bluuebunny/crossref_metadata_2025_split huggingface dataset:
1229-P: Clinical Characteristics and Hospital Care among Patients with Diabetic Ketoacidosis
Authors: LIU AIQUN , CARMICHAEL KIM , SCHALLOM MARILYN , ARROYO CASSANDRA 
Published: June 2020

Although the mortality rate associated with DKA has significantly reduced, hospitalizations for DKA are increasing. Identifying contributing factors for DKA admission could help target prevention efforts.
Aims: To explore risk factors for DKA admissions, investigate clinical characteristics of DKA among hospitalized patients, and describe inpatient DKA management and discharge plan.
Methods: We performed a retrospective analysis of adult patients’ medical records for DKA admissions from April-December 2017. Admission records from the year prior to 2017 review time period were also reviewed.
Results: Of 200 patients, 79 (39.5%) had pre-existing T1D, 94 (47%) had pre-existing T2D, 12 (6%) had new-onset DM, and 15 (7.5%) had other type of diabetes. Metabolic acidosis was more severe in patients with T1D than in those with T2D. Most patients (61.8%) were admitted to ICU. Mean ICU stay was 1.6±3.1 days, and mean hospital stay was 5.4±9.0 days. Insulin (93%) and fluid (95%) infusion were used for initial DKA treatment. Sixty-four (35%) had ≥1 hypoglycemic event, and 29 (14.5%) had a recurrent DKA event during hospitalization. Mortality rate was 2.5% (n=5); 1 patient death (0.5%) was directly related to DKA. Prior DKA admission was observed in 62 (31%) with mean of 2.1±3.9 admissions and were more common in African Americans, patients 18-39 years of age, and those with a history of bipolar disorder or pancreatitis. Nonadherence to home insulin regimen was the predominant precipitating cause of prior DKA admissions. Majority of patients (84.5%) were discharged to home, of whom 41% received medication delivery, 64.2% had a scheduled follow-up appointment, and 21% had a home healthcare referral.
Conclusions: Although patients with T1D had more severe acidosis, DKA admission in patients with T2D is as common as in those with T1D. Nonadherence is the leading precipitating factor of DKA readmissions. Future efforts should focus on reducing DKA recurrence and admission among vulnerable populations.

Disclosure
A. Liu: None. K. Carmichael: None. M. Schallom: None. C. Arroyo: None.
1233-P: Prediction of Type 2 Diabetes Occurrence Using Machine Learning Model
Authors: DEBERNEH HENOCK M. , KIM INTAEK , PARK JAE HYUN , CHA EUNSEOK , JOUNG KYONG HYE , LEE JONG SEON , LIM DONG SEOK 
Published: June 2020

Prediction of type 2 diabetes (T2D) occurrence allows a person at risk to take preventive actions that can prevent or delay the progression of the disease. In this study, we aim to develop a machine learning (ML) model to predict T2D occurrence in the year Y+1 using the variables in the year Y. The dataset was collected from electronic health records between 2013 and 2018 at a medical agency. We utilized 169,024 instances from 80,692 patients with longitudinal data to build the ML model. Each instance has 1,444 variables. To construct a prediction model, key variables or features were first selected using ANOVA and chi-square tests, and the recursive feature elimination methods. Then we employed random forest (RF) and XGBoost algorithms based on these variables to predict the outcome as normal, prediabetes or diabetes. Selected variables were fasting plasma glucose (FPG), HbA1c, triglycerides, body mass index (BMI), r-GTP, gender, age, uric acid, smoking, drinking, physical activity and family history. The accuracy of the RF classifier in predicting the occurrence in next year was 73.3% while that of the XGBoost classifier was 73.8%. The proposed prediction model using ML can provide both clinicians and patients with valuable information on the immediate incident of T2D. In addition to traditional predictors of T2D (FPG, HbA1c, BMI, family history), it should also be noted that variables such as r-GTP, uric acid, triglycerides, and lifestyle factors in the year Y increased the accuracy up to 3% in predicting T2D occurrence in the year Y+1.

