bluuebunny/crossref_metadata_2025_split huggingface dataset:
1500-P: Prevalence of Nonalcoholic Fatty Liver Disease in Unselected Patients with Type 1 Diabetes Mellitus Using Transient Elastography
Authors: VRIES MARIEKE DE , WESTERINK JAN , KAASJAGER KARIN , DE VALK HAROLD W. 
Published: June 2020

Background: Worldwide NAFLD prevalence is approximately 25% in the general population and 56% in patients with type 2 diabetes mellitus (T2DM). The relationship between NAFLD and type 1 diabetes mellitus (T1DM) is less clear, with widely varying prevalence estimates (0 to 50%), dependent on the study population, NAFLD definition and diagnostic method. Data on assessment of hepatic steatosis (HS) as well as fibrosis stage with transient elastography (TE) as single diagnostic method are lacking.
Methods: We assessed NAFLD using TE in an unselected group of adult patients with T1DM. Patients attending the outpatient clinic were eligible if they did not have any known secondary cause of liver disease including excessive alcohol consumption. We calculated a required group size of 150 patients. All patients underwent TE (M- or XL-probe when applicable). NAFLD was defined as isolated HS and/or fibrosis/cirrhosis. HS was assessed by controlled attenuation parameter: S0 (no HS) to S3 (severe HS). Fibrosis stage was assessed by liver stiffness measurement: F0/F1 (no fibrosis) to F4 (cirrhosis). Potential associated factors of NAFLD were explored using a multivariate logistic regression model, stepwise including predefined covariates.
Results: We prospectively enrolled 150 consecutive subjects with T1DM (mean age 46 ± 13 years, female 46%). The prevalence of NAFLD was 34% (51/150). Fifty-one patients (34%) had HS (S1 n=21, S2 n=4, S3 n=26). Six patients (4%) had HS with fibrosis/cirrhosis (F2 n=2, F3 n=2, F4 n=2). After stepwise adjustment for age and BMI, waist circumference remained statistically significantly associated with the presence of NAFLD (OR 1.16, 95% CI 1.02.-1.32).
Conclusions: Overall NAFLD prevalence in patients with T1DM is slightly increased at 34% compared to the general population. The prevalence of NAFLD in patients with T1DM is associated with visceral adiposity.

Disclosure
M. de Vries: None. J. Westerink: None. K. Kaasjager: None. H.W. de Valk: None.
1509-P: Development of a Noninvasive Fibrosis Score for Chinese Patients with Type 2 Diabetes and Nonalcoholic Fatty Liver Disease
Authors: LEE CHI HO , SETO WAI KAY , IEONG KELLY , LUI DAVID T.W. , FONG HO YI , WAN HELEN , CHOW WING SUN , WOO YU CHO , YUEN MAN FUNG , LAM KAREN S. 
Published: June 2020

Objective: In NAFLD, non-invasive serum-based fibrosis scores are often recommended as first-line assessment tools, followed by transient elastography to identify patients at high risk of liver fibrosis for consideration of liver biopsy. However, some studies had reported lower accuracy of these scores in diabetes. Therefore, we conducted this cross-sectional study to develop a non-invasive fibrosis score specifically for type 2 diabetes to improve risk stratification.
Research Design and Methods: A total of 815 adults with type 2 diabetes and NAFLD was recruited from the diabetes clinic in Hong Kong. A random sample of 643 individuals were included in the training set, and the remaining 172 in the testing set. All participants had transient elastography for assessment of liver fibrosis. Diabetes Fibrosis Score (DFS) was developed to identify patients with advanced fibrosis (AF) on transient elastography, defined as liver stiffness (LS) &gt;9.5kPa, using significant determinants of LS with variables selected based on Akaike information criteria. The performance of DFS was compared with conventional liver fibrosis scores (NAFLD fibrosis score [NFS], Fib-4 and APRI), based on their area under the receiver operating characteristic (AUROC) curve, sensitivity (Sn), specificity (Sp), positive (PPV) and negative predictive values (NPV).
Results: The variables included in DFS consisted of body mass index, platelet, alanine and aspartate aminotransferase levels. The AUROC of DFS for AF on transient elastography was 0.822, while those of NFS, APRI and Fib-4 were 0.629, 0.643 and 0.788, respectively. In the testing set, the AUROC of DFS was 0.852, with 76.7% Sn, 82.3% Sp, PPV 48.2% and NPV 94.3%.
Conclusions: Compared to conventional non-invasive fibrosis scores, DFS more accurately identified, amongst patients comorbid with type 2 diabetes and NAFLD, those who should undergo transient elastography to evaluate their risk of liver fibrosis.

