bluuebunny/crossref_metadata_2025_split huggingface dataset:
503-P: Association between Triglycerides–Glucose Index and Diabetic Nephropathy in Patients with Type 2 Diabetes
Authors: LIU LI , YUAN GANG 
Published: June 2020

Objective: To investigate the association between triglycerides-glucose (TyG) index and diabetic nephropathy (DN) in patients with type 2 diabetes (T2D).
Methods: A total of 682 adult patients with T2D hospitalized at Tongji Hospital from January 2007 to December 2009 were included in this cross-sectional analysis. Multiple logistic regression and ROC analysis were performed.
Results: Two hundred and thirty-two (34.0%) participants were identified as DN. Compared with Non-DN group, DN groups had a longer disease duration and a higher bodyweight, systolic blood pressure, diastolic blood pressure, HbA1C, triglycerides, total cholesterol, serum uric acid, 24h-urinary albumin, TyG index, and HOMA2-IR (P&lt;0.05 for each). TyG index presented the independent risk (OR=1.91, P=0.001) for DN (Table 1). TyG index was stratified into quartiles and taking the highest quartile (Q4) as reference, the odds ratios for DN was decreased in Q3 (0.36), Q2 (0.26), and Q1 (0.48) (P&lt;0.05 for trend). Subgroup analysis showed that TyG index was more significantly associated with DN in patients with HbA1C≥7% (OR=2.18, P=0.002). In addition, TyG index showed a higher AUC of 0.67 (P=0.002) than HOMA2-IR (AUC=0.61, P=0.029) in ROC analysis for DN predicting.
Conclusions: TyG index, as a marker of insulin resistance, was independently associated with DN in patients with T2D. It was a better predictor of DN in T2D than HOMA2-IR.

Disclosure
L. Liu: None. G. Yuan: None.

Funding
National Natural Science Foundation of China (81770817, 81700727)
520-P: Exenatide Ameliorates Diabetic Kidney Disease by Inhibiting Apoptosis via SIRT1/TXNIP Signal Pathway
Authors: WANG MEIJUN , LIANG RIYING , XU FEN , CAI MENGYIN 
Published: June 2020

Recent studies have indicated apoptosis to be a major contributor to the progression of Diabetic Kidney Disease. GLP-1 agonist such as Exenatide, which counteracts insulin resistance in humans with type 2 diabetes, has been shown to ameliorate Diabetic Kidney Disease in experimental models. In this study, we investigated whether exenatide could alleviate Diabetic Kidney Disease by apoptosis through SIRT1/TXNIP signal pathway. Male C57BL/6J mice challenged with a high-fat diet (HFD) for 12weeks were then treated with exenatide (HFD+exe) or normal saline(HFD+sal) by intraperitoneal injection for 8 weeks. The results revealed that Exenatide notably decreased body weight, urine albumin-to-creatinine ratio(ACR) and apoptosis in the kidney induced by HFD challenge. Western blot revealed the level of apoptosis were notably downregulated after exenatide treatment. In addition, the protein expression of SIRT1 was upregulated, whereas TXNIP was downregulated in the HFD+exe group. Collectively, the data indicate that Exenatide ameliorates Diabetic Kidney Disease by inhibiting apoptosis via SIRT1/TXNIP signal pathway.

Disclosure
M. Wang: None. R. Liang: None. F. Xu: None. M. Cai: None.
548-P: Early Liver Dysfunction Predicts Cardiac Autonomic Neuropathy in Adolescents with Type 1 Diabetes
Authors: VELAYUTHAM VALLIMAYIL , BENITEZ-AGUIRRE PAUL Z. , CRAIG MARIA E. , CUSUMANO JANINE , LIEW GERALD , DONAGHUE KIM C. 
Published: June 2020

Background: With increasing incidence of obesity, metabolic syndrome is not uncommon in type 1 diabetes (T1D). The association of liver dysfunction and cardiovascular disease is well established in type 2 diabetes but not in T1D. We aim to investigate associations between liver dysfunction and diabetic retinopathy and cardiac autonomic neuropathy (CAN) in adolescents with T1D.
Methods: A longitudinal study of 102 adolescents with T1D with repeated measures of liver function and CAN over 3 years. CAN was defined as 2 or more abnormal heart rate variability measures derived from a 10 minute ECG recording using Labchart Pro (mean HR; Standard deviation of mean NN intervals; root mean squared difference of successive NN intervals; low/high frequency ratio; geometric measure- Triangular index). Generalized estimating equations were used to explore associations between tertiles of liver function enzymes and cardiac autonomic neuropathy and retinopathy after adjusting for known risk factors.
Results: Baseline mean + age was 14.6 + 1.9yrs, HbA1C 8.2 + 1.4 and median duration 7.2yrs (IQR 4.8-9.6), mean BMI 23 + 4.1. Higher ALT was associated with CAN (Table1) but not retinopathy.
Conclusion: Higher ALT was associated with early CAN in youth with T1D. Inflammation might lead to higher ALT. Further studies into the potential role for obesity, liver dysfunction and CAN are required.

