bluuebunny/crossref_metadata_2025 huggingface dataset:
1351-P: Caffeine Intake Is Associated with a Lower Risk of Nonalcoholic Fatty Liver Disease–Related Fibrosis in Patients with Type 2 Diabetes
Authors: HAN JIAHAO , LIU CHUAN , YANG HUANHUAN , GAO RUIXIA , LI ZHIHUI , LI JIA , QI XIAOLONG
Published: June 2023

Background: Type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD) are conditions closely associated, the prevalence of which is continuously growing, providing a heavier socioeconomic and disease burden. Lifestyle modification is still considered the cornerstone of nonalcoholic liver steatohepatitis (NASH). We aimed to investigate the association between caffeine and NAFLD-related fibrosis in populations with different diabetes conditions.

Methods: Adult participants in NHANES from 2005 to March 2020 pre-pandemic were included with three group: T2DM group, prediabetes group and diabetes-free group. Liver fibrosis was assessed by Fibrosis-4 (FIB-4) index. Logistic regression was employed to interrogate the association between caffeine and liver fibrosis.

Finds: A total of 23711 participants were included. The proportions of high risk (FIB-4>2.67) for liver fibrosis in T2DM group was significantly higher than that of prediabetes group and diabetes-free group (5.9% vs 3.2% vs 2.4%, P<0.001). However, the proportions of high risk in prediabetes group is equal with that of diabetes-free group (3.2% vs 2.4%, P>0.05). Notably, the proportions of intermedium risk (FIB-4>1.3, and< 2.67) for liver fibrosis in prediabetes group was significantly higher than that of diabetes-free group (32.3% vs 24.2%, P<0.001). Participants with caffeine intake≤78mg/day had a high risk for liver fibrosis than that with caffeine intake >78mg/day in all groups (Diabetes-free group: OR 1.312[1.086-1.585]; Prediabetes group: OR 1.641[1.192-2.259]; T2DM group: OR 1.373[1.066-1.769]; all P<0.05).

Interpretation: Prevalence of liver fibrosis is high in patients with T2DM and prediabetes. And caffeine intake more than 78mg per day is associated with a lower risk for liver fibrosis in T2DM and prediabetes.

Disclosure

J.Han: None. C.Liu: None. H.Yang: None. R.Gao: None. Z.Li: None. J.Li: None. X.Qi: None.
1352-P: Ethnic Disparities in Diabetic Complications in the U.S.
Authors: YOSHIDA YILIN , FONSECA VIVIAN , ZU YUANHAO
Published: June 2023

Objective: To estimate the prevalence of diabetes (DM) complications and assess risk factors for complications by ethnicity and DM duration.

Methods: We used National Health and Nutrition Examination Survey data, 1999-2018. We defined cardiovascular disease (CVD) as a history of heart failure, stroke, or heart attack; chronic kidney disease (CKD) as an eGFR <60, albuminuria, or both; retinopathy as retinal microaneurysms or blot hemorrhages; and lower extremity disease (LED) as peripheral neuropathy, peripheral artery disease, or ulcers. We assessed the age-adjusted prevalence of each complication and multivariable logistic regressions for risk factors related to any complication by ethnicity in new (DM< 10 y without insulin) and established patients (DM≥10 y).

Results: Non-Hispanic Whites (W) had the highest CVD rates, followed by Blacks (B), Mexican Americans (M), and Asian Americans (A) in both new (31% W, 21% B, 14% M, 11% A) and established patients (38% W, 36% B, 29% M, 28% A). Blacks had the highest CKD rates in both new (40% B, 33% W, 31% A, 30% M) and established patients (63% B, 52% M, 51% W, 40% A). For retinopathy, in new patients, Mexican Americans had the highest rate (27% M, 20% B, 12% W), while in established patients, Whites had the most (62% W, 61% B, 57% M). Blacks had the highest rates for LED in both new (52% B, 47% W, 45% M) and established patients (78% B, 68% W, 59% M). Male gender was a risk factor for any DM complication in Asian Americans (new patients, odds ratio 3.9, 95% CI 2-7.5; established, 2.5, 1.1-5.4). Obesity was a risk factor in Black new patients (1.4, 1-1.8). Poor glycemic control was a risk factor in Asian American (4, 2.2-7.6) and White new patients (1.5, 1.1-2.1), and Black established patients (1.7, 1.2-2.4).

Conclusions: White patients had the highest rate of CVD, while Blacks had the most CKD and LED. Mexican Americans with < 10 y of DM had more retinopathy than their ethnic counterparts. Interventions to integrate the male sex and promote weight and glycemic control may reduce DM complications in ethnic minorities.

Disclosure

Y.Yoshida: None. V.Fonseca: Consultant; Abbott, Corcept Therapeutics, Eli Lilly and Company, Other Relationship; BRAVO4HEALTH, LLC, Research Support; Fractyl Health, Inc., Stock/Shareholder; Amgen Inc. Y.Zu: None.
1355-P: Risk of Chronic Kidney Disease in Early-Onset Type 2 Diabetes in Mexico
Authors: SILVA-TINOCO RUBÉN , CUATECONTZI-XOCHITIOTZI TERESA , GUZMAN-OLVERA EILEEN B. , DELATORRE-SALDAÑA VIRIDIANA , GALINDEZ-FUENTES ANA , CASTILLO-MARTINEZ LILIA , BERNAL-CEBALLOS FERNANDA , RIOS-CARBAJAL VIANEY , TORRES-SANDOVAL NARDA , MANUEL MEJIA-VILET JUAN , OCHOA-MORENO JORGE , SERNA JAVIER , LOPEZ-ARELLANO OLIVA
Published: June 2023

Patients with early onset type 2 diabetes (EOD) seem to be at increased risk of developing complications. Screening and diagnosis for CKD is poorly executed in primary care (PC) of low-and-middle income countries. Thus, we aimed to analyze the presence of CKD in EOD in comparison with later-onset diabetes (LOD). Data were obtained from the largest cohort of patients with T2D evaluated for CKD within the PC in Mexico (DIABEMPIC). EOD and LOD were defined as the age of diagnosis <40 and ≥40 years, respectively. CKD assessment included albuminuria through urinary albumin-creatinine ratio (≥30mg/g for CKD) and estimated glomerular filtration rate (eGFR≤60 ml/min/1.73m2 for CKD). A total of 1,592 patients were included. The burden of CKD at different diabetes durations are shown in Table 1. The prevalence of overall CKD was significantly higher in the EOD group (p<0.008), associated to a greater presence of albuminuria; a higher prevalence of albuminuria was observed after 10 years of diagnosis in the EOD (p<0.0001). In the univariate analysis, EOD was associated with an increased risk of CKD (OR 1.33, 95%CI 1.08-1.65). In conclusion, EOD patients presented a higher risk of CKD, particularly on account for albuminuric-CKD phenotype, even though they are comparatively younger. Our results enhance the need for the management of risk factors and proper screening of CKD in T2D, especially in EOD, in PC settings, and through albuminuria measurement.