Disclosure
C. Lee: None. W. Seto: None. K. Ieong: None. D.T.W. Lui: None. H. Fong: None. H. Wan: None. W. Chow: None. Y. Woo: None. M. Yuen: None. K.S. Lam: Advisory Panel; Self; Merck Sharp & Dohme Corp.
151-LB: A Pilot Randomized Controlled Trial to Reduce Hospital Readmission Risk of Patients with Diabetes: 90-Day Outcomes
Authors: RUBIN DANIEL J. , WATTS SAMANTHA , DEAK ANDREW , VAZ CHERIE LISA , TANNER SAMUEL , RECCO DOMINIC , TIVON MADELINE , DILLARD FELICIA R. , BRZANA EMILY , JOYCE KATHERINE E. , KARUNAKARAN ABHIJANA , IWAMAYE AMY , MILLER ELI , MATHAI CHRISTINE , KONDAMURI NEIL , ALBURY BONNIE S. , ALLEN SHANEISHA , NAYLOR MARY D. , GOLDEN SHERITA , WU JINGWEI 
Published: June 2020

Unplanned hospital readmission is a high-priority quality measure and target for cost reduction. Patients with diabetes are at higher risk of readmission than patients without diabetes. We previously presented results of a pilot randomized controlled trial (RCT) of an intervention designed to reduce readmission risk (the Diabetes Transition of Hospital Care [DiaTOHC] program) with outcomes assessed 30 days after hospital discharge. Here we present secondary outcomes assessed 90 days after discharge.
Patients predicted to be high risk (&gt;=27%) for readmission based on a validated readmission risk tool (DERRITM) were randomized 1:1 to the intervention (INT) or usual care (UC). The intervention consisted of inpatient diabetes education, coordination of care, post-discharge support by a nurse practitioner, adjustment of diabetes therapy, and weekly phone calls for 30 days after discharge.
There were 45 INT and 46 UC patients randomized and analyzed by intention-to-treat. Twenty-one INT and 23 UC patients had a readmission (46.7% vs. 50%) while 25 INT and 27 UC patients had a readmission or Emergency Department (ED) visit (55.6% vs. 58.7%). The ratio of the mean estimated cost of readmissions, ED visits, and the intervention in the INT group was 0.51 (0.25-1.02)95%CL the cost of readmissions and ED visits in the UC group.
Among the 69 patients with an admission A1C &gt;7%, 14 INT and 17 UC patients had a readmission (41.2% vs. 48.6%), and 18 INT and 21 UC patients had a readmission or ED visit (52.9% vs. 60.0%), yielding relative risk reductions of 15.2% and 11.8%. The INT:UC group ratio of the mean estimated cost was 0.50 (0.22-1.12)95%CL. No differences were statistically significant in this pilot study.
The DiaTOHC intervention may modestly reduce readmission risk and cut costs by half within 90 days after discharge among patients with an admission A1C &gt;7%. This merits further investigation in a larger RCT.