Disclosure
V. Velayutham: None. P.Z. Benitez-Aguirre: None. M.E. Craig: None. J. Cusumano: None. G. Liew: None. K.C. Donaghue: None.
559-P: Signs of Early Change in Peripheral Axons in People with Early-Onset Type 2 Diabetes Mellitus
Authors: GU YU , HARMER ALISON R. , DENNIS SARAH M. , LI TIFFANY , TIMMINS HANNAH C. , TIEN LOH PATRICIA CHIN , GARG NIDHI , DHARMADASA THANUJA , WONG JENCIA , GAULD AMANDA , MUNOZ PHILLIP A. , PARK SUSANNA B. 
Published: June 2020

Introduction: The prevalence of early-onset type 2 diabetes (EOT2D; diagnosed with T2DM before 40 years old), has increased sharply in recent years. Peripheral neuropathy (DPN) is a common and debilitating complication associated with T2DM, and it is also common in EOT2D, even among adolescents. Nerve excitability studies (NES) examine nerve axonal ion channel function; and may allow early detection of axonal dysfunction. The aim of this study was to explore the differences in NES outcomes between a cohort with EOT2D and matched healthy controls.
Method: Thirteen participants with EOT2D with no clinical evidence of DPN and 14 matched healthy control participants (HC) were included in the study. Nerve conduction studies (NCS) were used to assess amplitude, latency, and conduction velocity in sural (sensory) and peroneal (motor) nerves. Motor and sensory NES were conducted on the median nerve. NES parameters assessed included strength-duration time constant, threshold electrotonus (TE), current-threshold relationship and recovery cycle. HbA1c was measured. Independent sample t-tests were used to compare the group means ± standard deviations.
Results: Participants with EOT2D (F:M 5:8, age 34.1±6.7yr, BMI 31.7±5.4kg∙m-2) differed from matched HC (F:M 6:8, age 32.5±5.1yr, BMI 29.6±4.4kg∙m-2) for HbA1c (EOT2D=6.8±1.0%, HC=5.2±0.3%, p&lt;0.0001). There were no significant between-group differences in any NCS parameters, confirming the absence of clinical neuropathy. Minor changes in sensory axon NES were found in TE, which measures internodal conductances. Sensory depolarizing TE (TEd) at 10-20ms was decreased significantly in the EOT2D group (TEd 10-20ms: EOT2D = 60.1±2.9ms, HC = 62.9±3.0ms, p = 0.02). There were no significant changes in motor NES.
Conclusion: Participants with EOT2D and no clinical evidence of DPN may demonstrate minor changes in sensory axonal function. Prospective studies are required to determine the clinical significance and progression of these changes.

Disclosure
Y. Gu: None. A.R. Harmer: None. S.M. Dennis: None. T. Li: None. H.C. Timmins: None. P. Loh: None. N. Garg: None. T. Dharmadasa: None. J. Wong: Advisory Panel; Self; Sanofi. Speaker’s Bureau; Self; AstraZeneca, Merck & Co., Inc. A. Gauld: None. P.A. Munoz: None. S.B. Park: None.

Funding
Diabetes Australia; Sydney Local Health District
586-P: Characteristics of 24-Hour Urinary Electrolyte Excretion and Its Correlation with Renal Function in Type 2 Diabetics
Authors: WANG YANRU , LI NAN , BU LE , SUN HANG , ZHU BING , LI HONG , QU SHEN 
Published: June 2020

