bluuebunny/crossref_metadata_2025_split huggingface dataset:
897-P: Real-World Response to Real-Time Continuous Glucose Monitoring by Caregivers of Children with Type 1 Diabetes
Authors: HOWELL HALEY , YEUNG BRITTANY J. , NGUYEN ANDREW , WONG JENISE C. 
Published: June 2020

The use of real-time continuous glucose monitoring (CGM) is on the rise in children with type 1 diabetes (T1D), but little is known about how caregivers respond to high and low sensor glucose (SG) values in a real-world setting. We previously reported results from a cross-sectional survey, distributed throughout the United States, of 169 caregivers of children with T1D using CGM. In the current study, 21 of these participants, who were also using insulin pumps, voluntarily contributed their device data anonymously through the Tidepool platform. Up to 90 days of CGM and pump data per participant were analyzed to determine how caregivers respond to SG levels below and above target range. The children had a mean age of 8.8 ± 3.0 years, were 60% female, were 15% ethnic minority or mixed ethnicity, and had an average hemoglobin A1c of 7.2% ± 0.8%. For these participants in a 90-day period, there were a total of 453,908 CGM values, or a mean of 7205 values per 30 days per participant (mean 2263 to 14,323 values per 30 days for each participant). The average SG was 171.7 ± 29.9 mg/dL, with 57.8% of sensor values between 70-180 mg/dL. The percentage of values in hypoglycemic range (&lt;70 mg/dL) was 2.9% and the percentage in hyperglycemic range (&gt;180 mg/dL) was 39.3%. Per 30 days, participants had means of 26.6 ± 30.3 hypoglycemic and 73.7 ± 28.6 hyperglycemic events lasting at least 15 minutes. Glucose values were rarely entered into pumps within 5 minutes of having SG values outside of target range for at least 15 minutes and were entered for 2.7% ± 5.3% of hypoglycemic and 3.0% ± 3.5% of hyperglycemic episodes. In response to high SG lasting at least 15 minutes, an insulin bolus was given 4.7% ± 4.0% of the time within 5 minutes and 59.3% ± 36.8% of the time within 60 minutes. The variable response to hypo- and hyperglycemia suggests further interventions that decrease the need for caregivers to perform active tasks in response to CGM data may help ease management burden and improve time in target range.

Disclosure
H. Howell: None. B.J. Yeung: None. A. Nguyen: None. J.C. Wong: Consultant; Self; pH Pharma. Research Support; Self; Dexcom, Inc.

Funding
Dexcom, Inc. (IIS-2017-048)
9-LB: Novel Somatostatin Receptor 2 Antagonist ZT-01 Prevents Hypoglycemia Onset in STZ-Diabetic Rats by Improving Glucagon Secretion
Authors: AIKEN JULIAN , D’SOUZA NINOSCHKA C. , SIMONSON ERIC , FARHAT RAWAD , CHAN OWEN , LIGGINS RICHARD , RIDDELL MICHAEL 
Published: June 2020

Iatrogenic hypoglycemia remains one of the most serious risks for people with type 1 diabetes (T1D) undergoing intensive insulin therapy. Development of counterregulatory failure, occurring in the early stages of diabetes, highlighted by loss of the ability to secrete glucagon in response to hypoglycemia, is one of the main contributing factors. While the reason for this loss is still uncertain, it has been suggested that enhanced secretion of the pancreatic hormone, somatostatin, in T1D may play a role. Previously, it was reported that antagonism of somatostatin receptor 2 (SSTR2) with the peptide PRL-2903 successfully improved the glucagon response to insulin-induced hypoglycemia in streptozotocin (STZ)-diabetic rats. In the current study, we assessed the effectiveness of a new SSTR2 antagonist, ZT-01, to prevent hypoglycemia during an insulin bolus challenge and evaluated the effect of both ZT-01 and PRL-2903 under stepped hyperinsulinemic-euglycemic-hypoglycemic clamp conditions. In both studies, STZ-diabetic rats maintained with daily insulin were administered either vehicle, PRL-2903 (10 mg/kg) or ZT-01 (10 mg/kg) intraperitoneally, one hour prior to the induction of hypoglycemia. ZT-01 was more effective than PRL-2903 in preventing the onset of hypoglycemia in response to the insulin bolus challenge. Median time of hypoglycemia onset (BG ≤54 mg/dL) was 60 min in controls, 70 min with PRL-2903 administration, and 125 min with ZT-01 administration. Furthermore, all control and PRL-2903 dosed rats experienced, while 28% of rats receiving ZT-01, avoided hypoglycemia. During the hypoglycemic clamp, ZT-01 was more effective than PRL-2903 at improving glucagon responses in hypoglycemia. ZT-01 administration increased glucagon peak by 4-fold over the response to PRL-2903 (P&lt;0.05). We conclude that ZT-01 may be an effective compound that can be used for the restoration of the glucagon response to hypoglycemia in patients with T1D.

