bluuebunny/crossref_metadata_2025 huggingface dataset:
678-P: Postprandial High-Intensity Interval Exercise Suppresses the Impaired Endothelial Function Induced by High Carbohydrate Ingestion
Authors: FUKUBA YOSHIYUKI , KASHIMA HIDEAKI , MIURA KOHEI , ENDO MASAKO Y.
Published: June 2020

High-carbohydrate meals acutely impair endothelial function, whereas exercise, particularly high-intensity intermittent exercise (HIIE), plays a beneficial role. Data about the interaction of exercise and dietary intake on endothelial function are scarce. We, therefore, evaluated flow-mediated dilation (FMD) of the brachial artery (BA) as a standard measure of endothelial function after glucose drink ingestion immediately before or after HIIE. Healthy young volunteers (n = 11) participated in three protocols in random order. At 30 min before (preprandial Ex) or 15 min after (postprandial Ex) 500 mL glucose (75 g) drink ingestion, participants performed HIIE (28-min leg cycling). In control protocol (Con), participants ingested the same drink without exercise. FMD and blood flow profiles [ante- and retrograde shear rates (SRs)] were evaluated by ultrasound before and 60 and 120 min after glucose ingestion. Blood glucose (BG) and plasma insulin (PI) concentrations were measured. At 60 min after ingestion, postprandial Ex showed significantly higher %FMD (see Figure) and antegrade SR and lower BG and PI compared with Con and preprandial Ex.

In conclusion, postprandial HIIE effectively suppresses subsequent endothelial dysfunction via postprandial hyperglycemia suppression and antegrade shear stress elevation in the BA.

Disclosure

Y. Fukuba: None. H. Kashima: None. K. Miura: None. M.Y. Endo: None.

Funding

Japan Society for the Promotion of Science (17K01616); Uehara Memorial Life Science Foundation
68-OR: Dramatic Drop in Ketoacidosis Rate after FreeStyle Libre System Initiation in Type 1 and Type 2 Diabetes in France, Especially in People with Low Self-Monitoring of Blood Glucose (SMBG): A Nationwide Study
Authors: ROUSSEL RONAN , GUERCI BRUNO , VICAUT ERIC , DEPOUVOURVILLE GERARD , DETOURNAY BRUNO , EMERY CORINNE , LEVRAT-GUILLEN FLEUR , RIVELINE JEAN-PIERRE
Published: June 2020

Diabetic ketoacidosis is a life-threatening condition and is generally preventable through close glucose monitoring. Initiation of the FreeStyle Libre™ system could prevent ketoacidosis. We conducted a retrospective study of the ketoacidosis rates (ICD-10 codes E10.1, E11.1) on the French exhaustive nationwide reimbursement claim database in FreeStyle Libre system initiators (reimbursed from 2017/06/01). Ketoacidosis rates were recorded in the year prior to first FreeStyle Libre sensor claim (index date for initiation), and in the year after. We identified 33,203 and 40,955 people with type 1 and type 2 diabetes, respectively, initiating the FreeStyle Libre system during the study period (2017/08/01 to 2017/12/31). Overall, yearly ketoacidosis rates were reduced after FreeStyle Libre system initiation by 52% for type 1 and 47% for type 2 diabetes. Results are also presented according to the mean daily number of SMBG strips reimbursed, estimated for the year prior to FreeStyle Libre system initiation (Figure). It is plausible that the use of the FreeStyle Libre system allowed people to detect and limit persistent hyperglycemia, and subsequently ketoacidosis. The reduction of rates was marked for both types of diabetes, especially for people with very low and very high adherence to SMBG.

Disclosure

R. Roussel: Advisory Panel; Self; Abbott, AstraZeneca, Diabnext, Eli Lilly and Company, Merck & Co., Inc., Mundipharma International, Novo Nordisk A/S, Sanofi-Aventis. B. Guerci: Board Member; Self; Abbott. E. Vicaut: Consultant; Self; Abbott, Boston Scientific, Celgene, Pfizer Inc. G. Depouvourville: Advisory Panel; Self; Abbott, AbbVie Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp. Consultant; Self; Abbott, AbbVie Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp. B. Detournay: Advisory Panel; Self; Merck Sharp & Dohme Corp., Novo Nordisk A/S. Consultant; Self; Lilly Diabetes, Merck Sharp & Dohme Corp., Pfizer Inc., Sanofi. Employee; Self; CEMKA. C. Emery: Employee; Self; CEMKA. F. Levrat-Guillen: Employee; Self; Abbott. J. Riveline: None.
682-P: Carbohydrate Needs for Prolonged Fasted Exercise with and without Basal Rate Reductions in CSII
Authors: MCGAUGH SARAH M. , POONI RUBIN , ZAHARIEVA DESSI , D’SOUZA NINOSCHKA C. , VIENNEAU TODD , LY TRANG T. , RIDDELL MICHAEL
Published: June 2020

The amount of oral carbohydrate (CHO) needed to prevent hypoglycemia during prolonged fasted exercise in CSII is unclear. We assessed CHO intake needs during 3 different basal rate strategies during prolonged fasted exercise in active patients with T1D.

Individuals with T1D on CSII (n=15) completed three 120-min treadmill exercise (∼45% of VO2peak) visits in a randomized crossover design. Strategies included: A) no basal rate reduction (BRR) and a dextrose intake of 0.3 g/kg/hr when BG was <10mmol/L (CHO only); B) a 50% BRR set 90 min pre-exercise, with dextrose as needed to treat hypoglycemia (50% BRR); and C) a 50% BRR set at exercise start plus dextrose intake of 0.3 g/kg/hr when BG was <10 mmol/L (Combo).

