients with T2D on metformin monotherapy.

Methods: Seventy-eight T2D overweight patients on metformin monotherapy were randomized 1:2:1 to 12 weeks intensive nutrition program to follow high-fiber diet (HFD), dietary fiber supplementation (FS) or standard diet recommendations (SDR). Dietary recommendations were reinforced in all groups every 4 weeks by study dieticians. Biochemistry, anthropometric measures, food frequency questionnaires to asses DFI were collected at baseline and after 12 weeks.

Results: At baseline groups did not differ in terms of mean age, BMI, metformin intake, HbA1c, fiber and calorie intake (p>0.05 for all). After three months, DFI significantly increase in both HDF and FS group but not in SDR group (HFD: 19.8 ± 6.1 g vs. 24.3 ± 6.8 g, p= 0.0001; FS: 17.5 ± 5.9 g vs. 27.0 ± 6.2 g p< 0.0001; SDR: 22.8 ± 9.1 g vs. 21.2 ± 6.4 g, p= 0.32). HbA1c significantly improved in all groups (HFD: 7.1 ± 0.5 % vs. 6.6 ± 0.6 %, p< 0.0001; FS: 7.1 ± 0.5 % vs. 6.8 ± 0.5 % p< 0.001; SDR: 7.2 ± 0.4 % vs. 6.7 ± 0.5 g, p< 0.001). All HFD, FS and SDR intervention reduced mean body weight by 2.1 ± 2.6 Kg (p< 0.0001), 1.0 ± 1.8 Kg (p< 0.05) and 1.1 ± 2.1 Kg (p< 0.05), respectively. Changes in HbA1c and body weight did not differ among groups. A significant correlation between calorie intake and the reduction of HbA1c levels was seen across groups (r= 0.307 p<0.01). No significant correlation between DFI and HbA1c levels was observed.

Conclusions: Intensive nutrition education programs with monthly meetings similarly reduced HbA1c in all groups. Furthermore, our study suggested that rather than fiber intake, caloric restriction followed by moderate weight loss is the main driver for glycemic improvement in overweight patients with T2D.

Disclosure

F. Tramontana: None. E. Maddaloni: Consultant; Self; Merck KGaA. Speaker’s Bureau; Self; Abbott, AstraZeneca, Pikdare. S. Greci: None. G. Defeudis: None. R. Strollo: None. P. Pozzilli: Advisory Panel; Self; Abbott, AstraZeneca, Eli Lilly and Company. Research Support; Self; Medtronic, Sanofi. N. Napoli: None.
2271-PUB: Rate of Diabetes Complications during the Initial 6 Months of the First Large-Scale Longitudinal Nationwide Study on Management and Real-World Outcomes of Diabetes in India (LANDMARC)
Authors: GHOSH ROMIK , DAS ASHOK K. , JOSHI SHASHANK , MITHAL AMBRISH , KUMAR PRASANNA , KALRA SANJAY , UNNIKRISHNAN AMBIKA GOPALAKRISHNAN , THACKER HEMANT , SETHI BIPIN , MOHANASUNDARAM SENTHILNATHAN , MENON SHALINI K. , NAIR ARJUN , RAIS NADEEM , WANGNOO SUBHASH KUMAR , CHOWDHURY SUBHANKAR , ZARGAR ABDUL H.
Published: June 2020

LANDMARC (CTRI/2017/05/008452) aims to evaluate the development and progression of diabetes complications over 3 years in Indian participants with T2D. Rate of diabetes complications was compared from baseline to 6 months (visit 2 [V2]) using McNemar’s test and Chi square test (when complications were stratified in subgroups). There was an increase in the rate of microvascular complications by V2 (Table). Microvascular complications were reported more commonly in participants with A1C≥7% than A1C<7%, with BMI≥23 kg/m2 than BMI<23 kg/m2, and in those with than without cardiovascular (CV) risk factors (Table). In case of macrovascular complications, 7 new cases of peripheral vascular disease, 2 new cases each of MI, stroke and ACS, but no new case of heart failure or unstable angina were reported at V2. Notably, neuropathy was the most common complication at 6 months. The real-world data on complications in LANDMARC may help in understanding disease progression and offer insights on treatment adjustments.

Disclosure

R. Ghosh: Employee; Self; Sanofi. A.K. Das: Advisory Panel; Self; Novo Nordisk A/S, Sanofi. S. Joshi: Advisory Panel; Self; Novo Nordisk A/S, Roche Pharma, Sanofi. A. Mithal: Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Johnson & Johnson, Lilly Diabetes, Novo Nordisk A/S. K. Kumar: None. S. Kalra: Advisory Panel; Self; Eli Lilly and Company. Speaker’s Bureau; Self; Novo Nordisk A/S, Sanofi-Aventis. A. Unnikrishnan: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi. Speaker’s Bureau; Self; Eli Lilly and Company, Ipca Laboratories, Merck Sharp & Dohme Corp., Novartis AG. H. Thacker: None. B. Sethi: None. S. Mohanasundaram: Employee; Self; Sanofi. S.K. Menon: None. A. Nair: Employee; Self; Sanofi. N. Rais: None. S. Wangnoo: None. S. Chowdhury: Advisory Panel; Self; Novo Nordisk A/S. A.H. Zargar: None.

