bluuebunny/crossref_metadata_2025_split huggingface dataset:
1359-P: Neck Circumference: A Useful Tool for the Diagnosis of Gestational Diabetes and Risk of Adverse Outcomes in Overweight Pregnancy
Authors: DUALIB PATRICIA , CARVALHO CAMILA R.D. , MATTAR ROSIANE , DIB SERGIO A. , PITITTO BIANCA ALMEIDA 
Published: June 2020

Introduction: Few studies addressed the role of neck circumference (NC) as a risk factor during overweight pregnancy.
Objective: To evaluate the association of NC with GDM and adverse outcomes in overweight and obese women.
Methods: This longitudinal study included 132 (BMI&gt;25kg/m2) pregnant women. Standardized questionnaire and biochemical/physical evaluation were performed when they were admitted at GDM outpatient clinic (2018-2019): during the 1st to 3rd trimester (without and with DMG according to the IADPSG criteria). Fifth-five women were evaluated regarding hypertension in pregnancy, type of delivery and neonatal complications (death, intensive care unit admission and hypoglycemia). ANOVA, Chi-square test and logistic regression were performed.
Results: Women with (n=61) and without (n=71) GDM had similar mean(SD) pre-gestational BMI [30.3(4.0)vs29.4(3.5)Kg/m2,p=0.16], familiar history of diabetes, physical activity, schooling, lipid profile, TSH levels and blood pressure. Women with GDM were older [32(6)vs28(6)yrs,p&lt;0.001] and had greater NC [36.0(2.7)vs34.5(1.8)cm,p&lt;0.001] than those without GDM. NC was similar in women with GDM diagnosed in first or third trimester [p=0.4] and was correlated with FPG [r0.29,p=0.01] and systolic [r0.28,p=0.001] and diastolic [r0.25,p=0.004] blood pressure. In logistic regression analysis, NC was associated with GDM [OR1.25,95%CI1.03to1.52] adjusted for age, physical activity, schooling and familiar history of diabetes. In ROC analysis, the area under the curve was 0.655 and the cut-off value of 34.5cm had 0.70 of sensitivity and 0.51 of specificity for GDM. Women who had NC≥34.5 vs. &lt;34.5cm had higher frequencies of hypertension [32.3vs4.2%,p=0.01] and C-section [58.1vs29.2%,p=0.03] but not neonatal complications [45.2vs25.0%,p=0.12].
Conclusions: In a group of overweight or obese pregnant women the NC can be a useful tool for identifying GDM and obstetric adverse outcomes.

Disclosure
P. Dualib: None. C.R.D. Carvalho: None. R. Mattar: None. S.A. Dib: None. B. Almeida Pititto: None.

Funding
Fundação de Amparo a Pesquisa do Estado de São Paulo (18/14795-9)
136-OR: Lipid Profile in Men with Hypogonadism and Type 2 Diabetes Improves during Long-Term Treatment with Testosterone Undecanoate Injections (TU) in Comparison to an Untreated Control Group: Update of Real-World Registry Data
Authors: SAAD FARID , HAIDER KARIM S. , HAIDER AHMAD 
Published: June 2020

