bluuebunny/crossref_metadata_2025 huggingface dataset:
701-P: Predictors of Engagement and Weight Loss in Real-World Diabetes Prevention Program (DPP)
Authors: AUYOUNG MONA , LUU KIMBERLY , RUIZ MONICA , WALKER CHRIS , PHILIS-TSIMIKAS ATHENA , FORTMANN ADDIE L.
Published: June 2019

Weight loss can significantly reduce an individual’s risk for T2D. However, it can be challenging to engage participants in the DPP long enough to lose weight. This analysis examines sociodemographic characteristics and health behaviors as predictors of participant engagement and weight loss/gain. Participants were recruited into the DPP through a referral from a provider, family/friend, or other. Classes were conducted through local ambulatory clinics and community settings in San Diego, CA. Baseline self-report surveys were administered prior to program start, and weight was assessed at every session. Participants (N=290) were mostly female (81%) with a mean age of 57 (±14), diverse [51% Hispanic, 9% Asian/Native Hawaiian or Pacific Islander (ANHPI), 4% Other], and reported household incomes <$24,000 (77%). Regression models also controlled for age, baseline BMI, education, and employment. Baseline healthful eating was a significant predictor of DPP engagement; each 1-point increase on the Towsend Food Behavior Checklist was associated with an average of 0.25 fewer sessions (p=0.016) attended (out of 34 possible sessions). Participants of Other race/ethnicity averaged significantly fewer sessions (11.5±8.5) than whites (17.40±8.6, p=0.004), Hispanics (17.36±7.7, p=0.009), and ANHPIs (16.16±8.9, p=0.01). There were significant differences in weight loss for men (-8.07±9.5) vs. women (-6.30±9.4, p=0.04) and for retirees (-6.50±7.59) vs. the employed (-8.14±10.87, p=0.023) and self-employed (-5.48 ±10.64, p=0.04), and retirees. Participants with healthier eating behaviors may not feel the need to attend as many sessions as others, although the difference in attendance is relatively small. The racial/ethnic differences in engagement should be interpreted with caution since there may be differences within the different racial/ethnic groups in this category. The weight loss differences by work status suggest more tailored approaches and strategies to lifestyle management.

Disclosure

M. AuYoung: None. K. Luu: None. M. Ruiz: None. C. Walker: None. A. Philis-Tsimikas: Advisory Panel; Self; AstraZeneca, Lilly Diabetes, Novo Nordisk A/S, Sanofi. Employee; Spouse/Partner; Ionis Pharmaceuticals, Inc. Research Support; Self; Dexcom, Inc., Glooko, Inc., National Institute of Diabetes and Digestive and Kidney Diseases. Stock/Shareholder; Spouse/Partner; Ionis Pharmaceuticals, Inc., Novo Nordisk Inc. A.L. Fortmann: None.
707-P: Diabetes Education through Shared Medical Appointment: Utilizing Digital Health—A Comparison of Platforms and Integrating Devices with Result Review
Authors: FAIMAN MATTHEW , HUSTAK LEIGHANNE KRAMER , MAGGIORE ANNE J. , SUMEGO MARIANNE
Published: June 2019

Chronic disease management is over whelming the Unites States Healthcare System. Often the barriers to care in chronic disease include limited access, inadequately trained caregivers, travel costs, lack of real time data, and the limitations of office time for education. The novel use of digital health seeks to optimize care and address many of the social barriers to quality care. At the same time, the new requirements of health care regulation in the United States, challenge health care organizations to improve population management. The Distance Health team and Shared Medical Appointment (SMA) team, in an effort to positively affect population management of type 2 diabetics across practices, developed a work effort to compare two telehealth platforms for the delivery of group education and medication management. The utilization of smart devices for real time data collection in the management of diabetes and associated chronic diseases was also implemented. The team sought to compare the American Well platform with the TruClinic platform for delivery of group education translating traditional SMA in office visits to virtual delivery engaging multiple patients. The participants were identified through care gap registries, internal medicine provider referrals for diabetes education and patient self-referral. The patients were randomly assigned. A family nurse practitioner with CDE certification followed and engaged the patients monthly in SMA education sessions through one of the digital platforms, over a 4 month period using change in A1C and qualitative patient satisfaction data to review SMA engagement, improved disease state and platform usability. The process from patient identification, digital consent, appointment invitation, and qualitative data review of provider satisfaction, patient engagement, and A1C improvement is described in detail comparing the two platforms’ usability.

Disclosure

M. Faiman: None. L.K. Hustak: None. A.J. Maggiore: None. M. Sumego: None.
717-P: Effect of Telephone Coaching Support on Glycemic Control in Type 2 Diabetes Treated with Glargine U300 Insulin
Authors: GUERRERO DIEGO BELLIDO , BELLIDO VIRGINIA , MORALES CRISTOBAL , GARCÍA JOSÉ , MUÑOZ-GARACH ARACELI , FERNANDEZ MORERA JUAN LUIS , AGUILERA BEATRIZ GONZALEZ , LÓPEZ DE LA TORRE MARTÍN , FUENTEALBA PAULINA
Published: June 2019

Background and Aims: “T-Coach® program” is a telephone support platform for type 2 diabetes (T2D) on glargine U300 insulin. This study aimed to evaluate whether this program was effective in helping patients reach their optimal insulin dose.

Materials and Methods: Both T2D patients who were initiating glargine U300 or requiring dose titration, enrolled in T-Coach® program, were included in the study. Telephone intervention was delivered by diabetes nurse educators and consisted of regular telephone sessions, aimed at achievement of target fasting blood glucose (FBG) and reinforce diabetes education. The optimal insulin dose (OID) was defined as the dose of Glargine U300 required to achieve target FBG. The primary outcome was whether a patient reached the OID dose within 6 months.

