bluuebunny/crossref_metadata_2025 huggingface dataset:
1543-P: Dietary Inflammatory Index Associated with Complications in Long Duration Type 1 Diabetes
Authors: SHAH HETAL , WOLFSON EMILY , YU MARC GREGORY , ADAM ATIF , HU FRANK , KING GEORGE L.
Published: June 2020

Cognitive impairment, micro and macrovascular complications contribute to the high morbidity and mortality of type 1 diabetes (T1D) in an aging population. The dietary inflammatory index (DII), a validated measure of the inflammatory potential of dietary nutrients, has not been evaluated for its relationship to complications in T1D. To this end, validated semiquantitative food frequency questionnaires were administered at baseline to 591 individuals of the Joslin 50-year Medalist Study (“Medalists”), a well-characterized cohort having ≥50 years of T1D. The DII score was derived for each Medalist as a weighted summary score from 35 nutrients that have been associated with inflammatory markers in literature. A higher score indicated the pro-inflammatory potential of the diet. Logistic and linear regression models were applied to test cross-sectional relationships between the DII and complications. A higher DII was significantly (p<0.05) associated with 1.6 and 1.4 times increased odds of nephropathy (eGFR≤60 ml/min/1.7m2) and neuropathy (MNSI score >2) respectively, independent of glycemic control, diabetes duration, or other confounders. The DII was not associated with baseline self-report history of cardiovascular disease, nor with proliferative diabetic retinopathy (ETDRS >53). In a subset (n=69) who were given a cognitive battery, a higher DII was significantly associated (p=0.02) with worse working memory (Wechsler memory scale) but not with motor skills (Grooved Pegboard), executive function (Delis Kaplan) or immediate or delayed recall (Rey Auditory Verbal Learning Tests). To conclude, in aging adults with chronic T1D, a pro-inflammatory diet is associated with nephropathy, neuropathy and worse working memory, signaling a need for further studies examining diet and inflammation to eventually inform better strategies to lower morbidity in populations with long duration T1D.

Disclosure

H. Shah: None. E. Wolfson: None. M. Yu: None. F. Hu: None. G.L. King: Research Support; Self; Janssen Pharmaceuticals, Inc.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (1DP3DK112192-01, 1DP3DK094333-01); Beatson Pledge Fund
1554-P: Abnormal Glucose Tolerance Due to Beta-Cell Failure Is Common in Nonobese Africans
Authors: HOBABAGABO ARSENE F. , HORMENU THOMAS , SHOUP ELYSSA M. , OSEI-TUTU NANA H. , DUBOSE CHRISTOPHER , MABUNDO LILIAN , CHUNG STEPHANIE T. , SUMNER ANNE E.
Published: June 2020

Obesity and insulin resistance are the hallmarks of abnormal glucose tolerance (Abnl-GT) in African Americans and African Caribbeans. In contrast, prevalence, phenotype and etiology of Abnl-GT in African-born blacks are unknown. Working with African-born blacks living in America, we determined (a) the prevalence of Abnl-GT, and (b) the etiology of Abnl-GT by BMI category (i.e., primary β-cell failure vs. insulin resistance). OGTT was performed in 461 African-born blacks (male: 66%; age: 39±10 (mean±SD), range: 20-65y; BMI: 27.6±4.5, range: 18.4-42.4 kg/m2). Abnl-GT was diagnosed by glycemia: 0h glucose≥100 or 2h glucose≥140 mg/dL. Insulin resistance was defined by the cutoff at the lowest quartile of the Matsuda Index for the population (≤2.97). Primary β-cell failure was diagnosed if Abnl-GT was present and Matsuda Index was >2.97. Obesity occurred in 27% (123/461). Abnl-GT occurred in 38% (173/461). By BMI category, Abnl-GT occurred in 35% (117/338) of the nonobese and 46% (56/123) of the obese. Overall, β-cell failure occurred in 61% (105/173) of participants with Abnl-GT (Figure). Yet, the odds of primary β-cell failure as the cause of Abnl-GT were 4 times higher in the nonobese than the obese (OR: 4.2; 95% CI: 2.2, 8.3). In short, the prevalence of Abnl-GT was high in both nonobese and obese African-born blacks. However, in nonobese Africans with Abnl-GT, primary β-cell failure was more common than insulin resistance.

Disclosure

A.F. Hobabagabo: None. T. Hormenu: None. E.M. Shoup: None. N.H. Osei-Tutu: None. C. DuBose: None. L. Mabundo: None. S.T. Chung: None. A.E. Sumner: None.
1555-P: Physiologic Stress Measured by Allostatic Load Score Is Associated with Abnormal Glucose Tolerance in African Immigrants
Authors: HORMENU THOMAS , HOBABAGABO ARSENE F. , SHOUP ELYSSA M. , OSEI-TUTU NANA H. , DUBOSE CHRISTOPHER , SUMNER ANNE E.
Published: June 2020

The extent to which abnormal glucose tolerance (Abnl-GT) is associated with either physiologic stress measured by allostatic load score (ALS) or inflammation in African immigrants is unknown. Our goals were to determine in African-born blacks living in Washington, DC: a) the prevalence of physiologic stress measured by ALS and b) the association of ALS with Abnl-GT and key inflammatory markers. Enrollees were 324 African-born blacks who immigrated to the United States as adults (age of immigration ≥18years, current age 40±10y (mean±SD), range 21-65y, duration of stay in the United States 11±9y, range 0.2-43y, BMI 27.9±4.4 kg/m2, range 18.4-42.4 kg/m2, 70% male). ALS was calculated with 10 variables: cardiovascular (SBP, DBP, pulse, CHOL, HDL, homocysteine), metabolic (BMI, A1C, albumin), and immunological (hsCRP). Variables were divided into sex-specific quartiles with high-risk defined by the highest quartile for each variable except for albumin and HDL, which used the lowest quartile. One point was assigned if the variable was in the high-risk range and 0 if not. Physiologic stress was defined by ALS≥4 (upper quartile). Glucose tolerance was determined by the OGTT. The markers of inflammation were: TNF-alpha, IL-6 and MCP-1. Visceral adipose tissue (VAT) was measured by CT scan. High ALS occurred in 31% (102/324) of enrollees. The high ALS group were older than the low ALS group (45±9 vs. 39±9, P<0.01). BMI, WC and VAT were higher in the high ALS group even after adjusting for age (all P<0.01). Abnl-GT occurred in 41% (132/324). But the odds of Abnl-GT was higher in the high ALS than the low ALS group (OR= 2.6, CI: 1.63-4.67, P<0.01). The three inflammatory markers were higher in the high ALS group but after adjustment for age, the difference only approached significance. Overall, nearly one-third of African immigrants experience physiologic stress measured by ALS and this may represent a predisposition to abnormal glucose tolerance.