Disclosure
H.M. Deberneh: Consultant; Self; Health connect. I. Kim: Consultant; Self; Health Connect. J. Park: Employee; Self; health connect. E. Cha: None. K. Joung: None. J. Lee: Employee; Self; health connect. D. Lim: Employee; Self; health connect.
1234-P: Utility of Sliding Scale Insulin on Inpatient Glycemic Care of Type 2 Diabetes Mellitus
Authors: ARAO KEVIN A. , EBADI FARHA N. , CAPISTRANO MARIA CHRISTINA VICTORIA M. , CHEN KENNETH K. 
Published: June 2020

Background: According to the American Diabetes Association (ADA), sliding scale insulin (SSI) monotherapy as inpatient diabetes management is strongly discouraged. The focus of our study is to determine the use of SSI on patients with type 2 diabetes mellitus (T2DM) on oral agents admitted to the general medical floor in a community hospital.
Methodology: A chart review was performed on patients with T2DM on oral agents admitted as an inpatient to our community hospital, from July 1, 2018 to July 1, 2019, that had SSI ordered. Patients were excluded if they were admitted to the ICU or had surgical intervention. Diabetes management was determined which can include additional basal and prandial insulin or continuation of home oral medication. Other data obtained included demographics, blood glucose levels, hypoglycemia (&lt;70 mg/dl), recent hemoglobin A1c level (HbA1c), and length of hospital stay.
Results: After 242 patient charts were reviewed, a total of 105 patients met exclusion criteria. In the 137 included patients, the mean age was 72.4 years, mean HbA1c level of 7.5%, and 55.4% were men. The mean length of hospital stay was 5.9 days. Most of the patients received SSI alone (n=108, 78.8%) followed by SSI with home oral medications (n=27, 19.7%), and lastly SSI with basal insulin (n=2, 1.5%). Mean blood glucose level was elevated in patients who had SSI with basal insulin (193.5mg/dL) and SSI alone (182.8mg/dL). On all included patients, six had hypoglycemia and all of them received SSI alone. Of the two patients who received basal insulin, they were provided with less basal insulin dose compared to weight-based calculation.
Conclusion: SSI is commonly used as monotherapy for inpatient diabetes management despite having recommendations against its use. SSI monotherapy is associated with increased rates of hypoglycemia episodes and poor glycemic control. Quality improvement interventions will be initiated among providers with regard to the appropriate inpatient diabetic care to improve patient care.

Disclosure
K.A. Arao: None. F.N. Ebadi: None. M.M. Capistrano: None. K.K. Chen: None.
1238-P: Developing a Culturally Tailored Social-Support Group Visit Model for South Asian Immigrants with Type 2 Diabetes in Atlanta
Authors: SHAH MEGHA K. , KURRA NITHIN C. , ALI MOHAMMED K. , NARAYAN K.M. VENKAT 
Published: June 2020

Background: Lifestyle interventions can prevent, delay, and improve management of type 2 diabetes (T2D). However, implementation of these programs is challenging in diverse populations. South Asians have higher risk for T2D, yet to date, there have been limited programs specifically for this community. The aim of this project was to develop and test the feasibility of a tailored group visit model for South Asians based in a family medicine clinic.
Methods: In conjunction with a local community-academic board, we conducted focus groups to tailor an existing evidence-based curriculum to a culturally acceptable lifestyle interventions program for South Asians with T2D or prediabetes. Fourteen participants enrolled in the 16-week program focusing on healthy diet, exercise, and weight loss. Weight, blood pressure, cholesterol, HbA1C, were measured at the beginning and end of study. Participants were asked to evaluate each session on level of satisfaction. One tailed t-tests were used to test significance of pre-post changes in outcomes.
Results: Ten of 14 participants had baseline and follow-up data. Participant attendance averaged 50%. Statistically significant reductions in mean weight (-3.16lbs, p&lt;0.05), systolic/diastolic blood pressure (-12.7mmHg, p&lt;0.05/-3.7mmHg p&lt;0.05, respectively), and triglycerides (-62.6 mg/dl, p&lt;0.05) were noted. Overall, participants reported high levels of satisfaction with the program.
Discussion: A lifestyle program based in primary care is feasible and acceptable for South Asian immigrants. Larger studies testing the effectiveness of group programs, based in primary care, in improving cardiometabolic factors and weight reduction are important. Overall, these interventions may have broader application to other culturally cohesive communities.