Results: A total of 589 patients consented and were included in TCoach program®. Median age was 65.4±11.2 years; 51.8% men; BMI 30.3±6 kg/m2. Of them, 65.9% were already on basal insulin (17.7% on Glargine U300). Mean glargine U300 dose was 27.4±15.9 UI. Mean baseline HbA1c was 9.4±1.8%, and basal FBG was 215.2±66.2 mg/dL. Mean FBG target was 88.7-132.3 mg/dl. Of them, 77.6% reached their OID at 6 months (75.7% at 3 months, and 41.2% at 1 month), and they did so in an average of 2.2±1.8 months. Mean FBG levels fell from 215.2 mg/dL to 137.9 mg/dL, 117.9 mg/dL and 115.9 mg/dL at months 1,3 and 6, respectively. Mean glargine U300 dose increased from 27.4 UI to 30.4 UI at month 6. Knowledge and adherence questionnaires were given to the patients. Mean score in knowledge questionnaire increased from 4.8 to 7.6 after the program. Moreover, a satisfaction survey was completed by 208 patients. The program was very well graded, with an average score of 9.1 out of 10.

Conclusion: The T-Coach® program is an effective way to help patients reach their optimal insulin glargine U300 dose, improves glycemic control and can be an effective support for diabetes education.

Disclosure

D. Bellido Guerrero: None. V. Bellido: None. C. Morales: Other Relationship; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. J. García: None. A. Muñoz-Garach: Speaker's Bureau; Self; Lilly Diabetes, Novo Nordisk A/S, Sanofi-Aventis. J.L. Fernandez Morera: None. B. Gonzalez Aguilera: None. M. López de la Torre: None. P. Fuentealba: Employee; Self; Sanofi.
728-P: Accuracy of Energy Expenditure Measurements by Activity Monitors in Type 1 Diabetes and Control Subjects
Authors: POONI RUBIN , MCGAUGH SARAH , PATEL RIDDHI , RIDDELL MICHAEL
Published: June 2019

Physical activity monitors have become increasingly popular in recent years and researchers have started integrating these devices into artificial pancreas (AP) systems to improve the management of T1D. The accuracy of these devices at measuring energy expenditure (EE) may be important for the function of AP systems. Most research to date has determined the accuracy of activity monitors during steady state aerobic exercise in healthy individuals. In this study, the accuracy of the Fitbit Ionic and Garmin vívosmart 3 at measuring EE was assessed against indirect calorimetry (Cosmed K5) during 5 forms of non-steady state activities in individuals with and without T1D. Fourteen adults (Age: 25.8 ± 8.1 year; BMI: 24.1 ± 3.4 kg/m2; 8 T1D) performed a VO2 peak test, resistance exercise, activities of daily living, and high-intensity interval training on treadmill and cycle ergometer, while wearing a Fitbit and Garmin watch. A significant difference in accuracy was displayed by Garmin between individuals with T1D and healthy controls (T1D: 22.6 ± 35.4%; Control: -15.6 ± 24.0%, P<0.0001), but no such difference was exhibited by Fitbit (T1D: 13.5 ± 35.8%; Control: 19.5 ± 37.0%) (Figure).

In summary, the Garmin vívosmart 3 overestimates EE during physical activity in individuals with T1D as compared to healthy controls. This difference may need to be addressed before integrating these devices into AP systems.

Disclosure

R. Pooni: None. S. McGaugh: None. R. Patel: None. M. Riddell: Advisory Panel; Self; Xeris Pharmaceuticals, Inc. Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc., Insulet Corporation, Novo Nordisk Inc., Sanofi. Speaker's Bureau; Self; Medtronic MiniMed, Inc., OmniPod. Stock/Shareholder; Self; Zucara Therapeutics Inc.
729-P: Post-Breakfast Physical Activity Is Most Optimal for Improving Postprandial Glycemic Control in Healthy Adults
Authors: SOLOMON THOMAS P. , TARRY ELOISE , HUDSON CHLOE O. , FITT ALICE I. , LAYE MATTHEW
Published: June 2019

Purposeful and deliberate exercise improves postprandial glucose control. However, there is less information concerning the effects of simple physical activities (standing, walking, circuit exercise) that can easily be integrated into a person’s day. Furthermore, the optimal timing between such an activity and a meal that elicits the most optimal glucose control is completely unknown. Three groups of 16 healthy adults volunteered to participate in three separate interventions: Stand (30-minutes standing still; RPE = 6±1), Walk (30-min treadmill walk at a self-selected brisk pace; RPE = 11±2, 5.6±0.8 kph), and Circuit (three sets of 10 squats, 10 push-ups, 10 lunges, 10 sit-ups; RPE = 11±2, 7.1±1.8 minutes to complete). In each intervention, participants completed four trials during which they drank a mixed-nutrient breakfast shake containing 500 kcals. Interstitial glucose responses were measured by continuous glucose monitoring (Dexcom G5). Postprandial glucose tolerance was quantified during the 2-hours period after meal ingestion. In each trial, the physical activity was completed either 2-hours after (trial A; control), immediately before (trial B), immediate after (trial C), or 30-minutes after (trial D) the meal. While trials B and D showed some improvement in postprandial glucose control compared to trial A, this was not statistically significant. Trial C, however, showed a significant improvement in mean glucose, standard deviation for glucose, and the area under the glucose curve in all three interventions (P<0.05), when compared to trial A. Energy intake (diet records) and energy expenditure (Actigraph) were consistent throughout the studies and did not influence the findings.

In conclusion, low to moderate-intensity physical activity (either standing, walking, or body-weight circuit exercise) is best implemented soon after a meal to induce the greatest improvement in blood glucose control, in young healthy adults.