Disclosure

T. Hormenu: None. A.F. Hobabagabo: None. E.M. Shoup: None. N.H. Osei-Tutu: None. C. DuBose: None. A.E. Sumner: None.
1559-P: Associations of Changes in Fat-Free Mass with Risk for Prediabetes and Type 2 Diabetes in the Hispanic Community Health Study/Study of Latinos
Authors: LECROY MADISON N. , HUA SIMIN , KAPLAN ROBERT , SOTRES-ALVAREZ DANIELA , QI QIBIN , THYAGARAJAN BHARAT , GALLO LINDA , PIRZADA AMBER , DAVIGLUS MARTHA L. , TALAVERA GREGORY A. , ISASI CARMEN R.
Published: June 2020

Background: Loss of muscle mass may increase risk for type 2 diabetes (T2D), but few prospective studies have examined this association. The objective of this study was to determine whether loss of muscle mass (approximated with fat free mass [FFM]) is associated with risk for prediabetes and T2D in a population disproportionately burdened by T2D.

Methods: Participants were Hispanic/Latino adults (aged 18-74 years) in the Hispanic Community Health Study/Study of Latinos (6.1-year follow-up), a multi-site, community-based cohort in the United States. Eligible participants were free of T2D at baseline (2008-2011; n=6264). Fasting glucose, HbA1c, and fasting insulin were measured. Diabetes was defined according to American Diabetes Association criteria. Analysis: Survey-weighted Poisson regression models examined the association of percent change in relative FFM (FFM/total body weight; %∆FFM) with incident prediabetes and T2D. Survey-weighted linear regression models examined associations of %∆FFM with changes in glucose and insulin measures. Models were adjusted for age, sex, Hispanic/Latino background, site, nativity, education, income, physical activity, years between visits, and diabetic medication use (for lab values only).

Results: Relative FFM declined by 2.1% between visits. %∆FFM was inversely associated with incident prediabetes (p-for-trend=0.001) but not T2D. %∆FFM was inversely associated with changes in glucose and insulin measures (p-for-trend<0.0001). After adjustment for 1) fat mass index or 2) BMI and waist circumference, only the association with HOMA-IR remained significant. Associations were generally stronger for individuals who were overweight/obese at baseline (p<0.05).

Conclusions: Findings suggest that muscle mass maintenance/accumulation during adulthood may reduce T2D risk (primarily insulin resistance), particularly among individuals who are overweight/obese.

Disclosure

M.N. LeCroy: None. S. Hua: None. R. Kaplan: None. D. Sotres-Alvarez: None. Q. Qi: None. B. Thyagarajan: None. L. Gallo: None. A. Pirzada: None. M.L. Daviglus: None. G.A. Talavera: None. C.R. Isasi: None.

Funding

National Heart, Lung, and Blood Institute (N01HC65233, N01HC65234, N01HC65235, HHSN268201300003I, N01HC65236, N01HC65237, T32HL144456)
1560-P: Impaired Glucose Tolerance: Estimates for 2019 and Projections for the Years 2030 and 2045
Authors: SAEEDI POUYA , KAUNDAL ABHA , KARURANGA SUVI , MALANDA BELMA , MOTALA AYESHA A. , ASCHNER PABLO , RATHMANN WOLFGANG
Published: June 2020

Background: Impaired glucose tolerance (IGT) is an important risk marker for the development of type 2 diabetes. The 9th edition of the International Diabetes Federation (IDF) Diabetes Atlas provides updated estimates on the worldwide prevalence of IGT in 2019 and its projections for the years 2030 and 2045.

Methods: A literature review of studies reporting the age-specific prevalence of IGT between 1990 and 2019 was conducted. The number of studies that satisfied the selection criteria according to the analytical hierarchy process was limited to 62 studies (from 49 countries). A generalised linear regression model was used to estimate the prevalence of IGT in the world’s 211 countries and territories. IGT prevalence estimates for countries without high quality in-country data sources were extrapolated from countries deemed to be similar.

Results: In 2019, the estimated global prevalence of IGT in adults aged 20-79 years is 7.5% (374 million people). The vast majority (72.2%) of people with IGT live in low- and middle-income countries and 48.1% (180 million) are under the age of 50 years. The projected prevalences for 2030 and 2045 are estimated to be 8.0% and 8.6%, respectively. The IDF North America and Caribbean Region has the highest age-adjusted comparative prevalence of IGT (12.3%) in 2019, while the Europe Region has the lowest in 2019 (4.4%). The top three countries with the largest number of people in the age group 20-79 years with IGT in 2019 are China (54.5 million), the United States of America (37.4 million) and Indonesia (29.1 million), while Papua New Guinea (29.2%), Indonesia (17.8%) and New Zealand (17.5%) have the highest age-adjusted comparative prevalences of IGT in 2019.

Conclusion: The majority of people with IGT are living in low- and middle-income countries. Given that IGT signifies a risk for future diabetes, its early detection and intervention can play a crucial role in primary prevention of type 2 diabetes.