Disclosure
M.K. Shah: None. N.C. Kurra: None. M.K. Ali: Research Support; Self; Merck & Co., Inc. K. Narayan: None.

Funding
National Center for Advancing Translational Sciences (UL1TR002378, KL2TR002381)
1240-P: Dyslipidemia over Time in Youth with Type 2 Diabetes: The SEARCH for Diabetes in Youth Study
Authors: BRADY RYAN P. , SHAH AMY S. , JENSEN ELIZABETH T. , STAFFORD JEANETTE M. , DAGOSTINO RALPH , DOLAN LAWRENCE M. , KNIGHT LISA M. , IMPERATORE GIUSEPPINA , TURLEY CHRISTINE B. , LIESE ANGELA D. , URBINA ELAINE M. , LAWRENCE JEAN M. , PIHOKER CATHERINE , MARCOVINA SANTICA M. , DABELEA DANA 
Published: June 2020

Limited information exists regarding the evolution of dyslipidemia in youth with type 2 diabetes (T2D). Understanding dyslipidemia risk factors may influence treatment.
We studied 212 youth with T2D not on lipid lowering therapy (68% female, 43% non-Hispanic black, mean age 14.9±2.7y at baseline, mean follow-up 7.0±2.0y). Dyslipidemia was defined as HDL-C&lt;35mg/dL, LDL-C&gt;100mg/dL, or triglycerides (TG)&gt;150mg/dL. Progression was defined as normal lipids at baseline, dyslipidemia at follow-up; regression as dyslipidemia at baseline, normal at follow-up; stable abnormal as dyslipidemia at both; stable normal as normal at both. Associations of A1c and abdominal adiposity (waist to height ratio, WHtR) over time (area under the curve, AUC) with progression and stable abnormal were examined and relative risks estimated.
HDL-C progressed, regressed, was stable normal and stable abnormal in 12%, 11%, 62%, and 14%, respectively. Corresponding LDL-C values were 16%, 13%, 43% and 29%; TG were 17%, 11%, 56% and 16%. Each 1% increase in A1c AUC was associated with 13% higher risk of TG&gt;150mg/dL and 22% higher risk of LDL-C&gt;100mg/dL, after adjusting for WHtR (Table). There were no significant associations with WHtR.
In youth with T2D, 33% and 45% had progression or stable dyslipidemia of TG and LDL-C, respectively. Higher A1c over time is associated with worse TG and LDL-C, highlighting the importance of glycemic control.

Disclosure
R.P. Brady: None. A.S. Shah: None. E.T. Jensen: None. J.M. Stafford: None. R. Dagostino: Consultant; Self; Amgen, AstraZeneca, Celgene, Daiichi Sankyo. L.M. Dolan: None. L.M. Knight: None. G. Imperatore: None. C.B. Turley: None. A.D. Liese: None. E.M. Urbina: None. J.M. Lawrence: None. C. Pihoker: None. S.M. Marcovina: None. D. Dabelea: None.

Funding
Centers for Disease Control and Prevention (1U18DP006131, U18DP006133, U18DP006134, U18DP006136, U18DP006138, U18DP006139); National Institutes of Health (1UC4DK108173)
1243-P: NMR-Derived Biomarkers Identify Cardiometabolic Disease Risk in Youth
Authors: CHUNG STEPHANIE T. , MATTA SAMANTHA , MEYERS ABBY , CRAVALHO CELESTE K. , VILLALOBOS-PEREZ ALFREDO , MABUNDO LILIAN , COURVILLE AMBER B. , SAMPSON MAUREEN L. , OTVOS JAMES D. , MAGGE SHEELA N. 
Published: June 2020

