bluuebunny/crossref_metadata_2025 huggingface dataset:
93-LB: Comparison of Glycemic Control between Multiple Daily Injections and Hybrid Closed-Loop System in Children and Adolescents during the Restrictions Due to COVID-19
Authors: PETROVSKI GORAN , CAMPBELL JUDITH , HUSSAIN KHALID ,   ALKHALAF AND CONSULTANTS/EDUCATORS
Published: June 2021

Introduction: The COVID-19 pandemic forced health authorities to issue restrictive measures on daily activities from March 12th to June 15th, 2020 (‘lockdown’) in Qatar, which may have influenced the glycemic control in patients with type 1 diabetes (T1D). The aims of the study was to evaluate glycemic control between Multiple Daily Injections (MDI) and Hybrid Closed Loop (HCL) system in children and adolescent with T1D during the lockdown.

Methods: This single-center analysis included 168 patients with T1D, using MDI or HCL system MiniMed 670G (Medtronic, Northridge, USA) at least 3 months before the study. Glycemic control from face-to-face visits, three months before lockdown were analyzed and compared to face to face or remote visits during the lockdown of 3 months. Data was collected through the electronic medical record system and reports generated by Carelink Therapy Management Software. HbA1c, glucose and insulin data were analyzed before and 3 months after restrictions.

Results: Patients were analyzed in two groups: 1) 92 patients (age 12.4±3.1 years, female:51) on MDI and 2) 76 patients (age 11.2±2.6 years, female:36) HCL system. HbA1c in patients on MDI increased from 8.3±1.5% (67±16.4 mmol/mol) before lockdown to 8.9±1.7% (74±18.6 mmol/mol) during the lockdown, compared to patients on HCL system, where HbA1c remained stable (7.0±0.9% (53±9.8 mmol/mol) to 7.1±1.2% (54±13.1mmol/mol) respectively). No significant difference on DKA events were found in MDI group, before and after lockdown, while no DKA was noted in HCL group during the study. No severe hypoglycemia was observed in both groups. Remote visits were 54% in patients on HCL system, compared to 38% in patients on MDI during the lockdown.

Conclusion: Children and adolescents using HCL system maintained stabile glycemic control during the lockdown compared to patient on MDI, where the glycemic control deteriorated.

Disclosure

G. Petrovski: None. J. Campbell: None. K. Hussain: None. Alkhalaf and consultants/educators: n/a.
930-P: Improving Access and Communication through Telehealth for Pediatric Type 1 Diabetes (T1D): Twelve-Month Outcomes
Authors: RASBACH LISA E. , PAGE LAURA C. , FREEMARK MICHAEL , PURRINGTON VIRGINIA , GRIFFIS MONA , ANNAS ANGELA , HALL RACHEL , BENJAMIN ROBERT
Published: June 2021

Improving access for diabetes care may help youth with poor glycemic control. Telehealth can expand access to care.

Youth with T1D, Medicaid, and initial A1c 9-12% had quarterly diabetes goal setting and monthly telehealth glucose review/goal reinforcement. Over 12 mo we measured A1c q 3mo and assessed diabetes empowerment (1-5; higher=greater self-efficacy), diabetes distress (1-6; higher=greater), and intervention satisfaction (1-5; higher=greater).

Youth (N=32, 56% male, 53% AA), aged 5-22 yr, had T1D for 5.1±3.5 years, baseline mean A1c 10.7±1.5%; 19% on CSII and 34% on CGM. At baseline, participants reported low levels of distress (mean 1.9 youth, 2.1 parents) and high self-efficacy (mean 4.2). There were no effects of intervention on distress or self-efficacy at 12-months for youth (p=0.11) or parents (p=0.36). There was no correlation between youth/parent distress scores.

Baseline A1c correlated positively with youth burden and negatively with motivation: “takes too much mental/physical energy”(r=0.65, p=0.02); “controls my life” (r=0.70, p=0.008); “I can find ways to feel better about diabetes” (r=-0.67, p<0.02); “I know what helps me stay motivated” (r=-0.69, p=0.01). In contrast, baseline A1c correlated negatively with parental frustration and worry: “I’m the only one who takes responsibility” (r=-0.46, p<0.05); “worrying others will blame me if diabetes not well-controlled” (r=-0.57, p=0.03).

A1c did not change and there were no differences in ED/hospitalizations compared to 2 years prior. However, participants reported satisfaction with the intervention (mean 4.3).

While well received by families, a monthly telehealth intervention failed to impact A1c. Parental worry and frustration was higher in children with better A1c levels. Identifying ways to maintain parent involvement in diabetes care and enhance mental health support may help diabetes control and burden of disease. Future work should explore the long-term impact of telehealth support.

Disclosure

L. E. Rasbach: None. L. C. Page: None. M. Freemark: Advisory Panel; Self; Rhythm Pharmaceuticals, Inc., Research Support; Self; Rhythm Pharmaceuticals, Inc. V. Purrington: None. M. Griffis: None. A. Annas: None. R. Hall: None. R. Benjamin: None.

Funding

Duke University School of Medicine
937-P: Mealtime Insulin in New-Onset Type 1 Diabetes Mellitus: Fixed Dose vs. Insulin:Carbohydrate Ratio
Authors: REYES DIAZ JACQUELINE V. , FELNER ERIC
Published: June 2021

Over the past 20 years, advances in diabetes technology and along with carbohydrate counting (CC) to determine insulin dose, has provided an opportunity for improvement in glycemic control and quality of life for children and adolescents with type 1 diabetes (T1D). These advances, however, have not translated into improved outcomes. This may be due to the stress and anxiety the child and family experience with the large amount of information taught during diabetes education sessions at diagnosis. A simplified teaching approach may reduce stress for the child and family. This study assessed the effects of two approaches to mealtime insulin delivery on parental stress. In the fixed dose (FD) regimen, the same dose of insulin is delivered for a set range of carbohydrates. In the insulin:carbohydrate ratio (ICR) regimen, insulin delivery varies based on the exact number of carbohydrates.