Disclosure

P. Saeedi: None. A. Kaundal: None. S. Karuranga: None. B. Malanda: None. A.A. Motala: None. P. Aschner: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Merck Sharp & Dohme Corp., Sanofi. Speaker’s Bureau; Self; Novo Nordisk A/S. W. Rathmann: Advisory Panel; Self; AstraZeneca. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Research Support; Self; Novo Nordisk Inc. Speaker’s Bureau; Self; Eli Lilly and Company, Novo Nordisk Inc.
1562-P: Predictive Risk Factors for Renal Dysfunction and Cardiovascular Disease: An Analysis Using Medical Checkup Data
Authors: TERAYAMA RYO , KOSHIZAKA MASAYA , SHIBATA TAKAHISA , BAN TOSHIAKI , MAEZAWA YOSHIRO , YOKOTE KOUTARO
Published: June 2020

Objective: Early prevention of renal dysfunction progression and cardiovascular disease is important in diabetes. We aimed to determine the risk factors for renal dysfunction and cardiovascular disease among medical insurance subscribers between 40 and 74 years of age in Japan.

Methods: This retrospective study involved 1585 subjects, including 97 patients with diabetes, who had undergone a specific health checkup in 2013 and 2019. The primary composite outcome included decline in estimated glomerular filtration rate (eGFR) by ≥30%, increase in urine albumin-to-creatinine ratio (UACR) by ≥30 mg/gCre, and increase in the Framingham Risk Score by ≥5%. We categorized the subjects into groups with and without these outcomes. Univariate analysis was conducted using Welch’s t-test, Pearson’s correlation coefficient, and Fisher’s exact test. Based on the univariate analysis, principle component and logistic analyses were performed to determine the predictive risk factors.

Results: Significant between-group differences were noted in terms of age, BMI, waist circumference, blood pressure, hemoglobin, hematocrit, triglyceride, HDL-C, LDL-C, AST, ALT, γ-GTP, HbA1c, serum creatinine, eGFR, urine creatinine, UACR, urine protein-to-creatinine ratio, sex, antihypertensive medication, history of anemia, diabetes, smoking, alcohol consumption, weight change, exercise habits, the will to improve and others. Logistic analysis showed that age (odds ratio [95% confidence interval]: 1.04 [1.02-1.06], P <0.0001), HDL-C (0.97 [0.96-0.98], P <0.0001), HbA1c (1.35 [1.12 -1.63], P =0.0015), and male sex (3.90 [2.97-5.11], P <0.0001) were predictive risk factors.

Conclusion: Lower HDL-C and higher HbA1c were detected as the risk factors for patients with diabetes and without diabetes. The results of this study indicate that the harmful effects of hyperglycemia and dyslipidemia may have started before the patients actively exhibit metabolic disorders.

Disclosure

R. Terayama: None. M. Koshizaka: None. T. Shibata: None. T. Ban: None. Y. Maezawa: None. K. Yokote: Research Support; Self; Astellas Pharma Inc., Daiichi Sankyo, Eli Lilly Japan K.K., Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Mochida Pharmaceutical Co., Ltd., Nippon Boehringer Ingelheim Co. Ltd., Novartis Pharma K.K., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Pfizer Japan Inc., Sanofi K.K., Shionogi & Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. Speaker’s Bureau; Self; Abbott, Astellas Amgen, AstraZeneca K.K., Bayer Inc., FUJIFILM Pharmaceuticals U.S.A., Inc., Kaken Pharmaceutical Co., Ltd., Sanwa Kagaku Kenkyusho.
1571-P: Cadmium and Type 2 Diabetes in a Superfund Site Lead Smelter Community in Dallas, Texas
Authors: LITTLE BERT B. , REILLY ROBERT F. , WALSH BRAD
Published: June 2020

Introduction: Six of 14 prior studies reported significant associations between cadmium (Cd) and type 2 diabetes mellitus (T2DM).

Materials and Methods: In a Superfund Cleanup community, Phase II screening included physical examination and laboratory tests. Participants were African Americans aged ≥19 years to ≦89 years. Multiple logistic regression was used.

Results: Of 873 subjects environmentally exposed, 109 T2DM individuals who lived in the community for an average of 21.0 years, and 766 non-T2DM individuals resident in the study community for 19.0 years. Most T2DM individuals (70.3%) were ≥50 years old (p<0.00001). Blood Cd levels were significantly higher among T2DM subjects (p<0.006). T2DM status was regressed on age ≥50 years, Cd, other metals, decades of residence in smelter community, gender, abnormal GGT, and smoking. T2DM predictors were age ≥ 50 years (OR = 3.10; 95% CI: 1.91-5.02, p<0.0001), Cd level (OR = 1.85; 95% CI: 1.14 - 2.99, p < 0.01), and BMI (OR=1.07; CI: 1.04-1.09).

Discussion: Cd exposure is associated with T2DM in an EPA Superfund community, controlling for covariate effects. Comparing our findings with 14 prior Cd and T2DM studies shows that T2DM rates less than 10% were not sufficiently powered, unless OR ≥ 3.0 (See Figure). Findings suggest that Cd is associated with T2DM, and studies failing to show a significant effect may have a Type II error, and not an indication of no association.

Disclosure

B.B. Little: None. R.F. Reilly: None. B. Walsh: None.
1575-P: Health-Related Quality of Life in Patients with Type 2 Diabetes: A Case-Control Study
Authors: MURAKAMI HIROSHI , FUJITA TOMOYUKI , MURABAYASHI MASAYA , MIZUSHIRI SATORU , OSONOI SHO , MATSUHASHI YUKI , DAIMON MAKOTO
Published: June 2020

Background: Health-related quality of life (HR-QOL) assessment is considered an important aspect of outcome in diabetes treatment.

Objective: We investigated the association between QOL and clinical characteristics of patients with diabetes.

Methods: Among 571 patients with type 2 diabetes and 958 healthy control subjects, the target subjects who were matched by age and sex were divided into two groups (504 in the diabetic group and 504 in the nondiabetic group). The 36-Item Short Form Health Survey questionnaire (SF-36) was used to evaluate HR-QOL. Unpaired Student’s tests and Pearson’s chi-square test were used for statistical analyses.

