bluuebunny/crossref_metadata_2025_split huggingface dataset:
133-LB: Cardiovascular Outcomes in Older Adults Initiating Empagliflozin vs. DPP-4 Inhibitors and GLP-1 Receptor Agonists: A Subgroup Analysis from the EMPRISE Study
Authors: PATORNO ELISABETTA , PAWAR AJINKYA , BESSETTE LILY G. , NAJAFZADEH MEHDI , WEXLER DEBORAH J. , FRANKLIN JESSICA , DERUAZ-LUYET ANOUK , BRODOVICZ KIMBERLY , KOENEMAN LISETTE , SCHNEEWEISS SEBASTIAN 
Published: June 2020

EMPRISE aims to study the effectiveness, safety and healthcare utilization of empagliflozin (EMPA) in routine care patients. In an interim analysis, we assessed the comparative cardiovascular (CV) effectiveness of EMPA in older adults. Using data from Medicare (2014-2017), we identified 11,579 pairs of 1:1 propensity score-matched patients ≥66 years with type 2 diabetes initiating EMPA or a DPP-4 inhibitor (DPP-4i), and 17,500 pairs initiating EMPA or a GLP-1 receptor agonist (GLP-1RA). We assessed hospitalization for heart failure (HHF), defined as a HF discharge diagnosis in the primary (HHF-Specific) or in any position (HHF-Broad) and a modified MACE outcome (MI, stroke, or all-cause mortality). We estimated HR and 95% CI adjusting for &gt;140 baseline covariates. Compared to DPP-4i, EMPA was associated with a decreased risk of HHF [HHF-Specific: 0.43 (0.30-0.63); HHF-Broad: 0.57 (0.47-0.69)] and MACE [HR (95% CI) = 0.63 (0.50-0.79)]. Compared to GLP-1RA, EMPA had a reduced risk of HHF [HHF-Specific: 0.67 (0.50-0.91); HHF-Broad: 0.83 (0.71-0.96)] and a similar risk of MACE [1.02 (0.85-1.23)](Table 1). Results for the individual components of MACE were consistent and robust to competing risks. These findings, addressing the comparative effectiveness of EMPA in routine care patients with mean age of 72 years, complement available information from RCTs.

Disclosure
E. Patorno: Other Relationship; Self; Boehringer Ingelheim International GmbH. A. Pawar: None. L.G. Bessette: None. M. Najafzadeh: None. D.J. Wexler: Other Relationship; Self; Novo Nordisk A/S. J. Franklin: None. A. Deruaz-Luyet: Employee; Self; Boehringer Ingelheim International GmbH. Employee; Spouse/Partner; Sanofi-Aventis Deutschland GmbH. K. Brodovicz: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. L. Koeneman: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. S. Schneeweiss: None.

Funding
Boehringer Ingelheim
1350-P: Ehealth Technologies for Gestational Diabetes Mellitus: Summary of Features and Effectiveness: Scoping Review
Authors: BALAJI BHAVADHARINI , HALPERIN ILANA , MUKERJI GEETHA , LIPSCOMBE LORRAINE 
Published: June 2020

Background: There has been growing availability of ehealth technologies (ETs) for management of gestational diabetes mellitus (GDM). While ETs have the potential to improve the efficiency and quality of GDM care, the nature of information and support provided through such technologies and their benefits are unclear. This review aims to summarise data on features and outcomes for ETs specific to GDM.
Methods: We conducted a systematic literature search of studies on ehealth technologies in EMBASE, OVID, SCOPUS and Web of Science in November 2019. Studies reporting data on use of ETs for management and follow up of women with GDM were included.
Results: We identified 17 studies with data on over 2,000 women with GDM that described ETs for management and follow up of women GDM. The studies were categorised into telemedicine (n=4), web-based (n=4) and smartphone application (n=9). The types of studies included in the review include randomized controlled trials (n=9), cohort studies (n=3), quasi experimental study (n=3) and focus group discussions (n=2). Some features of the ETs include electronic transfer of blood glucose data, bidirectional communication with physician, web based lifestyle program and a virtual diary to log blood glucose measurements (BGM), step count and dietary intake. Studies evaluating telemedicine and web based systems showed significant reductions in the number of in person clinic visits during pregnancy (2 studies), better glycemic control (2 studies), lowered insulin use (2 studies), and weight loss after delivery (1 study). Studies that evaluated smartphone applications showed significantly higher adherence to BGM (4 studies), patient satisfaction (92% in one study) and acceptance through thematic evaluation of app (5 studies), supporting the potential of smartphone app for managing GDM.
Conclusion: Ehealth technologies have the potential to improve management and outcomes for women with GDM.