Twenty-four subjects (8-15-yrs) with new-onset T1D were randomized to the FD or ICR group. The primary endpoint was parental stress using the Parental Stress Survey, at 1-month and 4-months after diagnosis. Secondary endpoints included glycemic variability (% of values within target range) and HbA1C (%), at 1-month and 4-months after diagnosis.

The FD group experienced less stress than the ICR group at 1-month (27 ± 2.29 vs. 37.28 ± 2.57)and 4-months (27.62 ± 2.34vs. 35.14 ± 2.57) (interactive p = 0.04). The FD group had similar glycemic variability and HbA1C levels as the ICR group at 1-month (67.5% vs. 63.2% and 9.76 ± 0.53vs. 9.2 ± 0.58) and 4-months (63.3% vs. 69.0% and 7.27 ± 0.55 vs. 7.71 ± 0.58). Complications (severe hypoglycemia or DKA) did not occur in either group during the study.

The additional stress associated with learning CC at the onset of T1D education may be reduced with a simple mealtime insulin and carbohydrate regimen. A simple insulin regimen that does not adversely affect glycemic control may alleviate the stress that many patients and families experience when a child is diagnosed with new-onset T1D.

Disclosure

J. V. Reyes diaz: None. E. Felner: None.
949-P: Reasons for Nonelective Readmissions among Hospitalizations with Diabetes Complicating Pregnancy and the Perinatal Period: Insights from the U.S. National Readmission Database for 2018
Authors: AGUILERA MARIA C. , SHAKA HAFEEZ , CORPUZ CARLOS GABRIEL D. , RAMIREZ MARCELO , YAP SARA ELIZABETH T. , ESEATON PRECIOUS O. , MURTHI MUKUNTHAN
Published: June 2021

Introduction: With the increasing prevalence of diabetes mellitus (DM), there is an increasing burden of DM among pregnant women. Gestational DM (GDM), is a known complication of pregnancy which could affect the outcome for mother and child. This study looked into the burden of DM related gestations and readmissions.

Methods: Data was obtained from the US National Readmissions Database for 2018, the largest database for readmissions in the US, which approximates yearly estimates. Index hospitalizations for DM complicating pregnancy and the postpartum period were obtained using ICD-10 codes. Hospitalizations less than 18 years of age and elective admissions were excluded. Outcomes included the rate of 30-day readmission (30DR) as well as identifying the commonest reasons for readmission among the studied cohort.

Results: A total of 61,675 hospitalizations were included in the study as index admissions. Of these hospitalizations, 2,768 (4.50%) were readmitted within 30 days of discharge. The top reasons for readmission included severe pre-eclampsia, gestational DM, pre-existing DM type 1 in pregnancy, maternal care for scar from previous cesarean delivery, pre-existing DM type 2 in pregnancy and endometritis following delivery. Readmission was associated with increased healthcare utilization.

Conclusion: Among pregnancies complicated by DM that led to hospitalization, a small proportion of patients get readmitted within 30 days for known complications of pregnancy. These could be associated with mortality, hence, research into factors and predictors of readmission in this population should be encouraged.

Disclosure

M. C. Aguilera: None. H. Shaka: None. C. D. Corpuz: None. M. Ramirez: None. S. T. Yap: None. P. O. Eseaton: None. M. Murthi: None.
957-P: Characteristics and Pregnancy Adverse Outcomes in Women with Hyperglycemia in Pregnancy According to Insulin Resistance
Authors: COSSON EMMANUEL , NACHTERGAELE CHARLOTTE , VICAUT ERIC , SAL MERIEM , BERKANE NARIMANE , PINTO SARA , TATULASHVILI SOPIO , VALENSI PAUL , CARBILLON LIONEL , BIHAN HELENE
Published: June 2021

Recent studies have shown that pregnancies complicated by hyperglycemia in pregnancy (HIP) and insulin resistance had the highest risk of poor outcomes as compared to normoglycemic pregnancies. This study aimed to determine, only among women with HIP, the characteristics and pregnancy outcomes by increasing insulin resistance. We included from a prospective cohort study 1,423 women with HIP whose insulin resistance was evaluated using the homeostasis model assessment for insulin resistance (HOMA-IR) when HIP care begun. We compared characteristics and pregnancy outcomes by tertiles of HOMA-IR (intertertile range: 1.9 and 3.3). Increasing tertiles of HOMA-IR were positively associated with plasma glucose levels during screening for HIP; preconception BMI; family history of diabetes; previous pregnancy with HIP, macrosomia and hypertensive disorders; and non-European ethnicity (p<0.05 to 0.001). Gestational weight gain was similar but insulin rate increased by tertile of HOMA-IR (tertile 1, 2 and 3: 34.8, 49.0 and 62.7% respectively, p<0.0001). So were Caesarean section (23.5, 26.3 and 32.1%, respectively, p=0.01), pregnancy-induced hypertension (1.3, 3.0 and 6.6%, p<0.0001), preeclampsia (1.5, 3.0 and 4.6% respectively, p<0.05), large-for-gestational-age infant (4.1, 6.4 and 11.2% respectively, p<0.001) and neonatal hypoglycemia (0.6, 1.5 and 3.3% respectively, p<0.01). The risk for large-for-gestational-age infant was higher in women with HOMA-IR in the 3rd tertile as compared to 1st-2nd tertiles (aOR 1.43 [95% confidence interval 1.01-2.03]) in multivariable logistic regression analysis adjusting for BMI, HIP subtypes (early-diagnosed GDM, GDM, diabetes in pregnancy), ethnicity, HOMA-B, parity and gestational weight gain. To conclude, among women with HIP, higher insulin resistance is associated with a more adverse metabolic profile and greater risk of adverse outcomes, although insulin therapy is more often used.

Disclosure

E. Cosson: None. H. Bihan: None. C. Nachtergaele: None. E. Vicaut: None. M. Sal: None. N. Berkane: None. S. Pinto: None. S. Tatulashvili: None. P. Valensi: None. L. Carbillon: None.
959-P: Mothers’ Weight Class in Pregnancy and Beta-Cell Function in Their Infants
Authors: STAIMEZ LISA R. , DUTTA ANUBRATI , BEYH YARA S. , VYAKARANAM SAPNA , NOULE HARI K. , KOTHAPALLY DEEPA , NARAYAN K.M. VENKAT , GUPTA RUBY , PRABHAKARAN DORAIRAJ , BETHA KALPANA , PRABHAKARAN POORNIMA
Published: June 2021

Background: Poor nutritional status in pregnant women can impact the risk of diabetes in their children. The Asian Indian Beta Cell function (ABCs) in Infants Study examined the association of maternal weight class and pregnancy weight gain on infant pancreatic beta-cell function during the first year of life.