Results: (1) Scores of physical functioning, role physical (physical and mental), general health, and social functioning were significantly lower in the diabetic group than in the nondiabetic group (P<0.01). (2) The physical component summary score (PCS) was significantly lower in the diabetic group (P<0.01). There was no significant difference in the mental component summary score (MCS) between the two groups. (3) The PCS score was significantly decreased (P<0.01) with age in both groups. Reduction in the PCS score was faster in the diabetic group than the nondiabetic group, with an approximate difference of 11 years. (4) In the diabetic group, patients with retinopathy, nephropathy, or neuropathy demonstrated a significant reduction in the PCS score (P<0.01); however, no difference was observed in the MCS score. (5) Regarding the association of complications, such as retinopathy, nephropathy, or neuropathy, more were the complications, significantly lower was the PCS score (P<0.01).

Conclusions: QOL was significantly decreased in patients with type 2 diabetes compared with that in healthy subjects. QOL of patients with diabetic complications was significantly decreased; thus, such conditions should be taken into account when providing treatment to patients with diabetes.

Disclosure

H. Murakami: None. T. Fujita: None. M. Murabayashi: None. S. Mizushiri: None. S. Osonoi: None. Y. Matsuhashi: None. M. Daimon: None.
158-OR: Calcium Channel Blockade Protects against Severe Hypoglycemia–Induced Fatal Cardiac Arrhythmias in Rats
Authors: RENO CANDACE M. , HUANG YIQING , CHRISTENSEN CAMILLE G. , OXSPRING MILAN B. , BAYLES JUSTIN , FISHER SIMON J.
Published: June 2020

It was hypothesized that in response to insulin-induced severe hypoglycemia, excess calcium influx into the heart causes fatal cardiac arrhythmias. To test if blocking the calcium channels would decrease fatal cardiac arrhythmias during severe hypoglycemia, L-type calcium channel blocker (Verapamil; 1 mg/kg, n = 25) or saline (n = 24) were infused into Sprague Dawley rats during a hyperinsulinemic (0.2 mU/kg/min) severe hypoglycemic (10-15 mg/dl) clamp for 3 hours with ECG. During severe hypoglycemia, verapamil completely prevented mortality compared to 21% mortality in controls (p < 0.05; Figure). Decreased mortality was associated with a 99% decrease in 2nd degree heart block (Figure) and prevention of 3rd degree heart block compared to saline (p < 0.05). Glucagon and epinephrine were similar between the groups suggesting verapamil does not affect hypoglycemic counterregulation. Consistent with the notion of calcium-mediated arrhythmias, separate experiments demonstrated that pharmacological blockade of ryanodine receptor-mediated calcium signaling also reduced heart block by 97% and prevented mortality due to hypoglycemia.

In summary, blocking calcium channels protects against severe hypoglycemia-induced fatal cardiac arrhythmias. Blockade of cardiac calcium channels could be a potential approach to prevent arrhythmias in people with diabetes at risk for hypoglycemia.

Disclosure

C.M. Reno: None. Y. Huang: None. C.G. Christensen: None. M.B. Oxspring: None. J. Bayles: None. S.J. Fisher: None.

Funding

National Institutes of Health (5T32DK091317, R01NS070235); JDRF (3-APF-2017-407-A-N)
1588-P: Therapy Trends in Initial 6 Months of the First Large-Scale Longitudinal Nationwide Study on Management and Real-World Outcomes of Diabetes in India (LANDMARC)
Authors: GHOSH ROMIK , DAS ASHOK K. , MITHAL AMBRISH , JOSHI SHASHANK , PRASANNA KUMAR K.M. , KALRA SANJAY , UNNIKRISHNAN AMBIKA GOPALAKRISHNAN , THACKER HEMANT , SETHI BIPIN , MOHANASUNDARAM SENTHILNATHAN , MENON SHALINI K. , NAIR ARJUN , RAIS NADEEM , WANGNOO SUBHASH KUMAR , CHOWDHURY SUBHANKAR , ZARGAR ABDUL H.
Published: June 2020

Therapy patterns were examined across various subgroups during the first 6-months of this 3 year prospective longitudinal study (LANDMARC; CTRI/2017/05/008452). During the observational period investigators were free to modify treatment in adults with T2D controlled/uncontrolled on ≥2 antihyperglycemic medications. Treatment patterns were analyzed using descriptive statistics and paired t-test. From baseline to 6-months (visit 2 [V2]), glycemic parameters analyzed for 5703 subjects improved significantly (p<0.001) across all treatment types (Table). This improvement was more evident in the insulin subgroup vs. insulin naïve subgroup (p<0.0001). No difference (p=0.7746) in mean A1C values of those receiving >3 OADs vs. ≤3 OADs was noted in insulin naïve subgroup. Notably, in participants receiving insulin along with OADs, PPG improved more in basal vs. premix regimen (p=0.0024). Overall, insulin regimen was more effective than OADs. Intensification of treatment with >3 OADs may not be effective in improving glycemic parameters. In real-world setting, adding basal insulin may be more effective than premix.

