bluuebunny/crossref_metadata_2025_split huggingface dataset:
1477-P: Clinical Utility of a Noninvasive Metabolic Approach in Assessing the Prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH) in Type 2 Diabetes
Authors: BELLIDO VIRGINIA , MARTÍNEZ-ARRANZ IBON , GOICOLEA IGNACIO , AMOR ANTONIO J. , PI JAVIER , PÉREZ ANTONIO , ESPIGA JAVIER , MONTALBAN CORAL , MAYO REBECA , GAZTAMBIDE SONIA 
Published: June 2020

Aims: We aimed to assess the utility of validated metabolomic-based non-invasive tests to estimate the prevalence of liver disease in overweight/obese T2DM patients.
Materials and Methods: A total of 97 T2DM patients with HbA1c &lt;7% and BMI &gt;25 kg/m2 were recruited. Patients underwent routine lab, liver ultrasound and FibroScan. OWLiver® Care test and OWLiver® test were measured (two serum-based, BMI-dependent lipidomic tests that discriminate between normal liver and NAFLD, and between isolated steatosis and NASH, respectively).
Results: Based on results from ultrasound and FibroScan, patients were divided into four groups (Table). The prevalence of NAFLD and NASH was 86.4% and 31.1%, respectively. Severe fibrosis (F2-F4) was found in 22.9% and cirrhosis (F4) in 12.2%. OWLiver® Care test classified correctly 95% of patients with NAFLD (AUC 0.929). It showed high sensitivity (95%) and high accuracy (80%). OWLiver® test showed high consistency with the results of ultrasound and FibroScan, classifying correctly 90% of the samples of patients with NASH.
Conclusions: The prevalence of NAFLD and NASH is high in overweight/obese T2DM patients. OWLiver® Care test and OWLiver® test can be good tools for early detection of NAFLD and NASH, respectively, in routine clinical practice.

Disclosure
V. Bellido: None. I. Martínez-Arranz: Employee; Self; OWL Metabolomics. I. Goicolea: None. A. Amor: None. J. Pi: None. A. Pérez: None. J. Espiga: Consultant; Self; Novo Nordisk A/S. C. Montalban: None. R. Mayo: Employee; Self; OWL Metabolomics. S. Gaztambide: None.
1483-P: Reproducibility of a Novel Classification of Type 2 Diabetes Patients into Subgroups (Clusters) at a Reference Center in Brazil: Differences in Body Composition Analyses
Authors: DANTAS ISABEL , BANDEIRA FRANCISCO 
Published: June 2020

Objectives and Methods: To stratify type 2 diabetes (T2DM) patients into subgroups (clusters) according to clinical and laboratory data from 80 adults including body composition analyses by Dual X-ray absorptiometry (DXA) and multi-frequency bio-electrical impedance (BIA).
Results: Four subgroups were identified. Cluster 1: Severe insulin deficiency (recruited by C-peptide &lt;0.8 ng/ml): 17.5% of patients; age 62.57 ± 8.23 ​​years, diabetes duration 17.07 ± 7.60 years (longer than the other clusters; p &lt;0.001), BMI 22.68 ± 1.95 kg/m2 (lower than the other clusters; p&lt;0.001), HbA1c 9.64 ± 1.30% (higher than the other clusters; p &lt;0.001), HOMA2-IR 0.68 ± 0.14. Cluster 2: Severe insulin resistance (recruited by the presence of metabolic syndrome): 35.0% of patients; age 58.32 ± 5.94 years, diabetes duration 8.50 ± 5.07 years, BMI: 26.39 ± 2.38 kg/m2, HbA1c 7.53 ± 0.96%, HOMA2-IR 3.10 ± 0.43(higher than the other clusters; p &lt;0.001). Cluster 3: Obesity-related (recruited by BMI &gt; 30 kg/m2): 21.25 % of patients; age 59.76 ± 8.86 years, diabetes duration 8.35 ± 3.97 years, BMI: 35.95 ± 4.51 kg/m2 (higher than the other clusters; p &lt;0.001), HbA1c 7.33 ± 1.04%, HOMA2-IR 1.77 ± 0.48. Cluster 4: Age-related (recruited by age &gt; 65 years): 26.25% of patients; age 72.38 ± 5.06 years (older than the other clusters; p &lt;0.001); diabetes duration 4.90 ± 2.81 years, BMI 27.21 ± 1.76 kg/m2, HbA1c 6.91 ± 0.69%; HOMA2-IR: 0.99 ± 0.47. Although significantly younger cluster 1 patients had significantly lower values for lean mass parameters by both DXA and BIA in comparison with cluster 4: Fat Free Mass Index (BIA)/Apendicular Skeletal Mass index (DXA) (16.39 kg/m2/6.66 kg/m2; p &lt;0.001 vs. 17.19 kg/m2/7.31 kg/m2; p &lt;0.001).
Conclusion: Our data demonstrated the heterogeneity of T2DM presentation in adults with marked differences between them. Insulinopenic diabetes had more sarcopenia than age-related diabetes.

