bluuebunny/crossref_metadata_2025_split huggingface dataset:
224-OR: Effect of Macronutrient Intake on Glycemic Outcomes over 1 Year in Youth with T1D
Authors: LA BANCA REBECCA O. , VOLKENING LISA K. , DASSAU EYAL , MEHTA SANJEEV N. , LAFFEL LORI M. 
Published: June 2020

Aim: Insulin bolus doses are mainly based on ambient glucose level and planned carbohydrate (CHO) intake, although fat and protein content of food also impact glycemic excursions. We examined the impact of macronutrient intake on glycemic outcomes in youth with T1D.
Methods: Youth (N=136, ages 8-17) with T1D provided diet (3-day food records) and glucose (3-day masked CGM [iPro™]) data every 3 months for 1 year (5 time points). Diet data were analyzed using Nutrition Data System for Research (NDSR). Macronutrient % intake was derived as the mean for each 3-day period. Glycemic outcomes were A1c and CGM metrics: glucose % time in range (TIR) 70-180 mg/dL, % time (T) &lt;70, %T&gt;180, and glucose CV. Longitudinal mixed models assessed the effect of macronutrient intake on glycemic outcomes.
Results: Youth (48% male) had a mean age of 12.8±2.5 years and T1D duration of 5.9±3.1 years; youth checked BGs 5.6±2.4 X/day and 73% used insulin pumps. At baseline, A1c=8.1±1.0%, %TIR=49±17% (11.8 hrs), %T&lt;70=6±8% (1.4 hrs), %T&gt;180=44±20% (10.6 hrs), and CV=41±8%; macronutrient % intake was 48±5% CHO, 36±5% fat, and 16±2% protein. Over 1 year, differences in macronutrient intake affected glycemic outcomes (Table).
Conclusions: Our data confirm the significant impact of fat and protein intake on glycemic outcomes. These findings offer an opportunity to tailor algorithms to assist with meal-time bolus dosing and automated insulin delivery systems.

Disclosure
R.O. La Banca: None. L.K. Volkening: None. E. Dassau: Consultant; Self; Eli Lilly and Company. Research Support; Self; Dexcom, Inc., DreaMed Diabetes, Tandem Diabetes Care, Xeris Pharmaceuticals, Inc. Speaker’s Bureau; Self; Roche Diabetes Care. Other Relationship; Self; Dexcom, Inc., Insulet Corporation, Roche Diabetes Care. S.N. Mehta: None. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US.

Funding
National Institutes of Health (P30DK036836, K12DK094721)
2243-PUB: Association between Blood Pressure, Adiposity, and Lifestyle Behaviors in Schoolchildren
Authors: HIRSCHLER VALERIA , GROUP DIOSES STUDY , MOLINARI CLAUDIA , LAPERTOSA SILIVA , GARCIA CONCEPCION 
Published: June 2020

Background: Childhood blood pressure (BP) is known to be associated with weight status. However, the association between BP and adiposity and lifestyle behaviors in normal-weight (NW) versus overweight/obese (OW/OB) schoolchildren should be further explored.
Objective: To determine the association between schoolchildren’s BP with adiposity and lifestyle behaviors.
Methods: Data for age, sex, BMI, waist circumference (WC), and BP were recorded. OW/OB was defined as a BMI &gt; 85%ile or &gt; 95%ile respectively. A 5-level index that ranked participants’ daily consumption of vegetables or fruits, milk, sweetened beverages, and TV viewing were performed.
Results: Schoolchildren (n = 1249, 554M) aged 9.4 ± 2.1 years from 9 elementary schools in five states of Argentina were examined. The prevalence of OW was 265 (21.2%) o and OB 265 (21.2%). All came from a low socio-economic background; 62% of the parents had an elementary school education or less. Children were divided into NW and OW/OB. Systolic BP was significantly associated with age (r=0.18), WC (r=0.17), and BMI (r=0.34) in NW children. However, systolic BP was significantly associated with age (r=0.37), WC (r=0.42), WC/height (r=0.24), BMI (r=0.19), low fruit intake (r=0.14), and TV watching (r=0.12) in OW/OB children. Diastolic BP was significantly associated with age (r=0.40), WC (r=0.37), WC/height (r=0.18), and BMI (r=0.33) in OW/OB children. Multiple linear regression analyses showed that systolic BP was only significantly associated with age in NW children (R2=0.02); but with age, WC, and TV watching (R2=0.22) in OW/OB children. In addition, diastolic BP was significantly associated with age and WC (R2=0.17) in OW/OB children but no association was found in NW children.
Conclusion: These results suggest that BP levels in schoolchildren were associated with adiposity and unhealthy lifestyle behaviors. Future longitudinal studies should be performed to confirm these findings.