Background: Previous studies reported inconsistent effects of testosterone therapy on the lipid profile in men with hypogonadism.
Methods: Of 356 men with hypogonadism and T2DM, 178 received TU 1000 mg/12 weeks (T-group), 178 opted against treatment (CTRL). Changes over time between groups were compared and adjusted for age, weight, waist circumference, fasting glucose, blood pressure, lipids and quality of life to account for baseline differences between the two groups.
Results: Mean follow-up 8.2±2.9, baseline age 61.5±5.4 (T-group) and 63.7±4.9 (CTRL) years. Total cholesterol (mmol/L) decreased by 2.9±0.1 (from 8.3±1.1 to 5.2±0.3) at 11 years in T-group and increased by 1.1±0.1 (from 7.1±1.2 to 8.1±1.3) in CTRL. Estimated adjusted difference between groups: -4.0 (p&lt;0.0001 for all). HDL (mmol/L) increased by 0.5±0.0 (from 1.0±0.4 to 1.6±0.4) in T-group and decreased by 0.3±0.0 (from 1.1±0.5 to 0.9±0.5) in CTRL, difference between groups: 0.8 (p&lt;0.0001 for all). LDL (mmol/L) decreased by 1.9±0.1 (from 4.7±0.9 to 2.6±0.2) in T-group and increased by 0.9±0.1 (from 4.1±1.4 to 4.9±1.5) in CTRL, difference between groups: -2.8 (p&lt;0.0001 for all). Triglyceride (mmol/L) decreased by 1.1±0.0 (from 3.5±0.6 to 2.2±0.1) in T-group and increased by 0.5±0.0 (from 3.1±0.6 to 3.7±0.6) in CTRL, difference between groups: -1.7 (p&lt;0.0001 for all). Non-HDL (mmol/L) decreased by 5.5±0.3 (from 9.6±4.3 to 3.4±0.8) in T-group and increased by 4.9±0.3 (from 8.0±3.9 to 11.3±6.8) in CTRL, difference between groups: -10.4 (p&lt;0.0001 for all). Remnant cholesterol (mmol/L) decreased by 1.4±0.1 (from 2.6±1.0 to 1.0±0.2) in T-group and increased by 0.5±0.1 (from 2.0±1.0 to 2.3±0.7) in CTRL, difference between groups: -1.9 (p&lt;0.0001 for all).
Conclusions: Long-term treatment with TU in men with hypogonadism and T2DM progressively improved the lipid profile, which worsened in controls.

Disclosure
F. Saad: Consultant; Self; Bayer AG. Stock/Shareholder; Self; AbbVie Inc., Bayer AG. K.S. Haider: None. A. Haider: None.

Funding
Bayer AG
1364-P: Barriers and Facilitators of Diabetes Self-Management among Pregnant Women with Preexisting Type 2 Diabetes: A Scoping Review
Authors: PHONYIAM RATCHANOK , BERRY DIANE C. 
Published: June 2020

Background: Pregnant women with pre-existing type 2 diabetes (T2DM) are at risk for poor maternal and neonatal outcomes. Previous systematic reviews in women with T2DM have focused on physical activity, blood glucose monitoring, and insulin injections. The purpose of this review was to examine the barriers and facilitators of diabetes self-management.
Method: PubMed, CINAHL, and EMBASE databases were searched using PRISMA-ScR guidelines from January 1, 2009, to July 30, 2019. Inclusion criteria included manuscripts written in English and qualitative studies. Themes were compared and contrasted to identify areas of congruence and discrepancy.
Results: The review included ten manuscripts with 241 pregnant women with pre-existing T2DM, and eight family members were enrolled with sample sizes ranging from 5-89. First, barriers to knowledge about diabetes in pregnancy, physical activity, dietary control, medication adherence, financial constraints, stress, lack of social support, and cultural beliefs. Second, stress related to the diagnosis, infant outcomes, and cultural expectations. Third, barriers to access to care and disrespect from health care providers. Fourth, a loss of self-control. Fifth, facilitators of diabetes self-management in pregnancy were related to support from family, financial support, support from health care providers.
Discussion: Pregnant women with pre-existing T2DM have multiple barriers. Only one manuscript incorporated family members. Further qualitative research may need to seek the perspectives of family members about diabetes self-management in pregnancy and examine how they can provide support to the women.
Conclusion: This supports an integrative model of maternity care to overcome critical barriers and optimize key facilitators to enhance diabetes self-management behaviors and improve maternal and neonatal health outcomes.

Disclosure
R. Phonyiam: None. D.C. Berry: None.
1369-P: Is Weight Loss after a Pregnancy Complicated by Diabetes Associated with Improved Subsequent Pregnancy Outcomes?
Authors: YU LULU , HERRICK CYNTHIA J. , DUCKHAM HILLARY E. , CARTER EBONY B. 
Published: June 2020