Disclosure
I. Dantas: None. F. Bandeira: None.
1485-P: Difference between Comprehensive Physical Fitness Age and Calendar Age Is a Potent Predictor of Incident Metabolic Syndrome (MetS)
Authors: SATO TAKAAKI , FUJIHARA KAZUYA , YAMADA MAYUKO H. , YAGUCHI YUTA , KITAZAWA MASARU , MATSUBAYASHI YASUHIRO , IWANAGA MIDORI , YAMADA TAKAHO , KATO KIMINORI , SONE HIROHITO 
Published: June 2020

Although grip strength, single-leg balance and trunk flexibility each are reportedly predictive of type 2 diabetes and atherosclerosis, little is known about the impact of comprehensive physical fitness adjusted by age on these cardiovascular risks. Thus, we developed a new index of comprehensive physical fitness standardized by age (e.g., the physical fitness index (PFI)) and examined its relevance to incident MetS in Japanese. Analyzed were 8,041 non-MetS persons (5291 men) aged 22 to 86 y who underwent the physical fitness tests cited above yearly for 4 y. MetS was defined according to Japanese guidelines. Participants were stratified yearly by sex and age (≤39, 40-49, 50-59, 60-69, 70≤), and an equation was developed using the above 3 tests by principal component analysis. We defined PFI as the difference between physical fitness age and calendar age. Discrete-time logit models were used to examine the influence of PFI on the incidence of MetS. MetS occurred in 355 persons. PFI was negatively correlated with MetS incidence. In multivariate analysis, comparison of the high PFI group with the moderate and low PFI groups showed a 1.38 (95% CI 1.01-1.88) fold and 1.98 fold (1.45-2.71) increased risk, respectively. The PFI could be used as a non-invasive and simple screening tool for those at high cardiometabolic risk, which is independent of calendar age in a Japanese population.

Disclosure
T. Sato: None. K. Fujihara: None. M.H. Yamada: None. Y. Yaguchi: None. M. Kitazawa: None. Y. Matsubayashi: None. M. Iwanaga: None. T. Yamada: None. K. Kato: None. H. Sone: Research Support; Self; Kyowa Hakko Kirin Co., Ltd., Novartis AG, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co.
149-LB: Reluctant to Lose Control: Older Patients’ A1C Goals Lower than ADA Guidelines
Authors: CUI MICHAEL , NATHAN AVIVA , MILES CRISTY , PRESS VALERIE G. , PUSINELLI MARIKO , ZHU MENGQI , ALI RABIA , SCALES KAMILAH , HUANG ELBERT 
Published: June 2020