Youth with obesity have increased risk for cardiometabolic (CM) disease but identifying those at highest risk remains a challenge. 4 potential biomarkers are “byproducts” of clinical NMR LipoProfile® lipid testing: LPIR (Lipoprotein Insulin Resistance Index), GlycA (inflammation marker), BCAA (total branched-chain amino acids), and glycine. All are strongly related to insulin resistance (IR) and type 2 diabetes (T2D) in adults (glycine inversely), but their clinical utility in youth is unclear. We compared fasting levels of these biomarkers in 184 youth (42 lean normal glucose tolerant (NGT), 88 obese NGT and 54 obese with abnormal glucose tolerance (AGT; 20 with T2D and 34 with prediabetes) and determined their relationships with HOMA-IR (homeostatic model of IR) and hemoglobin A1c (HbA1c). Compared to lean and obese NGT, AGT youth had higher systolic blood pressure and HbA1c (Table). All 4 biomarkers were higher in youth with obesity vs. lean, while only LPIR was higher in AGT youth vs. obese NGT (Table). While all 4 were correlated with HOMA-IR, LPIR had the strongest correlation (LPIR: r=0.6; GlycA: r=0.4, glycine: r=-0.4, BCAA: r=0.2, all P&lt;0.01). All 4 correlated with HbA1c (GlycA, LPIR, BCAA: r≥0.3 and glycine: r=-0.3, all P&lt;0.001). Plasma NMR-derived markers were related to CM risk in youth, with LPIR distinguishing between obese NGT and AGT. These biomarkers should be explored as predictive tools for development of IR and T2DM.

Disclosure
S.T. Chung: None. S. Matta: None. A. Meyers: None. C.K. Cravalho: None. A. Villalobos-Perez: None. L. Mabundo: None. A.B. Courville: None. M.L. Sampson: None. J.D. Otvos: Employee; Self; LabCorp. S.N. Magge: None.

Funding
National Institutes of Health (to S.T.C., L.M., A.B.C.)
1246-P: Mental Health among Youth Living with Type 2 Diabetes in Manitoba: A Cross-Sectional Study
Authors: MCGAVOCK JONATHAN , WICKLOW BRANDY , SELLERS ELIZABETH , KROEKER KRISTINE , BLYDT-HANSEN TOM , DART ALLISON 
Published: June 2020

Introduction: Mental health comorbidities are common in persons with type 2 diabetes (T2D). The magnitude of mental health comorbidities in youth with T2D and possible protective factors against comorbidities, remain unclear, as previous studies have not compared outcomes with population-based samples or included measures of resilience.
Methods: We performed a cross-sectional analysis of 178 Indigenous youth (15 yrs IQR: 13-17 yrs) with T2D from the iCARE cohort study and 270 randomly sampled population-based controls (15-24 yrs), from the Canadian Community Health Survey - Mental Health Component. Overall positive mental health and flourishing were assessed with the Mental Health Continuum-Short Form. Depression, anxiety and severe mental illness (SMI) were assessed with the Kessler Distress Scale. Measures of resilience were assessed in youth with T2D using the 64-question Resiliency Scales for Children and Adolescents.
Results: Youth with T2D, were more likely to be female (65 vs. 49%), Indigenous (96 vs. 29%), live remotely (70 vs. 26%) and within a low income neighbourhood (p&lt;0.0001 for all characteristics). After adjusting for these differences, youth living with T2D displayed lower positive mental health (-11.0, 95%CI: -13.3, -8.6), higher distress (3.53, 95% CI: 2.76, 4.29) and higher depression scores (2.76, 95% CI: 2.19, 3.32). Youth with T2D were also more likely to have SMI (aOR: 5.81, 95% CI: 2.2, 15.4) and are less likely to be flourishing (aOR 0.27, 95%CI: 0.18, 0.41) compared to population based controls. A sense of mastery and relatedness were associated with higher positive mental health and less depression and anxiety in youth with T2D.
Conclusion: Youth with T2D live with a profound degree of mental health comorbidities relative to the general population of in Manitoba, Canada. Future studies are required to address the specific mental health needs youth with T2D and determined best clinical care practices.

Disclosure
J. Mcgavock: None. B. Wicklow: None. E. Sellers: None. K. Kroeker: None. T. Blydt-Hansen: None. A. Dart: None.