Disclosure
D.J. Rubin: None. S. Watts: None. A. Deak: None. C. Vaz: None. S. Tanner: None. D. Recco: None. M. Tivon: None. F.R. Dillard: None. E. Brzana: None. K.E. Joyce: None. A. Karunakaran: None. A. Iwamaye: None. E. Miller: None. C. Mathai: None. N. Kondamuri: None. B.S. Albury: None. S. Allen: None. M.D. Naylor: None. S. Golden: None. J. Wu: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (K23DK102963)
1511-P: Diabetic Kidney Disease and Visit-to-Visit Variability of HbA1c, Blood Pressure, and Body Mass Index: A Nationwide Population-Based Study (ABB-DKD Study, JDDM)
Authors: MATSUTANI DAISUKE , MINATO SOICHIRO , TSUJIMOTO YUKI , MAEGAWA HIROSHI , SAKAMOTO MASAYA 
Published: June 2020

Aim: The present study is the first to investigate association between Diabetic Kidney Disease (DKD) and Visit-to-Visit Variability (VVV) of HbA1c, blood pressure (BP), and body mass index (BMI) in patients with T2DM whose HbA1c, BP, and BMI were measured ≥12 times during a 2-year period.
Material and Methods: This retrospective clinical trial initially analyzed data on 104,601 persons with T2DM in 38 clinical centers. We included 20- to 75-year-old patients whose HbA1c, systolic BP (SBP), and BMI were measured ≥12 times during a 2-year period. VVV was calculated using the coefficient of variation. VVVs of HbA1c, SBP, and BMI respectively, were divided into two groups by median value (high or low VVV). Risk of DKD were analyzed by multivariate logistic regression analysis. DKD was defined as urine albumin-to-creatinine ratio ≥30mg/g Cr or eGFR &lt;60 mL/min/1.73 m2.
Results: A total of 12,575 patients who met the inclusion criteria were finally analyzed. Adjusted odds ratios (ORs) for high risk of DKD were 1.33 (95% CI 1.22-1.46, p &lt; 0.001) for high VVV of HbA1c, 1.18 (1.08-1.28, p &lt; 0.001) for high VVV of SBP, and 1.19 (1.10-1.30, p &lt; 0.001) for high VVV of BMI. Male sex 1.29 (1.12-1.34, p &lt; 0.001), advanced age, longer diabetes duration, presence of hypertension 1.19 (1.03-1.38, p = 0.02), anti-hypertensive agent use 1.40 (1.22-1.61, p &lt; 0.001), presence of dyslipidemia 1.24 (1.11-1.39, p &lt; 0.001), higher 2-year mean HbA1c, higher 2-year mean SBP, and higher 2-year mean BMI were also related to high risk of DKD. Additionally, the analysis of antidiabetic drug use revealed that particularly use of insulin 1.50 (1.34-1.68, p &lt; 0.001) and sulfonylurea use 1.24 (1.13-1.37, p &lt; 0.001) were associated with high risk of DKD.
Conclusion: High VVV of HbA1c, SBP, and BMI were associated with DKD independently of mean HbA1c, SBP, and BMI values.

Disclosure
D. Matsutani: None. S. Minato: None. Y. Tsujimoto: None. H. Maegawa: Speaker’s Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Sanofi K.K., Takeda Pharmaceutical Company Limited. M. Sakamoto: None.
1524-P: Prevalence of Nonalcoholic Fatty Liver Disease in Patients with Type 2 Diabetes in a Spanish Population
Authors: SANCHEZ BAO ANA M. , BELLIDO VIRGINIA , TEJERA CRISTINA , BELLIDO DIEGO 
Published: June 2020