Disclosure
V. Hirschler: None. C. Molinari: None. S. Lapertosa: None. C. Garcia: None.
2244-PUB: Quantifying Adverse Childhood Experiences in a Pediatric Cohort with Type 1 Diabetes
Authors: ZAKHEIM EMMANUELLE , GILDENGORIN GINNY , AHMAD TARIQ 
Published: June 2020

Social determinants impacting health has been widely established in the pediatric population, but there is a paucity in the literature quantifying psychosocial stressors in children with chronic conditions. We administered the Pediatric Adverse Childhood Experiences and Related Life Events Screener (PEARLS) to a cohort of pediatric patients with type 1 diabetes (T1D), with at least 1 year duration, at UCSF Benioff Children’s Hospital Oakland. This two-section validated survey quantifies experiences such as (but not limited to): Section 1 (S1), abuse, neglect, and domestic dysfunction and Section 2 (S2), domestic hardship (eg food scarcity, housing). Our cohort included 38 males and 43 females, aged 4 to 21 years old. Scored surveys were compared to social determinants (insurance status, clinic location, and race) and health factors (HbA1c and BMI). Statistical analyses were performed using t-tests, chi-square tests, and multivariate regression models. Results revealed an average PEARLS score for the group as 1.16 ±1.79 and 0.63 ±1.05 for S1 and S2 respectively. There was a statistical difference between Caucasians and non-Caucasians for S1 (p=0.01), and for those patients who were seen in Oakland versus an upper-middle-class suburban clinic (San Ramon, CA) for both Sections (p=0.01 and p=0.007, for S1 and S2 respectively). For those with a HbA1c &gt; 10% there was a statistical difference for S2 (p=0.004). This is the first study quantifying adverse childhood experiences in a T1D cohort, as far as we know. As a group, those with T1D do not experience significant toxic stress, but statistically relevant risk factors for elevated PEARLS scores included being non-caucasian, having a HbA1c &gt; 10% and being seen in an urban clinic. Implementation of the PEARLS survey can help providers and diabetes care teams focus on stressors that may be impeding glycemic control and impacting current and future health, particularly in those risk groups mentioned prior. Use of larger cohorts may elucidate other associations.

Disclosure
E. Zakheim: None. G. Gildengorin: None. T. Ahmad: None.
2262-PUB: Association of Adipokines with Diabetes: Measurements in Blood and Saliva
Authors: VINITHA RAMACHANDRAN , RAGHAVAN KUNCHITHAPATHAM , ARUN VASUDEVAN K. , SUSAIRAJ PRISCILLA , RAGHAVAN ARUN , NANDITHA ARUN , SATHEESH KRISHNAMOORTHY , SNEHALATHA CHAMUKUTTAN , RAMACHANDRAN AMBADY 
Published: June 2020

The association of adiponectin, apelin, visfatin and vaspin with different glycaemic states (normal glucose tolerance (NGT), (impaired glucose tolerance (IGT) and type 2 diabetes (T2D)) and in the presence of periodontits were studied in saliva and blood (serum) samples. The utility of saliva and serum in measuring these adipokines was also compared. Prescreening was done to identify persons with ≥ 3 risk factors for T2D among; age 35 -55 years, overweight/obesity, high waist circumference, family history of T2D, hypertension or sedentary habits. They were then categorised as having no diabetes (NGT + IGT, Group A) and having diabetes (T2D, Group B) based on oral glucose tolerance test. Presence of periodontitis was assessed by a periodontist. Samples were analysed using ELISA. Of the 615 persons screened, 136 (22.1%) had 3 or more risk factors. Ninety (14.6%) persons (NGT (n = 48), IGT (n = 17) T2D (n = 25)) were enrolled. Concentrations of adipokines in groups A and B are presented in the table. Higher salivary vaspin and lower visfatin were observed in the presence of periodontitis. The utility of serum and saliva in the measurement of adipokines for diabetes vary considerably. In Asian Indians, lower adiponectin and higher visfatin in serum and increased salivary visfatin and apelin are useful biomarkers of diabetes, illustrating the involvement of inflammation in the pathogenesis of T2D.