Older adults (≥65 years) represent &gt;40% of patients living with diabetes. Multiple practice guidelines call for stratifying risk factor goals based on health status. “My Diabetes GOAL” is an intervention designed to introduce ADA guidelines to patients and to collaborate with them on setting glycemic goals.
Participants ≥ 65 years, with type 2 DM, and an active patient portal account (MyChart) were randomized to a 6 month intervention (n=42) or delayed start control arm. Intervention patients completed a MyChart survey to elicit health status to identify ADA goals and initial self-reported A1C goals. A diabetes nurse spoke with patients to review and potentially revise goals. We compared patients’ 1) baseline A1C, 2) self-reported A1C and 3) revised A1C goals, versus ADA guidelines.
Among 42 intervention patients, ADA A1C goals were &lt;7.5% for 24, &lt;8.0% for 13, and &lt;8.5% for 5 patients. Most (35/42) patients self-reported an A1C goal, among whom 66% (23/35) self-reported A1C goals &gt;0.5% lower than the ADA A1C goals. There were no statistically significant differences in baseline A1C, self-reported A1C, or revised A1C across patients with different ADA A1C goals (Figure 1).
Older patients’ personal A1C goals were more aggressive than ADA guidelines and did not alter with nurse intervention. The results suggest that older patients with diabetes are anchored to lower A1C goals, and find more lenient A1C goals difficult to choose.

Disclosure
M. Cui: None. A. Nathan: None. C. Miles: None. V.G. Press: Consultant; Self; Humana, Vizient Inc. M. Pusinelli: None. M. Zhu: None. R. Ali: None. K. Scales: None. E. Huang: None.
1493-P: The Impact of Adverse Social Determinants on Health Care Utilization and Expenditures among U.S. Adults with DKD
Authors: OZIEH MUKOSO N. , GARACCI EMMA , WALKER REBEKAH J. , EGEDE LEONARD E. 
Published: June 2020

Introduction: This study examined whether adverse social determinants of health (SDOH) are associated with higher health care utilization and out of pocket (OOP) expenditures in U.S. adults with diabetic kidney disease (DKD).
Methods: Data from 458 adults with self-reported DKD age ≥50 from the Health and Retirement Study 2008-2012 was analyzed. Primary outcomes were number of hospital overnight stays (HOS), number of physician visits (PV) and OOP expenditures. Primary independent variables were nine adverse SDOH factors clustered around three SDOH domains: psychosocial (depression, perceived social support and discrimination); financial hardship (difficulty paying bills, food insecurity, medication cost non-adherence); neighborhood (neighborhood social cohesion, social participation and physical disorder). Two variables were created, a continuous 0-9 and a categorical variable of 0, 1-2, 3+. We used negative binomial regression and marginalized two-part models to determine the impact of adverse SDOH on outcomes.
Results: In the unadjusted model, compared to adults with no adverse SDOH, adults with 3+ adverse SDOH had 3% lower likelihood of PV (95%CI 0.72-1.29), 75% (95%CI 1.10-2.79) and 87% (95%CI 1.31-2.65) higher likelihood of HOS and OOP expenditures respectively. In the adjusted model, having 3+ adverse SDOH was not significantly associated with PV (Ratio 0.94 95%CI 0.69-1.29) or HOS (Ratio 1.53 95%CI 0.93-2.49) but was associated with a 2-fold higher likelihood of OOP expenditures (95% CI 1.60-3.31). Adverse neighborhood factors were associated with 63% higher likelihood of HOS (adjusted 95% CI 1.19-2.24) and financial hardship factors were associated with 85% higher likelihood of OOP expenditures (adjusted 95% CI 1.42-2.41).
Conclusions: Our findings suggest having 3+ adverse SDOH especially financial hardship impacts OOP expenditures in adults with DKD. Interventions targeting adults with 3+ adverse SDOH may significantly decrease OOP expenditures in DKD.

Disclosure
M.N. Ozieh: None. E. Garacci: None. R.J. Walker: None. L.E. Egede: None.