Disclosure
B. Balaji: None. I. Halperin: Advisory Panel; Self; Tandem Diabetes Care. Speaker’s Bureau; Self; Abbott, Boehringer Ingelheim (Canada) Ltd., Dexcom, Inc., Novo Nordisk Inc., Sanofi. G. Mukerji: None. L. Lipscombe: None.
1352-P: Maternal Subclinical Hypothyroidism in the First Trimester Is Not Related to Gestational Diabetes Mellitus
Authors: LI PING , LIN SHUO , FAN JIANHUI 
Published: June 2020

This study aims to evaluate the relationship between subclinical hypothyroidism (SCH) during the first trimester and gestational diabetes mellitus (GDM) that was happened later on in our cohort. A total of 6530 pregnant women who first visited before 13+6 gestational weeks and accepted routinely prenatal services in the third affiliated hospital of Sun Yat-Sen University from January 2015 to September 2018 were finally met the inclusion criteria and recruited. Thyroid functions were performed at the first visit and a 2h 75-g OGTTwas performed between 24-28 weeks. The glucose levels of OGTT were shown no differences between SCH and euthyroid women [0 hour: 4.17 mmol/L (3.99-4.38) vs. 4.16 mmol/L (3.97-4.39), P = 0.730; 1 hour: 7.61 mmol/L (6.64-8.66) vs. 7.68 mmol/L (664-8.75), P = 0.449; 2 hour: 6.66 mmol/L (5.85-7.68) vs. 6.75 mmol/L (5.93-7.74), P = 0.142]. The incidence of GDM was no change as the TSH level increased in either TPOAb negative or positive SCH women (all P &gt; 0.05). After using the multivariate logistic regression analysis adjusted for confounders (maternal age, educational levels and preBMI), elevated TSH and TPOAb status also had no effect on the incidence of GDM (Table 1). These results suggested maternal SCH in the first trimester was not related to GDM, regardless of the TPOAb status or the TSH levels.

Disclosure
P. Li: None. S. Lin: None. J. Fan: None.

Funding
Science and Technology Planning Project of Guangdong Province (2017A020215026); Medical Scientific Research Foundation of Guangdong Province (A2017314)
1363-P: Continuous Glucose Monitoring (CGM) of Postprandial (PP) Glycemic Responses in Pregnancies Complicated by Diabetes
Authors: NOSOVA EMILY V. , CASTORINO KRISTIN N. , LEVY CAROL J. , JOHNSON TERRI , SHAH SALONI , HAROUSH GAL , NELSON KRISTEN , O’MALLEY GRENYE , OGYAADU SELASSIE J. , LEVISTER CAMILLA , BRACKETT SCOTT J. , POLSKY SARIT 
Published: June 2020