Funding

Sanofi India Limited
2295-PUB: Impaired First-Phase Insulin Secretion Predicts the Development of Hyperglycemia in a Human Model of Acute Beta-Cell Mass Reduction
Authors: MEZZA TERESA , FERRARO PIETRO MANUEL , GIUSEPPE GIANFRANCO DI , ASSUNTA CEFALO CHIARA MARIA , MOFFA SIMONA , QUERO GIUSEPPE , CINTI FRANCESCA , IMPRONTA FLAVIA , CAPECE UMBERTO , ALFIERI SERGIO , MARI ANDREA , GIACCARI ANDREA
Published: June 2020

β-cell functional defects temporally anticipate (and eventually cause) the subsequent development of hyperglycemia, whereas a significant reduction (∼50%) of beta-cell mass is observed at diagnosis of T2D. To further investigate the relative role of beta-cell mass reduction/dysfunction in the development of T2D, we performed, pre- and post-surgery, oral glucose tolerance tests (OGTT) and hyperglycemic clamps (HC), followed by arginine stimulation and mixed meal test (MMT), in 39 patients undergoing pancreatoduodenectomy (PD), as model of acute mass reduction. Based on post-surgery OGTT, subjects were divided into 3 groups depending on glucose tolerance: normal (NGT, n=11), impaired (IGT, n=10) or diabetic (DM, n=18) (23 F/16 M, 63±13.7 yrs, BMI 23.9±4.5 kg/m2). To evaluate β-cell function, β-cell glucose sensitivity (GS) was calculated during HC, MMT e OGTT as the ratio of insulin secretion (IS) and glucose increments. Comparison among the 3 groups revealed that PD had a significantly different effect on time-dependent change of glucose and insulin levels during all tests (P<0.01 for the interaction between PD, time and glucose tolerance). Before surgery, Arginine-stimulated Insulin Secretion rates (AIS) and GS were similar across groups, whereas incremental 1st phase IS were significantly lower in IGT and DM as compared with NGT subjects (p=0.01). Following PD, the reduction of GS during HC e OGTT was greater in IGT and DM compared to NGT (p=0.01 per HC and OGTT). A similarly reduction was observed in ΔAIS and 2nd phase of IS (p<0.01), but not in ΔIS1 (p=0.33). In this study the acute beta-cell mass reduction had a different impact on insulin secretory capacity, despite comparable functional mass at baseline, according to pre-surgery IS characteristics. This suggests that underlying impairment in β-cell dysfunction anticipates the decline of beta-cell responses, being the pivotal mechanism for the development of hyperglycemia.

Disclosure

T. Mezza: None. P. Ferraro: None. G. Di Giuseppe: None. C. Cefalo: None. S. Moffa: None. G. Quero: None. F. Cinti: None. F. Impronta: None. U. Capece: None. S. Alfieri: None. A. Mari: Consultant; Self; Lilly Diabetes. Research Support; Self; Boehringer Ingelheim International GmbH. A. Giaccari: Speaker’s Bureau; Self; Amgen, AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Mundipharma, Novo Nordisk A/S, Sanofi-Aventis.
2318-PUB: Indices Using Basal Glucose and Insulin Values Are Comparable to Dynamic Values in Assessing Changes in Glucose Metabolism following Bariatric Surgery (BS)
Authors: BRIX JOHANNA , TURA ANDREA , LUDVIK BERNHARD
Published: June 2020

Introduction: Improvement of insulin resistance (IR) as contributor of diabetes remission and prevention is a beneficial effect of BS. We investigated the ability of indices using either basal or stimulated glucose/insulin values to assess changes in IR and insulin sensitivity (IS) in morbid obese (MO) patients.

Methods: We included 339 patients: 27 with diabetes mellitus (DM, age 44±12 yrs, BMI 49±10kg/m²), 91 with impaired fasting glucose or impaired glucose tolerance (IFG/IGT), (age 41±11 yrs, BMI 47± 7kg/m²) and 221 with normal glucose tolerance (NGT, age 38±10 yrs, BMI 46± 7kg/m²). All patients underwent a 75g OGTT, glucose and insulin levels were repeatedly measured. IR and IS indices were calculated.

Results: Remission to NGT occurred in 70.4% of DM and in 97.8% of IFG/IGT. Basal and stimulated indices were equally able to demonstrate changes of glucose metabolism (table1). Before BS, IR was higher in DM for all indices (p<0.001). After BS, there were no differences in AUC glucose (p=0.454), HOMA (p=0.905) and Matsuda (p=0.469) but IFG/IGT patients had a higher AUC insulin (p=0.024) and a lower IGI (p=0.024) compared to DM.

Conclusion: Indices using basal values are equally able to assess changes in glucose metabolism compared to stimulated indices. They represent a tool for simple and valid determination of glucose metabolism in this cohort.

Disclosure

J. Brix: None. A. Tura: None. B. Ludvik: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk A/S, Sanofi. Research Support; Self; Bayer Healthcare Pharmaceuticals Inc., Eli Lilly and Company, Merck & Co., Inc., Novartis Pharmaceuticals Corporation. Speaker’s Bureau; Self; Amgen.
2319-PUB: Adipose Tissue Distribution Is Associated with the Risk of Stones in Patients with Type 2 Diabetes: A Cross-Sectional Study in China
Authors: NIE YUANPENG , TANG XIXIANG , LI HAICHENG , LI TING , LI MEI , PENG RONGDONG , MU PAN-WEI , CHEN YANMING
Published: June 2020

Purpose: This study aims to investigate the correlation between adipose tissue distribution and the prevalence of gallstones and urinary stones in patients with type 2 diabetes.

Methods: A total of 2477 patients with type 2 diabetes (T2DM) admitted to the Third Affiliated Hospital from January 2016 to December 2018 were enrolled in the study. Each patient was subjected to physical examinations including measurements of height, body weight, waist circumference (WC), hip circumference (HC), standard biochemical tests and abdominal ultrasound measurement. Body mass index (BMI) and waist to hip ratio (WHR) were calculated. Patients were stratified into 4 quartiles based on WHR: ˂0.8817, 0.8817-0.9240, 0.9240-0.9574 and ˃0.9574.