Objective: There are few studies on the characteristics of 24-hour urinary electrolyte excretion in patients with type 2 diabetes mellitus (T2DM),and it is unclear whether the level of 24-hour urinary electrolyte excretion is related to poor renal prognosis.This study aimed to explore associations between 24-hour urinary electrolyte excretion and renal function in T2DM patients.
Methods: A total of 479 patients with T2DM in our hospital from 2018 to 2019 were enrolled. According to the estimated glomerular filtration rate (eGFR), patients were divided into normal group(eGFR≥90 mL/min/1.73m`2,n=317)and abnormal group(eGFR&lt;90 mL/min/1.73m`2,n=162). The correlation between 24-hour urinary electrolyte excretion and eGFR in T2DM patients was analyzed. In addition, the 24-hour urine electrolyte excretion was compared with gender, diabetic duration, and HbA1c.
Results: The levels of 24-hour urinary potassium, sodium and chlorine excretion in abnormal group were higher than normal group, the levels of calcium and phosphorus excretion were lower. Therein, levels of sodium(P=0.037) and calcium (P&lt;0.001) had significant difference. The levels of 24-hour urinary potassium, sodium, chloride, calcium and phosphorus excretion in the male group were higher than female group, among which potassium (P&lt;0.001), sodium (P=0.001), chloride (P=0.002), and phosphorus (P&lt;0.001) were statistically significant. In addition, duration of disease and HbAlc was not related to 24-hour Urinary Electrolyte Excretion.
Conclusion:There is a certain correlation between 24-hour urinary electrolyte excretion in T2DM and renal function. With the increase of 24-hour urinary sodium excretion and decrease of urinary calcium excretion, eGFR decreased, which was related to gender. Therefore, in patients with T2DM of the same gender, 24-hour urinary sodium and calcium excretion may be useful metabolic parameters for predicting poor renal prognosis, which needs further study.

Disclosure
Y. Wang: None. N. Li: None. L. Bu: None. H. Sun: None. B. Zhu: None. H. Li: None. S. Qu: None.

Funding
National Key Research and Development Program of China (2018YFC1314100); National Natural Science Foundation of China (81970677)
6-OR: Blood Pressure as Predictor of Coronary Artery Disease (CAD)/Cerebrovascular Disease (CVD) According to Glucose Tolerance Status (GTS): Implications for Updated Guidelines
Authors: YAMADA MAYUKO H. , FUJIHARA KAZUYA , YAGUCHI YUTA , OSAWA TAEKO , KITAZAWA MASARU , MATSUBAYASHI YASUHIRO , IWANAGA MIDORI , YAMADA TAKAHO , YAMANAKA NAUTA , SEIDA HIROYASU , OGAWA WATARU , SONE HIROHITO 
Published: June 2020

Despite recent tightening of cutoffs for hypertension (HT) in major global guidelines, guidelines, especially according to GTS, remain debatable. We analyzed data from a nationwide claims database on 293,396 participants without prior CAD or CVD from 2008-16. Multivariate Cox regression model identified risks of CAD and CVD events. Hazard ratios (HRs) were compared among 5 levels of systolic blood pressure (SBP) (≤119, 120-129, 130-139, 140-149, ≥150) according to GTS [i.e., normal glucose tolerance (NGT), prediabetes (pre-DM), diabetes (DM)]. During the study period, 1099 CAD and 1990 CVD events occurred. Those with SBP levels ≥120 mmHg had a significantly higher risk of incident CAD/CVD than those with lower levels. The incidence of CAD and CVD did not differ significantly between NGT and pre-DM in those with SBP ≤119 whereas HRs for incident CAD for DM was almost 2.7, which was similar to NGT and pre-DM with SBP ≥150 mmHg (Table). Compared with NGT and SBP ≤119 mmHg, the HR for incident CAD among DM and SBP ≥150 mmHg was 5.91 (4.22-8.26), while SBP ≥150 mmHg significantly increased the risk of CVD about 4 fold regardless of GTS. These results based on a large database implied the need for even lower BP targets regardless of GTS. The impact of BP was stronger in DM in preventing CAD.

Disclosure
M.H. Yamada: None. K. Fujihara: None. Y. Yaguchi: None. T. Osawa: None. M. Kitazawa: None. Y. Matsubayashi: None. M. Iwanaga: None. T. Yamada: None. N. Yamanaka: None. H. Seida: None. W. Ogawa: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharma GmbH & Co.KG, Eli Lilly Japan K.K., Kowa Company, Ltd., Nippon Boehringer Ingelheim Co. Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd. Other Relationship; Self; Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Kyowa Hakko Kirin Co., Ltd., Novartis AG, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co.

