bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Diabetes-Related Outcomes Up to Two Years after Discharge from Ambulatory Clinical Pharmacist Clinics in a Large Public Safety Net Health System
Authors: CHOW DIEM , BOATRIGHT STEVEN M. , HULSTEIN JEFF , MOSS ELIZABETH , MATHEW ANNIE C. , ALVAREZ KRISTIN S.
Published: June 2018

There are 10 clinical ambulatory pharmacy specialist (CAPS) providing direct patient care under physician-approved drug therapy management protocols within the health system. Patients were referred to CAPS by their primary care physician (PCP) and subsequently discharged from CAPS services when individualized diabetes goals were met. Patients continued follow-up with their PCP for continuity of care. The primary outcomes are the A1Cs at 1 year (± 90 days) and 2 years (± 90 days) post-discharge from CAPS. Secondary outcomes include 1 and 2 year results in the number of emergency department (ED) visits, hospitalizations, and other clinical visits completed.

Results: At baseline, patients discharged from CAPS had an A1C of 6.7% (n=195). At 1 and 2 year post-discharge, the A1Cs were 7.5% (n=118) and 8% (n=100), respectively. In the first year following discharge, 1 patient had an ED visit and 2 patients required hospitalization for diabetes-related events. In the second year post discharge, 3 patients were seen in the ED and 4 diabetes related hospitalizations occurred. Patients continued to see their PCP 2.7 and 2.3 times a year in the first and second year post-discharge, respectively. A small number of patients were referred to nutrition (n=16), diabetes classes (n=2), and diabetes clinic (n=5) in the 2 year time frame. Patients were also referred back to CAPS for continued diabetes management (n=5 in year 1, n=13 in year 2) and these A1Cs were removed from analysis. While not all patients discharged from CAPS had subsequent A1Cs for analysis, the main reason identified was a lack of A1C results in the specified time frame.

Conclusions: Patients were able to fairly control their diabetes up to 2 years after discharge from clinical pharmacy services.

Disclosure

D. Chow: None. S.M. Boatright: None. J. Hulstein: None. E. Moss: None. A.C. Mathew: None. K.S. Alvarez: None.
Developing a Health Economic Model for Asians with Type 2 Diabetes Based on the Japan Diabetes Complications Study and the Japanese Elderly Diabetes Intervention Trial
Authors: TANAKA SHIRO , LANGER JAKOB , MORTON TIM , WILKINSON LARS , TANAKA SACHIKO , KAWASAKI RYO , MORIYA TATSUMI , HORIKAWA CHIKA , AIDA REI , ARAKI ATSUSHI , SONE HIROHITO
Published: June 2018

Cost-effectiveness analyses (CEAs) are becoming increasingly important in Japan following the introduction of the pilot-based health technology assessment (HTA) from April 2016. Although health economic (HE) models for type 2 diabetes (T2D) have been developed, most models are not generalizable to patients in Asia whose risk factor profiles are different from Caucasians, since they are based on risk equations derived from the United Kingdom Prospective Diabetes Study (UKPDS). The objective was to develop a HE model for T2D using risk equations validated in Japanese patients (JJ Risk Engine) designed to meet the criteria in the guidelines of the Ministry of Health, Labour and Welfare in Japan. The model cohort is defined by patient characteristics and four risk factors (HbA1c, BMI, blood pressure and cholesterol), and treatment effects on macro and micro vascular complications and mortality are applied as risk factor modification over specified duration. In addition to outcomes included in the JJ Risk Engine, end-stage renal disease, amputation, hypoglycemia, utilities and costs were incorporated in the model using data available in the literature. The HE model estimates risks of macro and microvascular complications, cost of complications and treatments, quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses can be conducted for assessment of uncertainty. Simulation settings related to e.g., time horizon, treatment duration, and discount rates can be varied. This HE model offers an opportunity for decision-makers to assess the long-term cost-effectiveness of interventions in Asian patients with T2D.

Disclosure

S. Tanaka: None. J. Langer: Employee; Self; Novo Nordisk Pharma Ltd.. Stock/Shareholder; Self; Novo Nordisk A/S. T. Morton: Consultant; Self; Novo Nordisk Inc. L. Wilkinson: Employee; Self; Novo Nordisk A/S. S. Tanaka: None. R. Kawasaki: None. T. Moriya: None. C. Horikawa: None. R. Aida: None. A. Araki: None. H. Sone: Research Support; Self; Novo Nordisk Inc., Eli Lilly and Company, MSD K.K., Chugai Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Development Center Asia, Pte. Ltd., Daiichi Sankyo Company, Limited, Ono Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Sanofi, Kowa Pharmaceuticals America, Inc., Eisai Inc..
Opportunities to Encourage Mail Order Pharmacy Use in Diabetes—A Qualitative Study
Authors: SCHMITTDIEL JULIE , MARSHALL CASSONDRA , WILEY DEANNE , CHAU CHRISTOPHER V. , TRINACTY CONNIE M. , WHARAM JAMES F. , KENRIK DURU O. , KARTER ANDREW J. , ESTACIO KAREN , BROWN SUSAN
Published: June 2018

Medication non-adherence is a major contributor to poor outcomes in diabetes. Previous research has shown an association between mail order pharmacy (MOP) and better medication adherence, but little is known about the barriers and facilitators to MOP use in diabetes patients. This qualitative study examined factors related to use of MOP vs. traditional pharmacies to obtain prescription medications. We conducted four 90-minute focus groups in 2016 among 28 diabetes patients in the Hawaii and Northern California regions of Kaiser Permanente, a large integrated health care delivery system. We queried participants on their preferred pharmacy use and perceptions of barriers and facilitators of MOP use. One researcher independently coded each focus group transcript, with two transcripts double-coded by an additional researcher to promote reliability. We employed thematic analysis guided by the Capability, Opportunity, Motivation, and Behavior (COM-B) framework using NVivo 11 software. The average age of participants was 64.1; 57% were female; 21% were Asian; 21% were black/African-American; 7% were Hispanic/Latino, and 14% were Native Hawaiian/Pacific Islander. Analysis uncovered 26 themes related to the decision to use MOP for dispensing medications. Most themes (18 out of 26) fell into the COM-B category of ’Opportunity.’ Barriers to MOP use included unpredictability of medication delivery date, concerns about mail security, and difficulty of coordinating refill orders for multiple prescriptions. In contrast, facilitators included greater access and convenience (e.g., no need to wait in line or arrange transportation) compared to traditional pharmacies. Receiving a MOP incentive of free one-month supply of prescriptions was a motivational facilitator to using MOP for delivering medications. These findings can be used to design interventions and quality improvement initiatives to increase MOP usage and improve medication adherence in diabetes patients across health care systems.