Disclosure
J. Aiken: None. N.C. D’Souza: None. E. Simonson: None. R. Farhat: None. O. Chan: None. R. Liggins: Advisory Panel; Self; Zucara Therapeutics Inc. Stock/Shareholder; Self; Zucara Therapeutics Inc. M. Riddell: Advisory Panel; Self; Zucara Therapeutics Inc. Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc., Insulet Corporation. Speaker’s Bureau; Self; Medtronic, Novo Nordisk A/S.

Funding
JDRF; The Leona M. and Harry B. Helmsley Charitable Trust
90-OR: Inhibition of miRNA-200b Rescues Diabetes-Impaired Angiogenesis
Authors: CANNIZZO CARLA , SOLLY EMMA , OLAYA LUISA F. , ABDOLLAHI MARYAM , SUTANTO SURYA S. , TWIGG STEPHEN M. , BURSILL CHRISTINA , TAN JOANNE T. , MCLENNAN SUSAN 
Published: June 2020

Impaired angiogenic responses to ischemia characterize the vascular complications associated with diabetes. Diabetic foot ulcers in the presence of ischemia are associated with the most severe outcomes, including a higher rate of mortality and lower probability of healing. Specific micro-RNAs (miRNAs) such as miRNA-200b have been shown to negatively regulate angiogenesis in ischemia. Therefore, we sought to investigate miRNA-200b as a target and biomarker of diabetes-impaired angiogenesis. To assess the importance of miRNA-200b in diabetes-impaired angiogenesis, we transfected endothelial cells with anti-miRNA-200b or anti-miRNA-Neg then performed a functional tubulogenesis assay under high glucose and hypoxic conditions. High glucose impaired tubule formation by 23.6% in response to hypoxia when compared to controls (51.9±15.4 vs. 39.7±23.2, P&lt;0.005), this decrease was prevented by anti-miRNA-200b treatment. Furthermore, in an in vivo hind-limb ischemia model, diabetic mice (n=8-11/group) were injected intramuscularly with anti-miRNA-200b or anti-miRNA-Neg at the time of hind-limb ischemia surgery. Diabetes impaired blood flow reperfusion was assessed by laser Doppler perfusion imaging (LDPI) in anti-miRNA-Neg control mice (LDPI: 0.27), and this was rescued by inhibition of miRNA-200b to nondiabetic levels (LDPI: 0.41, P&lt;0.05). To assess the utility of miRNA-200b as a biomarker of delayed healing, plasma miRNA-200b was measured in a rodent excisional wound model. When compared to controls, diabetes elevated plasma miRNA-200b in both unwounded and wounded animals, suggesting a diabetes related change. Whether this change is seen in humans remains to be investigated.
In conclusion, this study has identified that miRNA-200b is a potential target of diabetes-impaired angiogenesis as shown in this preclinical model of predominant ischemia in a diabetes setting.