Disclosure

T.P. Solomon: None. E. Tarry: None. C.O. Hudson: None. A.I. Fitt: None. M. Laye: None.

Funding

Physiological Society
732-P: Insulin Sensitivity Nonresponders after Long-Term Intensive Exercise Training Are Characterized by Perturbed Amino Acid Metabolism and Mitochondrial Dysfunction
Authors: LEE SINDRE , GULSETH HANNE L. , DREVON CHRISTIAN A. , BIRKELAND KARE I.
Published: June 2019

Exercise may effectively improve insulin sensitivity, although some individuals do not reap this benefit. Yet, mechanisms underlying variations in training-improved insulin sensitivity remain unknown. We investigated men with or without dysglycemia subjected to 12 w of high-intensity endurance and strength exercise, and classified them as nonresponders (n=5) or responders (n=21) based on glucose infusion rate (GIR) from euglycemic hyperinsulinemic clamping. We explored variables related to variation in training-improved GIR. VO2max, muscle strength, fat depots, adipose tissue (AT) and skeletal muscle (SkM) lipidomics, mRNA sequencing, and blood amino acid profiles were evaluated pre- and post-training. By design, nonresponders did not improve their GIR, whereas responders exhibited a pronounced increase (42%). There was no difference in attendance to training sessions between the groups, or any correlation between attendance rate and training-improved GIR. Both groups improved VO2max, leg press, pull down and chest press strength, but responders increased significantly more in VO2max and chest press strength. Nonresponders exhibited higher baseline plasma concentrations of leucine, isoleucine, valine, homocysteine and cysteine, more intraperitoneal AT and impaired insulin signaling, branched-chain amino acids and methionine and cysteine metabolism in AT, and higher SkM triacylglycerol, free fatty acids and cholesterol levels and impaired SkM oxidative phosphorylation, branched-chain amino acids degradation and tricarboxylic acid cycle. Failing to improve insulin sensitivity after long-term intensive training may relate to perturbed amino acids metabolism and mitochondrial dysfunction. Initial plasma levels of branched-chain and sulphur amino acids may determine individuals not obtaining glucometabolic improvements after training.

Disclosure

S. Lee: None. H.L. Gulseth: Consultant; Self; Novo Nordisk A/S. Speaker’s Bureau; Self; Merck Sharp & Dohme Corp., Sanofi-Aventis. C.A. Drevon: Board Member; Self; Vitas AS. Consultant; Self; Vitas AS. K.I. Birkeland: Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lifecare, Inc., Merck Sharp & Dohme Corp., Roche Diabetes Care. Other Relationship; Self; Norwegian Diabetes Association.
745-P: Lipidomics Studies on Brown Adipose Tissue by Exercise and Liraglutide in db/db Mice
Authors: YIN RUILI , ZHANG NING , ZHAO DONG
Published: June 2019

Background: Brown adipose tissue (BAT) is characterized by regulating whole body energy expenditure, mediating glucose and lipid metabolism. Exercise is one of the favorable lifestyle interventions in against hyperglycemia, and liraglutide is also an ideal therapy in decreasing blood glucose into the normal range and regulating lipid metabolism. But how and whether exercise and liraglutide have an effect on BAT for mediating glucose metabolism are unknown.

Method: Male leptin receptor deficient db/db and age-matched C57BL/6 control mice were used at 6 weeks of age, db/db mice were subjected either to sedentary or exercise training (run on the treadmill, 5.2 m/minutes, 5 days per week) with or without liraglutide (200 ug/kg, twice one day, subcutaneous injection) for 8 weeks. Mice were monitored weekly for blood glucose and body weight. For glucose test, mice were fasted for 8 hours and blood glucose were collected at 0, 15, 30, 60, 90, and 120 minutes. Plasma were collected in heparinized tubes for insulin, triglyceride and cholesterol analysis, then BAT were collected for targeted lipidomics studies (including phosphatidylcholines, phosphatidyl ethanolamine, ceramides and sphingolipids) in a surveyor HPLC system (HPLC-MS/MS).

Results: Moderate exercise training and liraglutide treatment significantly lowered blood glucose in db/db mice, only exercise + liraglutide group showed down-regulated triglyceride level. BAT targeted lipidomics results showed that 7 Lysophosphatidyl choline, 4 phosphatidylcholines and 1 sphingolipids fatty acids did not expression in db/db mice than control. Surprisingly, compared with db/db mice, exercise training and liraglutide did not significantly change in any fatty acid expressions.

Conclusions: In this study, exercise training and liraglutide treatment exert a significant role in lowering blood glucose, but they may have no effective regulation of fatty acids metabolism on BAT.

Disclosure

R. Yin: None. N. Zhang: None. D. Zhao: None.

Funding

National Natural Science Foundation of China
746-P: Effects of Exercise Modes to Improve Insulin Sensitivity in Obese and Patients with Type 2 Diabetes—A Meta-analysis
Authors: GARCIA MARIO , PERALES KRISTIN R. , WAGLER AMY E. , BAJPEYI SUDIP
Published: June 2019

Physical activity is effective in improving insulin sensitivity in an obese and type 2 diabetic population (T2D). However, most Americans do not adhere to the ACSM exercise guidelines. The effectiveness of different exercise modes to improve insulin sensitivity in an obese and T2D is unknown. Therefore, the purpose of this study was 1) to compare the effects of aerobic, resistance, and combination exercise training and 2) to determine the role of volume and intensity (aerobic) and repetitions and sets (resistance) on exercise induced improvement in insulin sensitivity in an obese and T2D population. 73 studies were used for this review. Meta-analysis methods were used to evaluate the role of moderators, such as volume, intensity, number of sets and repetitions, in the effectiveness of exercise training to improve insulin sensitivity. Aerobic, resistance and combination exercise training were effective modes in improving insulin sensitivity in obese and T2D (Z=5.43, p<.0001). Volume and intensity during aerobic exercise did not have an effect on degree of improvement in insulin sensitivity (Q=1323.6, p<.0001). During resistance exercise, greater number of sets resulted in a greater improvement however, number of repetitions did not have an effect on improving insulin sensitivity (Z=3.1370, p=0.0017). Although traditional aerobic exercise is an effective training method in improving insulin sensitivity in obese and individuals with T2D, resistance and/or combination exercise provide beneficial alternative training methods to improve insulin sensitivity. While prescribing resistance exercise, focusing on number of sets (3 or more), rather than number of repetitions, should be emphasized to improve insulin sensitivity.

