bluuebunny/crossref_metadata_2025_split huggingface dataset:
2210-PUB: Nonselective Mineralocorticoid Receptor Antagonist May Alter Morning Elevation of Plasma Glucose Levels after Waking
Authors: YAMAUCHI KEISHI 
Published: June 2020

Previously, we reported that morning plasma glucose (PG) elevation before wake-up(W1) and after wake-up(W2), occur through different mechanisms in patients with type 2 diabetes. We measured three point PGs by Point-of-Care Testing (POCT) and flash glucose monitoring system (FreeStyle Libre Pro™); midnight (3 am), the time of awakening (about 6 am) and just before breakfast (8 am), hormones and their metabolites in 32 hospitalized patients with type 2 diabetes. Those with insulin therapy or overtly elevated fasting PG (&gt;11 mmol/L) were excluded. W1 could be explained by relative insulin deficiency. Urinary normetanephrine, reflects a sum of production of norepinephrine was significantly correlated with W2 (R=0.422, p&lt;0.01). Level of other antagonistic hormones including urinary metanephrine was not correlated with W2. Norepinephrine, a relatively selective agonist of alpha-adrenergic receptor, within the normal range, may be responsible for W2. It has been reported that spironolactone, a nonselective mineralocorticoid receptor antagonist, may have a deleterious effect on glycemia. Spironolactone (25mg) was administered 5 female diabetic patients with hypertension for seven days. Spironolactone significantly increased W2 (8 am PG minus 6 am PG) (0.1±0.4 mmol/L to 0.5±0.9 mmol/L, p&lt;0.05) but not W1(6 am PG minus 3 am PG) (0.2±0.5 mmol/L to 0.2±0.3 mmol/L, p&gt;0.05). The Urinary normetanephrine was increased by the treatment (0.19±0.19 mg/gCre to 0.26±0.11 mg/gCre, p&lt;0.05). But the treatment did not change urinary metanephrine (0.16±0.10 mg/gCre to 0.17±0.08 mg/gCre, p&gt;0.05). Further, eplerenone(50mg), a selective mineralocorticoid receptor antagonist affected neither W1 nor W2 in 2 male diabetes patients with hypertension. These results suggested that nonselective mineralocorticoid receptor antagonist may affect glucose metabolism via change of alpha-adrenergic tone.

Disclosure
K. Yamauchi: None.
2219-PUB: Comparison of Efficacy of Canagliflozin 100mg vs. Canagliflozin 300mg on hs-CRP in Patients with Type 2 Diabetes Mellitus
Authors: GUPTA VISHAL , TELI VAISHALI , PATEL ALTAF 
Published: June 2020

Aim: To compare the efficiency of canagliflozin (C1) 100mg vs. canagliflozin (C3) 300mg on highly sensitive C reactive protein (hs-CRP) and other cardio-renal (CR) biomarkers.
Methodology: Between July and Sept 2018, a cohort of 190 T2DM patients aged 18-75 yrs, irrespective of baseline A1c, receiving SGLTi C1 or C3 were identified. A propensity score 1:1 matching was done for both the groups with variables that could affect treatment outcomes and to minimise confounding. Patients were evaluated every 2-3months for CR biomarkers (body mass index (BMI), A1c, systolic (S) BP, diastolic (D) BP, Lipid profile (TC, LDL, TG, HDL), Hs-CRP, creatinine, eGFR and urinary albumin/creatinine ratio {UACR}). NT-ProBNP was evaluated at 12 months. T2DM with history of IHD, revasularisation, major surgery, hyperkalemia &gt;5.5Meq/L and eGFR&lt;45 were excluded. Baseline characteristics were analyzed using descriptive statistics expressed as % or mean±SD. Comparison between the groups was performed using paired and unpaired t-test expressed as mean ± SE and p value &lt;0.05 was considered significant(S). For interaction between drug class, ANOVA was used.
Results: 44 patients were identified in C1 gr and 44 in C3 gr. Baseline characters were well matched in both gr except, SBP (mean±SD) (C1 129.05±17.54 vs. C3 138.05±22.22, P-0.38).C1 gr (baseline to 12m): there was a S reduction in hs-CRP, A1c, BMI, SBP, DBP, TC, TG, LDL. C3 gr (baseline to 12m): there was a S reduction in hs-CRP, A1c, BMI, SBP, DBP, TC, LDL. Difference between C1 and C3 at 12m: There was no difference in hs-CRP mg/L {C1 1.88±0.43 vs. C3 1.31±0.46, p-0.371}, A1c% {C1 1.27±0.19 vs. C3 1.44±0.34, p-0.666}, BMI kg/m2 {C1 1.24±0.27 vs. C3 1.23± 0.25, p-0.988}, NT-ProBNP pg/ml {C1 63.95±65.52 vs. C3 61.53±61.71, p-0.864} eGFR {C1 6.39±3.37 vs. C3 0.99±3.20, p-0.952}, UACR mg/gm {C1 25.48±10.86 vs. C3 9.61±7.87, p-0.240}, Lipid profile, SBP and DBP between both gr.
Conclusion: Canagliflozin 100mg is as good as canagliflozin 300mg in reduction of hs-CRP and CR markers.