Disclosure

J. Schmittdiel: None. C. Marshall: None. D. Wiley: None. C.V. Chau: None. C.M. Trinacty: None. J.F. Wharam: None. O. Duru: None. A.J. Karter: None. K. Estacio: None. S. Brown: None.
Hospitalizations during a Month of Emergency in a Department of Diabetology
Authors: AMOR NADIA BEN , MAMI FAIKA BEN
Published: June 2018

Introduction: Tunisia is not immune to the heavy expenses related to diabetes, especially the cost of hospitalization. The aims of the work were to evaluate the number of hospitalizations in a diabetes unit during an emergency month and to study the indications of these hospitalizations.

Material and methods: Our work is a retrospective, descriptive study, performed in the department C of the National Institute of Nutrition and Food Technologies of Tunis. The patients included in our study had all consulted the dispatching of the Institute during October 2017 and carried the indication to emergency hospitalization.

Results: The number of patients hospitalized was 90. The majority was female(72.2%). The mean duration of hospitalization was 5.3±2.8 days (from 3 to 21 days). The mean age was 39.8±4.7 years (from 16 to 81 years). The indications for hospitalization were as follows: acid-ketotic decompensation in 4.4%(n=4); ketotic decompensation in 14.4%; hyperosmolarity in 4.4%; diabetic foot in 5.6%; unstable diabetes in 7.8%; unbalanced diabetes in 22.2%; discovery of gestational diabetes in 21.1%; pregnancy and unbalanced diabetes mellitus in 16.7% and exploration of hypoglycaemia in a nondiabetic patient in 3.3%. The imbalance or decompensation factors for diabetes were lipodystrophy in 38.9%; drug and/or dietary non-compliance in 46.7%; an infection in 21.1%; insulin resistance in 16.7% and the absence of fast insulin bolus in 7.8%. As for hypoglycaemia in nondiabetics (n=3), two cases were confirmed and these were functional hypoglycaemias. The third case reversed was addressed in neurology and cardiology for exploration of discomforts.

Conclusions: The main indication of emergency hospitalization was decompensated or unbalanced diabetes with lipodystrophies and poor adherence as the main causes. This underscores the importance of the repetition of education sessions for diabetic patients and the psychological care of them.

Disclosure

N. Ben Amor: None. F. Ben Mami: None.
Results from a Population Health Strategy for Diabetes in a Large Health Care System
Authors: SUBRAMANIAN SAVITHA , HIRSCH IRL B. , EVERT ALISON
Published: June 2018

Population health is defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group. Awareness of population health management is increasing but the concept is not clearly defined or understood. Nevertheless, the overarching goal is to keep the patient population as healthy as achievable. Since diabetes is a chronic and progressive illness, population health management strategies hold promise and can be measured using health outcomes, disease burden or metabolic status. University of Washington Medicine, a large healthcare system in the greater Seattle area comprised of academic and community-based primary care clinics, recently initiated a diabetes population health (DPH) program. The is a centralized outlier management and surveillance system where a specialized team (endocrinologist and certified diabetes educator) remotely supports care teams (primary care providers, nurses) in diabetes management. In this pilot initiative, focus was on the highest risk patients with type 2 diabetes such as individuals who had chronically elevated A1C >9% over the past 12 months. The DPH team identified these individuals from an internal database, conducted chart reviews to identify potential areas for improvement, reached out to clinical care teams and offered individualized patient management strategies for the identified patients. Care of all identified patients remained with primary care teams. In 6 months there was a 1.4% point reduction in A1C (10.8% to 9.4%, n=34, p<0.01) primarily through the team’s work with care management nurses who in turn conducted outreach to patients to enable engagement, offered diabetes self-management support and improved care coordination. Thus, the number of individuals with diabetes and elevated A1C at any given period in the past 8 months was decreased by 60%. These early results suggest that an active diabetes surveillance program has the potential to improve health outcomes in diabetes.

Disclosure

S. Subramanian: Advisory Panel; Self; Intarcia Therapeutics, Inc., Akcea Therapeutics. I.B. Hirsch: Research Support; Self; Medtronic MiniMed, Inc.. Consultant; Self; Abbott, Bigfoot Biomedical, Roche Diabetes Care Health and Digital Solutions, ADOCIA. A. Evert: None.
Supporting Diabetes Management—Perspectives on Care Management in a Medicaid Health Home in Alabama
Authors: AGNE APRIL A. , MONDESIR FAVEL , SHELLEY JOHN P. , PISU MARIA , CHERRINGTON ANDREA
Published: June 2018

Background: Chronic diseases like diabetes require constant and ongoing self-management. The Health Home model provides a unique platform to facilitate diabetes management and connect patients to community resources that support and promote self-management. However, little is known about specific activities, barriers, and needs that exist in Health Homes particularly in Alabama which suffers disparately high rates of diabetes compared to other regions. To address this knowledge gap, the purpose of this study is to understand how a Medicaid Health Home facilitates diabetes management in Alabama.