Disclosure
R. Vinitha: None. K. Raghavan: None. V.K. Arun: None. P. Susairaj: None. A. Raghavan: None. A. Nanditha: None. K. Satheesh: None. C. Snehalatha: None. A. Ramachandran: None.
2264-PUB: Progress in Curating Gene–Disease Relationships by the ClinGen Monogenic Diabetes Expert Panel
Authors: POLLIN TONI I. , MAYERS MEGAN A. , GREELEY SIRI ATMA W. , MALONEY KRISTIN A. , NAYLOR ROCHELLE N. , PAKYZ RUTH E. , PATEL KASHYAP A. , UDLER MIRIAM , ZHANG HAICHEN , COLCLOUGH KEVIN , THAXTON COURTNEY 
Published: June 2020

Diagnosing and distinguishing monogenic diabetes, including some MODY (maturity-onset diabetes of the young), from type 1 or type 2 diabetes can have profound clinical implications: sulfonylureas vs. insulin or metformin for HNF1A- and HNF4A- diabetes, and no treatment for GCK-diabetes. Since 1996, the number of monogenic diabetes genes has expanded from three to 60 or more, with 14 called MODY genes; however newer evidence has called some of these gene associations into question. Monogenic diabetes is currently underdiagnosed, but the decreasing cost of sequencing and the ability to create multi-gene next-generation sequencing panels may increase access to testing and a proper diagnosis. For the testing to be useful, it is important that the genes chosen for these panels have appropriate evidence as causal genes. The NIH Clinical Genome Resource (ClinGen) Monogenic Diabetes Gene Curation Expert Panel was convened to bring together experts in clinical and laboratory aspects of monogenic diabetes and gene curation to publish curations for the ClinGen website based on evidence from clinical and molecular studies and population databases.
To date, we have published evidence-based gene curation summaries for Gene-Disease Validity for HNF1A and HNF4A (both classified as Definitive for monogenic diabetes) and are in the process of curating and publishing curations for GCK (Definitive for monogenic diabetes), INS (Definitive for monogenic diabetes and permanent neonatal diabetes), HNF1B (Definitive for renal cysts and diabetes), and KLF11 (Disputed for monogenic diabetes due to limited evidence and high population frequencies of variants previously asserted as causative). Curation of additional genes is in progress. Accurate curations will inform appropriate testing panel content to reduce ambiguous results and assure variants identified are clinically relevant for informing the care of diabetes in patients and their families.

Disclosure
T.I. Pollin: None. M.A. Mayers: None. S.W. Greeley: None. K.A. Maloney: None. R.N. Naylor: None. R.E. Pakyz: None. K.A. Patel: None. M. Udler: None. H. Zhang: None. K. Colclough: None. C. Thaxton: None.

Funding
National Institutes of Health (U24HD093486)
227-LB: Dietary Protein Restriction Induced–FGF21 Improves Metabolic Health during Aging
Authors: HILL CRISTAL M. , MCDOUGAL DAVID , MORRISON CHRISTOPHER 
Published: June 2020

Aging and obesity are risk factors linked to the impairment of both energy and glucose homeostasis. Conversely, reducing caloric intake or the intake of select macronutrients or amino acids, including dietary protein restriction (DPR) and methionine restriction, defends against the detrimental effects of aging and obesity. Our data demonstrate that DPR increases energy expenditure and improves glucose homeostasis, and that the metabolic hormone FGF-21 coordinates these adaptive responses to protein restriction in young mice. However, the role of FGF-21 in mediating the effects of DPR during aging remains unclear. C57BL6 mice were fed either a normal protein (NP) or a low protein diet (LP), beginning at either young (3-months) or middle (12-months) age. A separate group of middle-aged mice were fed either a high-fat (HFD) diet or a high-fat, low-protein (HFLP) diet. Bodyweight and food intake were assessed weekly in all groups. Energy expenditure and glucose tolerance were assessed at 12 and 20 months of age in young mice and 16 months of age in middle aged-mice. Serum collected at sacrifice was used to measure FGF-21 levels. LP diet increased energy expenditure and food intake, and reduced body weight gain, in both young and middle-aged mice (P&lt;0.05), and HFLP-diet similarly reduced body weight gain relative to HFD-fed controls (P&lt;0.05). Glucose tolerance was improved in LP-fed young mice, and in LP and HFLP fed middle-aged mice (P&lt;0.05). Lastly, FGF-21 levels were increased in both young and middle-aged mice in response to LP-diet (P&lt;0.05), and in response to HFLP in middle-aged mice (P&lt;0.05). These data indicate that the interaction of age or diet-induced obesity does not blunt the effects of DPR to induce-FGF-21, reduce body weight gain, increase energy expenditure, or improve glucose homeostasis.