Disclosure

R.Silva-tinoco: Speaker's Bureau; AstraZeneca, Boehringer Ingelheim Inc., Novo Nordisk. J.Mejia-vilet: None. J.Ochoa-moreno: None. J.Serna: None. O.Lopez-arellano: None. T.Cuatecontzi-xochitiotzi: None. E.B.Guzman-olvera: None. V.Delatorre-saldaña: None. A.Galindez-fuentes: None. L.Castillo-martinez: None. F.Bernal-ceballos: None. V.Rios-carbajal: None. N.Torres-sandoval: None.
1357-P: Conflicting Significance of High BMI as a Predictor of Individual Diabetic Complications
Authors: YAGUCHI YUTA , FUJIHARA KAZUYA , MON KHIN LAY , WU SIJIA , FERREIRA EFREM D. , SATO TAKAAKI , HORIKAWA CHIKA , MATSUBAYASHI YASUHIRO , KATO KIMINORI , SONE HIROHITO
Published: June 2023

Although weight management plays a central role in diabetes treatment, the association between body weight and diabetic complications is not fully elucidated. Therefore, we investigated the relationship between BMI and risk of diabetic complications in patients with diabetes mellius (DM) using nationwide claims data. Analyzed were 91097 patients with DM without prior treatment-requiring diabetic eye disease (TRDED), initiation of dialysis (dialysis), coronary artery disease (CAD), cerebrovascular disease (CVD), heart failure (HF) or amputation (mean age 52 y, HbA1c 7.2%, median follow-up 4.5 y). Participants were divided into 6 groups according to BMI (BMI<20.0, 20.0-22.4, 22.5-24.9, 25.0-27.4, 27.5-29.0, ≥30.0). Risk of diabetic complications was examined by Cox regression analysis. There was an inverse correlation between the risk of dialysis and BMI; hazard ratio (HR) for dialysis in patients with BMI ≥30.0 was 0.46 (0.29-0.74). There was a U-shaped relationship between the risk of HF and BMI; HRs for HF in patients with BMI <20.0 and ≥30.0 were 1.97 (1.15-3.37) and 1.76 (1.27-2.45), respectively (Figure). High BMI was significantly associated with a higher risk of HF, but lower risks of TRDED and dialysis. The relationship between BMI and diabetic complications was inconsistent among complications, suggesting that the target weight should be individualized according to diabetic complications.

Disclosure

Y.Yaguchi: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K.Fujihara: None. L.Khin: None. S.Wu: None. E.D.Ferreira: None. T.Sato: None. C.Horikawa: None. Y.Matsubayashi: None. K.Kato: None.
136-OR: The MDA5627X Variant Is Associated with Type 1 Diabetes Protection via Attenuated Inflammatory Antiviral Responses
Authors: IWALOYE OPEOLUWA , ARMITAGE LUCAS H. , MEACHAM AMY M. , MATHEWS CLAYTON E.
Published: June 2023

Type 1 Diabetes (T1D) is an autoimmune disease characterized by destruction of pancreatic β cells. Genetics and environmental factors play crucial roles in T1D development. Four single nucleotide polymorphisms in IFIH1, encoding the viral sensor MDA5 have been linked to T1D. MDA5 promotes anti-viral responses and may link genetics with environmental factors to promote or suppress T1D. A stop-gain mutation in IFIH1 (rs35744605) results in a non-functional MDA5 protein (MDA5627X). We hypothesized that MDA5627X protects against T1D by dampening inflammatory anti-viral responses resulting in reduced autoimmunity. We gene edited human induced pluripotent stem cells at rs35744605 using a CRISPR/Cas9 strategy to generate iPSC encoding the stop-gain variant (MDA5627X). Macrophages (Mφ) have been demonstrated to be indispensable for T1D-initiation and regulate anti-viral responses. We differentiated iPSCs into Mφ and studies responses to high molecular weight Poly I:C to mimic viral infection. The outcome measures were Type 1 Interferon (IFN1) production, antigen presentation, and immune activation markers. Treatment of MDA5 intact Mφ with Poly I:C resulted in 60-fold increase in IFN1 production and a 3-fold elevation in human leukocyte antigen Class I (HLA-I) expression. In contrast, treated MDA5627X Mφ failed to increase IFN1 or HLA-I at any Poly I:C dose. While Poly I:C did not increase HLA-I expression, untreated MDA5627X Mφ had elevated HLA-1 compared to MDA5 intact Mφ (P=0.0306). Also, we assessed the expression of CD80, CD86, CD40, and MHC-II, however there were no differences in the expression between Mφ with intact MDA5 or MDA5627X. In contrast, IFNg and LPS treatment elevated expression of CD80, CD86, CD40, and MHC-II in both Mφ populations. In conclusion, our data point to a protective effect of the MDA5627X variant in T1D through decreased inflammatory IFN1 levels and T cell activation by Mφ.

Disclosure

O.Iwaloye: None. L.H.Armitage: None. A.M.Meacham: None. C.E.Mathews: None.