Disclosure
C. Cannizzo: None. E. Solly: None. L.F. Olaya: None. M. Abdollahi: None. S.S. Sutanto: None. S.M. Twigg: Advisory Panel; Self; Abbott, AstraZeneca, Sanofi. Speaker’s Bureau; Self; Abbott, AstraZeneca, Novo Nordisk Inc., Roche Diabetes Care, Sanofi. C. Bursill: None. J.T. Tan: None. S. McLennan: None.
900-P: HbA1c Is an Insufficient Glucose Control Assessment Tool in Type 1 and Type 2 Treated with Insulin
Authors: TOTOMIROVA TZVETELINA , ARNAUDOVA MILA , DASKALOVA IVONA 
Published: June 2020

HbA1c is currently used for assessment of glucose control in type 1 and type 2 diabetes patients treated with different therapeutic regiments. Different conditions besides glucose concentration affect its level and, in many cases, HbA1c is insufficient to present glucose control. In our study we compare representativeness of usually used control assessment tools such HbA1c and multiple daily blood glucose measurements with results derived from CGM record. We studied a group of 106 patients (60 men, 46 women; mean age 58.23±10.81 years), 21 patients with type 1 diabetes (on intensified regimen) and 85 patients with type 2 diabetes (33 - on oral medications, 31 - on pre-mixed insulin, 21 - on intensified insulin regimen). Patients were observed for three-month period - they performed eight-point BG measurements at least three time weekly, HbA1c was measured at the end of this period and continuous glucose monitoring with iProTM was performed for seven days. In oral medication treated group a high positive correlation was found between HbA1c (7.13±0.85%) and average blood glucose level during period of CGM (7.15±1.80mmol/l) (p&lt;0.01) with correlation coefficient were (r1=0.742) (p&lt;0.05). In pre-mixed insulin treated group and type 2 with intensified regimen lower positive correlation was found (7.64±1.40% and 7.69±1.23%, respectively 7.64±1.48mmol/l and 7.60±1.30mmol/l), with r2=0.642 (p&lt;0.01) and r3=0.570 (p&lt;0.05). No correlation was found in type 1 diabetes group (r4=0.083). No correlations were found between HbA1c and number of excursions in other groups. Same trend of correlations was found comparing HbA1c and mean BG level in eight-point profile. We conclude that HbA1c is appropriate assessment tool only in oral treated type 2 diabetes patients. In type 1 and insulin treated type 2 patients HbA1c gives relative information about overall control with no precise presenting of glucose fluctuations and out-of-range values of BG.

Disclosure
T. Totomirova: None. M. Arnaudova: None. I. Daskalova: None.
906-P: The Association of British Clinical Diabetologists Audit of Freestyle Libre (FSL) in Diabetes in United Kingdom: Determinants of Time-in-Target Range
Authors: WILMOT EMMA G. , DESHMUKH HARSHAL , PATMORE JANE , SATHYAPALAN THOZHUKAT , WALTON CHRISTOPHER , HERRING ROSELLE , RYDER ROBERT E. 
Published: June 2020

Objective: Time in range (TIR) is a novel measure of glucose control endorsed by an international consensus group. TIR describes the percentage of TIR (3.9-10mmol/l), time above range (TAR &gt;10mmol/l) and time below range (TBR, &lt;3.9mmol/l) over a given time period. Given the increased use of FreeStyle Libre (FSL) in the UK we were keen to explore the glucose ranges commonly reported in routine clinical practice.
Methods: The ABCD UK FreeStyle Libre audit invited clinicians to submit routine clinical data from FSL users to a secure web-based tool. Data from 101 UK hospitals were analysed using R3.5.0. Linear regression analysis was used to compare the baseline predictors of TIR . TIR was categorised as internationally accepted (3.9-10mmol/l) or individualised (any range other than 3.0-10mmol/l).
Results: Data were available for 10,370 FSL users; age 38 (±18.7) years, 54% female, diabetes duration 16 (±49) years, and BMI of 25.2 (±16.5) kg/m2. Follow-up HbA1c and TIR data was available for 2191 patients. Of those with both follow-up HbA1c and TIR data, in only 343 (15%) cases did clinicians report on the internationally accepted TIR (3.9-10mmol/l), with a median TIR of 43% (27%-56%). Taking both international and individualised TIR together, 221 (10%) had ≥70% TIR, 822 (37%) ≥50% TIR and 1372 (62%) &lt;50% TIR over 14 days. On multivariate regression analysis baseline age (beta=0.13 P&lt;0.0001, number of FSL scans per day (beta= 0.22, P&lt;0.0001) and baseline HbA1c (beta=-0.45, P&lt;0.0001) were associated with higher TIR. The internationally accepted median TBR (&lt;3.9mmol/l) was 6% (3-11) in this cohort.
Conclusion: This population-based study of FSL users demonstrates a limited uptake of the internationally recommended TIR of 3.9-10mmol/l. There is a need for greater awareness of the international recommendations for TIR measures; only a small proportion of people with type 1 diabetes achieve their goals; the number of scans per day predicts greater TIR.