Funding
Canadian Institutes of Health Research; Diabetes Canada; Research Manitoba
1248-P: Youth with Type 2 Diabetes Have a High Rate of Treatment Failure after Discontinuation of Insulin: A Pediatric Diabetes Consortium Study
Authors: WOLF RISA , CHENG PEIYAO , GAL ROBIN L. , BEAULIEU LINDSEY C. , KOLLMAN CRAIG , ISGANAITIS ELVIRA M. , MAGGE SHEELA N. , MASTRANDREA LUCY D. , KLINGENSMITH GEORGEANNA J. , TAMBORLANE WILLIAM V. , VAN NAME MICHELLE A. 
Published: June 2020

Background: Given the paucity of treatment options for youth with type 2 diabetes (T2D), insulin is commonly used to rapidly reverse gluco-toxicity. Subsequently, some youth with short duration T2D can be weaned off insulin soon after diagnosis. We analyzed data from the Pediatric Diabetes Consortium (PDC) Registry to determine how long glycemic control is maintained off insulin.
Methods: Youth with T2D in the PDC Registry on metformin alone or lifestyle therapy alone upon registry enrollment but had previously been on insulin were included in this study (N=183). The primary outcome was time to treatment failure, defined by need to restart insulin or other diabetes medication (including metformin). Clinical data at enrollment and follow-up were analyzed using logistic regression to assess risk factors for treatment failure.
Results: Of participants who had previously been on insulin therapy (58% female, 53% Hispanic, mean age 15 ± 2 years, median diabetes duration 1.7 years), 54% (98/183) experienced treatment failure. In the subgroup on metformin alone at enrollment (N=140), 45% restarted insulin, while in the lifestyle alone subgroup (N=43), 81% restarted insulin or other diabetes medication. Time to treatment failure was a median of 1.2 years. High HbA1c (mean 7.7% vs. 6.1% in the treatment failure group vs. non-failure group; p&lt;0.001) and lifestyle alone treatment regimen (p=0.003) at enrollment were associated with treatment failure. At time of treatment failure, HbA1c had increased (mean: 1.2%) and BMI z-score decreased (mean: 0.07 kg/m2) from time of enrollment. HbA1c at diagnosis was not associated with treatment failure (mean 10.8 vs. 10.6% in the treatment failure group vs. non-failure group).
Conclusion: Youth with T2D previously treated with insulin have a high treatment failure rate on lifestyle or metformin therapy alone and are likely to restart insulin therapy. Youth with T2D should be monitored closely for worsening glycemic control.

Disclosure
R. Wolf: None. P. Cheng: None. R.L. Gal: None. L.C. Beaulieu: None. C. Kollman: Other Relationship; Self; Dexcom, Inc., Tandem Diabetes Care. E.M. Isganaitis: None. S.N. Magge: None. L.D. Mastrandrea: Board Member; Self; American Academy of Pediatrics. Research Support; Self; AstraZeneca, JDRF, Novo Nordisk Inc., Sanofi-Aventis. G.J. Klingensmith: Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc., Takeda Pharmaceutical Company Limited. W.V. Tamborlane: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Novo Nordisk Inc., Sanofi US. Other Relationship; Self; Eisai Inc., MannKind Corporation. M.A. Van Name: None.

Funding
Boehringer Ingelheim; Novo Nordisk; Takeda Pharmaceutical Company Limited
1249-P: Type 2 Diabetes in Prepubertal Children under 10 Years Old
Authors: ASTUDILLO MARCELA , REFAEY AHMAD K. , TOSUR MUSTAFA , SILLER ALEJANDRO F. , MCKAY SIRIPOOM , BALASUBRAMANYAM ASHOK , BACHA FIDA , REDONDO MARIA J. 
Published: June 2020