Methods: Three interviewers conducted semi-structured interviews with six staff at a health home organization. A guide facilitated discussion on patient recruitment, frequency and mode of communication with patients and health care delivery team, and clinical and non-clinical patient-related barriers. Content analysis was performed to identify major themes using an iterative, combined deductive and inductive approach.

Results: Six female participants were aged a mean 49 years; majority employed 4 to 5 years in current role. Professional qualifications included a dietician, social worker, and nurses. Five care management domains were identified: health education, medication management, nutrition therapy, and addressing psychosocial issues. Facilitators of staff roles discussed were a high degree of collaboration within their organization and externally with providers and other professionals. For example, staff described the value of reciprocal relationships in which providers interacted with the health home. Barriers to care management included state Medicaid cost-sharing policies, medication limits, timely access to care, and variation in the availability of community resources.

Conclusions: These findings suggest that opportunities exist to intervene at the policy and healthcare system level to improve adult diabetes management for a vulnerable population.

Disclosure

A.A. Agne: None. F. Mondesir: None. J.P. Shelley: None. M. Pisu: None. A. Cherrington: Advisory Panel; Self; AstraZeneca. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Consultant; Self; Novo Nordisk Inc..
Longitudinal Evaluation of Cardiometabolic and Diabetes Risk Factors in a Rural College-Aged Population
Authors: CYPHERT HOLLY , POWELL ROBERT
Published: June 2018

Throughout the U.S., obesity and diabetes rates continue to rise, especially in West Virginia. In fact, West Virginia’s obesity and diabetes rates exceed 40 percent of its population. Previous literature has demonstrated that childhood and early adult lifestyles, including poor dietary choices and reduced physical activity, predict future metabolic and cardiac issues. Therefore, we sought to determine the levels of risk factors for diabetes and cardiometabolic disease in college students in rural WV via a 4-year longitudinal study termed HERD2020 (Higher Education Reducing Diabetes). Freshmen were recruited at Marshall University and were stratified by BMI status to assess differences in physiological, molecular, and psychological status (BMI<25 kg/m2 vs. BMI≥25 kg/m2). Fifty three percent of the students were deemed overweight or obese (BMI≥25 kg/m2). Baseline analysis yielded no significant differences between BMI category and fasting glucose (p=.31); cholesterol (p=.473); triglycerides (p=.38); or HDL (p=.56). Strikingly, students with a BMI≥25 kg/m2 recorded fasting insulin levels twice as high as students with a BMI<25 kg/m2, (.42 vs. .96ng/ml, p=.003). This data suggests overweight/obese students are in a state of insulin-resistance, placing them at greater risks for future cardiometabolic diseases. Lastly, we evaluated plasma bile acid levels due to their newfound interest as antidiabetic molecules. Of the four bile acids altered (urodeoxycholic acid (UDCA), hyocholic acid (HCA), glycochenodeoxycholic acid (GCDCA), and taurodeoxycholic acid (TDCA)), two were higher in overweight patients (UDCA and TDCA) while the other two bile acids were lower in overweight patients (HCA and GCDCA). Continual recruitment and analysis of this study will provide more insight into the strength of these associations following lifestyle intervention. Future strategies should consider these factors to encourage successful lifestyle modification in this population.

Disclosure

H. Cyphert: None. R. Powell: None.
Impacts of Type 1 Diabetes on Patients during the First Two Years—A Qualitative Research Study
Authors: SENIOR EMMANUELLE , FONG REGAN , CHRISTIAN ANNA , MARKOWITZ JESSICA T. , STRZOK SARA , SCHMIDT TIM , HARRIS KRISTINA , MARQUIS PATRICK
Published: June 2018

The impact of type 1 diabetes (T1D) on patient’s lives has been described in the literature, but little insight exists on the experience of newly diagnosed pediatric patients. This timeframe is unique for clinical reasons (honeymoon period) and psychosocial reasons (adapting to living with T1D). This project aimed to identify concepts core to describing the experience of pediatric patients in the first two years of T1D and organize them into a framework.

Based on literature and clinician input, a semi-structured interview guide was developed. Patients (n=29) ages 7-17 recruited by an agency and childrenwithdiabetes.com participated in face-to-face (age <10) or phone interviews. Interviews were recorded, transcribed, and inductively coded using ATLAS.ti software. Detailed concepts were categorized into overarching domains reflecting their conceptual underpinning to design the framework.

The sample mean age was 12 years, and was 48% male and 72% white. The interviews confirmed symptoms of hyper and hypoglycemia already described in the literature, but above all, they provided in-depth information as to how symptoms and impacts are experienced within the first two years of T1D diagnosis.

The proposed conceptual framework includes symptoms, impacts, and disease management. Symptoms include hyper and hypoglycemia. Impacts include peers, school, sports, emotions, diet, preoccupation with the disease, conflict with parents (adolescents only) and parental supervision (children only). Disease management focused on checking blood glucose, giving insulin, carrying supplies, the pain of treatment, and adapting to management of the disease over time.

This study highlights the impact of T1D within the first two years of diagnosis in pediatric patients. It provides a conceptual foundation for the measurement of the benefit of medical or psychosocial interventions and monitoring while patients and their caregivers assimilate to the implications of the disease on their day-to-day lives.

Disclosure

E. Senior: Employee; Self; UCB, Inc. R. Fong: Employee; Self; UCB, Inc.. A. Christian: None. J.T. Markowitz: None. S. Strzok: None. T. Schmidt: None. K. Harris: Employee; Self; UCB, Inc.. P. Marquis: None.
Diabetes Mellitus Type 1 in Patient with Medium-Chain Acyl-Coenzyme A Dehydrogenase Deficiency
Authors: MOLL GEORGE W.
Published: June 2018

Introduction: Medium-chain acyl-coenzyme A dehydrogenase deficiency (MCADD) is an inborn error of fatty acid oxidation requiring carbohydrate (CHO) to avoid disabling encephalopathy with non-ketotic hypoglycemia. We report diagnosis and management of T1DM in an MCADD patient.