Methods: A convenience sample of 150 pregnant women ages 18-35 years were recruited in Hyderabad, India. Women were classified by 1st trimester (a) underweight (UW), i.e., BMI<18.5kg/m2 or (b) non-underweight (N-UW), i.e., BMI=18.5-27.4kg/m2. At 8 months postpartum, infants had a newly developed oral glucose tolerance test (OGTT, 1.75g glucose/kg, 33% w/v) after a 3-hour fast. Maternal BMI groups were examined for 30-min C-peptide by ANOVA.

Results: In the first trimester, UW (n=62) and N-UW mothers (n=69) were similar in mean age (22 years) with differing mean BMI (UW: 17.0 ± SD 1.2, N-UW: 22.4 ± 2.6 kg/m2). At the time of birth, % female and mean gestational age were similar (half female; 38 weeks). UW-infants had lower birthweight (2.7± 0.4 kg) than N-UW (2.9 ± 0.4 kg, p<0.008), but not length (UW: 47.0 ± 2.3, N-UW: 47.1 ± 3.1cm, p=0.2). During OGTT, infants had similar fasting glucose (UW: 79.8 ± 9.5, N-UW: 82.8 ± 13.7 mg/dL, p=0.16) and fasting C-peptide (UW: 157.7 ± 161.7, N-UW: 201.7 ± 166.4 pmol/L, p=0.13). Although mean differences were not statistically significant, 30-min glucose was 6% lower in UW vs. N-UW (UW: 106.1 ± 21.9, N-UW: 113.0 ± 21.9 mg/dL, p=0.08), whereas 30-min C-peptide was 27% lower in UW vs. N-UW (UW: 397.0 ± 233.2 vs. N-UW: 543.9 ± 270.0 pmol/L, p=0.20).

Conclusions: While Asian Indian infants from underweight mothers had similar basal C-peptide and glucose levels to infants from normal- and overweight mothers, first phase insulin secretion may be lower in infants from underweight mothers. The results from this pilot study warrant further examination of intergenerational risk of beta cell dysfunction and support ongoing antenatal care strategies to improve nutritional status in pregnancy.

Disclosure

L. R. Staimez: None. K. Betha: None. P. Prabhakaran: None. A. Dutta: None. Y. S. Beyh: None. S. Vyakaranam: None. H. K. Noule: None. D. Kothapally: None. K. Narayan: None. R. Gupta: None. D. Prabhakaran: None.

Funding

Emory Global Health Institute; Emory Global Diabetes Research Center
960-P: The Usefulness of CGMS in Identifying and Treating Suboptimal Blood Glucose Patterns in In Vitro Fertilization Pregnancies with Normal OGTT and Increased Amniotic Fluid
Authors: THOMAKOS PETROS , BARETTO CAROL , ZOUPAS CHRISTOS S.
Published: June 2021

IVF pregnancies have an increased incidence of polyhydramnios. Increased amniotic fluid has been considered an indicator to test the mother for Gestational Diabetes Mellitus. Furthermore, IVF pregnancies are associated with a higher prevalence of GDM. In this study, suboptimal BG patterns were detected by CGMS in 19 singleton IVF pregnancies with a 4 quadrant Amniotic Fluid Index (AFI) ≥20cm and a normal OGTT. Clinical characteristics include the following; age: 35±3.7 years, BMI: 25.2±3.8 kg/m2, OGTT: 0’=83.6±7.3, 60’=157.5±19.3, 120’=129±30 mg/dL, HbA1c: 5.3±0.2%, Hadlock (BPD-HC-AC-FL) percentile: 59.7±12.1%, AFI: 21.7±1.6 cm, U/S polyhydramnios confirmation: 21.1±4.7 week. A blind recording of BG patterns was accomplished using a CGMS for 7 days. Mean Sensor BG: 104.2±5 mg/dL, time>120 mg/dL: 221±61 min/24h, time<63 mg/dL: 93.2±81 min, Fasting BG: 90.7±6 mg/dL, 1h-Postprandial BG: 116.6±11 mg/dL, CV: 18.6±3. Mitigation of polyhydramnios was obtained through tight glycemic control using insulin therapy (mean dosage: 32±10.7 IU). Insulin treatment was adjusted to reach the BG target <95 fasting and <120 mg/dL 1-h postprandial. After a treatment duration of 8-weeks, the AFI in 16 of the cases was reduced to less than the 20cm threshold. The decrease noted in the other 3 cases did not reach a level below the 20cm threshold. Pregnancy outcome; Week of delivery: 37.4±1.5, birth weight: 2990±425 g, Small for Gestational age: 2 cases, Large for Gestational age: 1 case, Caesarean Section: 84.2%, there were no cases of congenital malformations. Increased amniotic fluid maybe an indicator of abnormal BG patterns in IVF pregnancies. CGMS is a useful technology to identify suboptimal BG levels which the OGTT may be unable to detect. Timely insulin treatment targeting tight glycemic control could assist in decreasing amniotic fluid. Aggressive and prompt GDM screening in IVF pregnancies is recommended.

Disclosure

P. Thomakos: None. C. Baretto: None. C. S. Zoupas: None.
966-P: Glucose Control and Cognitive Function in Older Adults with Diabetes or Prediabetes: Results from the 2011-2014 National Health and Nutrition Examination Survey (NHANES)
Authors: KIM MIN JUNG , FRITSCHI CYNTHIA
Published: June 2021

Objective: Poor glucose control (A1c) has been associated with cognitive impairment in adults with diabetes, but it is unknown whether people with prediabetes who have elevated A1c are also at risk. Our aims were to 1) examine the relationships between A1c and cognitive function in older adults with diabetes or prediabetes and 2) explore whether body mass index (BMI) and functional disability affect cognitive function.