Only a few cases of type 2 diabetes (T2D) have been reported in children younger than 10 years of age. Given the aggressiveness of youth-onset T2D and the accelerated development of comorbidities and complications, recognition of this unique subgroup and its characteristics is imperative. We aimed to determine the prevalence and characteristics of children with T2D diagnosed &lt;10 years old (y/o) at a large academic pediatric hospital in the Southwestern U.S. We conducted a retrospective review of electronic medical records of 1,138 children and adolescents up to 21 years of age who were given a diagnosis of T2D in our clinic. We compared the demographic and biochemical characteristics at the time of diabetes diagnosis between children diagnosed &lt;10 y/o vs. ≥10 y/o, and by puberty status within the &lt;10 y/o group. In our overall T2D population, 67.3% were females, 9.9% non-Hispanic White (NHW), 59% Hispanic (Hisp), 26.8% African-American (AA). The mean age at diagnosis was 13.8± 2.6 (±SD) y/o (range 3.0-21.7). The children diagnosed with T2D &lt;10 y/o constituted 5.6%, n=64 of our total T2D population; mean age 8.8± 1.0 y/o (range 4.1-9.9). 52.2% were prepubertal (Tanner Stage [TS]-I). 81.2% had islet autoantibodies test available (including GAD, ICA-512 and IAA) and all had negative results. Children with T2D diagnosed &lt;10 y/o were more likely to be female (79.7%) than youth diagnosed ≥10 y/o (61.4%, p=0.003). We observed no racial/ethnic distribution differences between the two groups (p=0.58). Within the group diagnosed &lt;10 y/o, children who were prepubertal, compared with those at ≥TS-II, were more likely to be male (33.3% vs. 0%, p=0.035), had a higher BMI-Z score (2.71 vs. 2.47, p=0.036), and tended to have a different racial/ethnic distribution (83.3% Hisp and 16.7% AA vs. 45.5% and 54.6%, respectively, p=0.057).
In conclusion, less than 10% of youth with T2D are diagnosed under age 10 years; those in this group who are prepubertal (&gt;50%) are distinctly atypical and have other unique characteristics that warrant further study.

Disclosure
M. Astudillo: None. A.K. Refaey: None. M. Tosur: None. A.F. Siller: None. S. Mckay: None. A. Balasubramanyam: None. F. Bacha: Research Support; Self; AstraZeneca, Takeda Development Center Americas, Inc. M.J. Redondo: None.
125-OR: Polyunsaturated Omega-6 Fatty Acids Reduce Axonal Mitochondrial Trafficking in Dorsal Root Ganglion Sensory Neurons
Authors: RUMORA AMY , LOGRASSO GIOVANNI , MCGRATH JACKSON D. , LENTZ STEPHEN I. , FELDMAN EVA L. 
Published: June 2020

Peripheral neuropathy is a prevalent complication of diabetes and prediabetes characterized by distal-to-proximal peripheral nerve damage. Dyslipidemia is a contributory factor that underlies neuropathy development in type 2 diabetes and prediabetes. However, the molecular pathways that underlie sensory neuron dysfunction in peripheral neuropathy associated with diabetes and prediabetes are unknown. Our recent lipidomic and transcriptomic analyses identified altered metabolism of polyunsaturated omega-6 fatty acid linoleic acid in the peripheral nerves of prediabetic mice with neuropathy. However, the molecular effect of linoleic acid on sensory neurons remains unknown. Since sensory dorsal root ganglion (DRG) neurons are dependent on trafficking mechanisms to transport healthy mitochondria throughout the length of the axon, we evaluated the effect of linoleic acid on axonal mitochondrial trafficking and function in DRG neurons. Primary DRG neurons from adult C57BL/6J mice were treated with physiological concentrations of linoleic acid ranging from 31.25-250 µM for 24 hours. Following treatment, we evaluated the effect of linoleic acid treatments on mitochondrial trafficking, mitochondrial membrane potential, ATP level, and apoptosis in DRG neurons. Interestingly, all concentrations of linoleic acid ranging from 31.25-250 µM preserved mitochondrial membrane potential and ATP level in DRG neurons. In line with these results, linoleic acid treatments did not stimulate neuronal apoptosis. However, physiological diabetic concentrations of 250 µM linoleic acid significantly impaired mitochondrial trafficking in the axon of DRG neurons. Overall, these results suggest that elevated levels of linoleic acid impair axonal mitochondrial trafficking without effecting mitochondrial function, and that defects in mitochondrial trafficking of sensory neurons may contribute to neuropathy pathogenesis in diabetes and prediabetes.

Disclosure
A. Rumora: None. G. LoGrasso: None. J.D. McGrath: None. S.I. Lentz: None. E.L. Feldman: Consultant; Self; Novartis Pharmaceuticals Corporation.

Funding
American Diabetes Association (7-12-BS-045 to E.L.F.); National Institutes of Health (1R24082841, 1DP3DK094292); National Institute of Diabetes and Digestive and Kidney Diseases (T32DK101357, F32DK112642, K99DK119366, P30DK020572); NeuroNetwork for Emerging Therapies; A. Alfred Taubman Medical Research Institute