Objective: To determine whether inter-pregnancy weight loss is associated with improved perinatal outcomes among pregnancies complicated by recurrent diabetes.
Methods: We performed a retrospective cohort study of all women with at least 2 singleton pregnancies complicated by gestational (GDM) or type 2 (T2DM) and cared for by the Resident Diabetes in Pregnancy Clinic at a large tertiary referral center from 2007-2017. Women whose initial pregnancy weight decreased between pregnancies were compared to those whose weight stayed the same or increased. Demographic characteristics were compared between groups and logistic regression was used to control for potential confounding variables including maternal age, race, and depression.
Results: There were 62 pregnancies complicated by recurrent diabetes during the study period. Weight loss between pregnancies occurred in 24 women. Women with pregnancies with inter-pregnancy weight loss were older (31.6 vs. 27.6, p=0.01) and had higher early pregnancy Edinburgh Postnatal Depression Scale scores (median 7; IQR 5,8 vs. median 2; IQR 1, 3, =0.01). Adjusted analyses using logistic regression demonstrated no significant association between inter-pregnancy weight loss and adverse maternal/neonatal outcomes including large for gestational age, small for gestational age, cesarean section, shoulder dystocia, birth injury, NICU admission&gt;24 hours, and preterm birth.
Conclusions: Inter-pregnancy weight loss was not associated with improved maternal or neonatal outcomes among pregnancies complicated by GDM or T2DM. Future studies are needed to identify the impact of depression on gestational weight gain/loss and subsequent pregnancy outcomes.

Disclosure
L. Yu: None. C.J. Herrick: None. H.E. Duckham: None. E.B. Carter: None.

Funding
American Diabetes Association/Pathway to Stop Diabetes (1-19-ACE-02 to E.B.C.); Robert Wood Johnson Foundation (74250); Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD095075)
1376-P: Association of Continuous Glucose Monitoring (CGM)-Derived Parameters with Adverse Pregnancy Outcomes in Pregnant Women with Type 1 Diabetes
Authors: LUO SIHUI , LING PING , DING YU , ZHENG XUEYING , YANG DAIZHI , ZHOU YONGWEN , YAN JINHUA , WENG JIANPING 
Published: June 2020

Background: The relation of CGM derived parameters and adverse pregnancy outcomes (APOs) in pregnant women with type 1 diabetes (T1D) is not completely clear.
Methods: During 2015 - 2018, data were prospectively collected from pregnancies of women with pregestational T1D receiving intermittent CGM in 11 centers in China. Characteristics and CGM derived parameters were compared between the women who had severe APOs and those who did not. Severe APOs were defined as maternal death, neonatal death, congenital anomaly, pregnancy loss in 2nd/3rd trimester and neonatal admission to intensive care unit.
Results: Data of 84 pregnant women with pregestational T1D were collected. Among them, 56 had received CGM in the 1st trimester, 55 in the 2nd trimester, and 59 in the 3rd trimester. 30 of these 84 women had severe APOs. Compared with women without severe APOs, women who had severe APOs had lower age at diagnosis, longer diabetes duration at conception. For CGM derived parameters, women who had severe APOs had significantly higher mean glucose (MG), MG at wake, MG at night, and time above range (TAR, &gt;7.8mmol/L) throughout all 3 trimesters, compared with women who did not have. Details see Table.
Conclusions: Higher MG, MG at wake, MG at night, and TAR throughout pregnancy were associated with the presence of severe APOs in women with T1D. These parameters should be closely monitored.

Disclosure
S. Luo: None. P. Ling: None. Y. Ding: None. X. Zheng: None. D. Yang: None. Y. Zhou: None. J. Yan: None. J. Weng: None.

Funding
National Health and Family Planning Commission of the People’s Republic of China; Foundation for Public Welfare Industry Research Project (201502011)
1377-P: Early Diagnosed Gestational Diabetes Mellitus: Initial Care Is Associated with Improved Prognosis when Fasting Plasma Glucose at Diagnosis Is ≥5.5 Mmol/l
Authors: COSSON EMMANUEL , VICAUT ERIC , BERKANE NARIMANE , BAUDRY CAMILLE , CIUNGANU TIT-LIVIU , VALENSI PAUL , CARBILLON LIONEL 
Published: June 2020