Disclosure

M. Garcia: None. K.R. Perales: None. A.E. Wagler: None. S. Bajpeyi: None.
748-P: Effects of Exercise on Continuous Glucose Monitoring Outcomes in Type 2 Diabetes: A Meta-analysis
Authors: MUNAN MATTHEW , PINTO OLIVEIRA CAMILA LEMOS , REES JORDAN , BOULE NORMAND G.
Published: June 2019

Objective: To examine the short and long-term effects of exercise on glucose outcomes as assessed by continuous glucose monitors (CGM) in type 2 diabetes (T2D).

Methods: A search of databases was performed up to May 2018. Eligible studies had participants complete standardized exercise interventions using CGM. In all short-term studies (<2 weeks, often a single exercise session) participants completed both an exercise and non-exercise control condition. In long-term studies (>8 weeks) the difference pre and post exercise training values were compared. The within participant mean differences and standard errors in 24-hour glucose concentrations between conditions was used to obtain a weighted mean difference according to the Generic Inverse Variance method (RevMan version 5.3). The I2 statistic was calculated to represent the percentage of the variability due to heterogeneity.

Results: A total of 27 studies were included. Of these, 22 studies were short-term, and 5 studies were long-term interventions. Exercise decreased 24-hour glucose in short-term (-0.6 mmol/L; -0.8 to -0.4; p<0.01, I2 =79%) and long-term studies (-0.5 mmol/L; -0.7 to -0.2; p<0.01, I2= 0%). To explain the heterogeneity in the short-term studies, subgroup and meta-regression analyses were performed. Comparison of subgroups defined according to the timing of exercise in relation to meals revealed significant differences among subgroups. In the 11 studies that performed exercise after breakfast, 24-hour mean glucose was reduced by 0.7 mmol/L (-0.9 to -0.5). In the 3 studies that performed exercise before dinner, there was no effect on 24-hour glucose (0.0 mmol/L -0.2 to 0.2). Elevated glucose in the control condition predicted a greater decrease in mean 24-hour glucose following exercise (R2= 0.29, P=0.0001).

Conclusion: Both short and long-term exercise can lower glucose in individuals with T2D. The timing of exercise as well as non-exercise glucose values were predictors of glycemic response to short-term exercise.

Disclosure

M. Munan: None. C. Lemos Pinto Oliveira: None. J. Rees: None. N.G. Boule: Research Support; Self; Abbott, Medtronic.
749-P: What Type of Physical Activity Is More Important? The Nagahama Study
Authors: MANO FUMIKA , IKEDA KAORI , TANAKA DAISUKE , INAGAKI NOBUYA
Published: June 2019

Background: Moderate-intensity physical activity improves insulin sensitivity and shows beneficial effects for prevention of diabetes. However, it hasn’t been investigated what type of physical activity is more effective in reducing insulin resistance. In the current study, we examined the association between the type of physical activity and insulin resistance in Japanese general population.

Methods: We conducted cross-sectional analysis using a community-based cohort, the Nagahama Prospective Cohort for Comprehensive Human Bioscience. In this study, “exercise habits” means the habit of exercise for over 30 min a time, 2 or more times weekly, and “non-exercise activity” means physical activity in daily life equivalent to one-hour or more walking. Multiple linear regression analysis was performed with log HOMA-IR as a dependent variable and exercise habits, non-exercise activity, tobacco smoking, medical history of diabetes, family medical history of diabetes, age, sex and BMI as simultaneous independent variables.

Results: A total of 7047 subjects were included in the analysis. Multiple regression analysis showed that log HOMA-IR was determined by exercise habits (β = -0.027, p = 0.011), non-exercise activity (β = -0.025, p = 0.017) and BMI (β = 0.571, p < 0.001). We divided subjects into two groups at the BMI of 23 (kg/m2), which is the cut point to consider diabetes screening for Asian adults (Diabetes Care, 2015). In the lower BMI group, multiple regression analysis showed that exercise habits (β = -0.047, p = 0.002) and BMI (β = 0.356, p < 0.001) were significant determinants of log HOMA-IR. In the higher BMI group, on the other hand, non-exercise activity (β = -0.042, p = 0.033) and BMI (β = 0.369, p < 0.001) were significant determinants of log HOMA-IR.

Conclusion: In Japanese people with BMI≧23 (kg/m2), “non-exercise activity” was more strongly associated with reduced insulin resistance, while in those with BMI<23 (kg/m2), “exercise habits” was the stronger predictor of reduced insulin resistance.

Disclosure

F. Mano: None. K. Ikeda: Research Support; Self; Terumo Medical Corporation. D. Tanaka: Research Support; Self; Merck Sharp & Dohme Corp. N. Inagaki: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Japan Tobacco Inc., Kyowa Hakko Kirin Co., Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Ono Pharmaceutical Co., Ltd., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited.
75-OR: Does Insulin Delivery Method Impact Risk of Hypoglycemia in Older Adults?
Authors: TOSCHI ELENA , SLYNE CHRISTINE , GREENBERG JORDAN , ATAKOV-CASTILLO ASTRID , DUFOUR ALYSSA B. , SIFRE KAYLA , CARL SAM , MUNSHI MEDHA
Published: June 2019

Adults with type 1 diabetes (T1D) using insulin pump have a lower risk of hypoglycemia than those using multiple daily injections (MDI). However, it is not clear if these benefits are maintained in the older adult population.