Funding

National Institutes of Health (R01DK127497, P01AI042288, UH3DK122638)
1367-P: Type 2 Diabetes Mellitus and Obesity Amplifies Nonalcoholic Fatty Liver Disease Risk with Age
Authors: SHARMA ANU , GODINEZ LEIVA EDDISON , LOMONACO ROMINA , VALDEZ SAENZ ENRIQUE , ORTIZ ROCHA ANDREA , GONZALEZ MARIA A. , MARANGI STEPHEN A. , SHRESTHA SULAV , SHETTY SHWETHA S. , BUDD JEFFREY T. , KALAVALAPALLI SRILAXMI , BARB DIANA , CUSI KENNETH
Published: June 2023

Nonalcoholic fatty liver disease (NAFLD) is becoming increasingly prevalent in the general population with multiple known metabolic risk factors. There is limited evidence on the impact of age on the prevalence of hepatic steatosis and fibrosis, and their relationship to cardiometabolic risk factors. To this end, we recruited 761 patients 35-75 years of age, with and without T2DM, who underwent screening for NAFLD with laboratory tests and imaging by elastography (steatosis by controlled attenuation parameter [CAP]; fibrosis by liver stiffness measurement [LSM]). Patients were divided into 3 age groups: <45 years (young), 45-64 years (middle age), and ≥65 years old (older age), with results reported in this order. Of the 761 patients included, 21% (n=161) were young, 52% (n=397) middle age, and 27% (n=203) older. In the older age group, prevalence of obesity was lower (53% vs. 53% vs. 40%, p=0.01) but T2DM was higher (15% vs. 39% vs. 44%; p<0.01). Similarly, hypertension, atherogenic dyslipidemia, and use of antihypertensives and statins were more frequent in the older age group. Despite this, there were no differences in steatosis (CAP ≥274 dB/m: 50% vs. 54% vs. 52%, p=0.7). A marker of NAFLD disease activity (NIS4) worsened with increasing age (p<0.01). There was a trend for fibrosis (LSM≥7.0 kPa) to be higher in middle (11%) and older (8%) vs. younger (5%) age. After multivariable analysis (sex, race, ethnicity, BMI, A1c, cardiometabolic risk factors), BMI was associated with both steatosis and fibrosis in all age groups (p<0.01). There was a significant association between A1c as a continuous variable and steatosis only in the older age group (OR 2.8, 95% CI 1.6-4.9), while its association with fibrosis started at middle age (OR 1.3, 95% CI 1.1-1.7) and was stronger in older age (OR 1.8, 95% CI 1.01-3.2).

Conclusion: Age was not associated with steatosis or fibrosis. BMI was the strongest predictor of hepatic steatosis and synergizes with T2DM for the development of fibrosis with age.

Disclosure

A. Sharma: None. E. Godinez Leiva: None. R. Lomonaco: None. E. Valdez Saenz: None. A. Ortiz Rocha: None. M.A. Gonzalez: None. S.A. Marangi: None. S. Shrestha: None. S.S. Shetty: None. J.T. Budd: None. S. Kalavalapalli: None. D. Barb: None. K. Cusi: Research Support; Echosens, Inventiva. Consultant; Poxel SA. Research Support; LabCorp, Zydus. Consultant; Altimmune, Arrowhead Pharmaceuticals, Inc., AstraZeneca, 89bio, Inc., Bristol-Myers Squibb Company, Lilly, Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Medscape, Myovant, Novo Nordisk, ProSciento, Quest Diagnostics, Sagimet, Sonic Incytes, Terns.
1368-P: Relative Risk of Nonalcoholic Fatty Liver Disease between Women and Men according to Glycemic Status
Authors: KYUNG KIM HAE , LEE SEJEONG , LEE MINYOUNG , LEE YONG-HO , SEOK KANG EUN , CHA BONG-SOO
Published: June 2023

Background: Nonalcoholic fatty liver disease (NAFLD) is closely associated with type 2 diabetes (T2D). However, there is no current study for NAFLD risk stratification by sex and glycemic status. We investigated whether different glycemic status may interfere with metabolic effects affecting NAFLD according to sex.

Methods: A total of 552 patients with normal glucose tolerance (NGT), prediabetes, and diabetes, were evaluated for odds ratio (OR) and hazard ratio (HR) for NAFLD (above steatosis stage 1) in cross-sectional and longitudinal study, respectively. Univariate analyses and subgroup analyses were performed to determine the risk factors for developing NAFLD according to sex and glycemic status. Hepatic steatosis and fibrosis were determined using transient elastography and body composition was analyzed by Inbody.

Results: In cross-sectional study, men with prediabetes and diabetes exhibited greater relative differences in metabolic syndrome, triglyceride and HDL cholesterol than women with prediabetes and diabetes when compared with their NGT counterparts. There was no difference in OR for NAFLD observed comparing women and men with prediabetes or diabetes. After 2.6 years of follow up, we found that women with prediabetes showed significantly increased HR (HR 1.81; 95% CI 1.01-3.26; p = 0.049) of NAFLD than men with prediabetes (HR 0.83; 95% CI 0.54-1.30; p =0.42), even after adjusting several confounders. Visceral fat area was significantly higher in women with prediabetes and diabetes compared to men throughout the study. Insulin resistance (HOMA-IR≥2.5) was prediabetes-specific risk factor, contributing for prevalent NAFLD (OR 6.56; 95% CI 1.15-37.31; p=0.034) without interaction between sex and insulin resistance (p=0.99).

Conclusions: Women with prediabetes showed higher risk for developing NAFLD compared to men due to greater burden of metabolic dysregulation between adipose tissue and insulin resistance.

Disclosure

H.Kim: None. S.Lee: None. M.Lee: None. Y.Lee: None. E.Kang: None. B.Cha: None.
1375-P: Child-Reported Food Security in Children with Type 1 Diabetes—Association with Glycemic Control and Mental Health Symptoms Independent of Household Food Security
Authors: JULCEUS EMMANUEL F. , FRONGILLO EDWARD A. , MENDOZA JASON A. , SAUDER KATHERINE A. , MALIK FAISAL , JENSEN ELIZABETH T. , DOLAN LAWRENCE M. , BELLATORRE ANNA , DABELEA DANA , REBOUSSIN BETH A. , REYNOLDS KRISTI , PIHOKER CATHERINE , LIESE ANGELA D.
Published: June 2023

Introduction: Typically, caregivers report on household food security (FS), but children’s experiences may differ from caregiver reports. We assessed if child-reported food insecurity (FI) was associated with glycemic control, acute complications of diabetes, depressive symptoms, and disordered eating in children with type 1 diabetes (T1D), independently from household FS.

Methods: In a cross-sectional analysis of the multicenter SEARCH for Diabetes in Youth Study (Phase 4, 2016-2019), including 601 children age 10-17 years with T1D, household FS and child-reported FS were assessed using the 18-item Household Food Security Survey Module and the six-item Child Food Security Assessment questionnaire. Age-stratified (10-13, 14-17) regression models were performed to estimate independent associations, adjusting for sociodemographic and clinical factors and household FS.