Disclosure
V. Gupta: None. V. Teli: None. A. Patel: None.
2222-PUB: Differences In Clinical Background between Patients with and without Increased Glucagon Secretion while on SGLT2 Inhibitors: A Comparison of Canagliflozin and Other SGLT2 Inhibitors
Authors: ISHIGURO MIZUKI , MORI YUTAKA , NISHIMURA RIMEI 
Published: June 2020

Objective: This study was conducted to characterize differences in clinical background between patients with and without increased glucagon secretion while on SGLT2 inhibitors (S).
Methods: Of the 75 type 2 diabetic patients admitted for glycemic control who were not receiving incretin-related drugs nor S at admission, 22 patients received S but no incretin-related drugs after admission and were subjected to meal tolerance tests (MTTs) during early morning fasting hours at admission and after improving glycemic control. Blood samples were drawn from these patients preprandially and 30, 60, and 120 minutes postprandially to measure their glucose, C-peptide, and glucagon (Mercodia) values. First, based on changes in glucagon secretion observed in MTTs, they were divided into those with increased AUC glucagon (n = 13) and those without (n = 9) and compared for changes in MTT parameters. Then, they were also divided canagliflozin (Cana) group (n = 12) and other S (non-Cana) group (n = 10) and compared for changes in MTT parameters.
Results: Although those without increased AUC glucagon showed a significant increase in ΔCPR/Δglucose 0-30 min after improving glycemic control, those with increased AUC glucagon did not. Increased Δ CPR/Δ glucose 0-30 min values were noted in 5 of 13 of those with increased AUC glucagon but in 9/9 of those without, suggesting that those without increased AUC glucagon were more likely to be associated with increased Δ CPR/Δ glucose 0-30 min values. On the other hand, no significant difference was seen in changes in AUC glucagon or in the proportion of patients with increased AUC glucagon between the Cana and non-Cana groups.
Conclusions: Study results suggest that differences in the recovery of insulin secretion between patients may affect glucagon secretion to a greater extent than differences between S with or without SGLT1-inhibitory properties.