Background: Diabetes in pregnancy portends increased maternal and fetal morbidity and mortality. Glucose testing is advised at 1 or 2 hours Pp. CGM during pregnancy may improve meal-time glycemic monitoring. Limited Pp CGM data exist for gestational diabetes (GDM), type 1 diabetes (T1D), or type 2 diabetes (T2D).
Methods: We report prospective Pp glycemic data for 32 pregnant women collected during a 6-hour YSI clinic session for a 10-day Dexcom G6 CGM accuracy trial. Each subject wore 2 sensors. During the session, food consumption was recorded and analyzed if &gt;5g. Meals were not standardized. CGM and YSI Pp responses within 2 hours of meals and carbohydrate content were evaluated.
Results: Most women had T1D (n=20) (See table). Subjects consumed 1 (n=6), 2 (n=13) or 3 (n=13) meals for a total 71 meals. Mean carbohydrate intake per meal was 29 ± 19 g (range 6-101). Peak CGM values were recorded for 32 morning and 31 afternoon meals in 2 sensors/subject (n=139 values). Pp CGM values peaked at 136 ± 32 mg/dL (range 78-233) at median 60 minutes (interquartile range: 44, 99).
Conclusions: Eating patterns are heterogeneous among pregnant women. These data support 1 hour Pp testing, and CGM use allows more detailed glycemic evaluations around meals. Our YSI results support CGM reliability. Timing of Pp peak glucose levels related to nutrient content in pregnancy needs further evaluation.

Disclosure
E.V. Nosova: None. K.N. Castorino: Research Support; Self; Abbott, Dexcom, Inc., Medtronic, Mylan, Novo Nordisk Inc. C.J. Levy: Consultant; Self; Dexcom, Inc. Employee; Spouse/Partner; Allergan plc. Research Support; Self; Abbott, Dexcom, Inc., Insulet Corporation. T. Johnson: Employee; Self; Dexcom, Inc. S. Shah: Employee; Self; Dexcom, Inc. G. Haroush: None. K. Nelson: None. G. O’Malley: Research Support; Self; Abbott, Dexcom, Inc. S.J. Ogyaadu: None. C. Levister: None. S.J. Brackett: None. S. Polsky: None.
1368-P: Carbohydrate Intake Is Associated with OGTT Levels in Pregnancy
Authors: ROSENBERG EMILY , JAMES KAITLYN , ARENAS JULIANA , CALLAHAN MICHAEL J. , CAYFORD MELODY , NELSON STACEY , BERNSTEIN SARAH N. , THADHANI RAVI , SEELY ELLEN W. , POWE CAMILLE E. 
Published: June 2020

Background: Traditionally, a carbohydrate-rich diet in the days preceding an oral glucose tolerance test (OGTT) has been recommended based on classic studies in non-pregnant individuals showing that carbohydrate restriction elevates post-load glucose levels. Instructions on carbohydrate intake given to pregnant women having an OGTT for gestational diabetes (GDM) diagnosis vary. We tested if self-reported carbohydrate intake in pregnancy is associated with OGTT results.
Methods: Pregnant women (N=79) with ≥ 1 risk factor for GDM underwent a fasting 75 g OGTT at 24-30 wks gestation and completed a 24-hr dietary recall using a validated self-administered instrument. We tested for an association between carbohydrate intake in the 24 hrs preceding the OGTT and 1-hour OGTT glucose using linear regression, with adjustment for age, BMI, gestational age, race, and total caloric intake. We also tested for associations with 30-minute and 2-hour OGTT glucose and glucose area under the curve (AUC).
Results: Women with lower carbohydrate intake (&lt;median=235g) were slightly older (34 vs. 32 yrs, P=0.03), but otherwise similar to women with higher intake (BMI, history of GDM in a prior pregnancy, race/ethnicity, fasting glucose). We observed a graded linear relationship between carbohydrate intake and 1-hour OGTT glucose. For every 50 g reduction in carbohydrate intake, there was a 6.2 mg/dl increase in 1-hour OGTT glucose (β=6.2 mg/dl, P&lt;0.01); this remained significant in the adjusted model (β=7.7 mg/dl, P=0.03). Lower carbohydrate intake was also associated with higher 30-minute (unadjusted β=4.4 mg/dl, P&lt;0.01; adjusted β=6.7 mg/dl, P=0.02) and 2-hour OGTT glucose (unadjusted β=4.3 mg/dl, P=0.03; adjusted β=6.9 mg/dl, P=0.05) and glucose AUC (unadjusted β=513, P&lt;0.01; adjusted β=683, P=0.03). Results did not change after excluding women with intake &lt;1000 calories or when % carbohydrate intake was used as the predictor variable.
Conclusion: Carbohydrate restriction or excess before an OGTT may affect the diagnosis of GDM.