Results: FI was reported by 13.1% (n=79) of children and 15.6% (n=94) of caregivers. Among child-caregiver dyads, 82.5% (n=496) of reports were concordant and 17.5% (n=105) discordant, Cohen’s kappa = 0.3. Child-reported FI was not independently associated with hemoglobin A1c, diabetic ketoacidosis, and hypoglycemia, including in age-stratified analyses. Child-reported FI was independently associated with elevated odds of depressive symptoms (OR 3.6, 95% CI 1.3-10.3) and disordered eating (OR 2.5, 95% CI 1.4-4.6) compared to FS; these associations remained in both age groups for disordered eating and in the older group for depressive symptoms.

Conclusion: Children with T1D may experience FI differently than caregivers. Child-reported FI was independently associated with depressive symptoms and disordered eating and thus may be an important attribute to assess in addition to household FS in children with T1D.

Disclosure

E.F.Julceus: None. B.A.Reboussin: None. K.Reynolds: Research Support; Novartis Pharmaceuticals Corporation. C.Pihoker: None. A.D.Liese: None. E.A.Frongillo: None. J.A.Mendoza: None. K.A.Sauder: None. F.Malik: None. E.T.Jensen: Consultant; Regeneron. L.M.Dolan: None. A.Bellatorre: None. D.Dabelea: None.

Funding

National Institutes of Health (R01DK117461, 1R01DK127208, 1UC4DK108173, T32GM081740)
1379-P: Adding Salt to Foods and Risk of Severe Nonalcoholic Fatty Liver
Authors: MA HAO , WANG XUAN , LI XIANG , HEIANZA YORIKO , QI LU
Published: June 2023

Background: High sodium intake is associated with insulin resistance, obesity, and metabolic syndrome, whereas very few studies have assessed the association of sodium intake with risk of nonalcoholic fatty liver disease (NAFLD). We recently found that the frequency of adding salt to foods could reflect a person’s long-term salt taste preference and sodium intake and was significantly related to life expectancy and cardiovascular disease risk. In this study, we aimed to evaluate the association between the frequency of adding salt to foods and liver proton density fat fraction (PDFF, a magnetic resonance imaging-based measure to assess liver fat content) and severe NAFLD risk.

Methods: A total of 494,240 participants from UK biobank, who were free of NAFLD at baseline (2006-2010) were analyzed in this study. Of the above participants, 9816 participants have MRI-PDFF data, measured in 2014. Generalized linear models were used to evaluated association between the frequency of adding salt to foods with liver-PDFF; Cox proportional hazards models were used to estimate the association between the frequency of adding salt to foods and severe NAFLD risk.

Results: During a median of 11 years of follow-up, 5,294 severe NAFLD cases were documented. Compared with participants who Never/Rarely added salt to foods, the adjusted Hazard Ratios (95% confidence interval) were 1.11 (1.04, 1.18), 1.27 (1.17, 1.37), and 1.45 (1.30, 1.62) across the groups of Sometimes, Usually, and Always, respectively (P-trend<0.001). The liver-PDFF values were 4.7 % (95% CI, 3.9, 5.5), 5.1% (4.3, 5.9), 5.2% (4.4, 6.0) and 5.5% (4.5-6.4) in the groups of Never/Rarely, Sometimes, Usually, and Always added salt to foods, respectively (P-trend<0.001). In sensitivity analyses, we replaced the frequency of adding salt to foods with estimated 24-hour urinary sodium extraction and found similar significant associations.

Conclusions: Our findings indicate that high sodium intake is associated with higher risk of severe NAFLD.

Disclosure

H. Ma: None. X. Wang: None. X. Li: None. Y. Heianza: None. L. Qi: None.
1386-P: Dipeptidyl Peptidase-4 Inhibitors and the Risk of Skin Cancer among Patients with Type 2 Diabetes—Population-Based Cohort Study
Authors: PRADHAN RICHEEK , AZOULAY LAURENT , PLATT ROBERT W. , HOI YUN YU ORIANA
Published: June 2023

Introduction: The dipeptidyl peptidase-4 (DPP-4) enzyme influences carcinogenic pathways in the skin, although its exact role remains uncertain. The objective of this study was to determine whether DPP-4 inhibitors are associated with the incidence of melanoma and nonmelanoma skin cancer, compared with sulfonylureas.

Research Design and Methods: Using the United Kingdom Clinical Practice Research Datalink, we assembled two new-user active comparator cohorts for each skin cancer outcome from 2007 to 2019. For melanoma, the cohort included 96,739 DPP-4 inhibitor users and 209,341 sulfonylurea users, and 96,411 DPP-4 inhibitor users and 208,626 sulfonylurea users for nonmelanoma skin cancer. Propensity score fine stratification weighted Cox proportional hazards models were to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) of melanoma and nonmelanoma skin cancer, separately.

Results: Overall, DPP-4 inhibitors were associated with a 23% decreased risk of melanoma compared with sulfonylureas (49.7 vs. 65.3 per 100,000 person-years, respectively; HR 0.77, 95% CI 0.61-0.96). The HR progressively reduced with increasing cumulative duration of use (0-2 years HR 1.14, 95% CI 0.84-1.54; 2.1-5 years HR 0.44, 95% CI 0.29-0.66; >5 years HR 0.33, 95% CI 0.14-0.74). In contrast, these drugs were not associated with the incidence of nonmelanoma skin cancer, compared with sulfonylureas (448.1 vs. 426.1 per 100,000 person-years, respectively; HR 1.06, 95% CI 0.98-1.15).

Conclusions: In this large, population-based cohort study, DPP-4 inhibitors were associated with a reduced risk of melanoma but not nonmelanoma skin cancer, compared with sulfonylureas.

Disclosure

R.Pradhan: None. L.Azoulay: Advisory Panel; Pfizer Inc., Consultant; Pfizer Inc., Speaker's Bureau; Roche Diagnostics. R.W.Platt: Advisory Panel; Pfizer Inc., Consultant; Boehringer Ingelheim (Canada) Ltd., Biogen, Merck & Co., Inc., Nant Pharma, Other Relationship; Boehringer Ingelheim Inc. O.Yu: Consultant; Novo Nordisk.