Disclosure
M. Ishiguro: None. Y. Mori: None. R. Nishimura: Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Speaker’s Bureau; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly Japan K.K., Medtronic, Merck & Co., Inc., Novo Nordisk Inc., Sanofi K.K., Takeda Pharmaceutical Company Limited.
2226-PUB: Direct Sanitary Cost of Diabetes Mellitus Ambulatory Treatment in the Institute of Prevision Social of Paraguay
Authors: ARZAMENDIA SADY P. , ROMERO FABIOLA , VALINOTTI ELIZABETH 
Published: June 2020

The Institute of Prevision Social (IPS), social security of Paraguay is responsible for the complete provision of diseases treatment of the worker and his family. Diabetes mellitus (DM) is one of the most prevalent diseases in our country.
Aim: To determine the direct health cost of DM outpatient treatment (medications and medical visits) of IPS in 2018.
Methods: Observational, descriptive, transverse. Data were collected on the type and quantity of antidiabetic medication consumed and the number of visits per patient with type 1 and 2 DM, of the computer registry: “SIH” from January to December 2018, available at all IPS centers in the country.
Results: 67,664 patients who received antidiabetic medication were included. Female 50.5%, age 64.5 ± 21.53 years. 79.7% use oral medication (1 or more drugs.) 30.3% use insulins (alone or in combination). In order of frequency, the most commonly used drugs are: Metformin 73% Glimepiride 41%, Insulin NPH 20% Basal insulin analogues 16%, Regular Insulin 5.4% Sitagliptin. 2% and ultrarapid analogs 1.8% of the total population. One visit per patient was averaged every 3.7 months with the internist, family doctor or endocrinologist; cost of $ 7,14/visit (stipulated by the Paraguayan Society of Internal Medicine), which yields an annual cost of outpatient visits of $2,166,720. The estimated annual cost used in antidiabetic medications was $ 3,842,977: Basal insulin analogs $ 1,802,808, NPH insulin $ 811,260, Ultrarapid insulin analogs $ 568,788, , Metformin $ 330,249, Sitagliptin $ 167,754, Glimepiride $ 103,656, Human rapid insulin 58,433 $; averaging a cost per patient of $ 89 per year.
Conclusion: The high costs generated by the disease, even without the calculation of hospitalizations, complications, work disability, suggests the need to promote primary prevention policies for DM. On the other hand, the optimization of health resources, using cost/effective medication, could help reduce health expenditure in our institution.

Disclosure
S.P. Arzamendia: None. F. Romero: None. E. Valinotti: None.
2241-PUB: The Effectiveness of Individualized Exercise Programs in a Multidisciplinary Pediatric Clinic for Patients with Type 2 Diabetes
Authors: EUROPA LEAH VENICE B. , BUENNAGEL LYNN N. 
Published: June 2020

Background/Purpose: The American Diabetes Association projects the incidence of type 2 diabetes (T2DM) among pediatric patients will increase to 49% by 2050. Physical activity and exercise modifications are primary recommendations in controlling diabetes. The purpose of this study is to describe the effects of a physical therapist (PT) prescribed personalized fitness plan to improve cardiovascular fitness in adolescents with T2DM.
Methods: Data was collected from patients treated at a multidisciplinary T2DM clinic at Children’s Hospital Los Angeles (CHLA). Physical therapy assessments were done when the patient visited the PT in clinic and included post-exercise heart rate, resting heart rate, rating of perceived exertion, and VO2 max. Multiple regression analysis was used to assess associations between change in fitness and covariates: age, sex, time since diagnosis, and time between first and last PT assessment.
Results: Fifty two patients who had at least 2 PT assessments at the T2DM clinic from April 2016 to October 2018 were included in the study. Patients with higher initial post-exercise heart rate experienced the greatest benefit from an individualized exercise program. Patients with lower initial VO2 max scores also experienced the greatest increase in VO2 max over time. There was no significant association with resting heart rate and rating of perceived exertion in regards to age, sex, time since diabetes diagnosis, and time between first and last PT assessment.
Conclusion: Prescribing a personalized fitness plan can improve fitness measures in patients with the lowest baseline fitness levels.
Implications: Maintaining a healthy and active lifestyle can be difficult for youth with T2DM especially if they lived a sedentary lifestyle prior to diagnosis. Health care providers and educators must consider the age and interests of the patient and family when creating a personalized fitness program.

Disclosure
L.B. Europa: None. L.N. Buennagel: None.