Disclosure

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

Funding

Sanofi India Limited
16-LB: Patient and Paramedic Experiences with a Direct Electronic Referral Program for Hypoglycemia (HG) Education following Paramedic Service Assist–Requiring HG: A Qualitative Study
Authors: LIU SELINA L. , ROSA ANDREW , SIBBALD SHANNON L. , MAHON JEFFREY , CARTER DUSTIN R. , PEDDLE MICHAEL , SPAIC TAMARA
Published: June 2020

Hypoglycemia requiring paramedic assistance negatively impacts outcomes in people with diabetes. Prior studies have shown only a small proportion of those with paramedic assist-requiring HG are brought to hospital. These episodes are thus “invisible” to the health care system. An innovative direct electronic referral program in which paramedics sent a referral for focused HG education to the Diabetes Education Centre (DEC) at the time of paramedic assessment was implemented for 18 months. Program uptake was lower than expected (133 referrals, 79 scheduled, and 50 attended). This qualitative study examines barriers and facilitators of DEC attendance for HG education after paramedic assist-requiring HG. We conducted semi-structured interviews of patients with paramedic-assisted HG and surveyed paramedics about their experiences. Of 34 paramedics, 30 (88%) attended at least 1 HG call in the study period and 26 (76%) used the referral program. Fourteen patients (18% response rate) participated: 8 men (57%); 13 (93%) age ≥ 50 yrs. Eight patients (57%) recalled the paramedic referral, 6 (43%) did not, and 4 (29%) thought they were referred by their family doctor. One patient thought attendance was mandatory to keep their drivers’ license. Themes identified from patient responses included: positive impact of diabetes education especially if delivered early after diagnosis, importance of spousal support and in-person education. Barriers to attendance were prior DEC attendance especially in those with long diabetes duration and embarrassment (failure to self-manage, memory loss around the HG event). While patients felt that focused HG education is an excellent strategy to reduce recurrent episodes, many had already attended similar sessions and felt further education was not needed. Hence, an important gap in providing HG education to patients with severe HG may be both system-based and disease-related.

Disclosure

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

Funding

Academic Medical Association of Southwestern Ontario (INN16-004)
1604-P: Glucose Intolerance Modifies the Association between Diastolic Blood Pressure Variability and All-Cause Mortality
Authors: VISARIA AAYUSH , DHARAMDASANI TINA , LO DAVID , WICKRAMASINGHE KAVINDYA , MALHOTRA RAJ
Published: June 2020

Purpose: There is growing literature on the association between blood pressure variability (BPV) and mortality. We sought to determine whether the association between BPV and all-cause mortality was modified by glucose intolerance (GI).

Methods: A total of 12,256 non-pregnant adults from the National Health and Nutrition Examination Surveys-III (1988-1994) were linked to the National Death Index through 2015. The primary predictors were systolic and diastolic BPV, defined as the standard deviation of 3-6 BP readings taken consecutively. Systolic and diastolic BPV were categorized into quintiles (<3, 3-8, 9-12, 13-15, >15 mmHg). We used Cox proportional hazards modeling to assess the risk of all-cause mortality, adjusting for confounders (age, sex, race/ethnicity, mean BP, BMI, lipids, kidney and liver function, c-reactive protein) and the survey design. Analyses were stratified by GI status (yes/no), defined as either a fasting glucose ≥100 mg/dl, HbA1c ≥5.7%, or diabetes medication use.

Results: Of the 12,256 participants, 28% had GI. The mean follow-up time was 22.1 years, with a total 3,632 deaths (2,096 [46%] among GI and 1,536 [20%] among non-GI) from all causes. Among those with GI, the highest quintile of diastolic BPV had 60% higher risk of mortality relative to the lowest quintile (unadjusted HR [95% CI] = 1.51 [1.04, 2.23], adjusted HR = 1.60 [1.12, 2.28]). This association did not exist among those without GI (unadjusted HR [95% CI] = 0.87 [0.60, 1.26], adjusted HR = 0.80 [0.58, 1.10]). Those in the highest quintile of systolic BPV had an insignificant increase in risk of all-cause mortality among both GI and non-GI participants (GI: adjusted HR = 1.41 [0.98, 2.01], non-GI: adjusted HR = 1.09 [0.78, 1.51], interaction p=0.34).

Conclusion: Only those with GI had a significant positive association between diastolic BPV and all-cause mortality. GI may play a role in modifying this association through changes in vascular autonomic regulation due to autonomic neuropathy.

Disclosure

A. Visaria: None. T. Dharamdasani: None. D. Lo: None. K. Wickramasinghe: None. R. Malhotra: None.
1606-P: Effect of Changes in Dark/Light Cycle on Physiological Homeostasis as a Confounding Prelude to Diabetes in Fischer 334 Animal Model
Authors: SUBRAMANIAN BALANEHRU , RAMAKRISHNAN GANAPATHY , TAMILMARAN PANNERSELVAM , SUNDARAKRISHNAN BALAKRISHNAN , SESHADRI KRISHNA
Published: June 2020

Understanding the role of modern life-style driven disruption in circadian rhythm can advance appropriate management of the shift in physiological homeostasis that may lead to groups of diseases such as diabetes. This study was carried out to determine the effect of light period changes on this possible shift using Fischer 344 rat model. Animals were split into 3 groups of 6 Males and 6 Females each: G I for normal light period (6 am to 6 pm); G II for reversed light period (6 pm to 6 am on alternate weeks); G III was G I with additional 8 h light period (6 pm to 2 am on alternate days). Daily feed, water intake and weekly body weight was recorded. Elevated plus maze for anxiety was done on day 21. On day 22, blood glucose, cholesterol, triglycerides and ACTH were measured. Histopathology of pancreas was done. Results showed no statistical difference in body weights of both sexes in G II and III. However, females in G III had 7% higher body weight than G I. Feed intake increased by 39.7% in both sexes in G III compared to G II. Water intake decreased by 7.2% in G II and 3.4% in G III compared to G I indicating change in normal physiology. G III showed increased blood glucose (38.4%), cholesterol (34.2%), and triglycerides (77.8%). In G III males ACTH was elevated by 38.9% while the same effect was seen in G II females (27.1%). Open arm behavior analysis decreased was by 24.9% in G III compared to G I indicating animals in a state of anxiety. G I Pancreas showed normal islets of Langerhans; G II with swollen acinar cells with vacuoles in few; G III with additional cellular degeneration of islets of Langerhans. Study indicates less adaptation capacity of Fisher 344 rats to disruption in light period as evidenced (p value <0.05) by changes in ACTH, blood chemistry, cellular morphology and behavioral pattern suggesting a shift in physiological homeostasis that may lead to group of diseases such as diabetes. Further investigation is underway to ascertain associated beta cell function and molecular changes.