Funding

Canadian Institutes of Health Research (FDN143328)
139-OR: An Obesity-centric Approach With and Without Antiobesity Medications Compared with the Usual-Care Approach to Management of Patients with Obesity and Type 2 Diabetes in an Employer Setting—A Pragmatic Randomized Controlled Trial (EMPOWER-T2D)
Authors: PANTALONE KEVIN M. , ROGEN BRUCE , BENA JAMES F. , XIAO HUIJUN , BARNARD GRETCHEN , BORUKH ELENA , PEECHAKARA SEENIA , GRIEBELER MARCIO L. , BURGUERA BARTO
Published: June 2023

Objective: Among patients with T2D and obesity, determine the effect of combining anti-obesity medications (AOM) with a comprehensive employer-based weight management program [obesity-centric approach (OCA) + AOM] compared with OCA alone, or usual care (UC) on weight and HbA1c.

Methods: A 1-year open-label, randomized, pragmatic clinical trial was conducted at the Cleveland Clinic (CC). Participants were adults with T2D (HbA1c >7.5%) and BMI ≥ 30 kg/m2 enrolled in the CC Employee Health Plan. Participants were randomized 1:1:1 to OCA+ AOM, OCA alone, or UC. Participants in the OCA+AOM group initiated treatment with 1 of 5 US FDA-approved AOMs according to standard practice. Linear mixed effect models were conducted for analysis.

Results: A total of 74 participants were randomized (24 OCA+AOM, 26 OCA, and 24 UC). Participants were predominantly female (59%), median age 53.5 (47, 60) years, 68% Caucasian, with baseline median BMI and HbA1c of 37.4 (34.2, 42.7) and 8.8% (7.9, 10.4), respectively. At 1 year, patients that received UC, OCA alone, and OCA + AOM had their mean % weight change (90% confidence interval, CI) by -4.48% (-6.52 to -2.45), -6.68% (-8.71 to -4.65), and -8.74% (-10.64 to -6.74) and mean HbA1c change (90% CI) by -1.65% (-2.09 to -1.22), -2.22% (-2.65 to -1.79), and -2.18% (-2.61 to -1.74), respectively. Only OCA + AOM treatment was found to be non-inferior (P=0.004) to UC approach in weight loss change. OCA + AOM treatment was also found to be superior to UC approach in weight loss change (P=0.022). OCA+AOM and OCA alone were non-inferior to usual-care in HbA1c change (P <0.05), but neither was superior (P>0.05).

Conclusion: An OCA +AOM approach to T2D treatment was associated with additional weight loss with non-inferior A1C reductions vs. UC. Larger long-term studies evaluating obesity-focused approaches to T2D management are needed.

Disclosure

K.M.Pantalone: Consultant; AstraZeneca, Bayer Inc., Corcept Therapeutics, Diasome, Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk, Sanofi, Research Support; Bayer Inc., Merck & Co., Inc., Novo Nordisk, Twin Health, Speaker's Bureau; AstraZeneca, Corcept Therapeutics, Merck & Co., Inc., Novo Nordisk. B.Rogen: None. J.F.Bena: None. H.Xiao: None. G.Barnard: None. E.Borukh: None. S.Peechakara: None. M.L.Griebeler: None. B.Burguera: Research Support; Novo Nordisk.
1396-P: Prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) and Advanced Fibrosis among Subjects without Type 2 Diabetes (T2D)
Authors: GOLABI PEGAH , PAIK JAMES M. , KUMAR AMEETA , GUNDURAO NAGASHREE , CUSI KENNETH , YOUNOSSI ZOBAIR
Published: June 2023

Background: NAFLD is highly prevalent in patients with T2D. The prevalence of NAFLD in nondiabetics (ND) is not known.

Aim: Assess the prevalence of NAFLD in ND subjects in the US.

Methods: Data from NHANES 2017-2020 were used. NAFLD was determined by transient elastography with a CAP of ≥285 dB/m without other causes of liver disease. Significant fibrosis (SF) definition was liver stiffness measurement (LSM) >8.0 kPa and advanced fibrosis (AF) definition was LSM>13.1 kPa. Prediabetes (Pre-D) definition was fasting glucose of 100-125 mg/dL or HbA1c of 5.7%-6.5% in T2D absence. ND definition was not having T2D or Pre-D.

Results: Among 5,142 patients (mean age 51.5 years, 19.4% T2D, 35.2% Pre-D and 45.4% ND). The prevalence of NAFLD among T2D, Pre-D and ND was 67.7%, 40.0% and 24.6%. As compared to Pre-D and T2D, ND patients were younger (45.6 years vs 53.4 and 62.2 years), more likely to be female (51.4% vs 43.9% and 45.3%) and less metabolically unhealthy [hypertension: 39.7% vs 56.9% and 83.9%, hyperlipidemia: 63.6%, 73.3%, and 89.0% and HOMA-IR > 2.5: 26.5%, 54.8%, and 84.9% (all p<.001)]. The prevalence of SF and AF among NAFLD with ND, Pre-D and T2D were 17.1% and 4.9%, 16.0% and 6.2%, and 32.4% and 11.8%, respectively. Factors associated with higher risk of AF varied by T2D status (Table).

Conclusions: NAFLD can occur in nondiabetics and associated with insulin resistance and elevated CRP.

Disclosure

P. Golabi: None. J.M. Paik: None. A. Kumar: None. N. Gundurao: None. K. Cusi: Research Support; Echosens, Inventiva. Consultant; Poxel SA. Research Support; LabCorp, Zydus. Consultant; Altimmune, Arrowhead Pharmaceuticals, Inc., AstraZeneca, 89bio, Inc., Bristol-Myers Squibb Company, Lilly, Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Medscape, Myovant, Novo Nordisk, ProSciento, Quest Diagnostics, Sagimet, Sonic Incytes, Terns. Z. Younossi: Consultant; AbbVie Inc., BMS, Gilead Sciences, Inc., Novo Nordisk, Merck & Co., Inc., Quest Diagnostics, Siemens, Intercept Pharmaceuticals, Inc., Viking Therapeutics.
1403-P: Agent Orange Exposure and Type 2 Diabetes in Korean Veterans—An Epigenetic Association Study
Authors: HYUN SEO JE , AN KIM YE
Published: June 2023

Objective: There has been contradictory evidence about the relationship between Agent Orange (AO) exposure and type 2 diabetes. By combining DNA methylation and DNA genotyping analysis, we intended to determine if AO exposure is related with the development of type 2 diabetes and to confirm the causal association between AO exposure and type 2 diabetes.

Research Designs and Methods: An epigenome-wide association analysis and DNA genotyping analyses were done on the blood of AO-exposed and AO-unexposed type 2 diabetes patients and healthy controls. To assess the causal influence of AO-exposure-identified CpGs on type 2 diabetes, methylation quantitative trait locus (meQTL) and Mendelian randomization (MR) studies were used. The risk of type 2 diabetes was compared between subgroups using polygenic risk score (PRS).