Results: There is a significant association between abdominal obesity and increased risk of stones in T2DM patients. After adjusting with regular confounding factors, multivariate logistic regression analysis showed that T2DM patients at the 4th quartile of WHR had a higher risk of gallbladder stones compared with patients in the 1st quartile (OR = 3.78, 95%CI:1.16-12.30, P = 0.027). Moreover, after adjusting for some confounding factors other than BMI, T2DM patients at 4th quartile of waist-to-hip ratio also had a significantly higher risk of kidney stones than those in the 1st quartile (OR=5.34, 95% CI: 1.14-25.01, P=0.033). However, after further adjusted for BMI, it was not significant.

Conclusion: T2DM patients with more severe abdominal obesity, i.e., the 4th quartile of WHR, show a significantly increased risk of gallstones. We conclude that WHR is an independent risk factor for gallstone in T2DM patients.

Disclosure

Y. Nie: None. X. Tang: None. H. Li: None. T. Li: None. M. Li: None. R. Peng: None. P. Mu: None. Y. Chen: None.

Funding

Research and Development Plans in Key Areas of Guangdong Province (2019B020227003); National Natural Science Foundation of China (81770826); National Key Research and Development Program of China (2017YFA0105803)
2322-PUB: PM2.5 Accelerated Impaired Pancreatic a-Cells by Increasing Expression of Inflammatory Factors in Mice with Streptozotocin
Authors: YIN RUILI , YANG LONGYAN , LANG JIANAN , ZHAO DONG
Published: June 2020

We investigated how PM2.5 exposure could affect glucose homeostasis in mice with streptozotocin (STZ). Male C57BL/6 mice were housed under filtered air (FA) or PM2.5 for 12 weeks and then received intraperitoneal injection of STZ (40 mg/kg of bodyweight) or acetic buffer daily for consecutive five days. Four weeks after the last injection, fasting glucose test was performed. Cholesterol and triglyceride levels were determined in the plasma and liver. Homeostasis Model Assessment of β cell function (Homa-β) were computed using fasting insulin and glucose. Interleukin-1β (IL-1β) and tumor necrosis factor alpha (TNF-α) levels in plasma, visceral adipose tissues, macrophage RAW264.7 and pancreatic β-cells MIN6 treated with PM2.5 (0-50 μg/ml) were quantified by ELISA. Before STZ injection, fasting blood glucose (FBG) levels were similar between FA and PM2.5 groups (p=0.92). After STZ injection, FBG levels were 1.2- fold higher in mice pre-exposed to PM2.5 than those pre-exposed to FA (p=0.17). When taking FBG levels ≥7 mmol/L as the criteria for impaired glucose tolerance, its incidence was 53.3% and 77.8% in FA and PM2.5 groups, respectively (p=0.08). IL-1β and TNF-α levels in the adipose tissues were greater in diabetic mice pre-exposed to PM2.5 than diabetic mice pre-exposed to FA (p<0.05 for all). The addition of PM2.5 stimulated IL-1β and TNF-α production in macrophages and pancreatic β-cells, and impaired the incretion of insulin in MIN6 cells in a dose-dependent manner.

In conclusion, pre-exposure of PM2.5 impaired pancreatic β-cells in mice upon STZ injection, partially via enhanced inflammation and suppressed the incretion of insulin.

Disclosure

R. Yin: None. L. Yang: None. J. Lang: None. D. Zhao: None.

Funding

National Natural Science Foundation of China (81800768)
267-OR: Reduction in Self-Reported Adverse Events Related to Severe Hypoglycemia in Individuals Using a Predictive Low Glucose System: Results from a Real-World Setting
Authors: SINGH HARSIMRAN , MANNING MICHELLE L. , MCELWEE-MALLOY MOLLY , HABIF STEPHANIE
Published: June 2020

Severe hypoglycemia (SH) is an acute complication of diabetes with potentially adverse clinical and psychosocial consequences. There is little published literature in terms of SH-related adverse events (AEs) in patients with type 1 diabetes (PwT1D) in a real-world setting. We recruited PwT1D who had recently started using the Tandem t:slim X2 insulin pump with Basal-IQ Predictive Low Glucose Suspend (PLGS). Amongst other measures, PwT1D reported SH-related AEs at baseline and then again at 6 months post-assessment (PA). Pre-Post differences were analyzed using Fisher’s exact test. In all, 665 PwT1D were included in the analysis (19% of these were <18 years old, mean age=37.11 years, female=55.5%, mean HbA1c=7.2%). Overall, 14.9% used multiple daily injections (MDIs) while 85.2% used insulin pumps as baseline therapy method. Nearly 91% of the sample reported using CGM at baseline. At PA, number of participants who reported to have 1 or more paramedic visits due to SH had significantly decreased from 35 to 19 (p<0.001), emergency room (ER) visits dropped to 9 (vs. 39 at baseline, p<0.001), and hospital admissions were reduced to 6 (vs. 24 at baseline, p<0.05) for the entire sample. These differences were observed irrespective of the baseline therapy method (MDIs vs. pump users) although the largest differences were noticed for MDIs (reduction of -9.47% (paramedic visits), -10.53% (ER visits), and -8.42% (hospital admissions). Risk-ratio assessment for AEs overall, per 100 person years showed a drop at PA for all 3 AE categories (paramedic visits, 21.98 vs. 7.33; ER visits, 19.24 vs. 4.27; hospital admissions, 11.30 vs. 2.75). The Basal-IQ PLGS technology demonstrated remarkable reductions in self-reported SH-related AEs for both pediatric and adult PwT1D.