Case Presentation: Our patient was born prior to MCADD newborn screening. She did well until 2 months of age when she slept 12 hours without feeding and BG 20 mg/dl in ER required IV glucose. By 1 1/2 y/o she had 3 similar events. Pediatric endocrine identified MCADD. She avoided severe hypoglycemia by attending to CHO intake especially during illness. At 8 y/o, she noted glucosuria without ketonuria. Her test results were normal with hemoglobin A1c (HgbA1c) 5.3%. She responded well to adjusted CHO diet until 13 y/o when she noted lethargy with persistent high BG. T1DM was diagnosed with her HgbA1c 6.7%. We hypothesized long-acting glargine insulin could assist BG control without hypoglycemia. She responded well to insulin to maintain HgbA1c less than 7.5% until 15 years of age when she expressed compliance problems to present.

Results: Her MCADD presented with non-ketotic hypoglycemia events, normal plasma carnitine but elevated MCADD specific octanoyl-acyl-carnitine levels. A known MCADD mutation was identified. At 13 y/o her BG 335 mg/dl, abnormal insulin release and positive pancreas islet directed antibodies were consistent with T1DM. After 1 year glargine therapy alone she required additional insulin to maintain excellent T1DM control.

Discussion: MCADD requires early detection to reduce risk for tragic mortality and morbidity. Our patient requires CHO favored diet but is not obese as sometimes reported with MCADD. Management of her T1DM with MCADD requires insulin monitored to avoid hypoglycemia. T1DM is rarely or not reported in patients with MCADD.

Conclusion: BG control in MCADD patients must focus on avoiding hypoglycemia but consider T1DM or other DM when an MCADD patient has persistent hyperglycemia.

Disclosure

G.W. Moll: None.
DNA Repair Enzyme Ogg1 Regulates Hepatic Insulin Resistance in High-Fat Diet-Fed Obese Mice
Authors: YUZEFOVYCH LARYSA , SCHULER MICHELE , NOH HYE LIM , SUK SUJIN , KIM JASON K. , RACHEK LYUDMILA
Published: June 2018

Mitochondrial DNA (mtDNA) damage has been implicated in the development of insulin resistance. The mtDNA is highly specialized and encodes for proteins essential for energy metabolism. Also, mtDNA damage heightens mitochondrial oxidative stress, which is very critical for insulin resistance. OGG1 (8-oxoguanine DNA glycosylase-1) is a DNA glycosylase mediating the first step in the base excision repair which removes 7,8-dihydro-8-oxoguanine (8-oxoG) and repairs oxidized nuclear and mitochondrial DNA. Previous studies showed that Ogg1 deficiency results in an increased susceptibility to high fat diet (HFD)-induced obesity, metabolic dysfunction and insulin resistance in mice, suggesting a crucial role of Ogg1 in glucose metabolism. In the current study, we performed a 2-hour hyperinsulinemic-euglycemic clamp to measure tissue-specific insulin sensitivity in wild type (WT) and Ogg1-/- (KO) mice after chronic feeding of low fat diet (LFD as controls) or HFD. On LFD, both WT and KO mice showed comparable body weight and insulin sensitivity. After 16 weeks of HFD, the KO mice were more obese than WT mice with significant increases in whole body fat mass. There was a strong trend of increased insulin resistance with lower glucose infusion rates and whole body glucose turnover and glycogen synthesis in HFD-fed KO mice compared to HFD-fed WT mice. Hepatic insulin action was significantly lower in the HFD-fed KO mice which was consistent with recent evidence showing Ogg1 regulation of hepatic gluconeogenesis in the fed state. This is the first evidence demonstrating that Ogg1 contributes to HFD-induced insulin resistance in liver. Our findings suggest that protecting mtDNA from damage might be crucial to prevent insulin resistance and further identify therapeutic strategies for stimulating OGG1 as potential treatment of insulin resistance.

Disclosure

L. Yuzefovych: None. M. Schuler: None. H. Noh: None. S. Suk: None. J.K. Kim: None. L. Rachek: None.
Identifying Patients with GDM at Risk for GCK-MODY
Authors: DICKENS LAURA T. , LETOURNEAU LISA R. , SANYOURA MAY , PHILIPSON LOUIS H. , GREELEY SIRI ATMA W. , NAYLOR ROCHELLE N.
Published: June 2018

GCK-MODY is characterized by stable, mild hyperglycemia without typical long-term diabetes complications. The prevalence of GCK-MODY is 0.1% in the general population. However patients are frequently misclassified as type 1, type 2, or gestational diabetes. Since all pregnant women undergo glycemic assessment, there is an opportunity to identify women with GCK-MODY within the Obstetrics (OB) clinic.

The purpose of this study is to use retrospective data from the electronic medical record (EMR) to identify a combination of anthropometric and glycemic data that can differentiate women with GCK-MODY from those with gestational diabetes in a multiethnic United States population. A screening cohort of 927 study patients was identified through the University of Chicago Clinical Research Data Warehouse (CRDW) using the parameters of age >=18, outpatient visit to the OB clinic from 2009 to present and ICD-9 or ICD-10 diagnosis code of pregnancy and diabetes.

A total of 1patients were identified who fulfilled criteria of BMI < 30 kg/m2 and fasting glucose 99-145 mg/dL or HbA1c 5.6-7.6%. Twelve patients were excluded due to confirmed type 1 diabetes (n= 11) and secondary CF-related diabetes (n= 1). The final cohort are predominantly African-American (66%), followed by Asian/Mideast Indian (13%) and white (11%). Diagnoses based on ICD9/10 codes included gestational diabetes (52%), type 2 diabetes (41%), unconfirmed type 1 diabetes (4%), and secondary diabetes (2%). The average BMI using lowest recorded BMI was 25.6 (range 16-29.96 kg/m2). Average hemoglobin A1c was 6.0% and fasting glucose was 100.6 mg/dL. These patients will be contacted for study enrollment and genetic testing to determine the pickup rate of GCK-MODY using the proposed screening cutoffs in this multiethnic population.