Introduction: The prevalence of liver disease due to nonalcoholic fatty deposits (NAFLD) has doubled in the last 20 years in parallel to the increased prevalence of obesity and type 2 diabetes mellitus (T2DM). Insulin resistance is a central element in the pathogenesis of NAFLD and it is known that the prevalence of NAFLD is higher among patients with T2DM.
Objective: To assess the prevalence of NAFLD in a sample of patients with T2DM and define the associated clinical characteristics.
Methods: Observational, retrospective and multicenter study in routine clinical practice with SLGT2 inhibitor (dapaglifozin) and DPP-4 inhibitor (sitagliptin) in patients with T2DM in Spain (DAPA-RWE study). Protocol code:FIS-DAP-2016-01. Inclusion criteria were patients between 18-75 years old on treatment with sitagliptin or dapaglifozin for at least 6 months, minimum data set available. Data were analyzed with SSPPSS® version 24 (statistical significance level 0.05, mean data ± standard deviation).
Results: Data from 1040 patients, belonging to 22 different centers, were analyzed. The average age of the patients is 59.6 ± 8.9, 50% were women and 45.7% were receiving treatment with insulin. In our sample, 8% of patients are diagnosed with NAFLD. Among patients with NAFLD the average BMI was 35 kg/m2 and the waist circumference was 111.83 cm compared to patients without NAFLD with an average BMI of 31 kg/m2 and a waist circumference of 102.36 mm. No statistically significant relationship was found between NAFLD and the development of ischemic heart attack (patients with NAFLD and Myocardial infarction were 11.9%) or neurovascular disease (patients with NAFLD and neurovascular disease were and 8.3%).
Conclusions: In our sample, patients with NAFLD had higher BMI and waist circumference compared to patients without NAFLD. It has not been possible to demonstrate the relationship between NAFLD and cardiovascular or neurovascular disease, although the potency is limited by the low prevalence in our sample.

Disclosure
A.M. Sanchez Bao: None. V. Bellido: None. C. Tejera: None. D. Bellido: None.
1526-P: Time-Dependent Effect of Kidney Disease on All-Cause and CVD Mortality in Adults with Type 2 Diabetes: A Secondary Analysis of the Look AHEAD Clinical Trial
Authors: WILLS ANDREW C. , KNOWLER WILLIAM C. 
Published: June 2020

The Look AHEAD trial compared an intensive lifestyle intervention (ILI) for weight loss with diabetes support and education in adults with T2DM and BMI ≥ 25 kg/m2. During 10 years of follow-up, ILI had no significant effect on mortality or incidence of CVD. Here we present a secondary analysis of urine albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) as predictors of all-cause mortality (361 deaths among 4865 participants) using time varying covariates proportional hazards models adjusted for age, sex, race/ethnicity, and ILI. Both ACR and eGFR predicted mortality (Figure 1a/b, respectively). In a joint analysis of ACR and eGFR, mortality was highest among groups with low eGFR and high ACR. Interestingly, high eGFR was also associated with higher mortality (Figure 1c). Effects of eGFR on mortality were nonlinear, but in each eGFR group, ACR was positively associated with mortality. In each analysis, ILI was beneficial, but not significantly so. There were no significant interactions between ACR or eGFR and insulin treatment, history of CVD, beta-blocker treatment, or age at baseline on mortality.
In conclusion, ACR and eGFR predicted mortality in time varying models. Results were similar for CVD mortality (106 deaths) and for the primary trial outcome of fatal or nonfatal CVD (796 events).

Disclosure
A.C. Wills: None. W.C. Knowler: None.
1527-P: Trends in Diabetic Ketoacidosis in Kentucky, 2008-2018
Authors: LACY MARY E. , BENITEZ JOSEPH , FOWLKES JOHN , SOHN MIN-WOONG 
Published: June 2020

Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes. In the U.S., DKA hospitalizations are increasing. We estimated DKA hospitalization rates in Kentucky across key subgroups.
Methods: Using the statewide Kentucky Inpatient Claims Files, we examined rates of DKA hospitalization in Kentucky for adults aged ≥18 in 2008-2018. In each year, the denominator was all diabetes-related hospitalizations (any position; ICD-9 250; ICD-10 E10, E11, E13). The numerator was all DKA-related hospitalizations (any position; ICD-9 250.1; ICD-10 E10.1, E11.1, E13.1).
Results: In 2008-2018, rates of DKA hospitalizations in Kentucky increased by 100% (from 2.2% in 2008 to 4.4% in 2018; Fig A). In certain subgroups, rates were markedly higher. In the subset of Medicaid-insured patients DKA rates surpassed 10% of all diabetes-related hospitalizations (Fig B). Compared to patients covered by commercial insurance or Medicare, Medicaid-insured patients show dramatic increase following Medicaid expansion (2014). In non-Hispanic (NH) blacks, rates reached 6% by 2018 (Fig C). Rates for urban and rural populations were mostly parallel but diverged slightly following Medicaid expansion (Fig D).
Conclusions: Consistent with previous studies, DKA rates were higher in NH black, Medicaid-insured, and urban patients. Rates increased in all subgroups. The trends for Medicaid enrollees may show the effect of the 2014 Medicaid expansion.

Disclosure
M.E. Lacy: None. J. Benitez: None. J. Fowlkes: None. M. Sohn: None.
153-OR: Glucose-Dependency of Insulinotropic and Glucagonostatic Effects of Glucagon-Like Peptide-1 after Gastric Bypass and Sleeve Gastrectomy
Authors: HONKA HENRI , AL ZUBAIDI ANAS M. , GASTALDELLI AMALIA , DEFRONZO RALPH A. , SALEHI MARZIEH 
Published: June 2020

Increased prandial GLP-1-induced insulin secretion after gastric bypass (GB), especially in those with late-complication of hypoglycemia, is well characterized. We previously reported that meal ingestion increases insulin and GLP-1 secretion during a sub-basal glycemic clamp in individuals after GB. Here, we investigated whether altered meal-stimulated β-cell output in this setting is due to the enhanced glucose-independent actions of GLP-1 using a potent GLP-1 receptor (GLP-1R) antagonist, exendin-(9-39) (Ex-9). Nine subjects with history of GB, 6 with prior sleeve gastrectomy (SG), and 4 non-operated healthy subjects were studied twice with and without Ex-9 infusion during a 5-hr hyperinsulinemic (120mU/m2/min) hypoglycemic (55mg/dl) clamp. The GB, SG, and CN groups were matched for BMI, FFM, A1c, and age; and the GB and SG for weight loss and time postsurgery; none had diabetes. Islet and gut hormones were measured before and after a liquid meal (280kcal, 20% glucose) at 2 hr of clamp studies. Fasting levels of glucose, islet and GI hormones were similar between 2 studies and among 3 groups. Insulin sensitivity (M/I) didn’t differ among the groups but insulin clearance was larger in surgical patients (P=0.08). Blocking GLP-1R did not affect β-cell secretory response before or after meal ingestion whereas α-cell responses to hypoglycemia alone or to meal ingestion were increased during Ex-9 infusion (pre-meal: 18, 9, 47%, and post-meal: 42, 14, 13% in GB, SG, and CN, respectively, P&lt;0.05). Prandial GIP was similar among 3 groups and not affected by Ex-9. GLP-1 response was larger in GB compared to SG and CN, and was further increased by Ex-9 (P&lt;0.01). Our findings indicate that in nondiabetic subjects with prior history of GB and SG, endogenous GLP-1 contribution to prandial β-cell secretion is glucose-dependent. Glucagonostatic effect of endogenous GLP-1, on the other hand, is preserved during hypoglycemic condition after these surgeries.

Disclosure
H. Honka: None. A.M. Al Zubaidi: None. A. Gastaldelli: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Gilead Sciences, Inc., Inventiva Pharma, Novo Nordisk Inc. R.A. DeFronzo: None. M. Salehi: None.