Methods: We evaluated a cohort of older adults (age≥ 65 years) with T1D. All participants underwent continuous glucose monitoring (CGM) for 2 weeks along with questionnaires and assessments for hypoglycemia fear (HFS II), hypoglycemia unawareness (Clarke method), cognitive function (Montreal Cognitive Assessment (MoCA)), and demographic and medical history. Glycemic control was measured by A1C.

Results: We evaluated 86 older adults, 32 on MDI and 54 on insulin pump. Average age was 71 years in both cohorts, diabetes duration 36 and 41 years, and A1C 7.5% and 7.4%, respectively. Participants using MDI had more clinically significant hypoglycemia (glucose ≤54 mg/dl) than those using an insulin pump (48 minutes/day vs. 26 minutes/day, p<0.05). Hypoglycemia unawareness and cognitive dysfunction did not differ between the groups (40% vs. 45%; 65% vs. 45%: p=ns respectively). The total scores on HFS II describing hypoglycemia fear were similar in both groups (32 vs. 25). However, participants using MDI were more fearful of hypoglycemia at night (p=0.03), and were more likely to keep their blood sugar higher than usual in social situations (p=0.03), or when doing important tasks (p=0.002).

Conclusions: Older adults with T1D using MDI had a higher risk of clinically significant hypoglycemia despite similar glucose control and hypoglycemia unawareness. Further studies are needed to understand the role of insulin administration methods on risk of hypoglycemia in older adults with T1D.

Disclosure

E. Toschi: Advisory Panel; Self; Lexicon Pharmaceuticals, Inc. C. Slyne: None. J. Greenberg: None. A. Atakov-Castillo: None. A.B. Dufour: None. K. Sifre: None. S. Carl: None. M. Munshi: Consultant; Self; Lilly Diabetes, Sanofi.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases
751-P: Effect of Morning (Fasting) vs. Afternoon High-Intensity Interval Exercise on Blood Glucose in Type 1 Diabetes
Authors: YARDLEY JANE E.
Published: June 2019

Studies of high intensity interval training (HIIE) in individuals with type 1 diabetes (T1D) have had variable blood glucose outcomes, including increases, decreases, and no significant change during and after exercise. A potential unaccounted factor that may influence these outcomes is the time of day during which participants exercise. We hypothesized that morning (fasting) exercise (AMx) would increase blood glucose levels, while afternoon exercise (PMx) would decrease blood glucose levels throughout exercise (45 min) and recovery (60 min). Ten individuals with T1D (4M/6F) aged 31±6.6 years, with VO2peak 42.2±7.2 mLO2·kg-1·min-1, and diabetes duration 18.7±10.3 years, performed a HIIT protocol both while fasting in the morning (7 am), and in the late afternoon (5 pm). Sessions were separated by at least 48 hours, with the order randomly assigned. A standard snack was provided one hour prior to PMx to replicate previous study designs. The HIIE protocol consisted of a warm-up (10 min), 12 maximal sprints (10 seconds every 2 minutes - 24 min), and a cool down (11 min). Exercise was followed by a monitored recovery period (60 min). Capillary glucose (CG) was recorded at baseline, at the end of exercise, and 60 minutes post-exercise. Data were analyzed using a 2X3 ANOVA. An interaction of time and condition (p = 0.017) was found, indicating that CG levels followed different trajectories during AMx and PMx. Changes in CG during exercise were not significantly different between conditions (AMx = +1.8±2.6 vs. PMx = -0.4±3.2 mmol/L; p=-.141). Changes during the 60-minute recovery were significantly different (p=0.039) with the AMx condition resulting in a continued increase in CG (+0.4±1.5 mmol/L) while CG declined during recovery in PMx (-1.2±2.8 mmol/L). The design of future studies of HIIE in T1D, as well as recommendations for insulin adjustments and carbohydrate intake, should take into account the time of day that exercise is performed.

Disclosure

J.E. Yardley: Research Support; Self; Abbott, Dexcom, Inc., LifeScan Canada. Speaker's Bureau; Self; Dexcom, Inc.

Funding

Augustana College
754-P: Full-Fat and Low-Fat Dairy, within the Same Caloric Intake, Have Similar Impact on A1C and Cardiovascular Risk Factors: A Randomized Controlled Study
Authors: MITRI JOANNA , TOMAH SHAHEEN , MOTTALIB ADHAM , SALSBERG VERONICA , ASHRAFZADEH SAHAR , ELSEAIDY TAHA , MARADNI AHMAD AL , ALSIBAI KHALED , ELDIB AHMED H. , TASABEHJI MHD WAEL , POBER DAVID M. , HAMDY OSAMA
Published: June 2019

The USDA Dietary Guidelines recommend consumption of 3 servings of low/non-fat dairy per day. However, the effect of higher consumption and fat content in type 2 diabetes (T2D) is unknown. This study evaluates the impact of higher consumption of full-fat (FF) and low-fat (LF) dairy on A1C and cardiovascular risk factors in patients with T2D.