Funding
American Diabetes Association (1-19-JDF-075 to R.J.W.); Advancing Healthier Wisconsin/Clinical and Translational Science (UL1TR001436, KL2TR001438); National Institutes of Health (K24DK093699, R01DK118038, R01DK120861, R01MD013826)
15-LB: Ready-to-Use Glucagon for the Prevention of Exercise-Induced Hypoglycemia during Aerobic Exercise
Authors: ARONSON RONNIE , RIDDELL MICHAEL , JUNAIDI MOHAMMED K. , CLOSE NICOLE C. , SEQUEIRA DAVID J. 
Published: June 2020

Objective: A novel ready-to-use liquid stable glucagon (RTUG; Xeris Pharmaceuticals) was evaluated for safety and efficacy in the prevention of exercise induced hypoglycemia (EIH) during and after moderate-to-high intensity aerobic exercise.
Method: A Phase 2 randomized, placebo-controlled, double-blind, clinical research center (CRC) crossover stage, followed by a 12-week 3-arm parallel Outpatient stage, enrolled 48 adults with type 1 diabetes using an insulin pump. In the outpatient stage, subjects were assigned to RTUG 150 μg plus 50% basal insulin pump reduction, or RTUG 150 μg with no insulin change, or to placebo. Blood glucose was measured by blood glucose meter before, during, and after moderate-to-high intensity, aerobic exercise to evaluate the incidence and severity of hypoglycemia. Continuous glucose monitors were utilized in the CRC and Outpatient stage.
Result: Of the 48 subjects, 45 subjects (93.8%) completed multiple exercise sessions and have entered the ongoing outpatient stage. On average, subjects were 37 (±11.2) years old with an average BMI of 26.7 (±4.6), 52.1% male and 81.3% white. In the CRC stage, the placebo group experienced more EIH (16.7% vs. 2.1%), had 7-times higher glucose tablet utilization during and after exercise, resulting in more post-exercise hyperglycemia (blood glucose &gt;250 mg/dL). To date, no SAEs have occurred, and RTUG 150 μg caused no edema, erythema, nor injection site reactions.
Conclusion: RTUG 150 μg maintained euglycemia during prolonged, continuous, intense aerobic exercise. In the CRC stage, RTUG was more effective than insulin reduction alone, to prevent EIH, and may result in less post-exercise hyperglycemia than ingestion of carbohydrate. Data from the ongoing Outpatient stage may support the use of RTUG to prevent EIH during and after aerobic exercise in real-world settings.

Disclosure
R. Aronson: Consultant; Self; AstraZeneca, Becton, Dickinson and Company, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Gilead Sciences, Inc., HTL Strefa, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi. Research Support; Self; AstraZeneca, Bausch Health, Bayer Inc., Becton, Dickinson and Company, Boehringer Ingelheim (Canada) Ltd., Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Janssen Pharmaceuticals, Inc., Kowa Company, Ltd., Medpace, Novo Nordisk Inc., Sanofi, Tandem Diabetes Care, Xeris Pharmaceuticals, Inc., Zealand Pharma A/S. 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. M.K. Junaidi: Employee; Self; Xeris Pharmaceuticals, Inc. N.C. Close: Employee; Self; EmpiriStat, Inc. D.J. Sequeira: Employee; Self; Xeris Pharmaceuticals, Inc.
1502-P: Trends in Cause-Specific Mortality in Those with and without Diabetes in the UK
Authors: PEARSON-STUTTARD JONATHAN , CHENG YILING J. , VAMOS ESZTER P. , BENNETT JAMES E. , CROSS AMANDA J. , EZZATI MAJID , GREGG ED 
Published: June 2020

Background: Increased longevity and reductions in diabetes(DM) complication rates have altered patterns of DM-related mortality in several countries. It is unclear whether this diversification of mortality has occurred in the UK.
Methods: With linked hospital and mortality data from 320,613 adults aged 26 - 91 from the 1998-2018 UK Clinical Practice Research Datalink, we used discrete Poisson regression to estimate death rates and proportional mortality from all causes, vascular diseases, cancers, and other (non vascular, non cancer) causes in DM patients. We compared this to age and sex matched individuals without DM.
Findings: From 1998-2018 all-cause death rates per 100 person-years declined by 36% in individuals with DM (4.42 (4.37-4.48) to 2.82 (2.79-2.85)). There were substantial reductions (57%, 1.84 (1.80-1.88) to 0.80 (0.78-0.81)) in vascular, moderate reductions in ’other’ (31%, 1.77 (1.73-1.80) to 1.21(1.19-1.23)), and minor reductions in cancer (8%, 0.92(0.89-0.94) to 0.84(0.82-0.86)) death rates. Within the ’other’ category, exceptions included increases in dementia (468%) and liver disease (86%) with static respiratory and accident death rates. These differential rates of decline resulted in increases in the proportion of all deaths due to cancer (20% to 29%) and ’other’ causes (39% to 43%). Rates of decline in all-cause and cancer mortality were greatest among young (&lt;55 years) and middle aged (55-75 years), whereas those &gt;75 years had no reduction in cancer mortality. All cause death rates also declined substantially among the non-DM population (from 2.78 (2.75-2.82) to 1.77 (1.75-1.79)/100 PYs) and across all major cause groupings.
Conclusions: Reductions in vascular mortality in patients with DM have not been matched by improvements in cancer mortality, while death rates for specific ’other’ causes (dementia and liver) have increased. This reflects a diversification of DM-related mortality with profound implications for management and prevention of DM.