Some guidelines recommend immediate care for women with fasting plasma glucose level (FPG) ≥5.1 mmol/L in early pregnancy (early-diagnosed gestational diabetes mellitus: eGDM). As diagnosis and care of hyperglycaemia can be delayed later in pregnancy, we assessed whether immediate vs. no immediate care for eGDM is associated with pregnancy outcomes. We retrospectively selected the women without known diabetes seen in our department (2012-2016) with a FPG level between 5.1 and 6.9 mmol/L before 22 weeks of gestation (WG) and separated them into two groups: (i) 255 who had immediate care; (ii) 268 who did not and performed an oral glucose tolerance test (OGTT) after 22 WG, with subsequent care if hyperglycaemia was present. We compared the occurrence of multiple outcomes including a composite adverse pregnancy outcome (large for gestational age infant, shoulder dystocia, preeclampsia). Among women without immediate care for eGDM, 134 had hyperglycemia after 22 WG. Women receiving immediate care were more likely than women with no immediate care to be insulin-treated (58.0 vs. 20.9%, p&lt;0.00001) and had a lower gestational weight gain (8.6±5.4 vs. 10.8±6.1 kg, p&lt;0.00001). After propensity score modeling and accounting for covariates, the rate of the composite outcome was similar in both groups (13.7 and 14.6% in women with and without immediate care respectively, p=0.87); however, when initial FPG was ≥5.5 mmol/L (n=134), the rates were respectively 8.0 and 17.7%, p=0.02. To conclude, immediate care of women with FPG ≥5.5 mmol/L in early pregnancy might improve pregnancy outcomes.

Disclosure
E. Cosson: None. E. Vicaut: Consultant; Self; Abbott, Boston Scientific, Celgene, Pfizer Inc. N. Berkane: None. C. Baudry: None. T. Ciunganu: None. P. Valensi: None. L. Carbillon: None.
1387-P: Risk of Perinatal Complications across Gestational Blood Pressure Levels in Women with and without Gestational Diabetes (GDM)
Authors: ZHU YEYI , FENG JUANRAN , NGO AMANDA , QUESENBERRY CHARLES , FERRARA ASSIAMIRA 
Published: June 2020

Hypertensive disorders in pregnancy and GDM are among the leading causes of maternal and perinatal morbidity. In 2017, the American College of Cardiology/American Heart Association released a new guideline for hypertension: systolic/diastolic blood pressure (SBP/DBP) ≥130/80 vs. previous 140/90 mmHg. However, these new cut-points have not been applied to pregnant women due to the lack of evidence on its impact on perinatal outcomes. We examined in women with and without GDM whether the risk of perinatal complications increased across SBP/DBP levels: normal (&lt;120/80 mmHg, untreated), elevated (120-129/&lt;80, untreated), stage 1 gestational hypertension (GH, 130-139/80-89, untreated), and stage 2 GH (≥140/90, treated or untreated). The study was conducted in 2017-2018 among 6458 women with GDM and 50885 without GDM, who were Kaiser Permanente Northern California members without pre-existing hypertension. Logistic regression examined associations of BP categories with perinatal outcomes, adjusting for sociodemographic, medical, and lifestyle covariates. The prevalences were higher in women with vs. without GDM: elevated BP 21.3% vs. 20.0%, stage 1 GH 18.6 % vs. 16.1%, and stage 2 GH 3.6% vs. 2.6% (all P &lt;0.05). Associations with risk of large-for-gestational age were more pronounced among women with vs. without GDM, with adjusted odds ratios (OR) for elevated BP of 1.54 (95% CI 1.28-1.84) vs. 1.22 (1.13-1.31) and for stage 1 GH of 1.35 (1.11-1.64) vs. 1.21 (1.11-1.31) (P for interaction &lt;0.01). Associations with preterm birth and small-for-gestational age were present only for stage 2 GH among women without GDM: OR 1.56 (1.26-1.91) and 1.59 (1.34-1.88), respectively (P for interaction=0.02 and 0.08, respectively). Although GH was more common in women with GDM, its associations with perinatal complications varied by GDM status. Also, our findings suggest the new guideline may identify women with subclinical high BP in pregnancy at risk of perinatal complications.