Disclosure

H. Singh: Employee; Self; Tandem Diabetes Care. M.L. Manning: Employee; Self; Tandem Diabetes Care. M. McElwee-Malloy: Employee; Self; Tandem Diabetes Care. S. Habif: Employee; Self; Tandem Diabetes Care.
268-OR: Conversations and Reactions around Severe Hypoglycemia (CRASH): Survey Responses of People Aged 65+ with T1DM or Insulin-Treated T2DM and Caregivers
Authors: SNOEK FRANK J. , SPAEPEN ERIK , BUSHNELL DONALD M. , CHILD CHRISTOPHER J. , BALANTAC ZANETA , MITCHELL BETH , PEYROT MARK
Published: June 2020

The CRASH online survey examined the experience and treatment of a severe hypoglycemic event (SHE) in people with T1DM or insulin-treated T2DM (PWD) or caregivers (CG). Eligible participants experienced ≥1 SHE in the last 3 years with insulin treatment at the time of event. Reported here are results from PWD aged ≥65 (T1DM 74, T2DM 104) and CG (T1DM 95, T2DM 231) from Canada, Germany, Spain, UK, and USA. During the last SHE, reported glucagon use was low for T1DM (9.5%) and T2DM (7.5%); primary reason reported was no prescription available or filled (T1DM 24.3%, T2DM 29.3%). Of those who ever discussed SHE at their healthcare provider (HCP) visit (T1DM 138, T2DM 243), less than half (T1DM 41.3%, T2DM 34.2%) reported discussion of SHE at every HCP visit. No discussion of the most recent SHE occurred for 34.3% (T1DM) and 31.0% (T2DM). During the most recent SHE many felt unprepared (T1DM 35.5%, T2DM 47.2%), scared (T1DM 60.9%, T2DM 64.2%), and helpless (T1DM 39.1%, T2DM 51.3%). After the last SHE, changes were reported to insulin regimens, meal plans, carrying sugar/sweets, checking blood glucose more often or using continuous glucose monitors, and increasing access to glucagon. Clinical guidelines recommending discussion of hypoglycemia at each HCP visit for PWD at risk for SHE are not being met and should occur, and CGs should be included in preparedness strategies.

Disclosure

F.J. Snoek: Advisory Panel; Self; Abbott, Lilly Diabetes, Novo Nordisk A/S, Roche Diabetes Care. Research Support; Self; Sanofi. E. Spaepen: None. D.M. Bushnell: None. C.J. Child: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. Z. Balantac: Other Relationship; Self; Eli Lilly and Company. B. Mitchell: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. M. Peyrot: Advisory Panel; Self; Eli Lilly and Company. Consultant; Self; CeQur Corporation, Eli Lilly and Company. Research Support; Spouse/Partner; Eli Lilly and Company.

Funding

Eli Lilly and Company
272-OR: Do Diabetes Prevention Treatments Promote Regression to Normal Glucose Regulation? A Network Meta-analysis
Authors: GALAVIZ KARLA I. , WEBER MARY BETH , GUJRAL UNJALI , WEI JINGKAI , SUVADA KARA , HAW JEEHEA SONYA , NARAYAN K.M. VENKAT , ALI MOHAMMED K.
Published: June 2020

Objective: In this meta-analysis, we compared the effect of different non-surgical diabetes prevention strategies on regression to normoglycemia among people with prediabetes.

Methods: We systematically searched MEDLINE, EMBASE and Cochrane Library for articles published between 01-01-2000 to 05-30-2017. We included randomized controlled trials testing non-surgical interventions to prevent diabetes or improve glucose tolerance in adults with prediabetes, lasting at least three months, and reporting regression to normoglycemia rates. Using the number of participants that regressed to normoglycemia (fasting blood glucose <100 mg/dL, or two-hour post load glucose <140 mg/dL, or Hemoglobin A1c <5.7%) at the end of the intervention, we estimated the pooled risk difference (RD), number needed to treat (NNT) and relative risk using a Bayesian arm-based network meta-analysis.

Results: Fifty-one studies were included (25,440 participants, mean age 54 years, 46% male). Of these, 30 study arms tested lifestyle modification (LSM), 15 tested medications (60% glucose sensitizers), 8 tested medications+LSM, 8 tested dietary supplements (vitamins, minerals and herbs), and 7 tested supplements+LSM. Compared to control arms (n=29) at a mean 1.6 years of follow up [range 0.2-5.0], medications achieved the largest regression rates (RD=12%, NNT=8), followed by LSM (RD=6%, NNT=17), medications+LSM (RD=5%, NNT=20), and supplements (RD=2%, NNT=50 with or without LSM). The corresponding relative risks were 2.06 (1.39, 2.95) for medications, 1.76 (1.34, 2.36) for LSM, 2.36 (1.55, 3.52) for medications+LSM, 2.60 (1.74, 3.66) for supplements+LSM, and 1.67 (1.07, 2.55) for supplements.

Conclusion: Medications, glucose sensitizers in particular, are the most effective treatments for restoring normal glucose regulation in adults with prediabetes. LSM is also effective either alone or in combination with medications.

Disclosure

K.I. Galaviz: None. M. Weber: None. U. Gujral: None. J. Wei: None. K. Suvada: None. J. Haw: None. K. Narayan: None. M.K. Ali: Research Support; Self; Merck & Co., Inc.