Funding
Good Hope Medical Foundation
2242-PUB: Gender-Specific Factors Associated with Metabolic Syndrome among Children and Adolescents in Korea
Authors: CHOI JIHEA , YOON TAE WOONG , YU MINHEUI , KANG DAE RYONG , CHOI SARAH E. 
Published: June 2020

Purpose: Metabolic syndrome (MetS) is a strong risk factor for type 2 diabetes and atherosclerotic cardiovascular diseases, and its pathological process starts from childhood and adolescence. Childhood and adolescence is an important developmental stage where gender-specific body image, self-identity, and health habits are formed. This study examined gender-specific factors associated with MetS among Korean children and adolescents.
Method: Using data from the Korea National Health and Nutrition Examination Survey 5th and 6th waves (2010-2015), a total of 4,149 respondents (representing 4.6 million children and adolescents aged 10 to 18) were evaluated. MetS was defined based on the guidelines of the modified NCEP ATP III. Data were analyzed with descriptive statistics, independent t-test, χ2 -test and univariate logistic regression analysis (p &lt; .05).
Results: The prevalence rate of MetS in Korean children and adolescents was 4.17% (4.88% in boys and 3.42% in girls). The prevalence of abdominal obesity was significantly higher in girls (8.96% vs. 11.17%), and the prevalence of low HDL-C and elevated BP were significantly higher in boys (14.13% vs. 9.65%; 29.15% vs. 25.65%). For boys, increasing age, BMI, Waist-to-Height ratio (WHtR), one meal per day, weight loss effort, and perceived body shape as “fat” were significantly associated with MetS. For girls, BMI, WHtR, familial medical history of low HDL-C, weight loss effort, and perceived body shape as “average” and “fat” were significantly associated with MetS. Risk factors unique to boys were age and frequency of meal per day, whereas familial medical history of low HDL-C and perceived body shape as “average” were specific to girls.
Conclusion: We found gender differences in the prevalence of MetS and its associated risk factors in Korean children and adolescents. Gender-difference should be considered in an effort to address MetS and risk factors in this population.

Disclosure
J. Choi: None. T. Yoon: None. M. Yu: None. D. Kang: None. S.E. Choi: None.

Funding
National Research Foundation of Korea (2017R1C1B5076837)
2249-PUB: Clustering Analysis as a Tool to Define Endotypes in Type 1 Diabetes (T1D)
Authors: SILLER ALEJANDRO F. , GU XIANGJUN , TOSUR MUSTAFA , ASTUDILLO MARCELA , BALASUBRAMANYAM ASHOK , BONDY MELISSA , REDONDO MARIA J. 
Published: June 2020

Due to heterogeneity in pediatric T1D, uniform treatment strategies are unlikely to benefit all patients equally. T1D endotypes, or subgroups with distinct characteristics amenable to particular interventions, are a potential solution, but defining endotypes remains a challenge. We used electronic medical records (EMR) to define clusters of distinct presentations of pediatric T1D in a diverse population with a high prevalence of obesity. We analyzed data collected through an EMR Population Health Diabetes Registry of 604 children newly diagnosed with T1D at a large academic hospital in southwestern USA. Using PROC Cluster (SAS 9.4), we applied the Centroid Clustering method to find the optimal number of clusters that minimized the sum of squared distance, then used SAS PROC Tree to identify subjects in each cluster. Variables used were age, DKA at diagnosis, weight, sex, race/ethnicity, c-peptide, hemoglobin A1c (A1c), thyroglobulin antibody (TgAb), and thyroid peroxidase antibody (TPO). Due to multiple testing, p-values &lt;0.01 were statistically significant. This yielded 6 clusters: Cluster 1 (n=424), was characterized by low C-peptide, normal weight, negative TgAb and TPO, intermediate or high A1C; Cluster 2 (n=73) by obesity, low or intermediate C-peptide, and negative TgAb and TPO; Cluster 3 (n=42) by positive TgAb; Cluster 4 (n=33), by positive TPO and negative TgAb; Cluster 5 (n=19) by high or intermediate C-peptide without obesity or intermediate C-Peptide with obesity and negative TgAb and TPO; Cluster 6 (n=13) by obesity, high C-peptide and negative TgAb and TPO. After adjusting for age, BMI Z-score and race/ethnicity, clusters were statistically different for A1c, C-peptide and TPO and TgAb status (all p&lt;0.01), but not for glucose or DKA. This strategy identifies distinct groups in T1D based on objective criteria. Endotypes from clustering analysis of more EMR data could be used for targeting therapeutic strategies to groups with similar characteristics and help personalize T1D treatment and care.