Disclosure
Y. Zhu: None. J. Feng: None. A. Ngo: None. C. Quesenberry: None. A. Ferrara: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (K01DK120807)
1396-P: The Impact of Neighborhood Factors on Glycemic Control for Women with Type 2 Diabetes during Pregnancy
Authors: ZAHEDI-SPUNG LEILAH , POLNASZEK BROCK E. , DUCKHAM HILLARY E. , HERRICK CYNTHIA J. , CARTER EBONY B. 
Published: June 2020

Objective: To determine whether women living in highly deprived neighborhoods, defined by Area Deprivation Index (ADI), have worse glycemic control than those in less deprived areas.
Methods: We performed a retrospective cohort study of low-income, previously uninsured pregnant women with T2DM from 2007-2017. We compared women living in high (≥ top quartile) or middle (middle quartiles) ADI neighborhoods to those living in low (≤bottom quartile) ADI neighborhoods. Demographic characteristics were compared and trends in mean A1c throughout pregnancy were tested with repeated measures analysis.
Results: Of 367 women meeting study criteria (ADI range 1-10; IQR 7-10), 81 lived in low, 181 in middle, and 105 in high ADI neighborhoods. Demographics were similar between groups, except the high ADI group had more Black women and more severe diabetes by White Class. All groups achieved significant improvement in HgbA1c; however, the high ADI group was unable to achieve the same level of glycemic control by the third trimester after controlling for race and disease severity. There were no differences in pregnancy outcomes.
Conclusion: Intensive prenatal care was insufficient to overcome neighborhood deprivation with regard to glycemic control; thus, additional neighborhood level interventions are likely needed to overcome this inequality.

Disclosure
L. Zahedi-Spung: None. B.E. Polnaszek: None. H.E. Duckham: None. C.J. Herrick: None. E.B. Carter: None.

Funding
American Diabetes Association/Pathway to Stop Diabetes (1-19-ACE-02 to E.B.C.); Robert Wood Johnson Foundation (74250); Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD095075)
1405-P: HbA1c Trajectories across Early Adulthood in the T1D Exchange Registry
Authors: TOSCHI ELENA , BAILEY RYAN , MILLER KELLEE , CALHOUN PETER 
Published: June 2020

Glycemic control in adolescents with type 1 diabetes (T1D) is poor; however, it typically improves during early adulthood. Factors related to improvement of glycemic control are unclear. A total of 1,775 participants aged 18-30 years at enrollment in the T1D Exchange Registry followed for an average of 6 years were included in this analysis. Latent class trajectory modeling was used to determine sub-groups following a similar HbA1c trajectory over time. Five distinct trajectories of HbA1c classes were identified: Groups 1 and 2 had low or moderate HbA1c with a gradual decline with age, Group 3 had high HbA1c and remained stable, and Groups 4 and 5 had very high HbA1c with rapid or gradual decline (Figure). Compared with Group 3, Groups 1 and 2 were more likely to be male (P = 0.01), white non-Hispanic (P = 0.02), non-smokers (P = 0.001), check glucose more frequently (P &lt; 0.001), and have higher education (P &lt; 0.001), lower BMI (P = 0.01), and lower daily insulin dose (P &lt; 0.001); if female, those in Group 1 were more likely to have a pregnancy during the time observed (P = 0.04). Group 4 was more likely to increase number of SMBG checks (P = 0.02) and have BMI increase over time (P = 0.02) compared with Group 5. We determined 5 distinct patterns of glycemic control from young adulthood into adulthood. Further evaluation into the modifiable factors associated with a declining A1c trajectory would aid in the development of targeted interventions.

Disclosure
E. Toschi: None. R. Bailey: None. K. Miller: None. P. Calhoun: Stock/Shareholder; Self; Dexcom, Inc.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust (G-2016PG-T1D053)
141-LB: The Reality of Diabetic Ketoacidosis in Patients with Type 2 Diabetes Using SGLT2 Inhibitors Revealed by a Nationwide Claim-Based Database in Japan
Authors: HORII TAKESHI , OIKAWA YOICHI , HIGASHIYAMA TOMOKO , ATSUDA KOICHIRO , SHIMADA AKIRA 
Published: June 2020