Disclosure
E.G. Wilmot: Advisory Panel; Self; Abbott, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic. Speaker’s Bureau; Self; Abbott, Eli Lilly and Company, Insulet Corporation, Novo Nordisk Inc., Sanofi. H. Deshmukh: None. J. Patmore: None. T. Sathyapalan: Research Support; Self; Amgen, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk A/S. Other Relationship; Self; Ipsen Biopharmaceuticals. C. Walton: Speaker’s Bureau; Spouse/Partner; Celgene, LEO Pharma, Novartis Pharmaceuticals Corporation. R. Herring: None. R.E. Ryder: Consultant; Self; GI Dynamics Inc. Other Relationship; Self; Novo Nordisk A/S.
908-P: Predictive Model for Glycemic Level of People with Diabetes Mellitus Using Data Extracted from Electronic Medical Records in Primary Care
Authors: MISTRO SOSTENES , AGUIAR THALITA V.O. , CERQUEIRA VANESSA V. , SILVA KELLE O. , LOUZADO JOSÉ A. , KOCHERGIN CLAVDIAN N. , SOARES DANIELA A. , AMORIM WELMA W. , MEDEIROS DANIELLE S. , BEZERRA VANESSA M. , CARVALHO VIVIAN CARLA H. , AMARO EDSON , OLIVEIRA MÁRCIO G. , CORTES MATHEUS L. 
Published: June 2020

Background: In Brazil, the use of electronic medical records in primary care has been expanding, improving the supply of information and data storage, and allowing the analysis of various aspects and prediction of future outcomes.
Aim: To develop a predictive model for the glycemic level of people with type 2 diabetes mellitus based on data from electronic medical records in primary care.
Methods: Data mining techniques were applied to choose response variables and potential predictors. Afterwards, data modelling was performed using Artificial Neural Networks (ANN), which are mathematical models inspired by the neural structure of intelligent organisms that acquire knowledge through experience. They detect non-linear relationships between the response variable and the explanatory variables without these variables having been defined.
Results: The highest probability of model accuracy was observed in the capillary blood glucose range between 100 and 300mg/dL. Model predictors and relative importance of each variable are shown in Figure 1.
Conclusion: Applying predictive modelling to data available in primary care electronic medical records can help the early identification of individuals with difficulty in glycemic control, and increase the efficiency in the allocation of efforts to treat diabetes.

Disclosure
S. Mistro: None. T.V.O. Aguiar: None. V.V. Cerqueira: None. K.O. Silva: None. J.A. Louzado: None. C.N. Kochergin: None. D.A. Soares: None. W.W. Amorim: None. D.S. Medeiros: None. V.M. Bezerra: None. V.H. Carvalho: None. E. Amaro: None. M.G. Oliveira: None. M.L. Cortes: None.