Funding

National Heart, Lung, and Blood Institute (1K01HL149479-01); National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024)
304-OR: 5-Hydroxymethylcytosines in Circulating Cell-Free DNA Reveal Diabetic Nephropathy
Authors: ZENG CHANG , YANG YING , ZHANG ZHOU , HE CHUAN , ZHANG WEI , LIU SONG-MEI
Published: June 2020

Background: Long-term complications of type 2 diabetes (T2D) are the major causes for T2D-related disability and mortality. Notably, diabetic nephropathy (DN) has become the most frequent cause of end-stage renal disease in most countries. A clinically convenient, noninvasive approach for monitoring the development of DN would improve the overall life quality of patients with T2D and help reduce healthcare burden through preventive interventions.

Methods: A selective chemical labeling strategy, the 5hmC-Seal, was used to profile genome-wide 5-hydroxymethylcytosines (5hmC), an emerging class of epigenetic markers implicated in complex diseases including diabetes, in patient-derived circulating cell-free DNA (cfDNA) in plasma. Differentially modified 5hmC marker genes were identified through the pair-wise comparisons among T2D patients with DN (DN) (n=12), T2D patients with non-DN complications(non-DN) (n=29), and T2D controls with no complications (T2D) (n=14),respectively.

Results: A panel of 271 differentially modified genes (fold-change > 10% and nominal p-value < 0.05) were detected between T2D and DN, involving genes and pathways relevant to synthesis of bile acids and bile salts, fatty acid metabolism(ACAA2), mitochondrial gene expression (POLRMT), and ion transport (OTX1, SRI). In addition, a 4-gene 5hmC marker panel (DNAH1, RAB11FIP4, POLRMT, RAB36) was found to be differentially modified among T2D, DN and non-DN patients. Further analysis indicated that this 4-gene signature showed capacity for differentiating DN from T2D (AUC= 83%; 95% confidence interval [66-100%]), healthy individuals (AUC= 83% [64-100%]), and non-DN (AUC = 88% [76-100%]).

Conclusion: The 5hmC profiles in cfDNA reflect epigenetic changes in T2D and DN that have the potential to be a clinically convenient, noninvasive approach for monitoring the presence and severity of diabetic retinopathy in high risk T2D patients.

Disclosure

C. Zeng: None. Y. Yang: None. Z. Zhang: None. C. He: Advisory Panel; Self; Shanghai Epican Genetech Co., Ltd. W. Zhang: Advisory Panel; Self; Shanghai Epican Genetech Co., Ltd. S. Liu: None.
318-OR: Ciliary GPCRs Regulate Glucose-Stimulated Insulin Secretion
Authors: WU CHIEN-TING , HILGENDORF KEREN , HANG YAN , BEVACQUA ROMINA J. , JOHNSON CARL T. , CHANG CHARLES A. , PARK SANGBIN , TELLEZ KRISSIE , KIM SEUNG , JACKSON PETER K.
Published: June 2020

Defects in primary cilia result in syndromes collectively called “ciliopathies”, which often present with obesity and diabetes. Although glucose is the primary mediator of GSIS, circulating factors including free fatty acids, amino acids, and various hormones also play critical roles. At the interface between these circulating factors and GSIS, GPCR signaling is often central. The primary cilium is a membrane and microtubule-based sensory organelle and is highly enriched with specialized GPCRs. Cilia are present on pancreatic β-cells, but the role of cilia in β-cell function remains unclear. To discover ciliary GPCRs important for β-cell function, we compiled a list of candidate β-cell specific or highly expressed GPCRs based on human pancreatic gene expression profiles. We identified 66 β-cell specific GPCRs comparing with α-cells and acinar-cells. These 66 candidate GPCRs was expressed as C-terminally tagged GFP fusion proteins and screened for ciliary localization in a mouse pancreatic β-cell line, MIN6. To date, we have identified the following GPCRs localize to cilia in MIN6 cells: FFAR4, PTGER4, ADRB2, KISS1R, and P2RY14. To validate ciliary localization of GPCRs, we also used antibodies against the endogenous GPCRs. We have confirmed that the free fatty acid receptor 4 (Ffar4) and the prostaglandin E receptor 4 (Ptger4) are localized to the primary cilium of mouse and human β-cells. In addition, the treatment of each of agonists of these receptors promote glucose-stimulated insulin secretion (GSIS) in mouse and human islet. Tulp3 is required for transporting GPCRs into the primary cilium. We used shRNA targeting Tulp3 delivered by lentivirus to knock-down Tulp3 in mouse and human islet cells. Tulp3 depletion leaves ciliary structure intact but impairs the localization of Ffar4 and Ptger4 in cilia and disrupts agonist-stimulated GSIS in mouse and human pseudo-islets. Together, these data suggest that primary cilia and ciliary GPCRs are important for the circulating factors-regulated GSIS in β-cell.

Disclosure

C. Wu: None. K. Hilgendorf: None. Y. Hang: None. R.J. Bevacqua: None. C.T. Johnson: None. C.A. Chang: None. S. Park: None. K. Tellez: None. S. Kim: None. P.K. Jackson: None.

Funding

Stanford Diabetes Research Center
398-P: Hypoglycemia Requiring Paramedic Assistance in London, Canada
Authors: SPAIC TAMARA , LIU SELINA L. , CARTER DUSTIN R. , PEDDLE MICHAEL , MAHON JEFFREY
Published: June 2020