The initial data indicate that the EMR can be used to identify patients at higher risk for GCK-MODY to undergo genetic testing. Several challenges were encountered including duplicate ICD codes but these did not preclude successful cohort identification.

Disclosure

L.T. Dickens: None. L.R. Letourneau: Other Relationship; Self; Novo Nordisk Inc.. M. Sanyoura: None. L.H. Philipson: Research Support; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Merck & Co., Inc.. Research Support; Self; JAEB Center For Health Research, JDRF, Janssen Pharmaceuticals, Inc., Medtronic MiniMed, Inc. S.W. Greeley: Research Support; Self; Novo Nordisk Inc.. R.N. Naylor: None.
Current Impact of Diabetes on In-Hospital Survival and Complication Outcomes in Acute Coronary Syndrome (ACS)
Authors: DAURIZ MARCO , DREZZA LUCIA , SANTI LORENZA , ALTOMARI ANNA , RINALDI ELISABETTA , TARDIVO STEFANO , BOVO CHIARA , RIBICHINI FLAVIO , BONORA ENZO
Published: June 2018

Prevalence of diabetes is increasing worldwide and outcomes after ACS are thought to improve. We assessed the prevalence of DM, previously known (known-DM) or newly-diagnosed (new-DM), in all patients (n=1,017, males 66.6%) admitted for ACS at the Intensive Coronary Care Unit of the Verona University Hospital from 1/1/2015 to 12/31/2016. DM was ascertained according to previous diagnosis, glucose-lowering therapy at admission/discharge or random plasma glucose ≥11.1 mmol/L. The association of DM with in-hospital death, infectious/cardiorespiratory complications, duration and costs of hospitalization was tested in all patients and separately in known-DM and new-DM. The prevalence of DM was 27.2% (74.1% known-DM; 25.9% new-DM). In-hospital death rate was 4.72%. Compared to nondiabetic patients, those with DM showed an increased risk of death (7.6 vs. 3.6%; OR 2.17 95% CI, 1.20-3.90) and complications (34.4 vs. 23.9%; OR 1.67, 1.23-2.28), a longer hospital stay (median[IQR], 11 [7-17] vs. 8 [6-13] days), higher hospitalization costs (mean±SD, € 10,033±7,626 vs. 8,513±6,363) and more need of rehabilitation at discharge (10.8 vs. 5.9%); P<0.for all comparisons. After multivariable adjustment (age, sex, BMI, e-GFR, LVEF, previous MI, lipid-lowering and anti-hypertensive drugs), DM remained an independent predictor of in-hospital death (OR 5.81, 1.31-25.7) but not complications (OR 1.14, 0.78-1.69). All study outcomes resulted significantly worse in new-DM vs. known-DM. In the former, ORs for in-hospital death and complications vs. nondiabetic controls were 2.40 (0.96-6.02) and 1.71 (0.99-2.96), respectively, while in known-DM figures were 2.09 (1.09-3.99) and 1.66 (1.18-2.33), respectively. These data highlight the extremely high frequency of DM in ACS and underscore the urgent need of strategies to anticipate DM diagnosis in patients at high cardiovascular risk.

Disclosure

M. Dauriz: None. L. Drezza: None. L. Santi: None. A. Altomari: None. E. Rinaldi: None. S. Tardivo: None. C. Bovo: None. F. Ribichini: None. E. Bonora: None.
Cardiovascular Risk Factors among Acute Myocardial Infarction Patients with and without Comorbid Diabetes Mellitus—Findings from the Yoga-CaRe Trial
Authors: SONI DIVYA , AMBALAM CHANDRASEKARAN M. , AJAY VAMADEVAN S. , SINGH KALPANA , SINGH KAVITA , PRAVEEN PRADEEP A. , ROY AMBUJ , MANCHANDA SUBHASH C. , MOHAN BISHAV , NEGI PRAKASH C. , BHAT PRABHAVATHI , SADANANDA K S. , R. PRASAD M. , RAGHAVA SARMA P.V. , NATARAJAN S , NARASIMHAN CALAMBUR , DESAI NAGARAJ , PATIL SHANKAR , CHADHA DAVINDER S. , CHANDRA SHARAD , KINRA SANJAY , PRABHAKARAN DORAIRAJ
Published: June 2018

Diabetes mellitus (DM) is a known independent predictor of mortality following acute myocardial infarction (AMI). In addition, patients with DM may have other risk factors for AMI such as hypertension (HTN), tobacco use, physical inactivity. This study aimed to explore the distribution of cardiovascular (CV) risk factors among patients of AMI with and without DM. Yoga-CaRe, a multicenter randomized controlled trial, included patients of AMI (first or consequent AMI) with DM (n=856) and without DM (n=2330), aged 18-80 years from 24 cardiac centers across India. The baseline socio-demographics, clinical and behavioral characteristics of those with and without DM were analyzed using multivariable logistic/linear regression models, sequentially adjusted for age, gender, education and physical inactivity. Patients of AMI with DM were older as compared to those without DM (mean age 56.4± 9.4 vs. 51.9 ± 11.2). Patients with DM had higher odds of having hypertension, being physically inactive and had lower odds of self-reported ever tobacco use. Patients with DM had higher mean waist circumference, systolic and diastolic blood pressure (Table). No differences were found in body mass index between diabetes and nondiabetes groups.The observed differential distribution of CV risk factors in AMI patients with DM calls for a tailored rehabilitation plan.