Glycemia was higher in C compared to A or B by 105 min of exercise (P < 0.05). The drop in blood glucose during exercise was greater in A (-2.7 ± 3.4 mmol/L) than in B (-1.9 ± 2.5 mmol/L) or C (0.3 ± 2.6 mmol/L). Total CHO intake was 38.0 ± 18.8 g, 0.8 ± 3.1 g, and 29.5 ± 16.2 g, for A, B and C, respectively. Compared to A, B had lower RER (0.83 ± 0.04 vs. 0.79 ± 0.04), higher ketones (0.1 ± 0.1 vs. 0.4 ± 0.3 mmol/L), greater net loss of calories (709.2 ± 217.4 vs. 859.7 ± 239.6 kcal) and greater fat oxidation rate (0.39 ± 0.1 vs. 0.51 ± 0.2 g/min) (all P < 0.05).

A BRR, set 90 min prior to exercise is associated with good glycemic control and an increased rate of lipid oxidation compared to CHO feeding alone or combined BRR and CHO feeding approach at exercise onset.

Disclosure

S.M. McGaugh: None. R. Pooni: None. D. Zaharieva: Speaker’s Bureau; Self; Ascensia Diabetes Care, Insulet Corporation, Medtronic. N.C. D’Souza: None. T. Vienneau: Employee; Self; Insulet Corporation. Stock/Shareholder; Self; Insulet Corporation. T.T. Ly: Employee; Self; Insulet Corporation. M. Riddell: Advisory Panel; Self; Zucara Therapeutics Inc. Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc., Insulet Corporation. Speaker’s Bureau; Self; Medtronic, Novo Nordisk A/S.

Funding

Insulet Corporation
686-P: Exercise Alone and in Combination with Liraglutide Exert Clinically Relevant Improvements in Cardiorespiratory Fitness during 1-Year Weight Loss Maintenance: The S-LITE Randomized Trial
Authors: JENSEN SIMON , JANUS CHARLOTTE , LUNDGREN JULIE R. , JUHL CHRISTIAN R. , BLOND MARTIN B. , STALLKNECHT BENTE , HOLST JENS J. , MADSBAD STEN , TOREKOV SIGNE S.
Published: June 2020

Introduction: Improved cardiorespiratory fitness (CRF) is associated with reduced mortality. Each metabolic equivalent (MET) increase in CRF is associated with 10-25 % improvements in survival. The aim was to explore changes in fitness during weight maintenance with the glucagon-like peptide-1 receptor agonist liraglutide and/or exercise.

Methods: Women and men with obesity (18-65 years, BMI 32-43 kg/m2) who achieved ≥ 5 % weight loss during an 8-week very low-calorie diet (VLCD) were randomized to (1) liraglutide 3 mg/day (LIRA), (2) exercise 150 min/week + placebo (EX), (3) exercise 150 min/week + liraglutide 3 mg/day (LIRA+EX), or (4) placebo (PLA) for one year. CRF was measured as peak oxygen consumption using indirect calorimetry during an incremental bicycle test. Physical functioning was evaluated as time to ascend/descend an 11-step stairway twice.

Results: A total of 215 participants were included. Changes in fitness after VLCD and 1-year weight maintenance program are presented in Table 1.

Conclusion: Exercise alone and in combination with liraglutide exert clinically relevant improvements in cardiorespiratory fitness and improve physical functioning. Thus, adding liraglutide does not interfere with the ability to improve fitness with exercise, supporting the combined use in weight maintenance.

Disclosure

S. Jensen: None. C. Janus: Research Support; Spouse/Partner; Mercodia, Novo Nordisk A/S. Research Support; Self; Novo Nordisk Foundation. Research Support; Spouse/Partner; Novo Nordisk Foundation. Speaker’s Bureau; Spouse/Partner; Merck Sharp < Dohme Corp. J.R. Lundgren: None. C.R. Juhl: None. M.B. Blond: None. B. Stallknecht: None. J.J. Holst: Advisory Panel; Self; AstraZeneca, Merck Sharp < Dohme Corp., Novo Nordisk A/S, Zealand Pharma A/S. Other Relationship; Spouse/Partner; Antag Therapeutics. S. Madsbad: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp < Dohme Corp., Novo Nordisk A/S, Sanofi-Aventis. Research Support; Self; Boehringer Ingelheim International GmbH, Novo Nordisk A/S. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S. S.S. Torekov: Research Support; Self; Novo Nordisk Inc.

Funding

Novo Nordisk Foundation (NNF16OC0019968, NNF15SA0018486); University of Copenhagen; Helsefonden; Danish Diabetes Academy
69-LB: A Wearable Microneedle Array Sensor Shows High Correlation between Dermal Glucose and Venous Blood Glucose
Authors: SAMANT PRADNYA P. , CHRISTIANSEN MARK P. , SATTAYASAMITSATHIT SIRILAK , CAMPBELL ALAN , PEYSER THOMAS A. , WINDMILLER JOSHUA R. , TANGNEY JARED R. , LAL RAYHAN , BHAVARAJU NARESH C.
Published: June 2020

Objective: Current continuous glucose monitors (CGM) measure glucose in the subcutaneous interstitial fluid (ISF). Previous ex vivo research with hypodermic needles has shown that glucose in the dermal ISF is highly correlated to venous glucose with little or no lag time. However, this methodology is not viable for continuous measurement. In this study, we have developed and tested a wearable microneedle array sensor for continuous in situ measurement of glucose in the dermal ISF. A dermal CGM could be applied without an introducer needle and without pain during application.

Methods: In this study the microneedle array sensor was tested against venous glucose measured every 15 minutes from a YSI analyzer in 8-hour sessions over 2 days (Phase One) and 5-7 days (Phase Two).

Results: Five participants without diabetes and 10 participants with diabetes were recruited for phase One and 10 participants with diabetes were recruited for phase Two. A high degree of linear correlation (R2 ≥ 0 .90) between the microneedle array measured dermal ISF glucose and venous glucose was observed. The figure shows the linear correlation (A) and temporal profile (B) for one microneedle array sensor over 8 hours.

Conclusions: A wearable microneedle array measuring dermal ISF glucose can accurately track glucose values. The study demonstrated early human feasibility of a CGM based on microneedle sensing of dermal ISF.