Hypoglycemia requiring paramedic assistance places a large burden on the health care system (HCS), and negatively impacts quality of life and long-term outcomes in patients with diabetes. Prior studies have shown that only a small proportion of patients with paramedic-assist requiring hypoglycemia are subsequently brought to the Emergency Room; thus severe hypoglycemia (SHG) is often “invisible” to the HCS and is not adequately followed up on. We created an innovative, two-step hypoglycemia education program in London, Canada which consists of a direct electronic referral system by paramedics at the time they assess patients with SHG to the local Diabetes Education Center (DEC) for a standardized hypoglycemia education. There were a total of 446 SHG calls to the Middlesex-London Paramedic Service from September 2017- June 2018. Of those, 322 (72%) were eligible for our study, of whom 135 (42%) were referred to the DEC and only 79 patients agreed to attend. Of the 79 patients who were enrolled over 21 months, 49 (62%) were male; the mean age was 61±16 (range 18-88 yrs); and 40 (51%) had type 2, 32 (41%) type 1, and 7 (9%) were unknown diabetes type. Of those 48 (61%) were taking insulin, 8 (10%) oral hypoglycemic agents of which the most common was glyburide (5/8, 63%), and 19 (24%) were on both oral agents and insulin. Three (4%) patients were on an insulin pump. Mean HbA1c was 63±9 mmol/mol (7.9±1.3, range 4.8-10.6%) and the majority did not have an Endocrinologist (49, 62%). Only 50 (63%) completed the education program. There were no statistically significant differences between the characteristics of the patients who attended and did not attend DEC program. Patients experiencing SHG remain ’hidden’ from the HCS. Hence, the impact of SHG is underestimated and understudied. Despite an accessible referral system to a focused intervention, our program was not successful in engaging many patients with SHG requiring paramedic assistance in a program to decrease their risk for SHG. Further study to explore barriers is needed.

Disclosure

T. Spaic: Research Support; Self; Novo Nordisk Inc. Speaker’s Bureau; Self; Dexcom, Inc., Sanofi. S.L. Liu: Consultant; Self; Merck & Co., Inc., Novo Nordisk Inc., Sanofi. Research Support; Self; Novo Nordisk Inc., Sanofi. D.R. Carter: None. M. Peddle: None. J. Mahon: None.

Funding

Academic Medical Organization of Southwestern Ontario
404-P: Cardiovascular Risk Scoring and Stratification in Patients with Type 2 Diabetes Enrolled in a Medicare Advantage Plan
Authors: HAYDEN JENNIFER D. , PIMPLE PRATIK , LUTHRA RAKESH , PREWITT TODD G. , CHIGULURI VINAY , KATTAN MICHAEL , HARVEY RAYMOND , GOSS ASHLEY M. , CAPLAN ELEANOR O.
Published: June 2020

Current tools to identify patients at risk for cardiovascular (CV) disease or events are variable, limiting their utility and generalizability. The purpose of this study was to develop a predictive model to identify patients with type 2 diabetes (T2D) who are ≥65 years of age, enrolled in a Medicare Advantage Prescription Drug (MAPD) plan and at risk for future CV events. This retrospective cohort study used administrative claims, laboratory and enrollment data from 1/2011-12/2018. Patients with T2D were identified from 1/2012-12/2013 using diagnosis codes and/or claims for antihyperglycemic medications. The dependent variable was the first composite CV event defined as ≥1 inpatient hospitalization for myocardial infarction, ischemic stroke, unstable angina, or heart failure or any evidence of revascularization. Independent variables for the prediction survival model included baseline demographic and clinical characteristics prognostic for the dependent variable. C-statistic, accuracy, sensitivity, and specificity were used to assess model performance. Risk ranking was conducted, whereby patients were classified as low, medium or at high risk of an event based on probability distribution derived cut-points. A total of 362,791 patients with T2D were identified. The proportion of patients with ≥1 CV event was 18.0% up to 5 years after T2D identification. The final model included 42 demographic and clinical variables. The C-statistic was 0.68, and accuracy, sensitivity and specificity were 0.63. Results were consistent across the training, test and holdout datasets suggesting internal validity. Up to 5 years after identification, 11% of patients classified as low, 27% as medium, and 51% as high risk had a future CV event. A predictive model for composite CV events utilizing administrative claims to identify and risk stratify patients may be used to scale focused interventions to high-risk T2D patients in a MAPD population to prevent future CVD events.

Disclosure

J.D. Hayden: Employee; Self; Humana. P. Pimple: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Employee; Spouse/Partner; CVS Caremark. R. Luthra: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. T.G. Prewitt: None. V. Chiguluri: None. M. Kattan: Consultant; Self; GlaxoSmithKline plc. Research Support; Self; Boehringer Ingelheim (Canada) Ltd., Novo Nordisk Inc. R. Harvey: None. A.M. Goss: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. E.O. Caplan: Employee; Self; Humana.

Funding

Boehringer Ingelheim; Humana
42-LB: Factors Associated with Use of Diabetes Self-Management Education and Support Programs in Newly Diagnosed Type 2 Diabetes Patients in Louisiana
Authors: YOSHIDA YILIN , SHI LIZHENG , HONG DONGZHE , NAUMAN ELIZABETH , HU GANG , KATZMARZYK PETER T. , PRICE-HAYWOOD EBONI G. , BAZZANO ALESSANDRA N. , SHEN YUN , FONSECA VIVIAN
Published: June 2020

Background: Prevalence of and factors associated with use of diabetes self-management education and support (DSME/S) programs in newly diagnosed type 2 diabetes (T2D) patients in Louisiana (LA) have not been fully evaluated.

Methods: We used EHRs from 3 hospital systems in LA (01/01/2013 to 10/31/2019). Eligible patients were 35-94 y-old with T2D based on ICD-codes, an antidiabetic drug prescription, an HbA1c ≥6.5%, an FPG ≥126, a 2-hr OGT ≥200, or random plasma glucose ≥200 mg/dL. New T2D was defined as entry of T2D diagnosis in the condition list occurring ≥1 y after first recorded office visit. DSME/S were searched by HCPCS codes G0108 and G0109. Logistic regressions compared differences between DSME/S vs. non-DSME/S group ≥180 days before the first recorded DSME/S.