Objective: Using a nationwide claim-based database in Japan, we investigated the reality of diabetic ketoacidosis (DKA) in patients with type 2 diabetes (T2D) treated with sodium-glucose cotransporter 2 (SGLT2) inhibitors.
Research Design and Methods: We identified initiators of SGLT2 inhibitors in the claims data from April 2014 to June 2019, and investigated the incidence of DKA in patients with T2D. Moreover, in multivariable-adjusted Cox proportional hazard models, hazard ratio (HR) was calculated using age, sex, body mass index (BMI) and the use of continuous subcutaneous insulin infusion (herein referred to as insulin pumps). Furthermore, regarding DKA events as the objective variable, receiver operating characteristic (ROC) analysis was conducted to calculate a cut-off value for the periods from the initiation of the SGLT2 inhibitors.
Results: During the observation period, among 173,025 initiators of SGLT2 inhibitors, patients with a diagnosis of DKA were 1,848 (1.1%), and those requiring inpatient treatment were 247 (0.14%). Factors associated with the diagnosis of DKA were 60- &lt; 70years of age (HR, 1.59), BMI &lt; 25kg/m2 (HR, 1.22) and the use of insulin pumps (HR, 4.61). Moreover, Factors associated with DKA requiring inpatient treatment were 60-70 years of age (HR, 2.64) and BMI &lt; 25kg/m2 (HR, 1.31). As for the DKA events, ROC analysis revealed that the cut-off value was 60 days from the initiation of the SGLT2 inhibitors.
Conclusions: This survey revealed that the risk of DKA calculated using real-world database was particularly pronounced among 60- &lt; 70years of age and BMI &lt; 25kg/m2 patients. Furthermore, it became clear that special attention should be paid to the onset of DKA for about 60 days from the initiation of the SGLT2 inhibitors. This information would provide guidance to avoid DKA with SGLT2 inhibitors and optimize the treatment of T2D, especially in Asian descent.

Disclosure
T. Horii: None. Y. Oikawa: None. T. Higashiyama: None. K. Atsuda: None. A. Shimada: Advisory Panel; Self; Astellas Pharma Inc. Speaker’s Bureau; Self; Eli Lilly Japan K.K., Novo Nordisk Inc., Sanofi-Aventis.
141-OR: Efficacy and Safety of Naltrexone/Bupropion as Add-On to Incretin Agents in Patients with Obesity and T2DM
Authors: WHARTON SEAN , YIN PETER , CAMACHO FERNANDO , BURROWS MELONIE , BLAVIGNAC JESSICA , BARAKAT MAXIME 
Published: June 2020

There is significant overlap between obesity and type 2 diabetes (T2DM). Incretin agents (dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide 1 receptor agonists (GLP-1RAs)) are recommended as second-line to metformin in patients with T2DM due to their glucose-lowering effects, low risk of hypoglycemia, and favorable effect on weight. Naltrexone/bupropion (NB) is a combination therapy approved in North America and Europe for chronic weight management. This is an exploratory analysis of the efficacy and safety of NB in T2DM subjects enrolled in two double-blind, placebo-controlled Phase III studies (N=1344), that were stable on an incretin agent prior to randomization. At 1 year, mean weight change was -4.6% ± 0.21% in NB (N=700) compared to -1.1% ± 0.15% in placebo (N=644). In subjects randomized to NB that achieved at ≥5% weight loss at week 16 (early responders, N=269), mean weight change at 1 year was -8.8% ± 0.34%. An analysis of covariance using LOCF adjusting for age, sex, baseline BMI, baseline weight, and responder status revealed no significant interaction between incretin agent and weight treatment medication (p=0.1317), a significant treatment NB vs. placebo effect (p&lt;0.0001), but not a significant incretin agent effect (p=0.1388). Safety and tolerability profiles were in line as previously observed in the broader population.
In conclusion, NB is efficacious and safe in reducing weight in patients with obesity and T2DM on DPP-4 inhibitors and GLP-1RAs, and may be an effective addition when weight loss is a focus in treatment.

Disclosure
S. Wharton: Advisory Panel; Self; Bausch Health Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk Inc. P. Yin: Employee; Self; Bausch Health. F. Camacho: Consultant; Self; Bausch + Lomb, Janssen Pharmaceuticals, Inc. M. Burrows: Employee; Self; Bausch Health. J. Blavignac: Employee; Self; Bausch Health Canada. M. Barakat: Employee; Self; Bausch Health.