Disclosure

P.P. Samant: Employee; Self; Biolinq. M.P. Christiansen: Research Support; Self; Abbott, Ascensia Diabetes Care, Biolinq, Dexcom, Inc., Eli Lilly and Company, Lexicon Pharmaceuticals, Inc., Medtronic, Merck & Co., Inc., Novo Nordisk A/S, Sanofi-Aventis, Senseonics, ViroMed Laboratories, Xeris Pharmaceuticals, Inc. S. Sattayasamitsathit: None. A. Campbell: None. T.A. Peyser: Consultant; Self; Insulet Corporation. Employee; Self; Biolinq. J.R. Windmiller: Employee; Self; Biolinq. J.R. Tangney: Board Member; Self; Biolinq. R. Lal: Consultant; Self; Abbott, Biolinq. N.C. Bhavaraju: Employee; Self; Biolinq.
69-OR: Freestyle Libre System Use Is Associated with Reduction in Inpatient and Outpatient Emergency Acute Diabetes Events and All-Cause Hospitalizations in Patients with Type 2 Diabetes
Authors: BERGENSTAL RICHARD M. , KERR MATTHEW S.D. , ROBERTS GREGORY J. , SOUTO DIANA , NABUTOVSKY YELENA , HIRSCH IRL B.
Published: June 2020

Continuous glucose monitors (CGMs) improve glycemic control compared with self-monitoring of blood glucose. We aim to describe clinical outcomes in people with type 2 diabetes (T2D) who received FreeStyle Libre® system.

IBM MarketScan™ Commercial Claims and Medicare Supplemental databases were used in this retrospective, observational analysis. MarketScan contains insurance billing claims for inpatient, outpatient, and pharmacy expenses. Cohort requirements included: de novo FreeStyle Libre system purchase in 2017 Q4-2018 Q2, diagnosis of T2D, ≥18 years old, fast- or short-acting insulin, and ≥6-months pre-CGM observation time. Primary outcome was acute diabetes events (ADE): hospitalization with hyper-/hypoglycemia as the primary diagnosis or outpatient emergency associated with a code of hyper-/hypoglycemia. Secondary outcome was all-cause hospitalizations. Andersen-Gill Cox regression compared event rates 6-months pre-/post-CGM.

The cohort (n=1,244, age 53.6±9.7 years, 53.8% male) experienced a reduction in ADE from 0.158 to 0.077 events/patient-year (HR: 0.49 [0.34 0.69]; P:<0.001). Hospitalizations also reduced from 0.345 to 0.247 events/patient-year (HR: 0.72 [0.58 0.88]; P:0.002).

After FreeStyle Libre system purchase, T2D patients had lower rates of ADE and all-cause hospitalizations.

Disclosure

R.M. Bergenstal: Consultant; Self; Ascensia Diabetes Care, Johnson & Johnson. Other Relationship; Self; Abbott, Dexcom, Inc., Hygieia, Lilly Diabetes, Medtronic, Novo Nordisk A/S, Onduo, Roche Diabetes Care, Sanofi, UnitedHealth Group. M.S.D. Kerr: Employee; Self; Abbott. G.J. Roberts: Employee; Self; Abbott. D. Souto: Employee; Self; Abbott. Y. Nabutovsky: Employee; Self; Abbott. I.B. Hirsch: Consultant; Self; Abbott, Bigfoot Biomedical, Roche Diabetes Care. Research Support; Self; Medtronic, Omnipod.
690-P: Use of Physiological and Psychological States to Enhance Glucose Concentration Estimation
Authors: SEVIL MERT , HOBBS NICOLE , RASHID MUDASSIR , HAJIZADEH IMAN , ASKARI MOHAMMAD REZA , PARK MINSUN , QUINN LAURIE T. , CINAR ALI
Published: June 2020

The accuracy of blood glucose concentration (BGC) estimation affects insulin dosing decisions. Wristband biosignals (Empatica E4) are used to estimate physical activity type and intensity, and psychological stress to enhance BGC prediction accuracy. Three cases are compared: (1) BGC prediction by using only continuous glucose monitor (CGM) data, which considers only meal effects and plasma insulin concentration (PIC); (2) Incorporating physical activity information to complement CGM data; and (3) Incorporating both physical activity and psychological stress information to complement CGM data. Twenty-eight experiments with seven subjects with T1D are conducted including various physical activities and acute psychological stress inducements. The subjects wore a CGM, insulin pump and E4 wristband during the experiments. Physical activities included treadmill running, stationary bicycling, resistance exercises and activities of daily living. Acute psychological stress inducements included the Trier Social Stress test, playing competitive videogames, solving arithmetic problems, and daily stressful events. The overall mean absolute errors (%) were 10.42, 8.69. and 8.42 for Cases 1, 2, and 3, respectively. The results illustrate that incorporating estimates of psychological and psychological effects improve the BGC prediction accuracy by 17.18% (Freidman’s ANOVA test, p-value < 0.01).

Disclosure

M. Sevil: None. N. Hobbs: None. M. Rashid: None. I. Hajizadeh: None. M. Askari: None. M. Park: None. L.T. Quinn: 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.

Funding

National Institutes of Health (1DP3DK101075-01, 1DP3DK101077-01); JDRF (A18-0036-001)
692-P: Hyperglycemia Impairs Aerobic Adaptation to Exercise
Authors: MACDONALD TARA , PATHAK PRERANA , FERNANDEZ NATALIE M. , FREITAS ELLEN C. , HAFIDA SAMAR , MITRI JOANNA , LESSARD SARAH J.
Published: June 2020