Method: We extracted data of adults aged ≥ 60 years with self-reported diabetes or prediabetes from the 2011-2014 NHANES database. Variables included the Digit Symbol Substitution Test (DSST) for attention and processing speed; the Animal Fluency (AF) test for semantic fluency, and the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) Word Learning subtest for delayed and immediate memory. BMI, activities of daily living (ADL), instrumental ADL (IADL), and A1c were examined. Chi-square, t-test, and multivariate linear regressions were used.

Results: A total of 1,070 older adults were included (age 69.94±6.73 years, male 50.65 %, diabetes=870, prediabetes=200). Diabetes group had significantly lower scores for all cognitive assessments, higher A1c values, more ADL disability, and were more obese than prediabetes group. A 1% increase in A1c decreased DSST score by 1.24, AF by .29, and CERAD delayed memory by .17. Being underweight decreased cognitive function (DSST=-13.15, AF=-2.97), while obesity had a protective effect (DDST=3.18). Having at least one ADL or IADL disability also decreased cognitive function (DSST=-6.19; AF=-1.47, CERAD delayed=-.60, and CERAD immediate=-1.08).

Conclusions: Our findings suggest that higher A1c, being underweight, and functional disability are associated with cognitive impairment, which highlights the need for regular cognitive testing in older adults with higher A1c, especially those with high BMI and reduced functional ability.

Disclosure

M. Kim: None. C. Fritschi: None.
97-OR: Relationship between Time-in-Range and Laboratory HbA1c in Pregnant Women with Type 1 Diabetes Mellitus
Authors: LING PING , WANG CHAOFAN , YANG DAIZHI , LUO SIHUI , ZHENG XUEYING , LV JING , YAN JINHUA , XU WEN , YAO BIN , WENG JIANPING
Published: June 2021

Aims: To investigate the relationship between time-in-range (TIR) and laboratory glycated hemoglobin A1c (HbA1c) in pregnant women with type 1 diabetes mellitus (T1DM).

Methods: An observational study enrolled pregnant women with T1DM who wore continuous glucose monitoring (CGM) system devices (iProTM2 system) in the first, second, third trimesters and postpartum from 11 hospitals in China from January 2015 to June 2018. Data derived from the CGM system were used to calculate TIR, time above range (TAR), time below range (TBR), mean glucose (MG), and glycemic variability (GV) parameters. Relationships were explored between the CGM metrics and HbA1c. Linear and curvilinear regressions were conducted to investigate the best-fitting model to account for the influence of gestational changes in HbA1c on the TIR- HbA1c relationship.

Results: A total of 272 CGM data and corresponding laboratory HbA1c from 98 pregnant women with T1DM, as well as demographic and clinical characteristics were analyzed. Mean HbA1c and TIR were 6.49±1.29% and 76.16±17.97% during pregnancy, respectively. HbA1c was moderately correlated with TIR3.5-7.8(R=-0.429, P=0.001), mean glucose (R= 0.405, P=0.001) and the TAR7.8 (R=0.435, P=0.001), but was weakly correlated with TBR3.5 (R=0.034, P=0.001) during pregnancy. On average, a 1% (11 mmol/mol) difference in HbA1c corresponded to an 8.5% difference in TIR3.5-7.8. During pregnancy, HbA1c of 6%, 6.5% and 7% were equivalent to a TIR3.5-7.8 of 78%, 74%, and 69%, respectively.

Conclusions: We found a moderate correlation between HbA1c and TIR3.5-7.8 during pregnancy. To achieve the HbA1c target <6% for pregnant women with T1DM, women and clinicians should aim for TIR3.5-7.8 >78% (18h 43min/per day), during pregnancy.

Disclosure

P. Ling: None. J. Weng: None. C. Wang: None. D. Yang: None. S. Luo: None. X. Zheng: None. J. Lv: None. J. Yan: None. W. Xu: None. B. Yao: None.

Funding

National Health and Family Planning Commission of the People’s Republic of China; Foundation for Public Welfare Industry Research Project (201502011); National Key Research and Development Program of China (2017YFC1309600); National Natural Science Foundation of China (81941022)
979-P: The Relationship between Physical Activity (PA) and Coronary Artery Calcification (CAC) by Sex in Adults with Impaired Glucose Tolerance (IGT) or Diabetes
Authors: ROCKETTE-WAGNER BONNY , KRISKA ANDREA , YOUNES NAJI , EDELSTEIN SHARON , ORCHARD TREVOR J. , ARMSTRONG MARNI , BROWN ANGELA L. , DABELEA DANA , GADDE KISHORE M. , HORTON EDWARD , HOSKIN MARY A. , IBEBUOGU UZOMA N. , SCHLÖGL MATHIAS , GOLDBERG RONALD B. ,   DPP RESEARCH GROUP
Published: June 2021

Subclinical markers of atherosclerosis, including CAC, are less favorable in adults with IGT. In previous adult studies, higher PA has been associated with lower CAC with findings varying by age and sex. PA and CAC were examined by age and sex in the diverse Diabetes Prevention Program Outcomes Study (DPPOS) cohort with IGT who were randomized at baseline to lifestyle intervention, metformin, or placebo groups for a mean of 3.2 years, and subsequently observed in DPPOS for follow-up.

PA was measured via questionnaire (annually); accelerometry once at 11-13yrs and CAC Agatston score (AS) using chest computed tomography at 13-15 yrs from randomization. The relationship between PA and CAC was examined using Tobit regression models in 1434 participants with valid PA and CAC data (mean age 63±9.5 yrs; 70% female; 54% with diabetes) adjusted for treatment group, age, sex, race/ethnicity, lipid medication use, diabetes status, and cumulative metformin exposure; pairwise and three-way interactions were examined.