Disclosure

B. Subramanian: None. G. Ramakrishnan: None. P. Tamilmaran: None. B. Sundarakrishnan: None. K. Seshadri: None.

Funding

Primer Academy of Medical Sciences (PAMS-CAReTS-SBV)
1607-P: Real-World Evidence of the Impact of Obesity on Residual Teeth in the Japanese Population
Authors: HAYASHI MAYU , MORINO KATSUTARO , HARADA KAYO , ISHIKAWA MIKI , MIYAZAWA ITSUKO , TAKAKO YASUDA , ISHIKADO ATSUSHI , MAEGAWA HIROSHI
Published: June 2020

Previous studies have shown that diabetes and obesity increase the severity of periodontal disease—a well-known risk factor for tooth loss. However, the effect of obesity on tooth loss has not yet been fully characterized. Thus, we investigated the association between obesity and residual teeth (number and sites) using a large database of the Japanese population. We used the MinaCare database, composed of data from Japanese health insurance claims and health check-ups in 2015 to select 233,517 subjects from 706,150 based on the availability of BMI, HbA1c, teeth, and smoking information. Obesity was defined as BMI ≥25.0. The number of residual teeth at every age group was correlated with 4 BMI subsets (<18.5, 18.5-24.9, 25.0-30.0, >30.0). The unadjusted and adjusted odds ratios (ORs) for fewer than 24 residual teeth were estimated using logistic regression models. The number of residual teeth decreased with age (p for trend<0.001). Groups with higher BMIs had fewer residual teeth at all ages over 40s (p for trend<0.001). The number of residual teeth in the lowest vs. highest BMI groups in the 50s and 60s were 26.0 ± 3.2 vs. 25.2 ± 3.9 and 24.0 ± 5.0 vs. 23.3± 5.1, respectively. The negative effects of obesity on residual teeth were dominant in the right mandibular first molar. Additionally, smoking enhanced the effect of obesity. The OR for fewer than 24 residual teeth in obese people was 1.47 (95% CI: 1.43-1.52). Although diabetes (defined as HbA1c ≥6.5%) is an independent factor, the OR for fewer than 24 residual teeth in obese people after adjustment with sex, age, smoking status, and diabetes was 1.35 (95% CI: 1.31-1.40). Thus, obesity is an independent risk factor for tooth loss in the Japanese population, suggesting the importance of weight management to maintain oral health in obese people. Further studies are necessary to confirm our findings, due to limitations in our study such as data-availability from only the subject’s dental visit and the exclusion of full dentures and a small number of residual teeth.

Disclosure

M. Hayashi: Employee; Self; Sunstar Group. K. Morino: None. K. Harada: Employee; Self; Sunstar Group. M. Ishikawa: None. I. Miyazawa: None. A. Ishikado: Employee; Self; Sunstar Group. Employee; Spouse/Partner; Sunstar Group. H. Maegawa: Speaker’s Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Sanofi K.K., Takeda Pharmaceutical Company Limited.
1612-P: Liver Enzyme Is Associated with Future Remission from Impaired Fasting Glucose to Normal Fasting Glucose: The Kansai Healthcare Study
Authors: SHIBATA IZUMI , SATO KYOKO K. , SHIBATA MIKIKO , KOH HIDEO , UEHARA SHINICHIRO , OUE KEIKO , KAMBE HIROSHI , MORIMOTO MICHIO , HAYASHI TOMOSHIGE
Published: June 2020

Prediabetes is a key risk for type 2 diabetes and its remission to normal glucose regulation has been shown to prevent or delay the onset of diabetes. However, which factors play roles in remission is not fully understood. We prospectively examined the relationships between liver enzymes at baseline and future remission from impaired fasting glucose (IFG) to normal fasting glucose (NFG). We included 3334 middle-aged Japanese men with IFG and not taking diabetic medications at baseline. They were followed for up to 11 years. IFG was defined as fasting plasma glucose level 100-125 mg/dL and HbA1c <6.5%. Remission to NFG was defined as fasting plasma glucose level <100 mg/dL detected two times consecutively at the annual checkup. Those who had developed diabetes before they achieved remission to NFG were not counted as remission. Cox proportional hazard models were used to estimate hazard ratios (HRs) for achieving remission to NFG. Alanine transaminase (ALT) and aspartate transaminase (AST) were divided into the following quartiles: 5-19, 20-26, 27-37, and ≥38 IU/L for ALT; 11-19, 20-23, 24-29, and ≥30 IU/L for AST. A total of 1224 subjects remitted to NFG during 19780 person-years. Incidence rates per 1000 person-years for quartiles 1, 2, 3, and 4 of ALT/AST were 81/65, 62/67, 56/60, and 49/56, respectively. In a multiple-adjusted model that included age, fasting plasma glucose, body mass index, smoking status, regular physical exercise, alcohol consumption, and family history of diabetes, HRs of future remission to NFG for quartiles 2, 3, and 4 of ALT were 0.84 (95% CI, 0.72-0.99), 0.84 (0.72-0.99), and 0.82 (0.69-0.97), respectively, compared to quartile 1. In the same model except AST was substituted for ALT, HRs of those for quartiles 2, 3, and 4 of AST were 1.04 (0.89-1.22), 1.02 (0.87-1.20), and 1.02 (0.87-1.21), respectively, compared to quartile 1.

In conclusion, elevated ALT was inversely associated with future remission from IFG to NFG, but AST was not.