Improved aerobic exercise capacity (VO2max) has emerged as one of the most important health benefits of aerobic exercise training. However, hyperglycemia is associated with low VO2max in humans, even when physical activity levels are matched. To determine how glycemia influences aerobic adaptations with exercise training, we induced moderate hyperglycemia (+50-70 mg/dL vs. control) in mouse models that mimic the pathologies of type 1 or type 2 diabetes: 1) Low-dose Streptozotocin treatment (STZ), or 2) Western diet (WD) feeding. Normoglycemic mice acted as controls (CON). All mice completed ∼500 km of voluntary wheel running over an 8-wk aerobic training period, and achieved the expected metabolic benefits from exercise training. However, metabolic improvements were uncoupled from aerobic adaptation in hyperglycemic WD and STZ mice, who failed to improve VO2max beyond the level of sedentary controls. In contrast, CON mice had a 2-fold increase in VO2max in response to the same training intervention. In hyperglycemic models, blunted improvements in VO2max were associated with structural changes to muscle, including glucose-induced modifications to the extracellular matrix (e.g., glycation and collagen accretion), and reduced exercise-induced angiogenesis and oxidative fiber-type shifts. Thus, our data provide evidence that aerobic muscle remodeling, which is critical for augmenting VO2max, is impaired by hyperglycemia. In addition, we show that chronic hyperglycemia causes hyper-activation of a JNK/SMAD2 signaling network in muscle with acute aerobic exercise, which is a known molecular mechanism that inhibits aerobic adaptation. Accordingly, in human subjects, we show that impaired glucose tolerance strongly predicts hyper-activation of this inhibitory signaling network in conjunction with low VO2max. Taken together, we demonstrate that hyperglycemia, regardless of etiology, may interfere with fundamental adaptations to aerobic exercise training and negatively regulate improvements in VO2max.

Disclosure

T. MacDonald: None. P. Pathak: None. N.M. Fernandez: None. E.C. Freitas: None. S. Hafida: None. J. Mitri: Consultant; Spouse/Partner; Janssen Pharmaceuticals, Inc., kymera. Consultant; Self; national dairy council/local dairy council. Research Support; Spouse/Partner; AbbVie Inc., beigene, Janssen Pharmaceuticals, Inc. Research Support; Self; Kowa Pharmaceuticals America, Inc., national dairy council. Research Support; Spouse/Partner; pharma cyclic, TG therapeutics. S.J. Lessard: None.

Funding

American Heart Association (19POST34381036)
701-P: Effects of Exercise on Extracellular Matrix Modifiers in Subcutaneous Adipose Tissue of Obese Adults
Authors: VARSHNEY PALLAVI , RYAN BENJAMIN J. , AHN CHIWOON , SCHLEH MICHAEL W. , HOROWITZ JEFFREY F.
Published: June 2020

Mechanisms underlying the direct effects of exercise on metabolic health (independently of weight loss) are poorly understood, and very little is known about the effects of exercise on adipose tissue. The purpose of this study was to examine the effects of exercise training on the key extracellular matrix (ECM) modifiers, matrix metalloproteinase 2 (MMP2) and MMP9, in abdominal subcutaneous adipose tissue (aSAT) of obese adults. Seven obese adults (BMI=33±4 kg/m2; age=32±6) completed 12 weeks of exercise training (either 45min of steady-state exercise at 70% HRmax or 10x1min intervals at 90% HRmax with 1min recovery between intervals), and they were required to maintain body weight throughout. aSAT biopsies were collected before training (Pre) and twice after training - 1 day post exercise (1d PEX) and again 4 days post exercise (4d PEX; to wash out the acute effects of exercise). Using standard immunoblotting methods, we found no evidence for effects of training on either MMP2 or MMP9. However, using gelatin zymography (a technique with more than 100-fold higher sensitivity than immunoblotting) we found a strong trend for an increased MMP9 abundance 1d PEX (3.7±1.0 vs. 3.0±1.4 arbitrary units (AU), for 1d PEX vs. Pre; P=0.08). Interestingly, however, MMP9 returned to Pre training levels by 4d PEX (1.9±1.3 AU; P<0.05 vs. 1d PEX). Gelatin zymography can also allow for quantification of the active-form of MMPs, and we found trends for exercise training to increase MMP2 in both its active- (P=0.08 and P=0.22 for 1d PEX and 4d PEX vs. Pre, respectively) and inactive-form (P=0.13 and P=0.12 for 1d PEX and 4d PEX vs. Pre, respectively). We were unable to detect the active form of MMP9.

In summary, because increased abundance and activity of MMPs may alter the fibrotic content and composition of the ECM, exercise-induced increases in MMP2 and MMP9 within aSAT may contribute to favorable modifications within adipose tissue ECM of obese adults.

Disclosure

P. Varshney: None. B.J. Ryan: None. C. Ahn: None. M.W. Schleh: None. J.F. Horowitz: None.

Funding

National Institutes of Health (R01DK077966, P30DK089503, F32DK117522, UL1TR002240)
71-OR: Oligofructose Improves Small Intestinal Nutrient-Sensing Mechanisms via the Small Intestinal Microbiota
Authors: WENINGER SAVANNA N. , BEAUCHEMIN EVE , LANE ADELINA I.L. , MEYER RACHEL , DUCA FRANK
Published: June 2020

Manipulations to the microbiota may serve as a potential treatment for obesity. Oligofructose (OFS), a nondigestible carbohydrate, beneficially alters the distal gut microbiome and results in decreased food intake and bodyweight, although the exact mechanisms remain unknown. Despite the importance of small intestinal (SI) gut-brain nutrient feedback mechanisms in regulating food intake and energy homeostasis, no studies have directly examined whether OFS can improve SI gut-brain signaling, potentially via changes in the SI microbiota. Given recent evidence highlighting the importance of SI microbiota on regulating metabolic homeostasis, we tested the hypothesis that OFS specifically improves SI lipid-sensing mechanisms controlling food intake, via manipulation of SI microbiota. Before any significant changes in body weight are observed, acute (3d) treatment with OFS in high fat (HF)-fed rats results in a significant suppression of 2hr food intake following an intralipid or liquid meal SI infusion (6kcal) compared to HF alone, likely due to a restored gut to brain signal. OFS treatment also increased jejunal CD36 gene and protein expression, which is known to mediate lipid-induced release of GLP-1. As such, OFS-treated rats exhibited significantly increased portal GLP-1 levels and c-fos, a marker neuronal activation, in the NTS of the hindbrain following intralipid SI infusion, compared to HF-fed rats. Importantly, transplant of SI microbiota from 3d OFS HF-fed donors into HF-fed rats recapitulated these results, demonstrating the importance of OFS-induced SI microbiota changes in restoring nutrient-induced gut brain signaling. These results highlight the importance of the small intestinal microbiota in energy regulation and identify a potential role of the small intestine and small intestinal nutrient sensing in the beneficial effects of OFS.