We enrolled 111 patients with uncontrolled T2D (age 58.5±8.9 years, 46.8% female) who were consuming <3 servings of dairy/day and randomized them into 3 groups: control group maintained baseline dairy intake, LF group incorporated ≥3 servings of LF dairy/day, and FF group incorporated ≥3 servings of FF dairy/day. Participants were counseled by a registered dietitian to maintain their daily caloric intake and body weight. Patients maintained their diabetes, antihypertensive, and lipid lowering medications during the study. Participants were evaluated at baseline, 3 months, and 6 months. At baseline, T2D duration was 13.2±8.3 years, A1C 8.1±0.97%, body weight 93.3±18.9 Kg, BMI 32.47±5.68 Kg/m2, daily caloric intake 1925±553 kcal (43.4±7.0% carbohydrates, 37.8±5.5% total fat, 13.1±2.9% saturated fat, and 18.2±3.7% protein), LDL-C 84.3±27.4 mg/dL, TG 163.5±154.8 mg/dL, systolic BP 130±16 mmHg, and diastolic BP 71±9 mmHg. There were no differences between groups at baseline except for higher HOMA-IR in the FF group. At 6 months, % calories from saturated fat increased by 3.6% from baseline in the FF group (p<0.0001) and decreased by 1.9% in the LF group (p<0.05). The % calories from protein increased by 4.5% in the LF group (p<0.0001), but did not change in the FF group. There were no differences in total caloric intake, % calories from carbohydrates or protein, A1C, BMI, body weight, lipid parameters, or BP between the 3 groups.

Conclusion: When on isocaloric diet, increasing consumption of dairy to ≥3 servings/day has similar impact on A1C, lipid profile and BP in patients with T2D, irrespective of fat content.

Disclosure

J. Mitri: Research Support; Spouse/Partner; AbbVie Inc., Janssen Pharmaceuticals, Inc. Research Support; Self; Kowa Pharmaceutical Europe Co. Ltd., National Dairy Council. Research Support; Spouse/Partner; Takeda Pharmaceutical Company Limited. Other Relationship; Self; National Dairy Council. S. Tomah: Stock/Shareholder; Self; Amarin Corporation. A. Mottalib: None. V. Salsberg: None. S. Ashrafzadeh: None. T. Elseaidy: None. A. Al Maradni: None. K. Alsibai: None. A.H. Eldib: None. M. Tasabehji: None. D.M. Pober: None. O. Hamdy: Advisory Panel; Self; AstraZeneca, Sanofi-Aventis. Consultant; Self; Abbott, Merck & Co., Inc. Research Support; Self; National Dairy Council. Stock/Shareholder; Self; Healthimation, LLC.

Funding

National Dairy Council
757-P: Intensive Lifestyle Intervention for Diabetes Patients with Food Insecurity: A Preplanned Subgroup Analysis of the REAL HEALTH Randomized Clinical Trial (RCT)
Authors: BERKOWITZ SETH , WEXLER DEBORAH J. , CHANG YUCHIAO , PORNEALA BIANCA C. , DELAHANTY LINDA M.
Published: June 2019

Patients with type 2 diabetes who face food insecurity (limited access to nutritious food owing to cost) are at increased risk for diabetes complications. Intensive lifestyle interventions (ILI) are recommended for treatment of diabetes and obesity but it is unclear if these interventions are effective in patients with food insecurity, which can be a barrier to weight loss. We conducted a pre-planned subgroup analysis of the REAL HEALTH RCT, which compared a pragmatic group ILI (delivered in-person or by telephone) to medical nutrition therapy (MNT) in adults with type 2 diabetes. The analysis compared whether intervention effects differed by food security status, using mixed effects models to account for repeated measurements. The primary and secondary analyses examined percentage weight change from baseline at 6 and 12 months, respectively. Of 211 participants, those with food insecurity (n=28) were more likely to be racial/ethnic minorities (p<0.001), have lower education (p<0.001), and have lower income (p<0.001) than those who were food secure (n=183). The intervention led to greater reduction in weight at 6 months (mean: 5.1% reduction, SD: 5.3%) than MNT (mean: 1.1% reduction, SD: 3.7%), p <0.001. The ILI was similarly effective in those with versus without food insecurity (5.1% vs. 5.1% reduction, p for interaction 0.92). The ILI remained more effective at 12 months (4.7% reduction vs. 2.0% reduction for MNT), p=0.001, and remained similarly effective in those with versus without food insecurity (4.5% vs. 4.7% reduction, p for interaction 0.67). Adjusting for demographic differences in those who were and were not food insecure did not change the results at 6 (p for interaction 0.67) or 12 (p for interaction 0.88) months. The REAL HEALTH intensive lifestyle intervention yielded clinically significant weight loss at 6 and 12 months with similar effectiveness regardless of food security status.

Disclosure

S. Berkowitz: None. D.J. Wexler: Other Relationship; Spouse/Partner; APOLO1BIO. Y. Chang: None. B.C. Porneala: None. L.M. Delahanty: Advisory Panel; Self; Jana Care Inc., Omada Health, Inc., Weight Watchers International, Inc.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R18DK102737, K23DK109200)
759-P: Analysis of a Two-Year Continuous Care Intervention Including Nutritional Ketosis—Exploring Baseline Predictors of Diabetes Reversal and Remission
Authors: ATHINARAYANAN SHAMINIE J. , MCKENZIE AMY , ADAMS REBECCA N. , HALLBERG SARAH , MCCARTER JAMES P. , PHINNEY STEPHEN
Published: June 2019

Background: We recently reported 55% of the patients reversed type 2 diabetes in the continuous care intervention (CCI) while 18% of the patients achieved remission at 2 years. In this post hoc analysis, factors identified in previous studies as predictors of diabetes reversal and remission were examined.

Methods: Baseline factors including diabetes duration, HbA1c, fasting glucose and a composite index (HbA1c, fasting insulin and ALT1) were examined as potential predictors of T2D reversal and remission in the CCI group along with percentage weight loss over the study period. Spearman correlation was used to assess relationships between predictors and 2 years reversal and remission. Factors with significant correlation were analyzed using logistic regression.