Disclosure
E. Rosenberg: None. K. James: None. J. Arenas: None. M.J. Callahan: None. M. Cayford: None. S. Nelson: None. S.N. Bernstein: None. R. Thadhani: None. E.W. Seely: None. C.E. Powe: None.

Funding
National Institutes of Health (K23DK113218); Robert Wood Johnson Foundation; Harold Amos Medical Faculty Development Award (72456)
1390-P: Fetal Growth Acceleration Is Still Common in Well-Controlled Pregnant Women with Type 1 Diabetes Using Real-Time Glucose Monitoring
Authors: DE VALK HAROLD W. , OOSTERWIJK LISA , KAASJAGER KARIN 
Published: June 2020

Introduction: Glycemic control has a major effect on fetal growth in women with type 1 diabetes mellitus (DM1), worse control leading to increased growth (large for gestational age (LGA) or very large for gestational age (VLGA) fetus). Currently, we aim at strict control (at least HbA1c ≤ 48 mmol/mol) before and during pregnancy. Real Time Continuous Glucose Monitoring (RTCGM) offers new ways to achieve this. We performed a retrospective chart review of pregnancy outcomes in DM1 to assess outcome and CGM-data in well-controlled women with DM1.
Methods: Forty-eight pregnancies in 25 women were identified between 2016-2019; 19 women with a singleton pregnancy met the inclusion criterion of HbA1c ≤ 48 mmol/mol in 1st and 3rd trimester; 8 women had insufficient CGM-data.; CGM could be analysed in 11 women. LGA was defined as fetal weight &gt; 90th and VLGA &gt; 97.7th percentile. CGM-data were studied during 4 periods: 4-8 weeks gestation, 18-22 weeks, 30-34 weeks and last 8 days before delivery. Target range 3.5-7.8 mmol/L. Time in range (TIR), time below range (TBR) and time above range (TAR) were calculated.
Results: In the 19 women with adequate control, LGA (LGA and VLGA) in 36.8%; simple LGA 15.7%, VLGA 21.1%. There were no congenital malformations. Women with VLGA child were significantly older (p&lt;0.03), had higher BMI (p&lt;0.02) and longer duration of DM1 (p&lt;0.02). In women with normal growth fetus, LGA or VLGA, Time In Range (TIR) was 64.1%, 63.6% and 58.5%; Time Above Range (TAR): 24.4, 34.4 and 39.6%; Time Below Range: 4.0, 2.2 and 2.1%.
Conclusion: Our data show that current implementation of advanced technology was associated with mean TIR below recommended level of &gt;70% and TAR above recommended level (&lt;25%). Prevalence of LGA and VLGA was still increased. Adaptation of care and counselling re needed for improvement in outcome with technology.

Disclosure
H.W. de Valk: None. L. Oosterwijk: None. K. Kaasjager: None.
1392-P: Assisted Reproduction Technology Treatment and Risk of Gestational Diabetes
Authors: BIANCHI CRISTINA , PELLE CHIARA DELLA , GENNARO GIOVANNI DE , ARAGONA MICHELE , CELA VITO , DELPRATO STEFANO , BERTOLOTTO ALESSANDRA 
Published: June 2020