Disclosure
C.M. Hill: None. D. McDougal: None. C. Morrison: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK105032, F32DK115137); Pennington Biomedical/Louisiana Nutrition Obesity Center (P30DK072476)
2272-PUB: Association between Hypertension and Diabetes Medication Compliance and Complications in Korea
Authors: CHUN KI HONG 
Published: June 2020

Purpose: The purpose is to determine whether dosing compliance of person with hypertension(HT) or DM is related to the occurrence of AMI, stroke, and CRF.
Method: Since Korea’s health insurance is social insurance for all citizens and is operated by a separate act, there are data that claim the medical expenses of all citizens. This study uses the full medical expenses claims data of all citizens. As of 2011, all persons with HT or DM were enrolled in the year, and a retrospective cohort data was added to follow-up by 2018, adding new dosing patients each year. Since 2016, complications have been observed by year, and previous occurrences were excluded from the study. For those who took medications from 2011, we calculated the annual compliance rate of the medications up to the previous year of occurrence, and excluded those who are less than 3 years before 2018. By the age group, the annual incidence of 2016-2018 according to complications was calculated according to the average dose compliance rate and the ratio of the odds of complications among those in the 1/5 quintile and the odds of complications among others were analyzed by year.
Result: HT or DM medication compliance rates were highly associated with all complications in their 30s and 40s. Above 70 years of age was associated with stroke. In the fifties and sixties, DM or HT compliance were closely related to all complications, except that DM compliance was not associated with AMI.
Discussion: It is important for persons with HT or DM in their 30s and 40s to increase their dosing compliance to minimize their complications occurrence. It is necessary to thoroughly monitor DM compliance because this is highly related to the occurrence of the most expensive CRF. In the 50s and 60s, HT and DM compliance are closely related to the occurrence of all complications, which can significantly reduce future costs through thorough dosing of population.

Disclosure
K. Chun: None.
2276-PUB: Fecal Profile of Short-Chain Fatty Acids: Associations with Environmental Factors in the First Year of Life of Women Participating in the Nutritionist’s Health Study
Authors: BARBOSA MARINA G. , SOLAR ISABELA , FREITAS RENATA G. , RIBEIRO FRANCIELI B. , RAMOS CAMILA O. , SANT’ANA MARCELLA R. , HANADA ALFREDO S. , CROUCHAN NAJLA S.K. , XAVIER CAMILA M. , NETO BRUNO G. , FOLCHETTI LUCIANA G.D. , SILVA ISIS T. , ALMEIDA-PITITTO BIANCA , FERREIRA-VIVOLO SANDRA ROBERTA G. , VASQUES ANA CAROLINA J. 
Published: June 2020

Introduction: Many studies report that environmental factors occurring in childhood may modulate the composition of the gut microbiota in adulthood, which in turn, produces short chain fatty acids (SCFA) with metabolic effects on inflammatory cascades associated with glycemic homeostasis.
Objective: This study aims to analyze associations between type of delivery (vaginal/cesarean section), type of breast-feeding (maternal/artificial) and solid food introduction (start and quality) with fecal SCFA concentrations in women.
Method: A cross-sectional study including 106 women, 28±5 years old and BMI 25±5 kg/m2, a questionnaire regarding from birth until the first year of life. For quantification of acetate, butyrate and propionate it was used gas chromatography-mass spectrometry in fecal samples.
Results: Of the women surveyed 63% were cesarean delivered and 93% received maternal breast milk at some point. There was no correlation between SCFA concentration and type of delivery (p&gt;0.05). Positive correlation was found between breastfeeding time and butyrate (r=0.24; p=0.02), there was a tendency with propionate (r=0.20; p=0.06). There was no correlation between time received infant formula and SCFA. There was a tendency of correlation between butyrate and beginning of cow’s milk intake (r=0.194; p=0.052). Age at solid food introduction correlates with propionate (r=0.22; p=0.026) and butyrate (r=0.25; p=0.012), and report a tendency with the acetate (r=0.18; p=0.07). In the first year of life, individuals who prefer salty crackers and pasta/potatoes had less concentration of propionate and acetate, respectively (p=0.026).
Conclusion: The type of delivery was not associated with SCFA, but there was a favorable association with prolonged breastfeeding, late beginning of cow’s milk intake, introduction of solids starting after 6 months of age and lower intake of refined cereals.

Disclosure
M.G. Barbosa: None. I. Solar: None. R.G. Freitas: None. F.B. Ribeiro: None. C.O. Ramos: None. M.R. Sant’Ana: None. A.S. Hanada: None. N.S.K. Crouchan: None. C.M. Xavier: None. B.G. Neto: None. L.G.D. Folchetti: None. I.T. Silva: None. B. Almeida-Pititto: None. S.G. Ferreira-Vivolo: None. A.J. Vasques: None.