Disclosure
J. Pearson-Stuttard: Advisory Panel; Self; Novo Nordisk A/S. Consultant; Self; DnaNudge Ltd. Y.J. Cheng: None. E.P. Vamos: None. J.E. Bennett: None. A.J. Cross: None. M. Ezzati: Consultant; Self; Prudential, Scor, Third Bridge. Research Support; Self; AstraZeneca Youth Health Programme. E. Gregg: None.

Funding
UK Wellcome Trust
1505-P: Lower Extremity Amputation Trends among People with Diabetes in a Large Urban Environment
Authors: CHATHA KIRAN K. , WALSH BRAD , FONTAINE JAVIER LA , BOWEN MICHAEL E. , MENEGHINI LUIGI 
Published: June 2020

Non-traumatic lower extremity amputations (NLEAs) are a major complication for individuals with poorly controlled diabetes. We sought to identify trends for diabetic NLEAs in Dallas County between 2015 (4th quarter) to 2019 (3rdquarter) by using hospitalization data available from Dallas-Fort Worth Hospital Council Educational and Research Foundation and the CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Per BRFSS, the prevalence of diabetes in Dallas County is 11.7% with a mean (±SD) age of 53±19.1 years, and 56% male, 27% Hispanic, 35% black and 30% non-Hispanic white. The age-adjusted NLEA rates per 1,000 in this population of adults with diabetes increased 18.1% between 2015 and 2019 (incomplete years annualized), with men experiencing higher NLEA rates than women. There was a significant decrease in age-adjusted rates of all NLEAs in women from 2017 and 2018, reflecting prior reports at the national level. The age-adjusted rates for major NLEAs decreased in all age groups except ages 75+ between 2018 and 2019 with a concomitant increase in minor NLEAs; this had been preceded by a steady increase in rates of all NLEAs up to 2018. Of relevance is that starting in 2018 the proportion of major to minor NLEAs has been decreasing steadily.
In conclusion, we note a fall in NLEA rates in the last year of observation with the added benefit of a relative fall in major compared to minor NLEAs in patients with diabetes.

Disclosure
K.K. Chatha: None. B. Walsh: None. J. La Fontaine: None. M.E. Bowen: None. L. Meneghini: Advisory Panel; Self; Novo Nordisk Inc., Sanofi US. Consultant; Self; Applied Therapeutics, Sanofi US.
1508-P: Predicting Stress Hyperglycemia in Patients without Diabetes Admitted to the Hospital
Authors: MENDEZ CARLOS E. , WALKER REBEKAH J. , LU KAIWEI , DAWSON APRILL Z. , EGEDE LEONARD E. 
Published: June 2020