Disclosure
A.F. Siller: None. X. Gu: None. M. Tosur: None. M. Astudillo: None. A. Balasubramanyam: None. M. Bondy: None. M.J. Redondo: None.

Funding
Baylor College of Medicine
2251-PUB: Assessment of Fear of Hypoglycemia in a Large, Clinical Sample of Fathers of Children with Type 1 Diabetes
Authors: AMBURGEY DEBORAH J. , ODONNELL HOLLY , GOMER TARA , REZNICK-LIPINA TYLER , MAJIDI SHIDEH , DRISCOLL KIMBERLY A. 
Published: June 2020

The Hypoglycemia Fear Survey-Parent (HFS-P) is the most commonly used questionnaire to assess parental worries and behaviors about low blood glucoses occurring in their children with T1D. The purpose of this study was to provide descriptive statistics on the HFS-P’s three subscales using a large clinical sample of fathers, data that are notably absent from the extant literature. As part of their child’s routine T1D clinic visits, 302 fathers completed the HFS-P, which comprises three subscales: Maintaining High Blood Glucose (BG), Worry/Helplessness About Low BG, and Worry About Negative Social Consequences. Higher scores indicate greater fear/worry about hypoglycemia. Child demographic and medical variables were extracted from medical records. Child characteristics were: 43% female; mean age = 15.1±3.3 yrs (range 10-22); mean A1C = 8.7±1.9%. Fathers’ were more likely to engage in maintaining high BG behaviors with younger children (r=-0.17, p&lt;0.01). Fathers’ mean Maintaining High BG scores were significantly higher in 10-12 year olds (4.1±2.5) then in 13-17 year olds (3.4±2.6) and 18-22 years olds (3.2±2.6; F=3.01; p&lt;0.05). There were no differences in mean Worry/Helplessness About Low BG or Worry About Negative Social Consequences scores by age group (ps=0.14 and 0.68, respectively). None of the three subscales was significantly correlated with glycemic control (ps&gt;0.15). This is the first study to provide normative data for the three subscales comprising the HFS-P derived from a large clinical sample as all other studies have used research samples. Clinicians using the HFS-P to monitor worries and behaviors associated with hypoglycemia can use these data to assess fathers’ progress. These data also support other studies showing that glycemic control and fear of hypoglycemia are not related; although findings are generally mixed. This study adds to a growing body of literature on the importance of assessing fear of hypoglycemia in parents of children with T1D.

Disclosure
D.J. Amburgey: None. H. ODonnell: None. T. Gomer: None. T. Reznick-Lipina: None. S. Majidi: Advisory Panel; Self; Companion Medical. K.A. Driscoll: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (7K23DK091558-05)
2253-PUB: A Rare Case of Fulminant Type 1 Diabetes Postpartum
Authors: LANE KYRSTIN , OXMAN RACHAEL 
Published: June 2020