Results: The prevalence of DSME/S use in T2D patients was 5.6% (18,139/313,242). In newly diagnosed T2D patients, the prevalence was 6.2% (8,918/137,629). Comparing to gender-, age- and race-matched non-DSME/S group, DSME/S group had worse clinical profiles, e.g., higher mean A1c and triglycerides, lower mean HDL, and higher obesity rate. Adjusted models showed self-pay patients were 70% less likely (OR 0.3, 95% CI 0.2-0.6) to use DMSE/S than Medicare beneficiaries. Current smokers were 2.6 times more likely (2.6, 1.8-3.7), but former smokers were 40% less likely (0.6, 0.5-0.7) to use DMSE/S than never smokers. Patients with hypolipidemic or antihypertensive drugs were 50% (1.5, 1.4-1.8) or 60% (1.6, 1.4-1.8) more likely to use DSME/S than those without the medications. Patients with A1c >6.5% were 3.9 times more likely (3.9, 3.4-4.6) to use DSMES/S than those with normal A1c. Obese patients were 60% more likely (1.6, 1.4-1.9), but hypertensive patients (SBP>130/DBP>80 mmHg) were 60% less likely to use DSME/S (0.4, 0.3-0.5).

Conclusion: Use of DSME/S is low in LA, and there are marked differences in using the service by insurance type, smoking status and diabetes risk control.

Disclosure

Y. Yoshida: None. L. Shi: None. D. Hong: None. E. Nauman: None. G. Hu: None. P.T. Katzmarzyk: None. E.G. Price-Haywood: None. A.N. Bazzano: None. Y. Shen: 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.
422-P: Association between Nonalcoholic Fatty Liver Disease and Diastolic Myocardial Dysfunction and Myocardial Insulin Resistance in Patients with Type 2 Diabetes
Authors: KIM YOUNG-EUN , LEE MINYOUNG , LEE SEJEONG , CHA BONG-SOO , KANG EUN SEOK
Published: June 2020

Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in patients with type 2 diabetes and associated with cardiovascular risks. We investigated whether degree of NAFLD was associated with myocardial dysfunction in relation to myocardial glucose uptake in patients with type 2 diabetes. A total of 131 patients with type 2 diabetes were included from a tertiary care hospital. Myocardial glucose uptake was assessed using [18F]-FDG-PET scan. Hepatic steatosis and fibrosis were determined using transient liver elastography (Fibroscan). Echocardiogram was performed to evaluate cardiac structure and function. Patients with NAFLD revealed cardiac diastolic dysfunction with increased left ventricular filling pressure (E/e’ ratio) and left atrial volume index (LAVI) compared with patients without NAFLD (all p<0.05). Hepatic steatosis was correlated with E/e’ ratio and LAVI, and hepatic fibrosis was also correlated with E/e’ ratio (all p < 0.05). In linear regression analyses, degree of hepatic steatosis and fibrosis were independent determinant factors for a higher E/e’ ratio even after adjusting for confounding factors (r2=0.409, p=0.041 for steatosis and r2=0.423, p=0.009 for fibrosis). Higher degree of steatosis and fibrosis were associated with decreased myocardial glucose uptake (p for trends=0.084 and 0.012 for steatosis and fibrosis, respectively). Furthermore, decreased myocardial glucose uptake was an independent determinant factor for a higher E/e’ ratio (r2=0.409, p=0.04).

In conclusion, hepatic steatosis and fibrosis are significantly associated with diastolic heart dysfunction in patients with type 2 diabetes coupled with decreased myocardial glucose uptake.

Disclosure

Y. Kim: None. M. Lee: None. S. Lee: None. B. Cha: None. E. Kang: None.
451-P: Proteome Profiling in Rat Cardiomyoblasts: Understanding Diabetic Cardiomyopathy
Authors: STRATMANN BERND , EGGERS BRITTA , MATTERN YVONNE , MARCUS KATRIN , TSCHOEPE DIETHELM
Published: June 2020

Introduction: Diabetic cardiomyopathy is characterized by oversupply of nutrients with concurrent loss of metabolic flexibility. Even in excess substrate availability the heart suffers energy depletion as metabolic fluxes are diminished. We established a stably GLUT4 overexpressing cell line derived from H9C2 that presents a diabetic cardiomyopathy like phenotype. Protein expression patterns are analyzed by proteomic approaches.

Material and Methods: Rat cardiomyoblasts stably overexpressing GLUT4 (H9C2-GLUT4) were cultured under hyperglycemic conditions (30mM glucose) either short time (3 days) or long time (more than 3 months). Expression profile was compared to non-transfected H9C2 cells (H9C2), using same culture conditions. Cell culture samples were prepared for mass spectrometric analysis by sample lysis followed by tryptic digestion. Peptides were analyzed on an Orbitrap Elite (ThermoFisher, Scientific) and resulting files were taken for the identification and quantification of proteins using MaxQuant and Perseus. DAVID Bioinformatics Resources 6.8 functioned as Pathway and GO term enrichment tool for further in depth analysis of the data set.

Results: We were able to quantify 2,841 proteins of whose 881 were found to be significantly regulated (5% FDR; ANOVA corrected p-value). Further analysis of long time and short time exposure of either WT or GLUT4 overexpressing cells lead to the identification of 135 significantly expressed proteins in the WT and 112 significantly expressed proteins in the H9C2-GLUT4 model (5% FDR; ANOVA corrected p-value). In depth pathway and GO term enrichment analysis support effects on metabolism, protein biosynthesis and handling, and ECM composition.

Discussion: Chronic glucose overload in cardiomyoblasts induced by GLUT4 overexpression and hyperglycemia resulted in a metabolic induced proteome profile change. These models may thus increase our knowledge of biological effects of chronic hyperglycemia on the diabetic heart.