Stress hyperglycemia (SH) is associated with poor clinical outcomes in hospitalized patients. Delays in recognizing SH impact timing of treatment, however, the best way to identify those at risk is unclear. We assessed the value of a validated diabetes risk test, the Cambridge Risk Score (CRS), to predict SH in patients admitted to the hospital compared to using undiagnosed diabetes and prediabetes based on HbA1c. Adults admitted without diabetes or use of diabetes medication to medical and surgical services of an academic hospital over 4 years was analyzed. Patients with at least one measurement of blood glucose ≥ 140mg/dL during the stay were identified as having SH. CRS was calculated using age, sex, BMI, family history of diabetes, smoking status, and use of antihypertensives or steroids. Prediabetes was defined based on HbA1c 5.7-6.4 and undiagnosed diabetes was defined as HbA1c &gt;=6.5 without ICD code of diabetes in the medical record. Multivariate regression was used to assess the association between CRS, prediabetes and undiagnosed diabetes, and risk of SH controlling for relevant covariates. 5,535 adults met inclusion criteria, 25.9% developed SH. CRS as a continuous variable was significantly associated with risk of SH after adjustment (OR 2.25, 1.84 - 2.74). Prediabetes was significantly associated with risk of SH after adjustment (OR 1.31, 1.13-1.51). However, undiagnosed diabetes was not significantly associated with SH, but many individuals were missing A1c measures which could have influenced results.
In conclusion results of this study suggest CRS risk stratification and early assessment for prediabetes may allow early identification of individuals at risk for SH.

Disclosure
C.E. Mendez: Advisory Panel; Self; Monarch Medical Technologies. R.J. Walker: None. K. Lu: None. A.Z. Dawson: None. L.E. Egede: None.
151-OR: Radiologic Evidence that Hypothalamic Tissue Is Abnormal in Adults with Obesity and Type 2 Diabetes or Impaired Glucose Homeostasis
Authors: ROSENBAUM JENNIFER L. , SEWAYBRICKER LETICIA E. , CHANDRASEKARAN SUCHITRA , DE LEON MARY ROSALYNN , WEBB MARY , MELHORN SUSAN J. , SCHUR ELLEN 
Published: June 2020

Gliosis, a cellular response to injury in neural tissue, is linked to diet-induced obesity in rodent models. Growing evidence also implicates reactive gliosis and inflammation of the mediobasal hypothalamus (MBH) as a potential mechanism connecting obesity to insulin resistance. We tested for radiologic evidence of MBH gliosis in humans in relation to impaired glucose homeostasis and type 2 diabetes (T2D), independent of obesity.
Adults with obesity and 1) T2D not on insulin (N=17), 2) impaired glucose tolerance (IGT; N=21), or 3) normal glucose tolerance (NGT; N=29) by OGTT underwent magnetic resonance imaging to measure mean bilateral T2 relaxation time (ms) in the MBH and 3 control regions. Longer T2 relaxation time is a marker of gliosis.
Groups were matched for race, sex, BMI and % body fat (P=0.99), but age differed (T2D 54 ± 8 y, IGT 46 ± 11 y, NGT 45 ± 12 y; P=0.02). Group differences in T2 relaxation time varied by brain region (interaction: chi2(6) = 65, P&lt;0.0001, adjusted for sex and age). Bonferroni-corrected post-tests confirmed that MBH, but not control region, T2 relaxation times were longer in T2D (180 ± 26 ms) than IGT (160 ± 26 ms, P&lt;0.0001) or NGT (152 ± 17 ms, P&lt;0.0001) groups. Among all 67 subjects, fasting glucose, 2-hr post-glucose, and hemoglobin A1c values were each positively associated with MBH, but not control region, T2 relaxation times (interactions by region all P&lt; 0.0001, MBH all P&lt; 0.0001, control regions all NS). Among the 50 subjects without T2D, interactions remained significant (all P&lt;0.0001), and greater 2-hr post-glucose and hemoglobin A1c were associated with longer MBH T2 relaxation times (β = 0.22 ms, P&lt;0.0001 and β = 14.8 ms, P=0.002, respectively) whereas a trend was present for fasting glucose concentrations (β = 0.38 ms, P=0.06).
These data provide novel evidence that the degree of inflammation and gliosis in glucose-regulating areas of the brain is related to impaired glucose homeostasis and T2D in adults with obesity.

Disclosure
J.L. Rosenbaum: None. L.E. Sewaybricker: None. S. Chandrasekaran: None. M. De Leon: None. M. Webb: None. S.J. Melhorn: None. E. Schur: None.

Funding
American Diabetes Association (1-17-ICTS-085 to E.S.)