Funding
18K17897
61-LB: Use of Functional Near-Infrared Spectroscopy (fNIRS) to Assess Cognitive Effort in KATP-Related Neonatal Diabetes (KATP-NDM)
Authors: LETOURNEAU-FREIBERG LISA R. , MEIDENBAUER KIMBERLY L. , DENSON ANNA M. , TIAN PERSEPHONE , CHOE KYOUNG WHAN , BERMAN MARC G. , GREELEY SIRI ATMA W. 
Published: June 2020

Individuals with KCNJ11 or ABCC8 mutations express over-activated KATP channels both in pancreatic beta cells as well as in the brain, and consequently exhibit a spectrum of neurodevelopmental difficulties. Even those with milder mutations exhibit more difficulty than sibling controls on a wide range of measures including executive functioning and IQ measures; but how this relates to channel dysfunction is unknown. fNIRS is a non-invasive technique increasingly used to assess brain activity as reflected by hemoglobin concentrations. fNIRS can be used to quantify fractal scaling of brain hemodynamics to estimate cognitive effort, which we hypothesized would be increased at rest or during tasks in KATP-NDM. Participants completed fNIRS assessment during a 7 minute resting state; executive function was assessed by Stroop task. Scaling phenomena may be fully described by a single Hurst exponent (H), with higher H indicating greater scale-free signal. Sixteen participants completed the resting state and Stroop task (6 affected, 10 controls, 50% female, age 7-40 years). All participants performed worse (lower accuracy and increased reaction time) on incongruent versus congruent trials of the Stroop task (accuracy: p=0.005, reaction time: p=0.02). KATP-NDM participants performed worse than controls (lower accuracy, slower reaction time), with mutation severity correlating significantly with overall accuracy (p=0.009). During resting state, affected participants had lower H than controls, possibly related to increased cognitive effort. Overall, higher H at rest corresponded to better performance on the Stroop task. Our data suggest that those with KATP-NDM experience increased cognitive effort even at rest, which may contribute to greater difficulty with task engagement and learning potential. fNIRS assessment of fractalness or other measures will help to clarify the role of KATP channel dysfunction in a range of cognitive processes.

Disclosure
L.R. Letourneau-Freiberg: None. K.L. Meidenbauer: None. A.M. Denson: None. P. Tian: None. K. Choe: None. M.G. Berman: None. S.W. Greeley: None.

Funding
National Institutes of Health (R01DK104942)
653-P: An Interdisciplinary Team Approach to Managing Diabetes in a Patient-Centered Medical Home: Year 2 Results
Authors: LAMIE STEVEN M. , ROCKAFELLOW STUART D. , SCHEPPERLY DEBRA 
Published: June 2020

Background: Our private practice Patient-Centered Medical Home (PCMH) clinic proposed a pilot team-based program where patients would be seen between physician visits by an interdisciplinary team comprised of our CDE, Clinical Pharmacist, and Care Manager with the goal of helping to improve glycemic goals.
Methods: Patients age 18 or older with an A1c greater than 8.0 were identified through registry review and invited to participate. Team providers were under the supervision of the project lead physician. Number of visits was individualized for each patient. Visits centered on diabetes education, goal setting, and motivational interviewing. The project was pre-defined to have been successful if 15% of patients achieved improved control.
Results: A recruitment goal of 100 was targeted and initial 107 patients were identified and enrolled. One hundred and six patients completed year one, and 90 patients completed the second year. Nine patients were no longer followed through our clinic, and seven patients had died. Forty four (41%) patients achieved an A1c less than 8.0% at the end of the first year. At the end of year two, forty nine (54%) of the active patients achieved an A1c less than 8.0%. Starting in year 2, a second cohort of 46 patients with initial A1c greater than 8.0% were enrolled. The average A1c for this cohort was 9.39%. Thirty-nine patients continued to be actively followed at the end of year 2. The average A1c had dropped to 7.2% and 27 (69%) of this group had achieved an A1c less than 8.0%.
Conclusion: Most participants achieved diabetic control during Year 1 and maintained A1c at goal in Year 2 of the program. A greater percent of the second cohort was able to achieve A1c goal. This project demonstrates our interdisciplinary approach to help patients achieve and maintain glycemic control over a two-year period.