Disclosure

I. Shibata: None. K.K. Sato: None. M. Shibata: None. H. Koh: None. S. Uehara: None. K. Oue: None. H. Kambe: None. M. Morimoto: None. T. Hayashi: None.
1613-P: The Veterans Administration Diabetes Risk Cohort: Profile and Diabetes Incidence
Authors: KANCHI RANIA , THORPE LORNA , LOPEZ PRISCILLA M. , ELBEL BRIAN , MERCADO CARLA , SIEGEL KAREN R. , AVRAMOVIC SANJA , ALEMI FARROKH , SCHWARTZ MARK D.
Published: June 2020

Background: The Veterans Administration (VA) cares for over 8 million U.S. veterans annually, approximately 20% of whom have prevalent diabetes. To foster research and intervention opportunities, we developed the VA Diabetes Risk (VADR) Cohort using the VA electronic health record, a national cohort of diabetes-free U.S. veterans receiving primary care at the VA since January 1, 2008. This cohort provides important opportunities to study community-level risk factors for diabetes, such as attributes of the food environment, via geospatial linkage to residence information. We describe here the cohort profile and diabetes incidence by sub-group.

Methods: To be eligible, diabetes-free patients had to have at least 2 primary care visits at least 30 days apart prior to enrollment. Diabetes incidence was defined as having ≥2 inpatient or outpatient encounters with diabetes ICD-9/10 codes, any prescription of diabetes medicine, or one encounter with diabetes ICD-9/10 codes and ≥2 hemoglobin A1C ≥6.5%. The incidence of diabetes was calculated as the number of new cases diagnosed per 1000 person-years (PY) through December 31, 2018. Demographic and comorbidities data were abstracted using diagnostic codes, labs, prescriptions, and vital signs.

Results: The VADR cohort consisted of 6.17 million veterans, the majority of whom were male (91.7%) and non-Hispanic (NH) white (75.7%). Nearly half were above 60 years of age at enrollment (48.8%). The diabetes incidence rate was 27.0 per 1000 PY, increasing with age from 13.3 per 1000 PY among adults <45 years old to 41.8 per 1000 PY among those 65 years and older. Incidence was higher among men than women (34.6 vs. 18.6 per 1000 PY) and higher among NH black patients compared to NH white patients (38 vs. 31.7 per 1000 PY).

Conclusions: The VADR cohort provides a novel infrastructure for examination of community-level risk factors for diabetes among veterans, and facilitates assessment of the impact of national or regional strategies to prevent or manage diabetes in veterans.

Disclosure

R. Kanchi: None. L. Thorpe: None. P.M. Lopez: None. B. Elbel: None. C. Mercado: None. K.R. Siegel: None. S. Avramovic: None. F. Alemi: None. M.D. Schwartz: None.
1616-P: Stimulated ß-Cell Response Is Unaltered in Adult Autoantibody (AB) Negative Relatives of Individuals with Type 1 Diabetes (T1D)
Authors: NEYMAN ANNA , MOORS KELLY , EVANS-MOLINA CARMELLA , DIMEGLIO LINDA , MIRMIRA RAGHAVENDRA , MATHER KIEREN J. , HANNON TAMARA S. , SIMS EMILY K.
Published: June 2020

Emerging evidence suggests intrinsic β cell dysfunction contributes to T1D development. However, it is unclear whether defects in β cell response are evident in individuals at genetic risk for T1D without detectable islet autoimmunity. To explore this, we performed mixed meal tolerance tests (MMTTs) and hyperglycemic clamps to measure stimulated β cell response in 2 groups: Islet Ab negative 1st-degree adult relatives of persons with T1D (FDR-) and normoglycemic, age, sex, and BMI-matched controls without T1D family history. Median and IQR values for 1st phase responses, including C-peptide15min-0 (MMTT) and C-peptide incremental AUC (iAUC)0-10min (clamp), and 2nd phase responses, including C-peptide iAUC0-120min (MMTT) and average C-peptide (C-peptideavg) during the steady state (clamp), were compared using paired t-tests or Wilcoxon tests.

MMTTs and clamps were performed in 15 euglycemic (A1c<5.7%) FDR- and control pairs (34.3yrs ±7.7; 20% male; BMI 25.6kg/m2 ±4.4). There were no differences in 1st phase or 2nd phase-stimulated responses. For the FDR- vs. control group, C-peptide15min-0 was 1.2ng/mL (0.9,1.9) vs. 1.62(1.1,2.2), p=0.62, C-peptide iAUC0-10min was 22.6ng/mL*min (19.4-51.6) vs. 24.4 (19.3-31), p=0.72, and C-peptide iAUC0-120min was 404 (369.3,435.5) vs. 383.3 (291.2,558), p=>0.99, C-peptideavg steady state was 12 (10.8-18.9) vs. 11.5 (8.9-14.5), p=0.98.

In this small cohort, no significant differences between stimulated 1st or 2nd phase responses were detected between FDR- and matched controls, suggesting that FDR- relatives may not have a defect in stimulated β cell response. Nondiabetic relatives are heterogeneous in their risk of autoimmunity; this could explain a lack of between-group differences. At-risk pediatric cohorts, which have increased risks of developing autoimmunity, could be more likely to show a difference in β cell response. Ongoing investigations will define β cell function in relatives with detectable Abs.

Disclosure

A. Neyman: None. K. Moors: None. C. Evans-Molina: Consultant; Self; Bristol-Myers Squibb. L. DiMeglio: None. R. Mirmira: Advisory Panel; Self; Hibercell, Sigilon Therapeutics, Veralox Therapeutics. Employee; Spouse/Partner; Eli Lilly and Company. K.J. Mather: Research Support; Self; Abbott, Merck & Co., Inc., Novo Nordisk Inc., Sanofi. T.S. Hannon: None. E.K. Sims: None.