Results: Hypermethylated CpG sites (cg20075319, cg21757266, cg05203217, cg20102280, cg26081717, and cg21878650) and one hypomethylated CpG site (cg07553761) were linked to type 2 diabetes in AO-exposed individuals. Methylation levels at some CpG sites (cg20075319, cg20102280, and cg2608171) were considerably different, according to meQTL analyses. CpG sites discovered in AO-exposed patients were causally linked to type 2 diabetes, according to MR analysis; The impact of the reverse causality was insignificant. A PRS analysis revealed no discernible difference in the risk of type 2 diabetes between AO-exposed and AO-unexposed groups.

Conclusions: We validated a causal relationship between AO exposure and type 2 diabetes by identifying distinct epigenetic markers between AO-exposed and AO-unexposed patients with type 2 diabetes. These results highlight the need for more epigenetic research on the link between type 2 diabetes and AO exposure.

Disclosure

J.Seo: None. Y.Kim: None.

Funding

National Research Foundation of Korea (2022R1C1C1002929); Veterans Health Service Medical Center (VHSMC19033); National Institutes of Health; Centers for Disease Control and Prevention (2019-NG-053-02, 2022-NI-067-00)
1418-P: Identification and Follow-up of T2D by Subtypes and Their Cardiovascular Risk in Mexican Population—The Experience of the MIDO State Registry in Guanajuato
Authors: GALLARDO-RINCÓN HECTOR , MONTOYA ALEJANDRA , MORALES-JUAREZ LINDA , RIOS-BLANCAS MARIA J. , ÁLVAREZ-HERNÁNDEZ DIEGO-ABELARDO , ALBERTO MARTINEZ-JUAREZ LUIS , ALBERTO DIAZ-MARTÍNEZ DANIEL , JAVIER MAGOS-VAZQUEZ FRANCISCO , OSWALDO VARGAS EDWIN , TAPIA-CONYER ROBERTO
Published: June 2023

Type 2 diabetes (T2D) is a complex and heterogeneous disease that has been categorized based on its underlying physiological mechanisms to inform treatment strategies. However, patients with T2D often exhibit a wide range of phenotypic and metabolic profiles, and the subclassification of this disease has only recently been developed, enabling the possibility of personalized management and improved outcomes. The aim of this research was to identify and follow-up T2D subtypes and their cardiovascular risk (CVR) in the Mexican population. In this study, 14,124 patients with incident T2D were assessed to characterize their phenotypic and metabolic profiles and to identify their CVR as part of the MIDO State Registry in Guanajuato, Mexico between April 2014, and April 2022. Of the 14,124 patients with incident T2D, when clustered into subtypes according to their phenotypic and metabolic profile, 3,530 (24.9%) belonged to the mild age-related diabetes (MARD) subtype, 4,304 (30.5%) to the mild obesity-related diabetes (MOD), 3,180 (22.1%) to the severe autoimmune diabetes (SIRD), and 3,111 (11.5%) to the severe insulin-resistant diabetes (SIDD). When the CVR was assessed, 1,767 (50.1%) individuals had a medium CVR and 1,763 (49.9%) had a high CVR in the MARD, 3,313 (76.9%) had a medium CVR and 990 (23.1%) had a high CVR in the MOD, 1,699 (54.6%) had a medium CVR and 1,733 (45.4%) had a high CVR in the SIRD, and 2,290 (72.0%) had a medium CVR and 890 (27.9%) had a high CVR in the SIDD. Of the 13,192 patients that were followed for 6 months, up to 61.0% of the MARD, 61.4% of the MOD, 61.2% of the SIRD, and 40.9% of the SIDD achieved metabolic control (HbA1c <7%). Classifying the subtypes of T2D allows for the design of personalized treatment strategies aiming to delay the progression of the disease and prevent cardiovascular complications. In Mexico, this is a novel approach that seeks to improve the overall outcomes of patients with incident T2D.

Disclosure

H.Gallardo-rincón: None. R.Tapia-conyer: None. A.Montoya: None. L.Morales-juarez: None. M.J.Rios-blancas: None. D.Álvarez-hernández: None. L.Martinez-juarez: None. D.Diaz-martínez: None. F.Magos-vazquez: None. E.Vargas: None.
1427-P: Glycemic Trend in Metropolitan vs. Nonmetropolitan Cities of India—Three-Year Follow-up Results of LANDMARC
Authors: GOPALAKRISHNAN UNNIKRISHNAN AMBIKA , DAS ASHOK K. , JOSHI SHASHANK R. , MITHAL AMBRISH , KALRA SANJAY , PRASANNA KUMAR K.M. , THACKER HEMANT , SETHI BIPIN , CHOWDHURY SUBHANKAR , SUGUMARAN AMARNATH , SATPATHY ASHWINI , GADEKAR ARVIND , MENON SHALINI K. , NEOGI RENUKA , CHODANKAR DEEPA , TRIVEDI CHIRAG , KUMAR WANGNOO SUBHASH , ZARGAR ABDUL H. , RAIS NADEEM
Published: June 2023

Glycemic trends in type 2 diabetes (T2D) participants from Indian metropolitan and non-metropolitan cities have been less studied and hence, were evaluated in the LANDMARC trial (a 3-year nationwide prospective observational study; CTRI/2017/05/008452). A total of 5273 of 6222 evaluable participants with T2D taking ≥2 antihyperglycemic medications (with/without glycemic control) completed the 3-year follow-up visit. Age, T2D duration, and baseline A1C were comparable across participants from metropolitan and non-metropolitan cities. At 3-years, a decrease in all glycemic parameters was noted. FPG levels from baseline improved more in participants from metropolitan than non-metropolitan cities (mean [95% CI]: −21.6 mg/dL [−25.2, −18.0] vs. −15.8 mg/dL [−18.8, −12.8]; p=0.0149). No significant difference in change from baseline between metropolitan and non-metropolitan cities was noted for A1C (p=0.2070) and PPG (p=0.3592) (Table). Almost one third of the participants in metropolitan (492/1534 [32.07%]) and non-metropolitan (864/2166 [39.89%]) cities achieved glycemic control (A1C <7%). Overall, participants from both metropolitan and non-metropolitan cities showed marked improvement in all glycemic parameters from baseline to the end of 3 years. These results help compare the longitudinal glycemic patterns among participants with T2D in cities across India.