Assisted reproduction technology (ART) treatment has been suggested to increase the risk of gestational diabetes (GDM), though the nature of this association remains unclear. In the attempt to gain more insight in such an association we have carried out a study to evaluate whether ART represents an independent risk factor for GDM in single pregnancies. We collected retrospectively clinical and anthropometric data of 221 ART- and 256 age and BMI matched women with natural conception (NC) screened for GDM between 2011-2019. Out of 477 women, 32 were excluded from the analysis due to multiple pregnancies (PMA: 24; CN: 8). Between the two groups there were no differences in age (ART: 39 ± 5; NC: 38 ± 3 years; ns), BMI (ART: 23.6 ± 4.4; NC: 22.9 ± 3.6 Kg/m2; ns) and family history of diabetes (ART: 31.4%; NC: 24.2%; ns). ART-women were more frequently primiparous (62.6% vs. 22.6%; p&lt;0.0001), while a higher prevalence of previous GDM was observed among NC-women (9.7% vs. 2.6%; p=0.002). The prevalence of GDM in the whole cohort was 36.1% and was significantly higher in women with ART (52.3% vs. 23.4%; p &lt;0.0001). In the whole cohort, risk factors for GDM were: age (OR 1.07 95% CI 1.02-1.13), first degree family history of diabetes (OR 2.02 95% CI 1.31-3.10), previous GDM (OR 2.09 95% CI 1.39- 3.14), pre-pregnancy obesity (OR 3.28; 95% CI 1.57-6.86) and ART (OR 3.59; 95% CI: 2.39 - 5.39). On multivariate analysis, family history of diabetes (OR 1.67; 95% CI: 1.03-2.69), previous GDM (OR 7.05; 95% CI: 2.92-17.04); pre-pregnancy obesity (OR 2.72; 95% CI 1.21-6.13) and ART (OR 4.14; 95% CI 2.65-6.48) were independent risk factors for GDM . Among women requesting ART treatment, at least one in two develops GDM, and ART appears to be an independent risk factors for GDM.

Disclosure
C. Bianchi: None. C. Della Pelle: None. G. de Gennaro: None. M. Aragona: None. V. Cela: None. S. DelPrato: None. A. Bertolotto: None.
1393-P: Residential Inequality and Birth Outcomes of Gestational Diabetes
Authors: THOMAS LEELA , FAWCETT MITCHELL R. , JURKOVITZ CLAUDINE , LENHARD JAMES 
Published: June 2020

Introduction: Clinical studies have found disparities in gestational diabetes mellitus (GDM) outcomes due to individual racial and economic differences. In contrast, this pilot study examines the association of structures variations with GDM outcomes by race.
Methods: Data were obtained from a healthcare system for a study population of 2,189 women with GDM, 18 years and above, singleton births, who delivered between January 1, 2014 and December 31, 2018. Clinical data were merged with structural measures of mothers’ census tracts of residence from the U.S. Census Bureau. Outcome variables are mother and infant birth complications. Data are analyzed using zero correlations by race.
Results: Mother’s: white mothers tended to have fewer complications (r=-0.07, p&lt;.05); not other races. For African American women, living in a tract with a higher % of households below the poverty level and higher % of less than $35K earners increased the likelihood of their experiencing Hemorrhage (r=0.11, p&lt;0.03; r=0.12, p&lt;0.05). For women of other races, living in a tract with higher percentage of household below the poverty level increased the likelihood of Hemorrhage (r=0.11, p&lt;.05). For baby’s complications, white infants and infants from other races whose mothers resided in areas with a higher percentage of households below the poverty level had a higher risk of shoulder dystocia while infants of African American mothers who resided in census tracts with a higher percentage of earners below $35K were at higher risk for hospital revisit in &lt;30 days (r=0.12, p&lt;0.05). African American infants from neighborhoods with higher % of household below poverty level and no household vehicle had a higher likelihood of revisit.
Conclusion: Selected results show variations in complications among different races by neighborhood characteristics. The influence of race on GDM outcomes is linked to income and socioeconomic status. Income may be more important to GDM outcomes than race.

Disclosure
L. Thomas: None. M.R. Fawcett: None. C. Jurkovitz: None. J. Lenhard: Speaker’s Bureau; Self; Janssen Pharmaceuticals, Inc.