Results: Diabetes duration, baseline HbA1c, fasting glucose and the composite index were significantly correlated with diabetes reversal and remission (Table 1). Logistic regression analyses showed that diabetes duration (OR=1.2, p=7.0x10-6) and baseline HbA1c (OR=1.5, p=0.003) were associated with diabetes reversal at 2 years whereas weight loss percentage during the study period was not.

Conclusion: Shorter diabetes duration and lower baseline HbA1c are two factors strongly related to achieving diabetes reversal and remission in CCI participants at 2 years.

Disclosure

S.J. Athinarayanan: Employee; Self; Virta Health Corp. A. McKenzie: Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. R.N. Adams: Employee; Self; Virta Health Corp. S. Hallberg: Advisory Panel; Self; Atkins Nutritionals, Inc. Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. J.P. McCarter: Employee; Self; Virta Health Corp. S. Phinney: Advisory Panel; Self; Atkins Nutritionals, Inc. Board Member; Self; Virta Health Corp. Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. Other Relationship; Self; Beyond Obesity.

Funding

Virta Health Corp
76-LB: Adapting the Diabetes Prevention Program for Stroke
Authors: BAILEY RYAN R. , STEVENSON JENNIFER L. , SERRANO NATALICIO H.
Published: June 2019

Objective: History of stroke increases risk for diabetes, which is of great concern for stroke survivors. The Diabetes Prevention Program (DPP) is an effective lifestyle modification intervention for ameliorating diabetes and cardiovascular risk factors. Participation in the DPP for stroke survivors could be challenging, however, due to stroke-related impairments. The purpose of this study was to determine appropriate adaptations to the DPP for stroke survivors.

Design and Methods: Qualitative description using focus groups. Fifteen community-dwelling stroke survivors and 10 caregivers participated. Focus groups were recorded and transcribed. Inductive content analysis was used to identify key themes to inform appropriate DPP adaptations.

Results: Three themes were identified. First, several stroke-specific impairments were identified that could influence DPP participation: hand and arm impairment, mobility impairment, impaired memory and attention, changes in taste and vision, and depression. Second, facilitators of existing group-based DPP models were identified and included small group discussion for peer support and physical activity and nutrition-related content repeated across sessions for reinforcement and repetition. Third, adaptations were suggested that included caregiver participation for the provision of physical and cognitive assistance; a need for stroke-specific physical activity and nutrition-related recommendations such as adapted gym and cooking equipment; and modified session content, including shorter, simplified session handouts and addition of online content to complement session handouts.

Conclusion: Current DPP content and structure are insufficient to meet the unique needs of stroke survivors. The suggested adaptations should be incorporated into a stroke-specific curriculum and tested for efficacy and eventual implementation into community-based programs to promote lifestyle modification and diabetes risk reduction among stroke survivors.

Disclosure

R.R. Bailey: None. J.L. Stevenson: None. N.H. Serrano: None.

Funding

National Institutes of Health (P30DK092950, 5T32HL130357)
760-P: Factors Associated with Resolution of Steatosis and Fibrosis in T2D Patients Following Two Years of Continuous Care Intervention
Authors: ATHINARAYANAN SHAMINIE J. , ADAMS REBECCA N. , MCKENZIE AMY , HALLBERG SARAH , PHINNEY STEPHEN , MCCARTER JAMES P.
Published: June 2019

Introduction: Nonalcoholic fatty liver disease (NAFLD) is associated with type 2 diabetes (T2D) progression. Our 2-year study of T2D patients demonstrated a continuous care intervention (CCI) including nutritional ketosis improved non-invasive scores of steatosis and fibrosis, in addition to weight and glycemic control. This post hoc analysis assesses factors affecting steatosis and fibrosis resolution.

Methods: 262 T2D CCI patients were analyzed. Intent-to-treat correlation and ANCOVA assessed relationships between changes in selected variables (Table 1) and changes in NAFLD liver fat (NLF) and NAFLD fibrosis (NFS) scores, steatosis and fibrosis status.

Results: Changes in HOMA-IR, central abdominal fat (CAF) and beta-hydroxybutyrate (BHB) were correlated with changes in NLF, while changes in HbA1c, CAF and HDL-cholesterol were correlated with changes in NFS, even after adjustment for age, gender, race, diabetes duration and baseline BMI. ANCOVA confirmed that patients who resolved steatosis had greater BHB increase (p=0.01), HOMA-IR reduction (p=1.3x10-5) and CAF reduction (p=0.01) than those who did not.

Conclusions: Following the CCI, increased BHB and decreased insulin resistance are associated with steatosis resolution, while decreased visceral obesity is associated with steatosis and fibrosis reduction.

Disclosure

S.J. Athinarayanan: Employee; Self; Virta Health Corp. R.N. Adams: Employee; Self; Virta Health Corp. A. McKenzie: Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. S. Hallberg: Advisory Panel; Self; Atkins Nutritionals, Inc. Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. S. Phinney: Advisory Panel; Self; Atkins Nutritionals, Inc. Board Member; Self; Virta Health Corp. Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. Other Relationship; Self; Beyond Obesity. J.P. McCarter: Employee; Self; Virta Health Corp.

Funding

Virta Health Corp
763-P: Serum Fatty Acid Composition and Gut Microbiota Are Associated with Obesity in Type 2 Diabetes Patients
Authors: HIGA MARIKO , KAWAI MIKI , ETO RUMA , AYAKO FUCHIGAMI , SATO GENKI , HIJIKATA MAI , YAMASHITA KAORU , ICHIJO TAKAMASA
Published: June 2019

Aim: Polyunsaturated fatty acids (PUFAs) are essential fatty acids, because they cannot be synthesized in the body and must be taken from food, but excessive intake may cause obesity. Therefore, the measurement of serum fatty acid composition is useful for monitoring the fat composition of the diet. In recent years, accumulating evidence has indicated the importance of gut microbiota in maintaining human health. The aim of our study was to evaluate the relationship between fatty acid composition and gut microbiota in obese patients with type 2 diabetes.