Amongst women with gestational diabetes (GDM), the incidence of type 1 diabetes (T1DM) was 3.4% at 9 months post-partum and 6.6% at 2 years post-partum in one prospective study. Higher number of autoantibodies (Abs) during pregnancy is associated with a higher risk of T1DM. In rare cases, women with GDM can develop antibody-negative T1DM post-partum. The presentation of fulminant T1DM defined as rapid onset ketoacidosis, undetectable C-peptide, A1C&lt;8.5%, elevated pancreatic enzymes and often negative antibodies has only rarely been reported in the post-partum period and predominantly in individuals of Japanese descent. In our case, a 34-year-old woman of Indian descent presented for GDM which required low dose Detemir 6 units nightly. She had an uncomplicated delivery and stopped insulin. On post-partum day 8 she was hospitalized for 1 day of non-specific malaise symptoms and was incidentally found to have elevated lipase 398 U/L, serum glucose 93 mg/dL and mildly bulky pancreas by ultrasound imaging. Initially she clinically improved, but on post-partum day 15 she developed symptoms of fatigue, polyuria, polydipsia, and weight loss which progressed to vomiting, tachycardia and tachypnea. She was readmitted on post-partum day 19 with glucose 482 mg/dL, arterial pH 6.95, anion gap 34, and moderate ketones consistent with severe Diabetic Ketoacidosis. Hemoglobin A1C was 6% and lipase was normal. New onset T1DM was diagnosed based on undetectable C-peptide, though GAD and ICA Abs were negative. She was treated with an insulin infusion and later transitioned to a basal-bolus subcutaneous insulin regimen. Repeat labs at 12 months post-partum confirmed persistent undetectable C-peptide and negative Abs. We present a unique case of a woman of Indian descent with GDM found to have fulminant T1DM in the early post-partum period. To our knowledge, this is the first case of fulminant diabetes post-partum reported in a patient of Indian ethnicity. Our case highlights the importance of consideration of this rare diagnosis in diverse populations.

Disclosure
K. Lane: None. R. Oxman: None.
2261-PUB: Type 2 Diabetes Mellitus Debut in Peru: The DDPeru Study
Authors: ROCCA JESUS , CALDERON MARIA , WHITTEMBURY ALVARO , ULLOA VIVIANA 
Published: June 2020

Objective: To describe the clinical and metabolic characteristics of debut type 2 diabetes mellitus (T2D) Peruvian patients and to evaluate if there are any differences between the different geographical regions. To describe the initial pharmacological treatment of these patients.
Methods: Case series study that took place in different regions of Peru, from July 2016 to November 2017. The inclusion criteria were: patient older than 20 years old, ambulatory setting, first time diagnosis of T2D through: fasting glycemia ≥ 126 mg/dl or random glycemia ≥ 200 mg/dl with symptoms, or oral glucose tolerance test (OGTT) ≥ 200 mg/dl on the 2 hour sample. Also, a description of their initial treatment was registered.
Results: Five hundred eighty-one patients were identified, from which two hundred eighty-four (48.9%) were women. The average age of diagnosis was 53.2 ± 12.8 years old. Average weight was 77.3 +/- 16.6 kg, from which 228 patients (39.2%) were over weighted and 178 (30.6%) had type I obesity. Average glycemia was 249.4 mg/dl and average HbA1c was 8.9 %. In those who had abdominal ultrasonography (US), 56.7% had fatty liver. Most of the patients that were from Lima or the northern region of the country, had higher levels of glycemia and HbA1c. The T2D patients that were from high altitude presented more often fatty liver in the US, and lower levels of total cholesterol and LDL-c than those patients from the coast. The younger the patient, more cardiometabolic risk factors were present. Sixty percent of the patients received monotherapy, being metformin the preferred drug.
Conclusions: Patients with T2D debut from Lima and the northern region of Peru, and also the younger patients, have more cardiometabolic risk factors than their counterparts from the rest of the country and the older ones. We didn’t find any clinical difference between patients from the coast or from high altitude. Metformin was the most prescribed drug to treat these patients.

Disclosure
J. Rocca: Consultant; Self; Merck KGaA. Other Relationship; Self; Novo Nordisk A/S. M. Calderon: None. A. Whittembury: None. V. Ulloa: Employee; Self; Novo Nordisk A/S.

Funding
Novo Nordisk Peru S.A.C.