Funding
SUS Institutional Development Support Program; Brazil Ministry of Health; Israelite Hospital; Albert Einstein (25000.028646/2018-10); Medtronic Foundation
91-OR: CTRP3, a Novel Adipokine with Anti-inflammatory and Cardioprotective Properties, in Patients with Cardiovascular Diseases and Type 2 Diabetes Mellitus
Authors: KRATOCHVILOVA HELENA , KASPEROVA BARBORA JUDITA , LACINOVA ZDENKA , LANKOVA IVANA , TRNOVSKA JAROSLAVA , NETUKA IVAN , IVAK PETER , MAHRÍK JAKUB , HLAVÁCEK DANIEL , MRAZ MILOS , HALUZIK MARTIN 
Published: June 2020

Cardiovascular diseases (CVD) are the most common cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). C1q TNF-related protein 3 (CTRP3) is a novel adipokine that reduces inflammation and acts cardioprotectively. The aim of our study was to analyze serum levels and gene expression of CTRP3 in subcutaneous and epicardial adipose tissue in patients with CVD and T2DM undergoing elective cardiac surgery.
38 patients with coronary artery disease (CAD) without T2DM (CAD group), 21 subjects with CAD and T2DM (T2DM group) and 18 patients with a valvular defect without CAD or T2DM (nonCAD group) were included into the study. Peripheral blood, subcutaneous (SAT) and epicardial adipose tissue (EAT) were examined at the start and end of elective cardiac surgery. mRNA expression was determined using qRT-PCR. 21 healthy subjects served as controls for serum CTRP3 (C group).
Baseline anthropometric and biochemical parameters were comparable in all groups except of higher fasting blood glucose (6.0±1.2 vs. 5.5±0.2 vs. 6.0±0.9 vs. 8.5±0.4 mmol/l for CAD vs. nonCAD vs. C vs. T2DM, p&lt;0.001) and HbA1C (34.2±1.6 vs. 39.1±0.9 vs. 38.7±6.4 vs. 53.1±1.9 mmol/mol, p&lt;0.001) in T2DM group. Compared to controls, all 3 CVD groups showed lower systemic CTRP3 concentrations (65.6±2.2 vs. 69.3±4.7 vs. 64.8±3.5 vs. 90.8±3.7 ng/ml for CAD vs. nonCAD vs. T2DM vs. C, p&lt;0.001). In EAT, we found reduced mRNA expression of CTRP3 in T2DM compared to nonCAD group (0.61±0.27 vs. 6.61±2.33, p=0.005) and a similar, albeit non-significant trend in CAD group (1.55±0.32, p=0.132). Cardiac surgery resulted in a significant decrease in serum CTRP3 in all patients without affecting mRNA expression in EAT or SAT.
To conclude, decreased serum levels of CTRP3 in patients with CVD together with reduced mRNA expression in EAT in T2DM subjects with CAD indicate a possible role of CTRP3 in the pathogenesis of cardiovascular complications of type 2 diabetes mellitus.

Disclosure
H. Kratochvilova: None. B. Kasperova: None. Z. Lacinova: None. I. Lankova: None. J. Trnovska: None. I. Netuka: None. P. Ivak: None. J. Mahrík: None. D. Hlavácek: None. M. Mraz: None. M. Haluzik: Advisory Panel; Self; Lilly Diabetes, Sanofi. Consultant; Self; Ethicon US, LLC. Speaker’s Bureau; Self; AstraZeneca, Mundipharma International, Novartis AG, Novo Nordisk A/S.

Funding
Institute for Clinical and Experimental Medicine (00023001); RVOVFN64165; Ministry of Health of the Czech Republic (NV19-02-00118)
913-P: Higher Glucose Thresholds for Hypoglycemia Alarms on Continuous Glucose Monitoring Systems (CGMs) Are Associated with Less Time in Hypoglycemia in Patients with Impaired Awareness of Hypoglycemia
Authors: LIN YU KUEI , GROAT DANIELLE , CHAN OWEN , POP-BUSUI RODICA , VARNER MICHAEL , FISHER SIMON 
Published: June 2020