Disclosure

S.N. Weninger: None. E. Beauchemin: None. A.I.L. Lane: None. R. Meyer: None. F. Duca: None.

Funding

Arizona Biomedical Research Commission (NIA17-7401)
712-P: Safety and Efficacy of 36 Hours Prolonged Fasting on Glucose Metabolism in People with Type 1 Diabetes: A Crossover Trial
Authors: MOSER OTHMAR , TRIPOLT NORBERT J. , PFERSCHY PETER N. , OBERMAYER ANNA , KOJZAR HARALD , MADER JULIA K. , BRUNNER MARTINA , MUELLER ALEXANDER , YILDIRIM HAKAN , SOURIJ CAREN , ECKSTEIN MAX L. , SOURIJ HARALD
Published: June 2020

Evidence is accumulating that prolonged fasting (PL) might evoke improvements in metabolic health. Since fasting is accompanied by numerous endogenous processes to equilibrate blood glucose concentration, its feasibility is disputable in people with type 1 diabetes (PWT1D). We aimed to assess the safety and efficacy of PL in c-peptide negative (^< 0.9 ng/mL) PWT1D.

Methods: Glucose metabolism was assessed during the fasting period (CGM) and via a 75 g OGTT accompanied with the same bolus insulin dose after 12 (shortF) and 36 hours of fasting (longF). Area under the curve (AUC) was calculated following the trapezoidal rule. Safety was assessed by the number of hypoglycemic episodes (< 70 mg/dL) during fasting. Data were analysed using a paired sample t-test or Mann-Whitney-U-test (p≤0.05).

Results: In total, 17 PWT1D (6 women, aged 37 ± 11 years, BMI 24.9 ± 2.9 kg/m2, 10 MDI) were included. 13 episodes of mild hypoglycemia occurred in 9 participants during the shortF versus 27 in 15 participants during the longF. Incidence of hypoglycemia per hour was similar in both arms (median [IQR] shortF: 0.08 [0 - 0.08] vs. longF: 0.06 [0.03 - 0.07], p=0.62).

Conclusion: PL did not increase the risk of hypoglycemia in PWT1D. Intriguingly, the AUC for glucagon was significantly higher after longF compared to shortF, potentially explaining the numerically lower number of hypoglycemic events during longF.

Disclosure

O. Moser: Other Relationship; Self; Dexcom, Inc., Novo Nordisk A/S, Sanofi. N.J. Tripolt: None. P.N. Pferschy: None. A. Obermayer: None. H. Kojzar: None. J.K. Mader: Advisory Panel; Self; Becton, Dickinson and Company, Eli Lilly and Company, Medtronic, Prediktor Medical, Sanofi-Aventis. Speaker’s Bureau; Self; Abbott, Eli Lilly and Company, Medtronic, Novo Nordisk A/S, Roche Diabetes Care, Sanofi-Aventis. M. Brunner: None. A. Mueller: None. H. Yildirim: None. C. Sourij: None. M.L. Eckstein: Research Support; Self; Dexcom, Inc., Novo Nordisk A/S, Sanofi-Aventis. H. Sourij: Advisory Panel; Self; Amgen, AstraZeneca, Boehringer Ingelheim International GmbH, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. Research Support; Self; Boehringer Ingelheim International GmbH, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. Speaker’s Bureau; Self; Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi.
715-P: Diet Scores Associated with Increases in General and Abdominal Obesity in the Melbourne Collaborative Cohort
Authors: COURTEN BARBORA DE , KARIM MD NAZMUL , HODGE ALLISON
Published: June 2020

The prevalence of obesity is increasing rapidly worldwide, increasing the risk of several common chronic diseases. To ascertain which of the three diet scores - Alternative Healthy Eating Index 2010 (AHEI), Dietary Inflammatory Index (DII) and Mediterranean Diet Score (MDS) was a better predictor of future obesity, assessed as body mass index (BMI) or waist to hip circumference ratio (WHR), in the Melbourne Collaborative Cohort Study (MCCS).Prospective cohort study in 27,834 men and women aged between 40 and 69 years at baseline (1990-94). Body size measures were taken at baseline and follow-up in 2003-7. Diet was measure at baseline using a 121-item food frequency questionnaire, along with confounders - age, sex, measure of socioeconomic status, smoking status, alcohol drinking status, physical activity level, country of birth, baseline body size measure (BMI or WHR as applicable). Regression coefficients and 95% confidence intervals for the association of dietary scores at baseline with BMI and WHR at follow-up 2 were generated separately using multivariate linear regression models adjusting for variables listed above and dietary energy intake. Both BMI and WHR at follow-up increased across quintiles of baseline DII (Q5 vs. Q1 BMI 0.4102 (0.2060, 0.6145); WHR 0.0094 (0.0061, 0.0128)), while for AHEI the association was inverse (Q5 vs. Q1 BMI -0.5139 (-0.6791, -0.3487); WHR -0.0107 (-0.0134, -0.0080). Only WHR at follow-up was inversely associated with categories of baseline MDS (G3 vs. G1 BMI -0.0540 (-0.2349, 0.1270); WHR -0.0040 (-0.0070, -0.0010)). Based on Akaike’s Information Criterion (AIC) and Bayesian Information Criterion (BIC) statistics, AHEI was a stronger predictor of increased body size at follow-up than the other diet scores. Poor quality/pro-inflammatory diets predicted future overall and abdominal obesity. The AHEI may provide the best way to operationalise this and capture subtle differences between the scores.