Disclosure

B. Stratmann: Speaker’s Bureau; Self; AstraZeneca, Neoplas Tools GmbH. B. Eggers: None. Y. Mattern: None. K. Marcus: None. D. Tschoepe: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH. Research Support; Self; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Neoplas tools GmbH.
479-P: Inhibition of the NLRP3 Inflammasome by MCC950 Accelerates Renal Injury in Diabetes Model
Authors: ØSTERGAARD JAKOB A. , JHA JAY C. , SHARMA ARPEETA , DAI AOZHI , COOPER MARK E. , DE HAAN JUDY B. , JANDELEIT-DAHM KARIN
Published: June 2020

Background: Previous studies suggest that NLRP3 inflammasome activation could have pathological relevance in diabetic kidney disease (DKD). A recent study demonstrated that NLRP3 inhibition in a preventional approach in db/db mice provided reno-protection, potentially via a ROS dependent mechanism. We aimed to examine the therapeutical potential of the NLRP3 inflammasome inhibitor, MCC950 in a more clinically relevant interventional approach in a model of DKD and its impact on renal pathology.

Methods: Diabetes was induced by streptozotocin in ApoE-/- mice. A subgroup of control and diabetic mice was treated with MCC950 (5mg/kg/3 times/week). Treatment was commenced after 5 or 9 weeks of diabetes and continued for another 5 or 9 weeks for the assessment of renal gene expression as well its impact on albuminuria and renal morphology, respectively.

Results: Diabetes-induced mesangial expansion was further increased in MCC950 treated diabetic mice when compared to untreated diabetic group (18.9±0.6% vs. 16.3±0.7%, respectively). MCC950 treated diabetic mice showed a trend of increased albuminuria when compared to untreated diabetic mice (43±9 vs. 31±5 ug/24hrs, respectively). Gene expression of markers of fibrosis (fibronectin, collagen IV, α-smooth muscle actin and PCNA) and pro-oxidant enzymes (Nox2 and Nox4) were upregulated in diabetic mice compared to nondiabetic controls. These changes were further upregulated in MCC950-treated diabetic mice when compared to untreated diabetic mice. In addition, mRNA expression of pro-inflammatory markers (MCP-1 and IL-6) were increased in untreated diabetic animals as compared to controls and MCC950 treatment did not show additional upregulation of these parameters.

Conclusions: The present study indicates that inhibition of the NLRP3 inflammasome by MCC950 after establishment of disease, may not have a reno-protective effect. Our data rather shows an adverse effect of this drug at least in this model of DKD.

Disclosure

J.A. Østergaard: None. J.C. Jha: None. A. Sharma: None. A. Dai: None. M.E. Cooper: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Mundipharma International. Research Support; Self; Boehringer Ingelheim International GmbH, Novo Nordisk A/S. Speaker’s Bureau; Self; AstraZeneca, Merck Sharp & Dohme Corp., Novartis AG, Sanofi-Aventis, Servier. J.B. de Haan: Research Support; Self; Bayer Inc., Reata Pharmaceuticals. K. Jandeleit-Dahm: None.
48-LB: The Effect of Acute Psychosocial Stress in Adults with Type 1 Diabetes
Authors: PARK MINSUN , SONG YOUNGKWAN , CHU MINSEUNG , SEVIL MERT , HOBBS NICOLE , SHARP LISA , CINAR ALI , QUINN LAURIE T.
Published: June 2020

The effects of acute psychological stress, heart rate variability (HRV), an indicator of autonomic function and glycemic variability (GV) have not been extensively researched in type 1 diabetes (T1D). The aim of this study is to explore the effect of acute psychosocial stress on HRV and GV in people with T1D. Methods: Eleven participants with T1D (33.00 ± 11.25 years) participated in the study. To assess acute mental stress, the subjects 1) participated in the Trier Social Stress Test (TSST); and 2) played competitive video games (Nintendo Switch™). The TSST followed standardized procedures whereby stress was induced asking participants to provide a job talk and arithmetic in front of two judges. Participants played the Mario Kart to go-kart races (10 minutes) and rotated their controllers to untangle the Treasure Chest (10 minutes). Resting HRV and GV were obtained. The subjects wore a continuous glucose monitor and a Zephyr Bioharness™ to record GV and HRV, respectively. Nonparametric, paired samples T-tests were conducted using SPSS 24.

Results: During TSST, there were significant differences between the resting and TSST testing period in the sympathetic nervous sympathetic nervous system index (.57 ± 1.33 vs. 1.36 ± 1.40; z = -2.845, respectively; p <.01; and stress index (8.17 ± 3.69 vs. 10.27 ± 5.69; z = -2.578, respectively; p <.05). When subjects were playing video games, there were significant differences in the parasympathetic nervous sympathetic nervous system index (-.09 ± 1.75 vs. -.87 ± 1.05; z = -2.134, respectively; p <.05) compared to a resting period. However, there were no significant differences in GV compared to a resting period in during TSST and playing video game.

Conclusion: This study suggests that the TSST induced stress in people with T1D, increased sympathetic activity; however, the TSST did not change glycemic variability. Playing competitive video game did not appear to neither induces stress nor affected glycemic variability. The competitive video game did not cause stress compared to TSST.

Disclosure

M. Park: None. Y. Song: None. M. Chu: None. M. Sevil: None. N. Hobbs: None. L. Sharp: None. A. Cinar: Research Support; Self; Dexcom, Inc., JDRF. Stock/Shareholder; Self; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S, Tandem Diabetes Care. L.T. Quinn: None.

Funding

JDRF