A cross-sectional observational cohort analysis was conducted to assess whether higher hypoglycemia alarm thresholds on CGMs are associated with less hypoglycemia for both patients with normal (NAH) and impaired (IAH) awareness of hypoglycemia. Two-week CGM alarm/glucose data from 39 and 42 type 1 diabetes (T1D) patients with NAH and IAH (determined by the Clarke questionnaire) who have used CGMs for &gt;3 months and had an active CGM usage time of ≥86% were included in the analysis. IAH patients with higher hypoglycemia alarm thresholds (i.e., alarm thresholds set &gt;73 mg/dL vs. &lt;73 mg/dL) spent 57.8% and 75.6% less time with glucose &lt;70 and &lt;54 mg/dL, respectively, while no significant differences were found between higher/lower alarm thresholds in the NAH groups. (Figure 1a, 1b) Fewer day and night-time numbers of hypoglycemic episodes (defined as ≥1 glucose value &lt;70 and &lt;54 mg/dL; Figure 1c, 1d) and shorter duration of episodes with glucose &lt;54 mg/dL (Figure 1e, 1f) contributed to the reduced time spent in hypoglycemia in the IAH patients with higher alarm thresholds. The current analysis suggests that higher CGM hypoglycemia alarm thresholds are associated with less time spent in hypoglycemia in T1D patients with IAH, but not those with NAH.

Disclosure
Y. Lin: None. D. Groat: None. O. Chan: None. R. Pop-Busui: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Consultant; Self; Bayer Healthcare Pharmaceuticals Inc., Novo Nordisk Inc. Research Support; Self; AstraZeneca. Other Relationship; Self; American Diabetes Association. M. Varner: None. S. Fisher: None.

Funding
National Institute for Diabetes and Digestive and Kidney Diseases/Washington University School of Medicine (2P30DK020579); University of Utah Diabetes and Metabolism Research Center; National Institute for Diabetes and Digestive and Kidney Diseases (5T32DK091317); National Center for Advancing Translational Sciences (1ULTR002538)
937-P: Effects of Insulin and Exenatide on Glycemic Control and ß-Cell Function in Newly Diagnosed Type 2 Diabetic Patients with Severe Hyperglycemia
Authors: WU TSUNG-HUI , CHEN HARN-SHEN 
Published: June 2020

Objective: To assess the efficacy of short-term insulin therapy compared with exenatide treatment on glycemic control, beta-cell function, insulin sensitivity, and long-term glycemic control in newly diagnosed type 2 diabetic patients with severe hyperglycemia.
Methods: Newly diagnosed type 2 diabetic patients with HbA1c above 9% were treated with intensive insulin injection for 10-14 days in the hospital or outpatient clinic. The oral glucose tolerance test (OGTT) was performed after intensive insulin treatment. After the OGTT, the patients were randomized to receive either insulin therapy (NPH injection twice daily) or exenatide therapy (exenatide injection twice daily) for further 4 months. The patients started to take oral antidiabetes drugs after 4 months of randomization. The OGTT was repeated 6 months after randomization to evaluateβ-cell function and insulin sensitivity again. The subjects were continually followed up for another 1 year to evaluate long-term glycemic control.
Results: We recruited 44 patients and 40 patients were randomized to insulin group (n = 22) and exenatide group (n = 18). The HbA1c level between insulin group and exenatide group at 6th month (6.74 ± 1.12% vs. 6.88 ± 0.76%; P = 0.681) and 18th month (6.60 ± 0.92% vs. 7.13 ± 0.83%; P = 0.093) of the study showed comparable results. The glucose area under the curve, insulinogenic index, and total insulin secretion improved significantly in both groups after 4 months of treatment. Compared with the exenatide group, the homeostasis model assessment of β-cell function index, insulinogenic index, and total insulin secretion were better in the insulin group.
Conclusions: A 4-month course of both the insulin and exenatide treatment could achieve good glycemic control in newly diagnosed type 2 diabetes with severe hyperglycemia. However, the insulin treatment could improve more β-cell function than exenatide therapy.

Disclosure
T. Wu: None. H. Chen: None.