Disclosure
S.M. Lamie: Speaker’s Bureau; Self; Novo Nordisk Inc., Sanofi US. S.D. Rockafellow: None. D. Schepperly: None.
670-P: Effectiveness of Using Simulation to Train Nursing Students in Providing Preconception Counseling to Women with Diabetes
Authors: THURHEIMER-CACCIOTTI JENNIFER L. , CHARRON-PROCHOWNIK DENISE 
Published: June 2020

Nurses can be pivotal to providing diabetes education, including, preconception counseling (PC) to prevent pregnancy-related complications in women with diabetes. However, many health professionals, including nurses, have reported self-deficits in these areas due to a lack training or knowledge. Simulation is an effective educational strategy utilized in schools of nursing to enhance critical thinking, decision-making, skills building and increase knowledge. However, little is known about the effectiveness of using simulation to train nursing students in providing diabetes education and preconception counseling to patients. Therefore, this study examined the effectiveness of a newly developed diabetes education/PC simulation training program developed for nursing students. The sample was 30 junior level baccalaureate nursing students who completed pretest and posttest measures on their awareness and knowledge of diabetes, pregnancy and PC. We used the 45 min video of READY-Girls (Reproductive-health Education and Awareness of Diabetes in Youth for Girls) PC program during the simulation training session because it is a validated evidenced-based, theory-driven program that targets female adolescents, and is endorsed by the American Diabetes Association. They also observed a live 10 minute simulation of actors portraying a diabetic educator and a diabetic female adolescent and their clinical interaction. Data were analyzed using a paired t-test. The mean pretest score was 9.33, while the mean posttest score was 15.00 with a statistically significant gain (t = 15.89; p = .000). Therefore, it appears that PC simulation may be an effective educational strategy to train nursing students on caring for women with diabetes.

Disclosure
J.L. Thurheimer-Cacciotti: None. D. Charron-Prochownik: None.
694-P: Effect of Exercise on Sleep and Nocturnal Glucose in Type 1 Diabetes (T1D)
Authors: JACOBS PETER G. , LI ZOEY , CALHOUN PETER , GAL ROBIN L. , BECK ROY , CASTLE JESSICA R. , CLEMENTS MARK A. , DASSAU EYAL , DOYLE FRANCIS J. , GILLINGHAM MELANIE B. , MARTIN CORBY K. , RICKELS MICHAEL R. , PATTON SUSANA R. , RIDDELL MICHAEL 
Published: June 2020

Exercise increases nocturnal hypoglycemia risk which may impact sleep in T1D. Adults with T1D (n=25; 19 CSII; age 33±14yrs; HbA1c 7.6±1.3%; T1D duration 15yrs [IQR: 10, 22]) were divided into 3 exercise groups: aerobic, interval, or resistance, performed twice/week using instructional videos for 4 weeks. Participants used CGM, and wore an activity/sleep monitor (Garmin Vivosmart 3). Sleep duration was lower on nights following interval exercise compared to nights following sedentary days (p=0.04, Figure 1a). Participants experienced hypoglycemia earlier in the night following interval or aerobic exercise, compared to sedentary or resistance exercise (Figure 1b). Exercise types differentially impact sleep loss and nocturnal hypoglycemia.

Disclosure
P.G. Jacobs: Consultant; Self; SFC Fluidics. Research Support; Self; Dexcom, Inc. Stock/Shareholder; Self; Pacific Diabetes Technologies. Other Relationship; Self; AgaMatrix. Z. Li: None. P. Calhoun: Stock/Shareholder; Self; Dexcom, Inc. R.L. Gal: None. R. Beck: None. J.R. Castle: Advisory Panel; Self; Novo Nordisk Inc. Consultant; Self; ADOCIA, Dexcom, Inc., Zealand Pharma A/S. Other Relationship; Self; Pacific Diabetes Technologies, Roche Diabetes Care. M.A. Clements: Consultant; Self; Glooko, Inc. Other Relationship; Self; Glooko, Inc. 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. F.J. Doyle: Research Support; Self; DreaMed Diabetes, Tandem Diabetes Care, Xeris Pharmaceuticals, Inc. Stock/Shareholder; Self; Mode AGC. Other Relationship; Self; Dexcom, Inc., Insulet Corporation, Roche Diabetes Care. M.B. Gillingham: None. C.K. Martin: Advisory Panel; Self; EHE Health, NaturallySlim. Consultant; Self; Florida Hospital, Gila Therapeutics, OpenFit, Zafgen, Inc. Research Support; Self; Egg Board, Helmsley Trust, IDEA Public Schools, National Institutes of Health, NIHR, Patient-Centered Outcomes Research Institute, USDA, Weight Watchers International, Inc. Other Relationship; Self; Academy of Nutrition and Dietetics, Louisiana State Univ./Pennington Biomedical Research Center. M.R. Rickels: Consultant; Self; Semma Therapeutics, Inc. Research Support; Self; Xeris Pharmaceuticals, Inc. S.R. Patton: None. 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.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust (T1-DEXI Main Study)