Disclosure

B. de Courten: None. M. Karim: None. A. Hodge: None.
722-P: Pictorial Carbohydrate Counting: Engaging Youth with Diabetes in Nutrition Education
Authors: THIVIERGE MEREDITH R. , WAHEED MYRA , SEEL MAUREEN , WOLF RISA
Published: June 2020

Background: Carbohydrate counting is used to determine prandial insulin doses in pediatric diabetes management. Benefits to carbohydrate counting include improved glycemic control, improved diabetes-specific quality of life, and improved coping ability in daily life. Patients self-report knowledge and comfort in carbohydrate counting, but we have no quantifiable way to determine the accuracy of this self-report. Thus, we implemented nutrition quizzes with photos of popular foods to assess fundamental knowledge of carbohydrate counting.

Methods: Pictorial nutrition quizzes were developed to review basic, intermediate and advanced fundamentals of carbohydrate counting. The nutritionist administered the quizzes to children >8 years of age, as part of regular outpatient diabetes follow-up visits. Children completed the quizzes independently and were allowed to use their insulin pump and phone to calculate insulin doses. Quiz responses and scores were recorded, in addition to visit hemoglobin A1c (HbA1c). Demographic and clinical data were extracted from the electronic medical record.

Results: Nutrition quizzes were completed by 103 youth (99 with T1D, 4 with T2). Mean age was 14.2 (SD 2.6), 44% female, 70% White, mean duration of diabetes 6 y (SD 4). 65% used insulin pumps, 68% used CGMs. All patients (n=103) completed 1 quiz, and 31 completed more than 1 quiz (range 2-5 quizzes). Patients with better glycemic control scored higher on nutrition quizzes. Mean A1c at initial quiz administration was 9%, and at follow-up was 8.6% (p=0.4).

Conclusion: Pictorial nutrition quizzes engage children and adolescents with diabetes in reviewing the fundamentals of carbohydrate counting and provide opportunity for nutrition intervention during routine diabetes clinical care.

Disclosure

M.R. Thivierge: None. M. Waheed: None. M. Seel: None. R. Wolf: None.
726-P: Mediterranean Diet Adherence and Association with Cardiometabolic Risk after Behavioral Weight Intervention in Older Adults
Authors: MILLER RACHEL G. , VENDITTI ELIZABETH M. , MARCUS MARSHA D. , GERMEROTH LISA J. , CONLON RACHEL P.K. , LEVINE MICHELE D. , COSTACOU TINA
Published: June 2020

Adherence to a Mediterranean (Med) diet pattern, characterized by increased intake of fruits, nuts/seeds, vegetables, legumes, whole grains, seafood, yogurt and vegetables, and decreased intake of red/processed meats, refined grains, starches and added sugars, is associated with reduced cardiometabolic risk independent of total calorie intake or single nutrients. We examined whether adherence to Med diet was associated with risk factor change in the context of a behavioral weight management trial for U.S. community-dwelling older adults at elevated diabetes and cardiovascular risk. The Pitt Retiree Study (n=322) examined the impact of 12 weekly group lifestyle sessions on weight and cardiometabolic risk (BMI, waist, glucose, lipids, and blood pressure) in older adults (age 65-80 yrs). Dietary goals included calorie reduction, <30% of total calories from fat, lean protein at most meals, and following USDA MyPlate guidelines but not a Med diet. Adherence to a Med diet pattern (0-14 score) was assessed at baseline, 4, 12, and 24 months and categorized as low (0-5), moderate (6-9), or high (≥10). The baseline median Med diet score was 6 (range 0-13), with 45% categorized as low, 50% moderate, 5% high. Women were more adherent than men (p<0.01). Adjusting for sex, higher scores were correlated with older age (p=0.02), lower baseline BMI (p=0.01) and smaller waist (p=0.01). Median [IQR] scores improved at 4 months (+1 [0, +2] p<.001) with 27% low, 63% moderate, 10% high. Each 1-unit Med diet increase was associated with -0.1 kg/m2 BMI (SE=0.04, p=.006) and -1.0 mmHg Systolic BP (SE=0.47, p=0.03) at 4 months. Med diet improvement was maintained at 12 (+1, [0, +2] p<.001) and 24 months (n=299, +1 [0, +2] p<.001). Adherence to a food pattern consistent with a Med diet improves after lifestyle intervention, even when not specifically prescribed, and is associated with weight and blood pressure benefits. Importantly, older adults sustain change in dietary quality over 2 years.

Disclosure

R.G. Miller: None. E.M. Venditti: None. M.D. Marcus: None. L.J. Germeroth: None. R.P.K. Conlon: None. M.D. Levine: None. T. Costacou: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R18DK096404)
727-P: A Plant-Based Meal Affects Thalamus Perfusion Differently than a Conventional Meal: A Three-Group Randomized Crossover Study
Authors: KAHLEOVA HANA , KUDLACKOVA MICHAELA , TINTERA JAROSLAV , THIEME LENKA , VELEBA JIRI , MALINSKA HANA , OLIYARNYK OLENA , MARKOVA IRENA , HALUZIK MARTIN , PAVLOVICOVA RENATA , TURA ANDREA , PELIKANOVA TEREZIE
Published: June 2020

Objective: We tested the effects of a plant-based meal on these brain regions.

Methods: A randomized crossover design was used to test the effects of two energy- and macronutrient-matched meals: a vegan (V-meal) and a conventional (M-meal) on brain activity, gastrointestinal hormones, and satiety in participants with type 2 diabetes (T2D; n=20), overweight/obese participants (O; n=20), and healthy controls (H; n=20). Brain perfusion was measured, using arterial spin labeling functional brain imaging; satiety was assessed using a visual analogue scale; and plasma concentrations of gut hormones were determined at 0 and 180 min. Repeated-measures ANOVA was used for statistical analysis. Bonferroni correction for multiple comparisons was applied. The Hedge’s g statistic was used to measure the effect size for means of paired difference between the times (180-0 min) and meal types (M-V meal) for each group.