Cardiovascular risk factors among AMI patients with diabetes vs. without diabetesVariableDiabetes (n=856)Without diabetes (n=2330)Adjusted OR/Regression coefficient* [95% CI]Ever tobacco use (%)34.2%49.2%0.73 [0.60-0.88]Physical inactivity (%)57.8%49.2%1.38 [1.18-1.62]Body Mass Index ≥25Kg/m2 (%)57.6%50.8%1.13 [0.95-1.34]Waist circumference (cm) (mean)99.3±20.792.3±17.94.7 [3.1-6.3]*Systolic blood pressure (mmHg) (mean)123.4±17.2118.8±16.13.6 [2.3-4.9]*Diastolic blood pressure (mmHg) (mean)76.7±10.774.9±10.31.9 [1.02-2.7] *Hypertension (%)53.1%18.6%3.8 [2.9-5.1]

Disclosure

D. Soni: None. C.M. Ambalam: None. V.S. Ajay: None. K. Singh: None. K. Singh: None. P.A. Praveen: None. A. Roy: None. S.C. Manchanda: None. B. Mohan: None. P.C. Negi: None. P. Bhat: None. K.S. Sadananda: None. P.M. R.: None. P. Sarma: None. S. Natarajan: None. C. Narasimhan: None. N. Desai: None. S. Patil: None. D.S. Chadha: None. S. Chandra: None. S. Kinra: None. D. Prabhakaran: None.
Saccharomyces Boulardii Attenuates Autonomic Cardiovascular Dysfunction and Modulates Inflammatory Cytokines in Diabetic Mice
Authors: BRANDÃO ANA B.P. , DE ABREU ISABEL C. , AIMBIRE FLAVIO , HIGA ELISA M. , CASALI ADENAUER , FERREIRA FABIANA G. , ALBUQUERQUE RAQUEL CRISTINA M. , SANTOS LETICIA B. , IRIGOYEN MARIA CLAUDIA C. , CASALI KARINA R. , CUNHA TATIANA S.
Published: June 2018

The effects of probiotics on blood glucose and cardiovascular complications induced by diabetes have been inconsistent. Therefore, the aim was to assess the effect of Saccharomyces boulardii (Sb) on metabolic and cardiovascular dysfunction in streptozotocin (STZ)-induced type-1-diabetes (STZ-T1D). Male C57BL/6 mice were randomized into: control (C), diabetes (D), control+Sb (CSb) and diabetes+Sb (DSb) (n=6-12/group). Mice were made diabetic with STZ (150mg/kg) and daily treated with Sb (0,5x108 CFU) by oral gavage. After 8 weeks of treatment, blood pressure (BP) and heart rate (HR) signals obtained from conscious mice were recorded. Spectral analysis of systolic BP (BPV) and HR variabilities (HRV) was performed to estimate autonomic modulation to the heart and vessels. Plasma was collected and heart was excised for biochemical analyses. D mice presented metabolic dysfunction, with increased blood glucose, triglycerides and cholesterol, as compared with C animals. On the other hand, treatment with Sb reduced blood glucose (DSb=238±39 vs. D=378±17 mg/dl) and triglycerides (DSb=121±11 vs. D=169±10 mg/dl), with no effect on cholesterol levels (DSb=119±4 vs. D=106±9 mg/dl). Probiotic treatment also reduced cardiac IL-6 (DSb=80±8 vs. D=113±13 pg/mg) and increased IL-10 (DSb=251±16 vs. D=185±11 pg/mg), leading to a beneficial impact on heart nitric oxide levels (DSb=12.4±1.3 vs. D=7.6±0.9 pg/mg). D mice presented a significant reduction in HRV, BPV and also in low-frequency component of systolic BP (SBP). Treatment of D mice with Sb increased HRV (DSb=20±0.9 vs. D=10±0.9 ms²), BPV (DSb=8±0.4 vs. D=5±0.3 mmHg²) and low-frequency component of SBP (DSb=98±8 vs. D=55±8 mmHg²). Our study shows, for the first time, that administration of Sb is strongly associated with glycemic control, cardiovascular protection and improvement of inflammatory profile in STZ-T1D.

Disclosure

A.B.P. Brandão: None. I.C. de Abreu: None. F. Aimbire: None. E.M. Higa: None. A. Casali: None. F.G. Ferreira: None. R.M. Albuquerque: None. L.B. Santos: None. M.C. Irigoyen: None. K.R. Casali: None. T.S. Cunha: None.
Association between Serum Amylase Level and Incidence of Type 2 Diabetes
Authors: ISHII DAI , FUJIHARA KAZUYA , HARADA MAYUKO , ISHIZAWA MASAHIRO , KODAMA SATORU , SAITO KAZUMI , MORI YASUMICHI , YAMAMOTO-HONDA RITSUKO , ARASE YASUSHI , SONE HIROHITO
Published: June 2018

Although chronic pancreatitis is a known predictor of type 2 diabetes mellitus (T2DM), no previous studies have determined whether serum amylase (AMY) could be a predictor of T2DM with consideration of fasting plasma glucose (FPG) and HbA1c. We analyzed a historical cohort of 2,238 individuals without T2DM who underwent health examinations on an annual basis with a mean follow-up period of 9.6 y. AMY was categorized into quartiles and a multivariate Cox model was used to estimate the hazard ratio for incident T2DM. During a 10-y follow-up, 228 individuals developed T2DM. Median and interquartile range of baseline AMY(IU/L) was 74(62-91). Baseline AMY was significantly lower for participants who developed T2D compared to those who did not (71(59-84) vs. 75(62-92), p <0.001). When participants were stratified by age group (≤ 40 y, 41-50 y, 51-60 y, ≥ 61 y), AMY significantly increased with age among those who did not develop T2DM (p for trend <0.001), whereas there was no such significant trend among those who developed T2DM (p for trend = 0.18). After multivariate adjustment, lower AMY was associated with increased risk of T2DM independently of HbA1c (Q4, ref.; Q3, 1.21(0.78-1.90); Q2, 1.91(1.23-2.97); Q1, 1.61(1.01-2.56), p for trend = 0.01), but the association was not significant when adjusted for FPG (Q4, ref.; Q3, 1.10(0.66-1.61); Q2, 1.42(0.92-2.21); Q1, 1.23(0.78-1.93), p for trend = 0.21). The significantly increased risk for T2DM according to lower AMY quartiles even after multivariate adjustment including HbA1c (Q4, ref; Q3, 1.71(0.65-4.54); Q2, 3.30(1.17-9.23); Q1, 5.21(1.91-14.20), p for trend <0.001) was only found among those age ≥60 y.These results implied that low AMY is an independent predictor of T2DM especially among older people. Reasons for differences in effects of adjustment for HbA1c and FPG are unknown but are speculated to be associated with basal rather than postprandial glucose/insulin levels.