Funding

JDRF (2-SRA-2017-498-M-B)
1617-P: Association of High-Affinity Autoantibodies with High-Risk HLA Haplotypes
Authors: TRIOLO TAYLOR M. , PYLE LAURA , YU LIPING , GOTTLIEB PETER , STECK ANDREA
Published: June 2020

Electrochemiluminescence (ECL) assays are high-affinity autoantibodies (Abs) that are more specific than radiobinding assay (RBA) Abs for the prediction of type 1 diabetes (T1D) in natural history studies screening for risk and progression to T1D. We analyzed 603 subjects from the TrialNet Pathway to Prevention Study who were positive for at least one RBA diabetes related Ab and for whom ECL and HLA data were available. We sought to characterize ECL-GADA and ECL-IAA positivity and levels (z-scores) by HLA genotype and haplotypes. Mean age at initial visit was 19.4 ± 13.7 years; 345 (57.2%) were female and 104 (17.2%) carried the high-risk HLA- DR3/4*0302 genotype. At initial visit 425 (70%) of subjects were positive for either ECL-GADA or ECL-IAA, with 207 (34.3%) ECL-IAA positive subjects and 367 (60.9%) ECL-GADA positive subjects. For subjects with high-risk HLA-DR3/4 genotype (n=104), 80 (76.9%) were positive for ECL-GADA, while 42 (40.4%) were positive for ECL-IAA. ECL and RBA-GADA z-scores were higher in subjects with HLA-DR3 haplotypes, while ECL-IAA (but not RBA-IAA) z-scores were associated with HLA-DR4 haplotypes. Associations of ECL and RIA Abs with high-risk HLA haplotypes are shown in the Table.

In conclusion, ECL and RBA-GADA positivity are associated with both HLA-DR3 and DR4 haplotypes, whereas only ECL-IAA (but not RBA-IAA) positivity and levels are associated with HLA-DR4 haplotype.

Disclosure

T.M. Triolo: None. L. Pyle: None. L. Yu: None. P. Gottlieb: Advisory Panel; Self; Janssen Scientific Affairs, LLC., Tolerion, Inc., Viacyte, Inc. Research Support; Self; Caladrius Biosciences, Inc., Immune Tolerance Network, Janssen Pharmaceuticals, Inc., JDRF, Leona M. and Harry B. Helmsley Charitable Trust, Mercia/Nova Laboratories, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk Inc. Stock/Shareholder; Self; IM Therapeutics. A. Steck: None.

Funding

American Diabetes Association (1-14-CD-17 to A.S.); National Institute of Diabetes and Digestive and Kidney Diseases; National Institute of Allergy and Infectious Diseases; Eunice Kennedy Shriver National Institute of Child Health and Human Development; JDRF
1619-P: Trends in Severe Hypoglycemia and Mortality in Individuals with Type 1 Diabetes
Authors: BAE JAE HYUN , KIM KYOUNG JIN , KIM JI YOON , KIM SIN GON , KIM NAM HOON
Published: June 2020

Background: Hypoglycemia is one of the major complications in the management of individuals with type 1 diabetes, and severe hypoglycemia increases the risk of mortality.

Objective: To investigate trends and risk factors for severe hypoglycemia and mortality in individuals with type 1 diabetes.

Methods: We evaluated age- and sex-standardized annual incidence rates of severe hypoglycemia requiring hospitalization and mortality in individuals with type 1 diabetes using the Korean National Health Insurance Service Database from 2002 to 2016.

Results: Age- and sex-standardized incidence rates of severe hypoglycemia have increased from 2002 to 2016 in individuals with type 1 diabetes (5.79 per 1,000 in 2002-2004 to 12.57 per 1,000 in 2015-2016, P for trend < 0.0001). Individuals with severe hypoglycemia had significantly lower body weight (64.8 ± 12.4 kg vs. 57.7 ± 9.5 kg; P < 0.0001) and higher proportions of chronic kidney disease (2.5% vs. 5.3%, P = 0.0012) and end-stage renal disease (0.6% vs. 2.0%, P = 0.0071) compared with those without severe hypoglycemia. However, age- and sex-standardized mortality has decreased in both individuals with and without severe hypoglycemia (P for trends < 0.001). The use of new-generation insulin analogs was associated with a lower risk of severe hypoglycemia and mortality.

Conclusion: The incidence rates of severe hypoglycemia have significantly increased, while the mortality has significantly decreased in Korean individuals with type 1 diabetes from 2002 to 2016.

Disclosure

J. Bae: None. K. Kim: None. J. Kim: None. S. Kim: None. N. Kim: None.
1621-P: Period Prevalence of Chronic Kidney Disease and Obesity in Adults with Type 1 Diabetes
Authors: WALLACE AMELIA , CHANG ALEX R. , GRAMS MORGAN , SELVIN ELIZABETH
Published: June 2020

Introduction: Trends in the prevalence of chronic kidney disease (CKD) and obesity in adults with type 1 diabetes have not been rigorously characterized. We hypothesized that, like the type 2 diabetes population, there have been increases in the prevalence of eGFR <60 ml/min/1.73 m2 (CKD) and body mass index (BMI) >30 kg/m2 (obesity) in the population with type 1 diabetes.

Methods: We conducted a retrospective analysis of 4215 patients in the Geisinger Health System (central Pennsylvania) with type 1 diabetes, defined using the validated Klompas algorithm. We constructed period prevalent cohorts within each calendar year from 2004 to 2018 and estimated the prevalence of CKD and obesity using average values within each calendar year.

Results: The 2004 cohort contained 530 people with type 1 diabetes; the 2018 cohort contained 1485 people. Percent female was 54.0% in 2004 and 50.4% in 2018; average age was 43.9 (SD, 16.1) and 48.1 (SD, 15.9), respectively. The prevalence of CKD was 14.7% in 2004 and 17.4% in 2018 (p-trend = 0.80) (Figure). The prevalence of obesity was 30.0% in 2004 and 38.9% in 2018 (p-trend =0.006). The average BMI was 27.6 (6.0) in 2004 and 29.1 (6.6) in 2018 (p-trend = 0.002). In associations adjusted for demographics, trends were similar.

Conclusions: The prevalence of obesity increased, but there was no change in the prevalence of CKD over the last 15 years among people with type 1 diabetes in a rural health care system.

Disclosure

A. Wallace: None. A.R. Chang: None. M. Grams: Other Relationship; Self; DCI. E. Selvin: None.

Funding

National Heart, Lung, and Blood Institute (T32HL007024)