Funding
São Paulo Research Foundation (2017/10185-9, 2019/05450-0)
2279-PUB: High Prevalence and Suboptimal Management of Diabetes in India: Findings from a Community-Based Study
Authors: MOHAN SAILESH , JARHYAN PRASHANT , SHARNNGADHARAN GANESH KUMAR , PRABHAKARAN DORAIRAJ 
Published: June 2020

Purpose: Diabetes is rapidly increasing in India. This study aimed to determine the current prevalence of diabetes and its management in rural and urban India.
Methods: We conducted a large population based cross-sectional survey among 12284 participants aged ≥30 years residing in rural and urban North and South India. Participants were selected using a multistage cluster random sampling technique. Trained personnel collected the data using a questionnaire, measured blood pressure, conducted anthropometry and collected bio-samples. Diabetes was defined as FPG ≥ 126 mg/dl or HbA1C ≥ 6.5% or self-reported physician diagnosis or being on treatment. Control was defined as HbA1C &lt; 7%.
Results: The mean (±SD) age of participants was 49.2 (±12.6) years, women comprised 53% of the sample. The age-standardized prevalence of diabetes was 17.4% (95% CI: 16.7-18.1). The prevalence was higher among men [19.3% (18.3-20.3)], elderly i.e., ≥ 60 years [26.8% (25.1-28.6)], urban residents [23.1% (22.1-24.2)] and in those with higher socioeconomic status [22.5% (21.0-24.1)]. Nearly, one-third participants had prediabetes [29.7% (28.9-30.5)] and there were no rural-urban, gender or socioeconomic differences. The awareness and treatment [49.1% (46.8-51.4), 43.3% (41.0-45.5)] rates respectively, were poor among diabetics, who were young (41.9%, 36.0%), rural residents (37.8%,31.5%) and those with lower socioeconomic status (30.1%,28.4%). Overall control rate was 45.5% (42.9-48.1) with no significant differences between the aforementioned groups.
Conclusions: Despite the increasing burden of both diabetes and prediabetes in India, the awareness, treatment and control rates remain suboptimal. Active screening and tailored public education to increase awareness, are essential for promoting early detection and improving management, especially among poor rural populations.

Disclosure
S. Mohan: None. P. Jarhyan: None. G. Sharnngadharan: None. D. Prabhakaran: None.
228-LB: Chronic Treatment with a Vasodilator Augments the Effectiveness of Endurance Training to Improve Exercise Capacity and Increases Microvascular Blood Flow in Obese Mice
Authors: CAPPEL DAVID A. , WASSERMAN DAVID 
Published: June 2020

Peripheral vascular disease is a frequent co-morbidity of type-2 diabetes that impairs exercise capacity. We hypothesized that chronic treatment with a vasodilator would increase microvascular flow and exercise capacity. To test this hypothesis, we chronically treated obese mice with the vasodilatory agent Sildenafil during exercise training. Obese mice were fed a high fat diet (HFD) for 6 weeks prior to the study and remained on the diet for its duration. Mice performed an initial treadmill stress test to assess exercise capacity and injected twice daily with either vehicle or Sildenafil. Groups were matched to initial stress test run distance (Sildenafil 379±74 m vs. Vehicle 373±65 m n=17). Mice were exercise trained for 5-weeks with a 5-days per week 1-hour run at 40% of maximal stress test exercise intensity. After the training period, mice were subjected to a second exercise stress test. Sildenafil treated but not vehicle treated HFD-fed mice showed increased exercise capacity based on stress test run distance (Sildenafil 520±130 m vs. Vehicle 402±164 m n=17). Treating obese mice with a single acute dose of Sildenafil did not alter run distance on a treadmill stress test (Sildenafil 406±64 m vs. Vehicle 460±136 m n=8). To determine the effect of chronic Sildenafil treatment on vascular function, we measured blood flow in the microvasculature of the gastrocnemius muscle by intravital microscopy within one week of the final exercise test. Sildenafil treated mice showed increased vascular flow rate (Sildenafil 671±106 microns/s vs. Vehicle 527±198 microns/s, n=10-11) and vessel perfusion (Sildenafil 96±4% vs. Vehicle 92±4%, n=10-11). Overall, these results indicate that chronic treatment with a vasodilatory agent augments the effect of exercise training to improve exercise capacity in the context of obesity and increases blood flow rate and blood vessel perfusion in the microvasculature of skeletal muscle.

Disclosure
D.A. Cappel: None. D. Wasserman: None.

Funding
National Institutes of Health (DK059637, DK054902); American Heart Association