Accelerometry-assessed median (IQR) daily step counts and moderate+ PA (MVPA) minutes were 5302 (3576, 7104) and 21 (9, 41), respectively. Median (IQR) AS was 9 (0, 151). In fully adjusted models, each 1000 steps /day was associated with lower CAC (p=0.024). Results were examined by sex and age subgroups (<65 and ≥65 yrs) with significant inverse associations found in women (<65 and ≥65 yrs; both p<0.001) but not in men (<65 and ≥65 yrs; both p>0.05). Similarly, significant inverse associations between MVPA minutes and CAC AS were found in women (<65 yrs p=0.003; ≥65 yrs p=0.012) but not in men (<65 yrs p=0.91 and ≥65 yrs p=0.056). Questionnaire-measured PA and CAC associations showed similar trends. In contrast, minutes of sedentary and light PA were not significantly associated with CAC.

Suggested sex differences in the PA-CAC association in adults with initial glucose intolerance was found and should be investigated in other studies.

Disclosure

B. Rockette-wagner: None. E. Horton: None. M. A. Hoskin: None. U. N. Ibebuogu: None. M. Schlögl: None. R. B. Goldberg: None. D. Research group: None. A. Kriska: None. N. Younes: None. S. Edelstein: None. T. J. Orchard: None. M. Armstrong: None. A. L. Brown: Research Support; Self; Medtronic, National Heart, Lung, and Blood Institute, National Institute of Diabetes and Digestive and Kidney Diseases. D. Dabelea: None. K. M. Gadde: Other Relationship; Self; AstraZeneca, Research Support; Self; BioKier, National Institute of Diabetes and Digestive and Kidney Diseases.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (U01DK048489)
981-P: Truncal Fat-to-Leg Fat Ratio in Relation to Cardiovascular Disease in Patients with Type 2 Diabetes
Authors: SHIN JANG YEL
Published: June 2021

Truncal fat has been reported to be positively associated with the risk of metabolic syndrome (MS), type 2 diabetes (T2D), and cardiovascular disease (CVD). Meanwhile, leg fat was inversely related to MS, T2D, and CVD. This study examined the association between truncal fat to leg fat ratio (TLR) and the prevalence of CVD in patients with T2D. A total of 1,728 individuals with T2D were enrolled. Truncal fat, leg fat, and appendicular muscle mass (ASM) were assessed using dual-energy X-ray absorptiometry. All subjects were divided into 3 groups according to the tertile of TLR. CVD was defined as either coronary heart disease (CHD), ischemic stroke (IS), peripheral artery disease (PAD), or a combination these conditions. The prevalence of CVD, CHD, IS, and PAD were 24.8%, 17.4%, 7.5%, and 3.3%, respectively. Individuals with CVD were highly likely to be older, male, and hypertensive and had higher values for diabetic duration (DD), waist circumference (WC), and TLR, but lower values for diastolic blood pressure, HDL cholesterol, and estimated glomerular filtration rate (eGFR) than those without CVD. Patients with the highest TLR tertile were more likely to be elderly and hypertensive and had higher values for DD, WC, BMI, triglycerides (TG), HbA1c, and HOMA-IR, but lower values for HDL cholesterol, eGFR, and ASM/BMI, compared with those with the lowest tertile. The prevalence of CVD progressively increased with greatening tertile of TLR (the lowest vs. the middle vs, the highest = 19.4% vs. 26.0% vs. 29.1%, p = 0.001). The odd ratios (ORs) and 95% confidence intervals (IC) for the presence of CVD after adjusting age and sex, were 1.25 (0.93 - 1.69) in the middle and 1.51 (1.13 - 2.02) in the highest, respectively. The ORs and 95% CI in the highest tertile remained significant, further adjusting for WC, BMI, current smoker, DD, hypertension, HDL, TG, HOMA-IR, HbA1c, CRP, and eGFR.

In conclusion, we found that TLR was significantly associated with CVD in patients with T2D independently of potential confounders.

Disclosure

J. Shin: None.
99-OR: Effects of Early Time-Restricted Feeding during Gestation on Offspring Glucose Homeostasis in Mice
Authors: CARTER MOLLY E. , HABBAL NOURA EL , SNYDER DETRICK S. , REDD JEANNA R. , GREGG BRIGID , BRIDGES DAVE
Published: June 2021

Time-Restricted Feeding (TRF) is an increasingly common diet that may improve insulin sensitivity. This practice merits study in the setting of pregnancy, as the diet is common, pregnancy represents a critical period for the health of both mother and offspring, and the effects of TRF during pregnancy on maternal gestational health and long-term offspring consequences remain unexamined.

To test these effects, female mice were randomized to 6 hours of food availability in the dark cycle (early-time restricted feeding, eTRF), or given 24-hour ad libitum (AL) food access. After one week of acclimatization, females were mated. Food intake and body composition were measured weekly throughout gestation; insulin sensitivity was assessed at day 16 of pregnancy. Offspring birth rate, survival, birthweight, and gestational age were assessed. Body composition and food intake were assessed weekly. After 70 days on a normal diet, all offspring were switched to a 45% high-fat diet (HFD) with continued weekly monitoring. Glucose tolerance and insulin tolerance tests were conducted before and after 10 weeks of HFD feeding. Our data suggests that maternal eTRF does not affect birth weight or gestational age, but does reduce litter size (7.7 pups vs. 6.0 pups) and 3-day pup survival (95% vs. 58%) compared to AL. eTRF offspring had similar insulin and glucose tolerance compared to AL counterparts until adulthood (70 days of age). After 12 weeks of high-fat diet feeding, eTRF males develop concomitant glucose intolerance (auc, p<0.0001) and insulin sensitivity (auc, p=0.006), which was absent in females. These metabolic changes were present despite eTRF males having similar fat mass, body weight, and food intake when compared to AL males. Taken together, these data suggest that eTRF during pregnancy followed by offspring HFD feeding results in male-specific impaired glucose metabolism. Further work planned will evaluate the role of pancreatic islet insulin secretion in vivo and in vitro in future cohorts.

Disclosure

M. E. Carter: None. N. El habbal: None. D. S. Snyder: None. J. R. Redd: None. B. Gregg: None. D. Bridges: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK107535); University of Michigan
999-P: A Study to Assess Occurrence of NAFLD and Liver Fibrosis in Patients with T2DM and Associated Factors
Authors: NAWAL C.L. , YADAV ABHISHEK , MANGAL PANKAJ , SINGH ARADHANA
Published: June 2021

Introduction: NAFLD has become the most common cause of chronic liver disease worldwide. With increase in DM patients, incidence of NAFLD has been on the rise. AIM of our study is to assess frequency and severity of NAFLD and liver fibrosis among T2DM patients using non-invasive approach by ultrasonography (USG) and Fibroscan.