Funding
Finnish Cultural Foundation (00180071); National Institutes of Health (DK105379)
1531-P: Impact of Hurricanes Irma/Maria on Changes in Glucose Abnormalities and Diabetes Care
Authors: MARTINEZ-LOZANO MARIJULIE , NOBOA CARLAMARIE , JOSHIPURA KAUMUDI J. 
Published: June 2020

Aims: To evaluate the impact of hurricanes Irma/María on changes in glucose abnormalities and diabetes care.
Methods: Participants from the San Juan Overweight Adults Longitudinal Study (SOALS) aged 40-65 years and free of diabetes at baseline completed a follow-up exam. Of these, 324 participants without diabetes were enrolled in the Preparedness to Reduce Exposures and diseases Post-hurricanes and Augment Resilience (PREPARE) study evaluating risk and resiliency factors. Self-reported physician diagnosed diabetes data and blood samples were collected at all three visits. Paired t-tests were conducted to compare within person changes from baseline to follow up (pre-hurricanes) versus follow up to PREPARE visits (post hurricanes), both roughly similar 3 years follow-up periods, for fasting glucose, insulin and HbA1c. PREPARE participants with diabetes (N=56) recruited from another cohort were interviewed.
Results: At baseline, mean age was 54 years (SD=6.84), 77% were women and mean BMI was 33.5 (SD=6.30). The 3-year cumulative incidence of diabetes was 0.012 pre hurricanes and was 0.056 post hurricanes (p=.003). The increase in HbA1c post hurricane (M=0.66%, SD=5.49) was significantly higher than the changes pre hurricane (M=-0.18%, SD=0.23). The changes in fasting insulin post hurricanes (M=1.51uIU/mL, SD=8.69) was also significantly higher than pre hurricanes (M=0.38uIU/mL, SD=5.58). There were no significant differences for glucose. Of the 56 participants with diabetes, 18.9% had problems obtaining and storing insulin (median=112 days). Also, 16.7% had trouble getting good medical care for diabetes or related complications (median= 61 days), and needed to change their healthcare provider/facility, and/or find alternatives for insulin.
Conclusion: Hurricanes had a detrimental impact, increasing the incidence of diabetes, and fasting insulin and HbA1c. Among people with diabetes, hurricanes could disrupt healthcare and medications both short-term and long-term impact.

Disclosure
M. Martinez-Lozano: None. C. Noboa: None. K.J. Joshipura: None.

Funding
National Institutes of Health (R21MD013666, U54MD007587, R01DE010111)
1538-P: Prevalence of Late-Evening and Nighttime Eating in Individuals with Type 2 Diabetes
Authors: QUIST JONAS S. , BLOND MARTIN B. , FÆRCH KRISTINE , EWERS BETTINA 
Published: June 2020

Introduction: Late-evening food intake associates with metabolic risk. We assessed the prevalence of late-evening and night-time eating in individuals with type 2 diabetes and its association with BMI and HbA1c.
Methods: This cross-sectional analysis includes 348 individuals with type 2 diabetes from an outpatient diabetes clinic in Denmark. Frequency of late-evening and night-time eating was assessed from a food frequency questionnaire and clinical data were obtained from electronic medical records. Participants were divided into those reporting to eat frequently (≥3 times/week) during the evening after dinner and/or night (late-eaters) and those who did not (reference) and BMI and HbA1c were compared between groups with and without adjustment for diabetes duration and antidiabetic medication.
Results: Forty-two% reported to eat frequently (≥3 times/week) during late evening and 8% reported to do so during the night (Figure 1). Most late-eaters reported to eat breakfast regularly suggesting a long eating window and short fasting period. BMI and HbA1c did not differ between late-eaters and the reference group (Figure 1).
Conclusion: Eating late was prevalent among individuals with type 2 diabetes across BMI and HbA1c levels. Whether restriction of eating during evening and night-time can induce weight loss and improve glycemic control in individuals with type 2 diabetes needs testing in randomized controlled trials.

Disclosure
J.S. Quist: None. M.B. Blond: None. K. Færch: None. B. Ewers: None.

Funding
Steno Diabetes Center