Disclosure

D. Ishii: None. K. Fujihara: None. M. Harada: None. M. Ishizawa: None. S. Kodama: None. K. Saito: None. Y. Mori: None. R. Yamamoto-Honda: None. Y. Arase: None. H. Sone: Research Support; Self; Novo Nordisk Inc., Eli Lilly and Company, MSD K.K., Chugai Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Development Center Asia, Pte. Ltd., Daiichi Sankyo Company, Limited, Ono Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Sanofi, Kowa Pharmaceuticals America, Inc., Eisai Inc..
Clinical Characteristics of GADA-Positive Patients with Diabetes and the Role of GAD Antibody Assay to Reclassify the Diagnosis in a Limited Resource Setting
Authors: GOSWAMI PARIKSHIT J. , SABOO BANSHI D. , PATEL KAUSHAL K. , PATEL BHAVESH N. , WADHWA NAVNEET
Published: June 2018

Patients with diagnosis of T2DM may also have islet antibodies typically associated with T1DM, as Latent Autoimmune Diabetes of the Adult (LADA). More than 90% of LADA patients in have antibodies against Glutamic Acid Decarboxylase (GADA). Prevalence of LADA is between 4% and 12% of all adults with a clinical T2D phenotype. T1DM in a limited resource setting is generally diagnosed based mainly on clinical features which may lead to misclassified diagnosis. We utilised GAD antibody assay to reassess the challenging referred cases in our speciality centre by biochemical evaluation. We explore the clinical characteristics one-year post diagnosis of T1DM to reclassify the diagnosis in 20 patients (males = 15, females = 5). The complications reported at the time of diagnosis were, peripheral neuropathy (n=3), hypoglycaemia (n=2), peripheral vascular disease (n=1) and amputation of both toes (n=1). Five patients reported positive family history. Mean age (years) 33 ± 8.4, 95% CI 29 - 37, min 18, max 55. Mean levels of HbA1c (%) was 11 ± 3.1, 95% CI 9.6 - 13, min 7.4, max 17. Mean levels of GAD antibody (IU /ml) was 50 ± 84, 95% CI 11 - 90, min 3.6, max 255. Patients were categorised into subgroups by GADA status, GADA low: ≤ 200 IU ml (n=, GADA high: > 200 IU/ml. Three patients reported high GADA levels of which two were males and one female and two reported complications as amputation and hypoglycaemia. Following reclassification, nine patients were re-diagnosed as T2DM with the management plan shifted from primarily insulin based regimen to oral antidiabetics approach. Two patients each were re-diagnosed as Maturity Onset Diabetes of the Young (MODY) and early onset T2DM. Our study highlights the importance of GAD antibody assay for an early precise diagnosis in a limited resource setting.

Disclosure

P.J. Goswami: None. B.D. Saboo: None. K.K. Patel: None. B.N. Patel: None. N. Wadhwa: None.
The TenYear, Real-World Population-Based Study in Diabetes Nephropathy with Microproteinuria in Type 2 Diabetes Mellitus—Based on the Diabetes Case Management Program 2001, Taiwan
Authors: FUH MARTIN M.T. , CHEN PEI CHIN
Published: June 2018

Background and Aims: In order to evaluate the nephropathy with microproteinuria in T2DM in usual clinical care and ensuing development of personalized medicine.

Materials and Methods: From Jan. 20to Dec. 2015, 14711 diabetes beneficiaries were randomly and cumulatively recruited in DCMP 2001 via outpatient clinic visit. Accordingly, the bi-annual urine and albumin creatinine ratio (ACR) examinations were routinely performed in patients enrolled. Nephropathy with microproteinuria was defined that the ACR was ≧30. From this studied cohort, there were 222 cases without taking any antidiabetes medication except lifestyle intervention as Group I whereas, 14489 cases with diabetes drugs including insulin used classified as Group II and III. Matching with age, sex, duration of diabetes and A1c levels and with 1: 4 ratio of case number, there were 60 cases with A1c (%) (Mean± SD) 6.72± 0.96 in Group I, 240 cases in Group II with A1c 7.01± 0.85 and Group III with A1c 8.19± 1.13 respectively in last 10 years. Data analysis was performed by using ANOVA and log-rank test for the occurrence of diabetes nephropathy with microproteinuria.

Results: The baseline data among these 3 well-matched Groups were shown. There were no statistically significant difference of all metabolic measures among 3 Groups except FBG, A1c and serum TG that were significantly higher in Group III. The accumulating probability of diabetes nephropathy with microproteinuria amid these 3 Groups were totally identical and no statistically significant difference identified in 10-year time interval.

Conclusions: The results clearly indicated that the risk factors rather than antidiabetes medications of diabetes nephropathy, duration of disease and even long-term glycemic control would be considered in this T2DM population cohort.

Disclosure

M.M.T. Fuh: None. P. Chen: None.
Diabetes and Severe Malaria—Clinical Profile and Outcome
Authors: THATOI PRAVAT K.
Published: June 2018

Introduction: Diabetes mellitus is a global burden and India having second largest diabetics in the world. Malaria is a common vector borne disease in developing countries and so also in India. Diabetes mellitus may aggravate malaria infection like other infections.