Materials and Methods: We conducted a hospital based, observational and cross-sectional study on 100 patients aged >18 years, diagnosed with T2DM based on ADA 2018 criteria. USG and Fibroscan were used for assessment of frequency and severity of steatosis and liver fibrosis.

Results and Discussion: NAFLD was detected on USG in 52 out of 100 T2DM patients. These 52 patients were further evaluated for presence of liver fibrosis via Fibroscan, where 27 patients (51.9%) had mild fibrosis, 14 patients (26.9%) had significant fibrosis and 11 patients (21.2%) had severe liver fibrosis, thus revealing high proportion of NAFLD patients with significant and severe liver fibrosis. Proportion of NAFLD was more in patients with T2DM having high BMI (≥25kg/m2) and high waist circumference (WC) (p value <0.001) as compared to T2DM patients with normal BMI and WC.

Conclusion: NAFLD and liver fibrosis adds to the burden of disease in people living with diabetes. Early detection of steatosis and liver fibrosis using non-invasive techniques as USG and Fibroscan, aids in early detection of the condition, enabling early appropriate interventions to prevent or manage its grave complications.

Disclosure

C. Nawal: None. A. Yadav: None. P. Mangal: None. A. Singh: None.
Advancing Therapy in Suboptimally Controlled Basal Insulin-Treated Type 2 Diabetes: Clinical Outcomes with iGlarLixi versus Premix BIAsp 30 in the SoliMix Randomized Controlled Trial
Authors: Rosenstock Julio , Emral Rifat , Sauque-Reyna Leobardo , Mohan Viswanathan , Trescolí Carlos , Sifri Saud Al , Lalic Nebojsa , Alvarez Agustina , Picard Pascaline , Bonnemaire Mireille , Demil Nacima , McCrimmon Rory J. , Investigators the SoliMix Trial
Published: June 2021

Objective:
To directly compare the efficacy and safety of a
fixed-ratio combination, iGlarLixi, with a premix insulin analog (BIAsp 30) as
treatment advancement in type 2 diabetes suboptimally controlled on basal
insulin plus oral antihyperglycemic drugs (OADs).

Research
Design and Methods: SoliMix, a
26-week, open-label, multicenter study, randomized adults with suboptimally
controlled basal insulin-treated type 2 diabetes (HbA1c ≥7.5 % and
≤10 %) to once-daily iGlarLixi or twice-daily BIAsp 30. Primary efficacy
endpoints were non-inferiority in HbA1c reduction (margin 0.3 %) or
superiority in bodyweight change for iGlarLixi versus BIAsp 30.

Results:
Both primary efficacy endpoints were met: after 26
weeks, baseline HbA1c (8.6 %) was reduced by 1.3 % with iGlarLixi
and 1.1 % with BIAsp 30, meeting non-inferiority (least squares [LS] mean
difference [97.5% CI]: -0.2 [-0.4, -0.1] %; p<0.001). iGlarLixi was also
superior to BIAsp 30 for bodyweight change (LS mean difference [95% CI] -1.9
[-2.3, -1.4] kg) and percentage of participants achieving HbA1c
<7 % without weight gain and HbA1c <7 % without weight gain
and without hypoglycemia (all p<0.001). iGlarLixi was also superior versus
BIAsp 30 for HbA1c reduction (p<0.001). Incidence and rates of
ADA Level 1 and 2 hypoglycemia were lower with iGlarLixi versus BIAsp 30.

Conclusions:
Once-daily iGlarLixi provided better glycemic control
with weight benefit and less hypoglycemia than twice-daily premix BIAsp 30.
iGlarLixi is a more efficacious, simpler, and well-tolerated alternative to
premix BIAsp 30 in suboptimally controlled type 2 diabetes requiring treatment
beyond basal insulin plus OAD therapy.
LAWYER AS A SUBJECT OF PROFESSIONAL LEGAL AID IN CIVIL PROCEDURE OF UKRAINE
Authors: SHPAK M.V.
Published: June 2021

The revised version of the Civil Procedure Code of Ukraine was a consequence of the implementation of ideas on the unification of civil procedures. Now the Code of Administrative Procedure of Ukraine, the Economic Procedure Code of Ukraine have largely received an identical structure with the Civil Procedure Code of Ukraine. It is noteworthy that the aforementioned legislative acts have adopted a unified approach by the legislator, which has been enshrined in the Constitution of Ukraine, regarding the implementation of the so-called “advocate monopoly” in providing legal assistance to the participants of a muzzle considered by a court. “Advocate monopoly” was not perceived unambiguously in legal science. The approaches to this phenomenon are described in the article. Particularly it is noted a change in the positions of the subjects of the legislative initiative regarding the change of wearing and the legislative consolidation of the “advocate monopoly” in the direction of its restriction. Some ideas are assessed, which are set out in the draft Law of Ukraine No. 1013 “On Amending the Constitution of Ukraine (Regarding the Abolition of the Lawyer Monopoly)” dated 29 August 2019. Conclusions are given regarding the possible consequences if legislative novelties come into force that are proposed in the draft Law of Ukraine No. 1013 “On Amending the Constitution of Ukraine (Regarding the Abolition of the Lawyer Monopoly)” dated 29 August 2019. It is alleged that the abolition of the so-called “advocate monopoly” will positively affect the development of free law help in Ukraine. The author offers to provide new provisions to the content of the Civil Procedure Code of Ukraine, which will address in more detail the issue of participation of representatives in civil procedure.
THE HUMAN RIGHTS FUNCTION OF THE JUDICIARY IN ADMINISTRATIVE PROCEEDINGS: INSTITUTIONAL AND FUNCTIONAL ASPECTS
Authors: MOVCHAN V.V.
Published: June 2021