Results:Thalamus perfusion was the highest in patients with T2Dand the lowest in overweight individuals (p=0.001). Thalamus perfusion decreased significantly after ingestion of the M-meal in men with T2D (p=0.04) and overweight men (p=0.004), and it decreased significantly after ingestion of the V-meal in healthy controls (p<0.001). The effect size was -0.41 (95% CI, -1.14 to 0.31; p=0.26) for men with diabetes; -0.72 (95% CI, -1.48 to 0.01; p=0.05) for overweight/obese men; and 0.82 (95% CI, 0.09 to 1.59; p=0.03) for men with T2D. Changes in thalamus perfusion after ingestion of both test meals correlated with changes in satiety (r= +0.68; p<0.01), fasting plasma insulin (r= +0.40; p<0.01), C-peptide (r= +0.48; p<0.01) and amylin (r= +0.55; p<0.01), and insulin secretion at 5 mmol/l (r= +0.77; p<0.05).

Conclusion: Thalamus perfusion decreased after the M-meal in men with T2D and overweight/obese men, and it decreased after the V-meal in healthy controls. The changes in thalamus perfusion were associated with changes in satiety and insulin secretion.

Disclosure

H. Kahleova: None. M. Kudlackova: None. J. Tintera: None. L. Thieme: None. J. Veleba: None. H. Malinska: None. O. Oliyarnyk: None. I. Markova: None. M. Haluzik: Advisory Panel; Self; Lilly Diabetes, Sanofi. Consultant; Self; Ethicon US, LLC. Speaker’s Bureau; Self; AstraZeneca, Mundipharma International, Novartis AG, Novo Nordisk A/S. R. Pavlovicova: None. A. Tura: None. T. Pelikanova: None.

Funding

Ministry of Health of the Czech Republic (AZV15-27338A, IN00023001)
73-LB: Expanding the Definition of Intraday Glucose Variability
Authors: CHO PETER J. , BENT BRINNAE M. , WITTMANN APRIL H. , MERWIN RHONDA M. , THACKER CONNIE R. , FEINGLOS MARK N. , DUNN JESSILYN P.
Published: June 2020

Glucose variability (GV) is an established risk factor for hypoglycemia and diabetes complications. Over 20 GV metrics have been identified, but there is no consensus on which metrics are most effective for determining glucose control. A1c is the clinical standard of glucose control.

Two of the most common GV metrics include intraday standard deviation (iSD) and intraday coefficient of variation (iCV), which are calculated for each day and then averaged over multiple days. Thus, the current metrics of iSD and iCV are aggregate means, which are influenced by outliers and do not consider variations over multiple days. To reduce the influence of outliers and examine variation in these metrics over multiple days, we propose expanding the definition of iSD and iCV to include median and standard deviation of iSD and iCV over multiple days.

We examined iSD and iCV in a population of 14 high normoglycemic or prediabetic participants (A1c 5.5-6.4%). Participants wore a continuous glucose monitor for 8-10 days. In addition to iSD and iCV, 23 metrics of glucose and GV were calculated. To determine the strength of the relationship between each GV metric and A1c, Pearson correlation coefficients (PCC) were calculated. There were higher PCC between A1c and the standard deviation of iSD and iCV than the traditional metric of iSD and iCV (traditional: 0.296, SD: -0.387). Interestingly, all metrics of iSD and iCV calculated (mean, median, and standard deviation) were more closely correlated with A1c than mean glucose (0.296, 0.138, -0.387, and 0.220, respectively).

We demonstrate that expanding the definitions of iSD and iCV can provide a more comprehensive view of GV. Additionally, these metrics may provide more insight into glucose control than traditionally utilized metric, mean glucose.

Disclosure

P.J. Cho: None. B.M. Bent: None. A.H. Wittmann: None. R.M. Merwin: None. C.R. Thacker: None. M.N. Feinglos: None. J.P. Dunn: None.

Funding

MEDx (451-1746)
745-P: Novel Interventions in Children’s Healthcare (NICH): Attending to the Social Determinants of Health
Authors: CANTU ANNETTE , WAGNER DAVID V. , JENISCH CELESTE , LUZOD HANNAH , GOTTFRIED-LEE HANNAH , HARRIS MICHAEL A.
Published: June 2020

Objective: Novel Interventions in Children’s Healthcare (NICH) is a community-based, family-focused intervention for youth with T1D and is associated with improved glycemic control and lower rates of acute care utilization. This study examines whether NICH is associated with changes in preventative outpatient attendance, with specific attention to the role of social determinants of health (SDoH) as potential moderators.

Methods: Youth in NICH with T1D were included if they had SDoH and electronic health record (EHR) data available (n=52). Retrospective EHR review included outpatient attendance (endocrinology, primary care) for the years prior to and following NICH initiation and social risk endorsement (e.g., food and housing security). Youth mean age was 14.5 years; 59% were female; and 77% were non-Hispanic Caucasian.

Results: More than half of NICH families (52%) endorsed food insecurity, with 49% and 40% reporting housing insecurity and unreliable transportation, respectively. Prior to NICH services, minority youth and those experiencing food insecurity attended significantly fewer preventative outpatient appointments (p<.05). There were no significant differences in total number of outpatient visits attended while in NICH for the overall sample; however, following NICH initiation, minority youth demonstrated a significant increase in attendance, from 2.4 to 4.9 per year, and a significantly larger increase in attendance when compared to youth of majority race (p=.01).

Conclusions: This is the first study to examine the impact of NICH on preventative care access. There were no significant differences in total number of appointments attended while in NICH, which is unsurprising given that families are already attending additional weekly home sessions during program participation. However, minority youth seem to particularly benefit from NICH services, demonstrating more equitable access to preventative outpatient care during program involvement.