Disclosure

A.Unnikrishnan: Speaker's Bureau; Sanofi, AstraZeneca, Boehringer-Ingelheim, Intas Pharmaceuticals Ltd. A.Sugumaran: Employee; Sanofi. A.Satpathy: Employee; Sanofi. A.Gadekar: Employee; Sanofi. S.K.Menon: Employee; Sanofi. R.Neogi: Employee; Sanofi. D.Chodankar: Employee; Sanofi. C.Trivedi: None. S.Wangnoo: None. A.H.Zargar: None. N.Rais: Advisory Panel; Bayer Consumer Care AG, Board Member; Abbott, Biocon. A.K.Das: n/a. S.R.Joshi: Advisory Panel; Biocon, Zydus Cadila, Torrent Pharmaceuticals Ltd, Franco India, Consultant; Glenmark Pharmaceuticals, Twin Health, Speaker's Bureau; Abbott Nutrition, Sanofi, Abbott, Novo Nordisk, Lupin Pharmaceuticals, Inc. A.Mithal: Advisory Panel; Eris Lifesciences Ltd., Consultant; Glenmark Pharmaceuticals, Lupin Pharmaceuticals, Inc., USV Private Limited, Research Support; Sanofi, Speaker's Bureau; Novo Nordisk, Boehringer-Ingelheim, AstraZeneca, Sun Pharmaceutical Industries Ltd., Novartis. S.Kalra: Speaker's Bureau; Abbott, Bayer Inc., Novo Nordisk, Sanofi. K.Kumar: None. H.Thacker: None. B.Sethi: None. S.Chowdhury: None.

Funding

Sanofi India
1432-P: Lipid Profile and Visit-to-Visit Variability of LDL Cholesterol, the Association with Risk of Young-Onset Type 2 Diabetes—Nationwide Retrospective Cohort Study
Authors: HAE SEO MI , EUN PARK SE , RHEE EUN-JUNG , LEE WON-YOUNG
Published: June 2023

Background: It is reported that the prevalence of young-onset type 2 diabetes (YOD) is increasing in recent. YOD usually defined that it diagnosis at age <40 year. However, the underlying pathophysiology of YOD is still unknown. Previous studies suggested that lipid level and its variability associated with various health outcome.

Aim: We aimed to examine the effect of lipid profile and variability of low-density lipoprotein cholesterol (LDL-C) on the risk of young-onset type 2 diabetes in Participants with 20 to 40 Years

Methods: We examined the General Health Check-up sub-dataset of the Korean National Health Insurance Service (NHIS) of 1,376,416 participants with 20 to 40 year who had at least three health check-ups between 2012 and 2017, and were not reported to have diabetes during that time. The visit to visit variability of LDL-C was measured using variability independent of the mean (VIM), standard deviation (SD), average successive variability (ASV), and coefficient of variation (CV),.

Results: During a median of 5 years of follow up, 19,706 subjects (1.5%) developed YOD. Risk of incident YOD increased with quartiles 2, 3 and 4 versus quartile 1 in Total cholesterol (TC), LDL-C, triglyceride (TC) whereas, inversely associated with high density lipoprotein cholesterol (HDL-C) in multivariate analysis. Compare with the lowest quartile, the highest quartile of VIM, SD, ASV and CV of LDL-C was associated with 1.22-1.43 fold risk of YOD (VIM HR, 1.292; SD HR 1.428; ASV HR 1.364; CV HR 1.218, P for trend <0.0001) in the multivariable adjusted model. When calculating variability of TC, LDL and HDL-C index, we did not observe that consistent results were obtained.

Conclusion: Risk of incident YOD is increased with increasing lipid profile. High visit to visit LDL-C variability and level of LDL-C per se, were independent predictors of YOD. Both lowering and stabilizing LDL-C can be beneficial for reducing diabetes risk in young population.

Disclosure

M.Seo: None. S.Park: None. E.Rhee: None. W.Lee: None.
1442-P: Composite Scores Using Fasting and Stimulated C-Peptide Are Equivalent and Can Track Beta-Cell Function in New-Onset Type 1 Diabetes
Authors: CARR ALICE , COLLINS KIMBERLY S. , KARPEN STEPHEN , ATABAKHSH ELNAZ , LAM ANNA , TAYLOR PETER , DAYAN COLIN , SENIOR PETER A.
Published: June 2023

Composite scores using fasting samples have been developed to routinely monitor beta cell mass after islet transplantation in type 1 diabetes (T1D). They may also have utility in new onset or T1D prevention trials as an alternative to mixed meal tolerance tests measuring AUC C-peptide. We examined if a composite score using stimulated C-peptide was equivalent to fasting C-peptide in estimating beta cell mass in new onset T1D and reflected changes in AUC C-peptide over time. BETA-2 (fasting C-peptide, glucose, insulin dose, HbA1c) and BETA-2stim (using C-peptide AUC) were calculated in 1312 individuals from the TOMI dataset (median (IQR) age 16y (12, 24); 42% F). The dataset comprises 3200 participants within 100 days of diagnosis across 22 studies. Studies meeting their primary end point were deemed positive. BETA-2 and BETA-2stim were strongly correlated (R2=0.96, p<0.0001) and showed good agreement using Bland-Altman plots. Both BETA-2 and BETA-2stim showed changes over time which mirrored those for AUC C-peptide, but both composite scores showed differences between active and control participants in positive studies by 3 months while differences in AUC C-peptide were not seen until 6 months (Fig1). Composite scores using fasting C-peptide may provide a simple, sensitive and practical tool to monitor beta cell mass without complex stimulation tests in new onset diabetes.