Funding
National Institutes of Health (U54GM104941)
1397-P: Does Treating Depression in Pregnant Women with Diabetes Improve Diabetes-Related Pregnancy Outcomes?
Authors: SCANNELL MADELINE L. , DUCKHAM HILLARY E. , HERRICK CYNTHIA J. , CARTER EBONY B. 
Published: June 2020

Objective: To determine whether there is an association between medical management with psychotherapy and/or SSRIs and improved pregnancy outcomes among pregnant women with coexisting diabetes and depression.
Methods: We performed a retrospective cohort study of women cared for at the Resident Diabetes in Pregnancy Clinic at a large, tertiary referral center from 2007-2017. Inclusion criteria included a diagnosis of T2DM or GDM by the 2-step method, using Carpenter-Coustan criteria, and depression, defined via chart review or baseline pregnancy Edinburgh Depression score &gt;10. Patients with multiple gestations or fetal anomalies were excluded. Women who received medication therapy with SSRIs and/or psychotherapy were compared to those who did not. The primary outcome was large for gestational age birthweight (&gt;90th %). Secondary outcomes included other maternal and fetal diabetes-related outcomes. Demographic characteristics were compared between groups and logistic regression was used to adjust for potential confounders, including advanced maternal age, Black race, BMI, and smoking.
Results: Of 926 women seen during the study period, 255 (28%) had depression and met study criteria—115 with T2DM and 118 with GDM. Of these, 69 (27 %) had no treatment, 149 received an SSRI (58%), 37 received therapy (15%), and 9 (4%) received both. Demographics were similar between groups. Women who received SSRIs had lower rates of LGA infants (17% vs. 25%, aOR 0.51; 95% CI 0.27-0.97), shoulder dystocia (1% vs. 8%, aOR 0.15; 95% CI 0.03-0.71), and umbilical artery cord gas &lt;7.1 than those with no treatment. There were no differences in outcomes between women who received psychotherapy and those who did not. Findings were similar when the analysis was stratified by diabetes type.
Conclusions: Our findings suggest an association between improved diabetes-related pregnancy outcomes and SSRI use in women with diabetes. Further research is needed to determine potential mechanisms.

Disclosure
M.L. Scannell: 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)
1398-P: Mortality Implications of Comorbid Health Status in Older Adults with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: ROONEY MARY R. , TANG OLIVE , WINDHAM B. GWEN , ECHOUFFO TCHEUGUI JUSTIN B. , LUTSEY PAMELA , GRAMS MORGAN , SELVIN ELIZABETH 
Published: June 2020

Introduction: In older adults with diabetes, the potential risks of tight glycemic control are a major concern. The 2020 American Diabetes Association (ADA) guidelines suggest different A1C targets in older adults based on comorbid health status. However, the association of A1C levels with mortality by ADA health status categories is uncharacterized.
Methods: We conducted a prospective analysis of 2068 older participants (mean age 76±5; 57% women, 30% black) with diabetes in the ARIC Study (baseline, 2011-13). We categorized health status based on ADA criteria (see Table) and evaluated mortality risk overall and by A1C categories.
Results: In older adults with diabetes, 45% were classified as healthy, 39% were complex/intermediate, and 15% had very complex/poor health. Over 6 years of follow-up, those with complex/intermediate or very complex/poor health had higher mortality risk than those classified as healthy (Table). Regardless of health status, older adults with A1C &lt;7% were not at significantly higher risk of mortality than those with A1C 7-&lt;8%.
Conclusions: There were substantial differences in mortality based on the ADA health status categories but, within categories, those meeting more stringent A1C goals (&lt;7%) were not at substantially elevated risk. Our results suggest that certain patients may safely achieve lower A1C goals even in older age.

Disclosure
M.R. Rooney: None. O. Tang: None. B. Windham: None. J.B. Echouffo Tcheugui: None. P. Lutsey: None. M. Grams: Other Relationship; Self; DCI. E. Selvin: None.

Funding
National Heart, Lung, and Blood Institute (T32HL007024)