The article reveals the theoretical aspects of administrative legal proceedings, as one of the forms of the exercise of judicial power, the features and significance of the administrative judicial process in the mechanism of protecting the rights and freedoms of man and citizen, the analysis is given of the constitutional foundations of the human rights function of the judiciary, its essence and content, procedural actions. The author reveals the historical aspects of the formation and development of judicial protection in Russia, oreign experience and models of administrative justice are considered, the importance of administrative proceedings in the implementation of the human rights function of the judiciary in the Russian Federation when considering disputes with the participation of public authorities and citizens and the exercise of the rights, freedoms and legitimate interests of citizens is revealed. The author substantiates the advantages of the judicial administrative process as a procedural form of implementation of the human rights function of the judiciary and the implementation of the constitutional right to judicial protection, analyzes the reform of the judicial system of the judicial system, the creation of courts of appeal and cassation in the system of arbitration and general jurisdiction, substantiates the conclusion that the reform of the system of courts of general jurisdiction created organizational and judicial framework for the specialization of judges and court proceedings, the system of institutional intra-system control of the legality and validity of judicial acts, institutionally and functionally ensured the implementation of the human rights function of the judiciary and the availability of judicial protection in the system of courts of general jurisdiction.
Pengembangan Modul Termokimia Berbasis Inkuiri Terstruktur untuk Kelas XI SMA
Authors: Novia Novia , Azhar Minda
Published: June 2021

Thermochemistry is a topic of many chemical reaction equations and calculations so that students experience difficulties in learning. The purpose of this research is to develop a structured inquiry-based thermochemistry module 11th grade and reveal the validity and practice of developed modules. Research and development (R&D) is a type of research that is developed. There are 4 4-D models: Define; design; develop; and disseminate. This study only up to the stage of development, the test validity and practical.The research instrument used an observation sheet questionnaire The results of the analysis of the validity test data obtained kappa moment of 0.76 which is categorized as high. Obtained the mean kappa moment from the teacher of 1 is categorized as very high in the analysis of practicality test data and from students 0.94 is category as very high. Based on the results of this study, the structured inquiry-based thermochemistry module for 11th grade is valid and practical. Materi termokimia adalah materi yang banyak persamaan reaksi dan perhitungan kimia sehingga siswa kesulitan belajar. Tujuan penelitian ini ialah untuk mengembangkan modul termokimia berbasis inkuiri terstruktur kelas XI SMA dan mengungkapkan valid dan praktisnya modul yang dikembangkan. Penelitian dan pengembangan (R&D) adalah jenis penelitian yang dikembangkan. Ada 4 model 4-D yaitu: pendefisian (define); perancangan (design); pengembangan (develop); dan penyebaran (disseminate). Penelitian ini hanya sampai tahap pengembangan, yaitu uji kevalidan dan kepraktisan. Instrumen penelitian menggunakan angket lembar observasi. Hasil analisis data uji kevalidan diperoleh momen kappa rata-rata sebesar 0,76 dikatergorikan tinngi. Diperoleh momen kappa rata-rata dari guru sebesar 1 dikategorikan sangat tinggi analisis data uji kepraktisan dan dari siswa 0,94 dikategorikan sangat tinggi. Berdasarkan hasil penelitian tersebut maka modul termokimia berbasis inkuiri terstruktur kelas XI SMA sudah valid dan praktis.
EVALUASI KINERJA BADAN PENGELOLA KEUANGAN DAN ASET DAERAH KOTA PADANG MENURUT PERSPEKTIF BALANCED SCORECARD
Authors: Oktaviane Diga Putri
Published: June 2021

Each public sector organization was given an annual budget by the government which was used based on the programs launched, so that the vision and mission of the organization could be achieved properly. So far, the evaluation of organizational performance was assessed only on the basis of financial aspects, through financial reports that were provided annually by related agencies or agencies to the Padang City government and similar things were also carried out by the Regional Financial and Asset Management Agency of Padang City. Meanwhile, to assess whether a performance was good or not, it must also be measured based on other criteria, such as performance evaluation using the balanced scorecard method. This research was conducted through a descriptive study with a qualitative approach. Data collection techniques used in this study were interviews and documentation studies. The technique used to measure employee performance was balance scorecard method. Then the data were analysed through manual data analysis procedure. The results showed that in terms of budget management, the Padang City Financial and Asset Management Agency has not fully implemented the balance scorecard method in its performance.
PENGELOLAAN ASET NAGARI OLEH ANAK NAGARI UNTUK MENINGKATKAN PENDAPATAN ASLI NAGARI (PAN)
Authors: Rahmi Mutia , Malau Hasbullah
Published: June 2021

This study aimed to explain Nagari Asset Management by Nagari people to increase Nagari Income (PAN) in Nagari Minangkabau, Tanah Datar Regency. The research method used is descriptive quasi qualitative. The results showed that the management of nagari assets by nagari people to increase Nagari Original Income (PAN) in Minangkabau Nagari, Tanah Datar Regency consisted of: (a) Planning of village assets has been implemented properly, (b) The utilization of village assets in Nagari Minangkabau, Tanah Datar Regency has not yet carried out optimally, asset utilization has not been implemented in accordance with the specified asset utilization form, (c) Supervision by the Nagari government and custom density village in asset management carried out by the Nagari people is not maximized. Factors that become obstacles in asset management are: (a) The lack of awareness and participation of village people, (b) Incomplete village asset facilities, one of which is incomplete bath, wash and toilet facilities for public bath visitors, (c) Budget issues due to the rehab of public baths that will be carried out, of course, require large funds, (d) Regulatory problems are that there is no village regulation that regulates the management of nagari assets. Based on the obstacles faced, the efforts being made are: (a) Conducting socialization and empowerment to village children, (b) Trying to communicate with all institutional elements and community leaders in the village, (c) Designing Nagari Regulations (PerNag) regarding management village assets.
Video Interaktif Materi Tangga Nada Sebagai Media Pembelajaran di Era Pandemi Covid-19
Authors: Budi Arta Mulya , Siswantari Heni
Published: June 2021