Disclosure

A.Carr: None. K.S.Collins: None. S.Karpen: None. E.Atabakhsh: None. A.Lam: None. P.Taylor: None. C.Dayan: Advisory Panel; AstraZeneca, Consultant; Provention Bio, Sanofi, Avotres Inc., Other Relationship; Dompé, Merck & Co., Inc. P.A.Senior: Advisory Panel; Novo Nordisk Canada Inc., Consultant; Novo Nordisk Canada Inc., Bayer Inc., Viatris Inc., Vertex Pharmaceuticals Incorporated, ViaCyte, Inc., Insulet Corporation.
1445-P: A Glucose Fraction Independent of Insulin Secretion in Autoantibody Positive (Ab+) Individuals
Authors: SOSENKO JAY , CUTHBERTSON DAVID D. , REDONDO MARIA J. , ISMAIL HEBA M. , SIMS EMILY K. , JACOBSEN LAURA M. , NATHAN BRANDON M.
Published: June 2023

Among Ab+ individuals, reports suggest glucose is atypically associated with other T1D risk factors, such as a positive association with C-peptide. Using baseline OGTT data from 6,589 Ab+ TrialNet Pathway to Prevention participants, we hypothesized this finding is explained by a glucose fraction unrelated to insulin secretion. Index60 (fasting C-peptide, 60-min AUC glucose and C-peptide) was used as an insulin secretion proxy in regression [AUC Glucose=131.0+(8.9*Index60)] to quantify two AUC glucose fractions, each present to a degree in all individuals: one dependent on insulin secretion (DEP); the other independent (INDEP). DEP equaled predicted AUC glucose; INDEP equaled actual AUC glucose - predicted AUC glucose. The phenotype of the top DEP quartile was more typical for T1D than the top INDEP quartile (Table). INDEP correlated positively with AUC C-peptide [r=0.54 (p<0.001), 29% of AUC C-peptide variance.] With C-peptide index [(30-0 min C-peptide) / (30-0 min glucose)] as the insulin secretion proxy, findings were similar. In conclusion, Ab+ individuals with high proportions of INDEP have less typical features of T1D. The INDEP AUC glucose fraction’s positive correlation with AUC C-peptide, accounting for appreciable AUC C-peptide variance, suggests that INDEP is related to insulin resistance. Those with a higher proportion of INDEP may represent an atypical subset of the at-risk population.

Disclosure

J.Sosenko: None. D.D.Cuthbertson: None. M.J.Redondo: None. H.M.Ismail: Consultant; Rise Therapeutics. E.K.Sims: Speaker's Bureau; Medscape, American Diabetes Association. L.M.Jacobsen: None. B.M.Nathan: None.
1454-P: Food Insecurity in People with Type 1 Diabetes and Glycemic Outcomes
Authors: OSPELT EMMA L. , NOOR NUDRAT , SONYA HAW JEEHEA , HSIEH SUSAN , WEINSTOCK RUTH S. , HANSEN DAVID W. , COSSEN KRISTINA , FANTASIA KATHRYN , GUTTMANN-BAUMAN INES , RAMAN VANDANA , SEYOUM BERHANE , EBEKOZIEN OSAGIE
Published: June 2023

Background: This multi-center study aims to explore relationships between individuals with type 1 diabetes (T1D) who are at risk for food insecurity and glycemic outcomes.

Methods: Electronic health record data from T1D Exchange Quality Improvement Collaborative (T1DX-QI) categorized completed Hunger Vital Signs (HVS) questionnaires into at risk and no risk for food insecurity. At-risk individuals were defined as selecting “often true” or “sometimes true” to screening questions, whereas primary outcome was recent A1c levels. Demographic information and diabetes related covariates were assessed for potential relationships.

Results: In the total T1D cohort (N=4453), 3.8% were at risk for food insecurity. Stratifying by age, 6% of youth (<18 years) and 5% of adults (>18 years) were at risk. Statistically significant differences were observed among food insecurity risk and insurance type. Of those at risk, 54% had public insurance compared with 7% private. Individuals at risk had a higher mean HbA1c when compared with individuals not at risk (9.4% vs 8.5% respectively, p<.001). The odds of an individual having an HbA1c >7% were higher in the group at risk relative to the group not at risk OR1.4 (95% CI 0.9, 2.1).

Conclusion: Individuals in this population who were at risk for food insecurity also had elevated A1c levels. Interventions are needed to identify effective ways of improving food insecurity among people with T1D.

Disclosure

E.L.Ospelt: None. V.Raman: None. B.Seyoum: None. O.Ebekozien: Advisory Panel; Medtronic, Research Support; Eli Lilly and Company, Dexcom, Inc. N.Noor: None. J.Haw: None. S.Hsieh: None. R.S.Weinstock: Consultant; Jaeb Center for Health Research, Other Relationship; Wolters Kluwer Health, Research Support; Insulet Corporation, Medtronic, Eli Lilly and Company, Novo Nordisk, Boehringer Ingelheim Inc., Hemsley Charitable Trust, National Institute of Diabetes and Digestive and Kidney Diseases, Tandem Diabetes Care, Inc., Kowa Pharmaceuticals America, Inc. D.W.Hansen: Research Support; 3Boehringer Ingelheim Canada Ltd./Ltée, Lilly, Insulet Corporation, T1D Exchange, Medtronic. K.Cossen: None. K.Fantasia: None. I.Guttmann-bauman: None.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
146-LB: Impact of a Digital Health Educational Feature on Engagement and Glycemic Outcomes
Authors: HERSHCOVITZ YIFAT , GUREWITZ AMIR , MANEJWALA OMAR
Published: June 2023

Introduction: Digital health educational features have the potential to improve engagement and glycemic outcomes in individuals with diabetes by providing improved knowledge, increased motivation, and personalized learning. Engagement actions are well evaluated by digital monitoring or by logging iterations, and clinical outcomes by target range measurements. A new learning feature in the Dario application included educational videos and learning materials including healthy eating habits, activity, and stress relief. This study evaluated the effect of implementing such a feature on users’ engagement and clinical outcomes.

Method: A retrospective data evaluation study was performed on Dario TM members who experienced the educational feature. Engagement (blood glucose measurements and logging food to Dario app) and glycemic outcomes were assessed three months pre-post experiencing the feature.

Results: A group of 994 people with type 2 and prediabetes who were active in the app and measured their blood glucose 3 months before using the new feature and in the following 3 months after, was evaluated. The average number of measurements was increased by 34% (P<0.05) following the introduction of the new learning feature. A subgroup of 303 users that reported depression as a co-existing condition increased food logging events by 39%. In a subgroup of 234 high-risk users (baseline >180 mg/dL) the average blood glucose and glucose variability were significantly reduced by 13% and 11% on average, respectively (p<0.05).

Conclusion: The present study demonstrates that by providing improved knowledge, increased motivation, and personalized learning digital health educational features can help users feel more empowered to manage their diabetes effectively.

Disclosure

Y. Hershcovitz: Employee; DarioHealth Corp. A. Gurewitz: None. O. Manejwala: Employee; DarioHealth Corp. Stock/Shareholder; DarioHealth Corp.