Aim: To study the clinical profile and outcome of severe malaria in diabetes mellitus.

Methods: This was a descriptive analytical study where 200 adult patients of severe malaria according to WHO criteria admitted to our hospital (SCB Medical College and Hospital, Odisha, India) were studied for clinical profiles, associated comorbid conditions and outcome for a period of two years. We analysed patients with comorbid conditions like diabetes mellitus, hypertension and hypothyroid vs. no comorbid conditions. Only smear positive severe malaria patients were included and detailed clinical examination and laboratory investigations were done in all patients. Patients with other associated conditions like pregnancy, chronic kidney disease and immunocompromised states were excluded. The observed data was statistically analyzed.

Result: Out of 200 severe malaria patients 99 were males and 101 were females with mean age of 46.51± SD 3.67 years. Patients with established diabetes mellitus were 54 (male-27, female-27), hypertension were 36 (male-21, female-15), hypothyroid state were 36 (male-10, female-26) and no comorbidities were 74 (male-41, female-33). The mixed malarial infection of both Plasmodium falciparum and Plasmodium vivax was found more in diabetics vs. nondiabetics i.e., 22 (40.74%) vs. 23 (15.75%). There was more multi-organ involvement, shorter coma onset time and longer duration of coma observed on diabetics than nondiabetics. Nineteen (35.18%) patients died amongst 54 diabetics than 20 (13.69%) patients died amongst 146 nondiabetics.

Conclusion: There was more death and severity of malaria observed in diabetics than nondiabetics and then other comorbid conditions.

Disclosure

P.K. Thatoi: None.
Falls and Fall-Related Injuries among Adults aged =65 Years with Diabetes, United States, 2016
Authors: CHO PYONE , HORA ISRAEL A.
Published: June 2018

Older adults are at increased risk of unintentional falls and fall-related injuries. Chronic diseases like diabetes are also common among older adults. Older diabetic adults are at increased risk for falls partly due to diabetes-related complications and medication side effects. We analyzed 2016 Behavioral Risk Factor Surveillance System survey data from 50 states, District of Columbia, and three U.S. territories to assess the risk of falling (percentage of older adults with self-reported falls and injurious falls) among 34,462 older adults aged ≥65 years with diabetes. We also examined the risk of falling by selected self-reported fall risk factors—sex, bodyweight, general health status, and comorbid conditions (history of stroke, visual impairment, arthritis, depression, difficulty walking or climbing stairs). Among older diabetic adults, 35.5% reported falling one or more times in the past 12 months; of those, 38.7% suffered injuries from falls. Compared to their counterparts without salient risk factors stated above, older diabetic adults with selected characteristics were significantly more likely to fall (all p values < 0.001) (Table). Of eight risk factors under study, those with poor health, depression, and difficulty walking or climbing stairs had highest risk of falling. Understanding the role of potential risk factors is crucial for fall prevention in older adults with diabetes.Self-reported falls among older adults aged ≥65 years with diabetes by 3 selected risk factorsRisk FactorRisk FactorSample SizeSample SizePercent Who FellPercent Who FellComparisonComparisonCategoryClassificationTotalHistory of FallEstimate95% CIPercent Difference95% CI for DifferenceSexWomen19,1697,40037.836.2-39.44.62.4-6.8Men15,2925,45133.231.6-34.8Health statusPoor4,4462,44253.850.6-56.921.217.9-24.6Fair or better29,88210,35932.631.4-33.8Difficulty walking or Climbing stairsYes13,9577,11649.147.2-51.022.920.5-25.2No20,2865,64426.224.9-27.6

Disclosure

P. Cho: None. I.A. Hora: None.
Age and Gender-Related Variations in Comorbidities among Diabetes Patients—A Community-Based Cross-Sectional Study
Authors: UDDIN FAREED , ZAHEER SIDRA , SHAFIQUE KASHIF
Published: June 2018

Background: Diabetes is a pandemic disease; co-existence of several chronic diseases with diabetes is an important challenge around the world. However, sociodemographic variations in diabetes with other comorbidities are poorly understood in our region. We sought to describe age and gender differences in prevalence and pattern of comorbidities among diabetes mellitus (DM) patients.

Methodology: A population based cross-sectional study was conducted among residents of Gulshan town, Karachi, Pakistan. Data of healthy individuals and those having diabetes with any chronic condition were recorded. All self-reported chronic conditions including DM were further assessed based on physical examinations, history of medicines use and on laboratory findings. For analysis, individuals were grouped into following categories (1) healthy individual (those who have No Disease) (2) DM patients (3) DM with one comorbidity (4) DM with two comorbidities (5) DM with three or more comorbidities.

Results: A total 2968 participants were recruited in this study. DM was present in 685 (23.1%) participants. The most commonly co-occurring chronic conditions with DM were Hypertension (14.8%), Obesity (7.9%) and Depression (6.5%). Women were 34% less likely to have diabetes with one-comorbidity (aOR 0.66, 95% CI 0.45-0.96) but more likely to have 3 or more comorbidities (aOR 2.32, 95% CI 1.61-3.33) than men. Older age was also significantly associated to DM with comorbidities, individuals who aged ≥60 years were significantly more likely to have DM with 3+ comorbidities (aOR 5.47, 95% CI 3.07-9.75) compared to younger age group of 30-39 years.

Conclusion: Risk factors like diabetes alone was considerably higher in 40-49 years old patients, diabetes +1 comorbidity in male gender and patients with moderate physical activity, diabetes +2 comorbidities in Pashtun ethnic while diabetes +3 comorbidities were found considerably higher among females gender.

Disclosure

F. Uddin: None. S. Zaheer: None. K. Shafique: None.