Disclosure

A. Cantu: None. D.V. Wagner: None. C. Jenisch: None. H. Luzod: None. H. Gottfried-Lee: None. M.A. Harris: None.

Funding

JDRF; The Leona M. and Harry B. Helmsley Charitable Trust
747-P: (Social) Profiling Youth with T1D: Examining the Standard Care Nonresponders
Authors: WAGNER DAVID V. , HARTMAN ALEXANDRA , JENISCH CELESTE , GUTTMANN-BAUMAN INES , EL-MANSY HEBA , HARRIS MICHAEL A.
Published: June 2020

Objective: A subset of youth with chronic medical conditions, including T1D, are unresponsive to typical medical and behavioral health interventions, often resulting in avoidable acute health problems such as DKA. This study examines how youth with T1D who are unresponsive to standard care compare to similarly referred youth with other chronic medical conditions.

Methods: Participants were referred by medical providers due to lack of response to standard care - as evidenced by avoidable ED visits and/or lab values chronically out of range - including 50 youth with T1D and 54 with other chronic medical conditions, such as cystic fibrosis, end-stage renal disease, and seizure disorder. Retrospective chart reviews collected presence and frequency of social risks. Mean age was 14.5 years; 48% were female; 85% were non-Hispanic White.

Results: Social risk prevalence was high across medical conditions (see Figure).Youth with T1D were significantly more likely to have experienced multiple social risks, such as difficulty attending school, DHS involvement, and drug/alcohol abuse by youth and caregivers.

Conclusions: When compared to youth struggling with self-management of other chronic conditions, youth with T1D experienced significantly higher prevalence and frequency of social risks. Interventions developed for this vulnerable population should include components that directly target these important social factors.

Disclosure

D.V. Wagner: None. A. Hartman: None. C. Jenisch: None. I. Guttmann-Bauman: None. H. El-Mansy: None. M.A. Harris: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
755-P: Generalizability of Pediatric to Adult Transition Models: Preliminary Results from the Supporting Emerging Adults with Diabetes (SEAD) Program
Authors: LOPEZ-PRIETO CORAL , JANG ALYSSA , GREENBERG MICHAEL , AGARWAL SHIVANI
Published: June 2020

Structured programs facilitating healthcare transition of young adults (YA) (18-30 yrs) have shown improved A1c and loss to follow-up. However, generalizability of these models is lacking. We previously published on a transition program (SEAD) based in an adult diabetes center in Philadelphia, PA that improved A1c, glucose monitoring adherence, and loss to follow-up. We have since moved SEAD to a new health system in the Bronx, NY, expanding care to economically vulnerable and minority YA. We were interested in examining whether the SEAD model was generalizable to a new health system and population. We prospectively followed YA with T1D in the first year of SEAD and collected standardized data on sociodemographic, visit attendance, and clinical factors for 1 year prior to and during care. The program involved an adult endocrinologist and nurse practitioner, and focused on topics including pediatric care coordination, self-management re-education, adult healthcare orientation, behavioral support, and engagement in care efforts. We used multilevel linear and logistic regression with repeated measures to examine visit attendance, A1c, and diabetes technology use. Of 79 YA with a scheduled SEAD visit (mean age at transition 23 yrs, 46% female, 93% Hispanic or Black, 89% Medicaid), 30% (n=24) never attended SEAD or re-established care. Of the 55 YA who attended SEAD, 74% (n=41) returned for at least 1 follow-up within 3 months. Mean A1c improved by 0.97% from 9.81% to 8.84% (n=41, p<0.05). For diabetes technology use, 29% (n=14) were initiated while 66% (n=27) continued use (p<0.05). SEAD preliminary results from a new health system and population demonstrate retention of YA after initial establishment of care, rapid improvement in glycemic control, and robust technology use. More efforts to promote establishing care are needed. The SEAD program is promising as a generalizable model for healthcare transition of YA with T1D.

Disclosure

C. Lopez-Prieto: None. A. Jang: None. M. Greenberg: None. S. Agarwal: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115896)
767-P: Psychological Treatment Is Associated with Improved Diabetes Distress and Glycaemic Control
Authors: CROKER VANESSA M. , CALDERWOOD CLARE , HAYES STUART , HIBBERT EMILY
Published: June 2020

Introduction: Diabetes distress (DD) is associated with poorer health outcomes in diabetes mellitus (DM). Addressing DD through diabetes education improves glycaemic control. However, few studies have examined the effects of psychological therapy on DD and physical health outcomes, especially in low socioeconomic populations.

Methods: This study examines the impact of intervention by a clinical psychologist as part of a multidisciplinary team (MDT) on glycaemic control, hospital presentations and admissions, DD, and psychological factors. Participants were 50 outpatients aged 17-67 at a public hospital diabetes service in a socioeconomically disadvantaged area of Sydney, Australia. Inclusion criteria were DD, indicated by a PAID score ≥ 40, together with either 1) recent diabetes-related hospitalisation, 2) high HbA1c or 3) conflict over diabetes management. Measures used at baseline and treatment completion were the PAID, the 21-item Depression, Anxiety, Stress Scale (DASS-21), HbA1c, and number of emergency department presentations and hospital admissions in the three months before and after treatment commencement.

Results: All psychological variables showed a significant reduction: DD measured by PAID scores decreased by 36.8% from 57 to 36 (p<0.001); DASS21 scores showed depression reduced by 36.4 % from 11 to 7 (p<0.0001), anxiety by 33.4% from 10 to 6 (p<0.0001) and stress by 16.7% from 12 to 10 (p<0.0002). HbA1c decreased from 9.0% pre-treatment to 8.2% in the three months after treatment commenced. For 25 participants with matched pre and post treatment HbA1cs, mean HbA1c reduction was 0.7% (95% CI 0.1-1.3, p = 0.02). Emergency department presentations halved from 22% (11/50) of participants in the pre- treatment 3 months to 10% (5/50) in the 3 months post treatment. Hospital admissions halved, from 8% (4/49) to 4% (2/49).

Conclusion: This study provides preliminary evidence that treatment by a clinical psychologist can improve health outcomes for people with diabetes.

Disclosure

V.M. Croker: None. C. Calderwood: None. S. Hayes: None. E. Hibbert: None.