Research Design and Method: The subjects included 100 patients (age: 60.3±13.9 years, BMI 27.5±5.8 kg/m2) who were not taking EPA agents. They were divided into two groups, i.e., obese group (n=64) with a BMI of greater than 25 kg/m2 and non-obese group (n=36) with a BMI less than 25 kg/m2. Serum levels of fatty acids were measured using gas chromatography. In 45 of 100 patients, gut microbiota profiles were measured using T-RFLP methods.

Results: The serum levels of dihomo-gamma-linolenic acid (DGLA), which is an n-6 PUFA, and palmitic acid, a saturated fatty acid (SFA), were significantly higher in the obese group than in the non-obese group. No significant differences were observed in the serum levels of n-3 PUFA. The ratio of Firmicutes/Bacteroidetes in the fecal microbiota was significantly lower in the patients with high serum levels of DGLA. The rate of Bacteroidetes showed a significant positive correlation with serum DGLA and palmitic acid.

Conclusion: These results suggest that high levels of serum DGLA may play an important role in the development of not only obesity but also gut microbiota in type 2 diabetes patients. The fat quality in the diet might contribute to the development of obesity.

Disclosure

M. Higa: None. M. Kawai: None. R. Eto: None. F. Ayako: None. G. Sato: None. M. Hijikata: None. K. Yamashita: None. T. Ichijo: None.
770-P: Association between Diet Quality and Glycemic Control in African Americans with Type 2 Diabetes
Authors: TAHSIN BETTINA , KEIM KATHRYN S. , FOGELFELD LEON , FOGG LOUIS , LYNCH ELIZABETH
Published: June 2019

Literature is lacking on the impact of diet quality on glycemic control in those with type 2 diabetes (T2DM), especially African Americans with T2DM. 211 African American adults with T2DM and A1c ≥ 7.0% were randomized into intervention (26 sessions) and control (2 sessions) for an 18-month randomized community-based control trial, Lifestyle Improvement Through Food and Exercise (LIFE), assessing the impact of culturally-relevant lifestyle education on glycemic control. Participants lived in low-income Chicago-area neighborhoods and had regular medical care. Diet quality was assessed via 24-hour recall and translated into the Alternative Healthy Eating Index 2010 (AHEI-2010). AHEI-2010 total scores (0-110: higher score=healthier pattern) for intervention (n=95) and control (n=92) respectively were baseline: 47.4 ± 1.1 vs. 51.2 ± 1.1, 12 months: 51.4 ± 1.0 vs. 50.5 ± 1.1, 18 months: 50.3 ± 1.2 vs. 51.6 ± 1.2. Using repeated measures ANOVA, the AHEI-2010 18 month increase from baseline was significantly higher in the intervention group, df (2, 370), F (3.18), p=0.043. A1c% decline over 18 months (intervention: 9.1 ± 0.2 to 8.5 ± 0.2; control: 8.9 ± 0.2 to 8.6 ± 0.2, p<0.001) was significant but there was no difference between groups. Absolute AHEI-2010 scores by hierarchical multilinear regression, regardless of study group, accounted for improved glycemic control by 1.6% at 12 months and by 2.3% at 18 months after adjusting for age, insulin use, and number of diabetes complications at baseline. While the impact of higher diet quality on glycemic control was small, overall dietary change in this study was also small. With 41.2% of participants living below the poverty line, limited access to healthy foods might have hampered greater dietary change.

Disclosure

B. Tahsin: None. K.S. Keim: None. L. Fogelfeld: None. L. Fogg: None. E. Lynch: None.

Funding

National Institutes of Health
781-P: Glycemic Response to Diabetes-Specific Formulas and Associations with Sex, Age, Body Mass Index, and A1c in Adults with Type 2 Diabetes: A Subgroup Analysis
Authors: ALISH CAROLYN J.
Published: June 2019

Background: Diabetes-specific formulas (DSF) are designed to improve glycemic control in people with diabetes. We evaluated the relationships between study participant characteristics and impact on postprandial glycemic (PPG) response of Glucerna® formulas, other DSF, and typical foods consumed by adults with type 2 diabetes.

Methods: Fasting plasma glucose and PPG response data were extracted for analysis from 10 randomized, placebo-controlled, crossover studies conducted between 2003 and 2010. Interventions included Glucerna® formulas (Abbott Nutrition, Columbus, Ohio, U.S.), other non-Abbott DSF, and typical foods (oatmeal and a standard high carbohydrate breakfast). First period data for maximal change from baseline for glucose were analyzed for sex, body mass index (BMI), and A1c.

Results: A total of 505 participants were included in the analysis (median age, 59 years; median BMI, 31.7 kg/m2; and median A1c, 7.3%). Compared to other DSF and to food, Glucerna products elicited an improved PPG response (mean + standard error of the mean. Glucerna: 2.18 + 0.10 mmol/L; other DSF: 3.38 + 0.24 mmol/L, p<0.0001; foods: 2.98 + 0.21 mmol/L, p=0.0001). Glucerna products produced an improved PPG response compared to other DSF in overweight (p=0.002) and obese (p=0.0001) subjects. Among subjects with A1c < 7.3%, there was a trend for a better PPG response than among subjects with A1c > 7.3%, regardless of treatment (p=0.05).

Conclusions: Glucerna products elicited a better PPG response compared to other DSF and selected foods in adults with type 2 diabetes irrespective of sex, age or BMI. There appears to be variability in PPG responses to Glucerna and other DSF in overweight and obese adults with type 2 diabetes; this variability could be due to differences in nutrient composition and ingredients.

Disclosure

C.J. Alish: Employee; Self; Abbott Laboratories.