Pada era pandemi Covid-19 ini, pemanfaatan teknologi memiliki dampak baik bagi peserta didik sekolah dasar maupun guru. Pembelajaran pada era pandemi mengalami beberapa perubahan yang salah satunya adalah pembelajaran daring atau online. Pemanfaatan teknologi berupa media video interaktif pembelajaran dapat mempermudah peserta didik untuk memahami materi yang diajarkan meskipun tidak melakukan pembelajaran di dalam kelas. Penelitian ini menggunakan metode deskriptif kualitatif dengan subyek peserta didik kelas V sekolah dasar. Teknik pengumpulan data dalam penelitian ini menggunakan teknik angket dan observasi. Tujuan studi ini adalah untuk mengetahui penerapan media video interaktif kedalam pembelajaran SBdP secara online selama pandemi berlangsung. Hasil akhir pada penelitian ini adalah media video interaktif yang dijalankan sesuai dengan prosedur penggunaan dapat diterapkan dengan baik dalam pembelajaran SBdP di era pandemi Covid-19.
Kreativitas Guru dalam Pembelajaran Karawitan Jawa
Authors: Hartanti Christina Dwi
Published: June 2021

Karawitan Jawa (Javanese Gamelan Orchestra) masih diminati sebagian orang Jawa. Dari perspektif pendidikan musik, orang-orang Jawa tidak mengalami banyak kesulitan dalam bermain gamelan sebab musik tersebut sudah menjadi bagian dari tradisi mereka. Namun tidak demikian bagi mereka yang tidak terbiasa dengan musik Jawa, terutama jika dikaitkan dengan istilah-istilah Jawa itu sendiri. Penelitian ini bertujuan mendeskripsikan kata/istilah dalam gamelan Jawa tidak hanya berhenti pada makna, tetapi lebih dari itu menjadi stimulus, sedemikian rupa, sehingga pembelajar/pemain gamelan merespons stimulus tersebut menjadi perilaku musikal. Penelitian ini berada dalam ranah konseptual dengan beberapa pendekatan psikologi. Hasil penelitian menunjukan bahwa, antusiasme akan mendorong pembelajar untuk mendalami karawitan dengan lebih dalam, terutama nilai-nilai yang terkandung di dalam kesenian Jawa tersebut (behind the text) seperti nilai filosofis, sosial, kebijakan lokal, norma kemanusiaan, nilai keugaharian, nilai kerohanian, dan terutama untuk memperoleh ‘roso’ yang merupakan ‘roh’ dari estetika Karawitan Jawa.
Analisis Musik Iringan Lagu Aneuk Yatim Ciptaan Rafly Kande
Authors: Pratama Haria Nanda , Rozak Abdul , Gusmanto Rico
Published: June 2021

Lagu Aneuk Yatim merupakan karya musik bergenre pop ciptaan Rafly pada tahun 1999 yang menceritakan tentang keadaan sosial kehidupan anak-anak di Aceh terkait peristiwa konflik dan tsunami di tahun 2004, dan mencapai puncak popularitasnya baik secara lokal maupun nasional. Lagu Aneuk Yatim memiliki penggunaan instrumen dan harmoni iringan yang khas dalam kalimat lagu dengan harmoni iringan dan tangganada konvensional (background harmony). Hal tersebut menjadi rangkaian pendukung melodi yang dimainkan untuk menciptakan kesan dan pesan pada lagu. Penelitian ini mencoba untuk menguraikan dan mengidentifikasi penggunaan instrumen musik dan harmoni iringan pada lagu Aneuk Yatim, yang nantinya bisa dijadikan rujukan bagi peneliti dalam menganalisis karya musik lagu. Penelitian ini menggunakan pendekatan kualitatif dengan metode analisis deskriptif. Selanjutnya, pendekatan yang dilakukan untuk mempermudah pencarian data dilakukan dengan etik dan emik agar tercapainya kelancaran dalam proses pencarian sampai dengan pengelolaan data untuk mengindentifikasi penggunaan instrumen musik dan harmoni iringan pada lagu Aneuk Yatim. Metodologi yang dilakukan dalam penelitian ini adalah pengumpulan data yang terkait subjek maupun objek dengan cara berinteraksi langsung melalui dokumentasi, observasi, dan wawancara dengan partisipan. Penggunaan instrumen dalam lagu Aneuk Yatim terdiri dari accoustic guitar, keyboard, electric bass, dan drum set. Instrumen acoustic guitar, keyboard, dan electric bass merupakan instrumen melodis dan instrumen harmonis yang digunakan sebagai instrumen dalam memainkan melodi pada interlude, serta instrumen harmonis yang memainkan akor sebagai iringan pada melodi pokok. Harmoni iringan dan tangganada pada lagu Aneuk Yatim ini, seperti tangganada minor asli maupun minor harmonis, serta harmoni yang dipakai seperti akor I-IV-V (G-C-D
The Impacts of Traffic Noise on House Renting and Selling Prices Concerning Residential Areas Case of Sulaimaniyah City Center
Authors:   Salahaldin University  Erbil, Kurdistan Region – Iraq, Smaqaey Ayoub , AbdulKareem Mohammed ,   Ministry of Finance  Erbil, Kurdistan Region - Iraq, Komşu Meryem ,   Yuzungu Yil University - Turkey
Published: June 2021

The purposes of this research are to examine the impact of traffic noise on the sale and rent prices of the housing real estate in the Sulaimaniyah city center. Besides, highlight the concept of traffic noise pollution in general and in particular in the Sulaimaniyah city center. Thus, people have the right to choose the nature of the acoustic environment, as others should not impose it, the problem of traffic noise considered as one of the main problems that have imposed on the people in Sulaimaniyah city center. Which began to take severe economic and social dimensions, affects the decision-making process in the real estate market. Moreover, consequently, this research analyzes the impact of traffic noise pollution in the sale and rent prices of residential property in Sulaimaniyah city center, the results of the research have confirmed a clear and negative impact the traffic noise on residential real estate prices in Sulaimaniyah city center. Finally, the research indorsed range of important recommendations, such as necessity control the noise pollution at the level of governments and companies, either at the companies’ level by choosing vehicles that release less sound and the use of sound control devices of high efficiency. Either at the government level to determine the volume level or prevent annoying noises (painful), through legislation and laws of environmental protection and impose fees and raise awareness.