bluuebunny/crossref_metadata_2025_split huggingface dataset:
2163-PUB: Prevalence of Multiple Stress Factors in Young Adults with Type 2 Diabetes
Authors: DAVE SHRUTI , SUNTHARAMOORTHY KAJANA , MOHYIDDIN SYED SIKANDER , MUHAMMAD UMER , MALIK SANA , GUPTA NIKHIL 
Published: June 2020

Introduction: Incidence of type 2 diabetes (T2DM) among young adults (age &lt;= 40) has been increasing rapidly. We hypothesize that this could be due to increasing levels of stress seen in this age group due to demographic, economic and environmental shifts that have occurred in the past 30 years.
Method: Modifiable vs. non-modifiable risk factors were evaluated at a specialist diabetes and endocrinology clinic. Consecutive patients meeting the inclusions criteria (T2DM between the ages of 18 to 40), were provided with study questionnaire at their appointment over a 3 month period. The questionnaire assessed socio-economic factors, self-reported levels of stress, dietary habits, sleep duration and physical activity.
Results: 52 patients (Males = 38 (73%)) completed the study questionnaire. Mean age (± SD) at diagnosis of T2DM was 31 (± 5.8). Thirty five (79%) were immigrants to Canada, of which 47% had immigrated to Canada within the last 10 years (2010-2019). Of the study participants, mean stress level (on a scale of 1-10) was 5.9 (± 2.7). Work stress was reported by 79.1%, financial stress by 43.7%, family related stress by 39.5%, and unemployment related stress by 10.4% of the patients. Other stressors reported were weight management and medication coverage. Twenty (38%) participants reported sleeping an avg of ≤ 6 hrs/day. Moderate intensity physical activity (≥ 150 mins per week) prior to diagnosis was reported by 36% patients.
Discussion: High prevalence of modifiable risk factors such as stress, decreased physical activity, inadequate sleep was found in young adults with T2DM. Immigrants are at high risk of T2DM at a young age likely due to stressors as well as diet and lifestyle changes involved in relocating to a new country. Education regarding higher risk of T2DM at an early age, and interventions to reduce modifiable risk factors is paramount at an individual and societal level, in order to stem the epidemic of young onset T2DM.

Disclosure
S. Dave: None. K. Suntharamoorthy: None. S. Mohyiddin: None. U. Muhammad: None. S. Malik: None. N. Gupta: Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Inc., Sanofi.
2165-PUB: Jabuticaba Juice Improve Glucagon-Like Peptide-1 in Healthy Participants: Results from a Pilot, Single-Blinded, Randomized Controlled Trial
Authors: GERALDI MARINA V. , CAZARIN CINTHIA B.B. , VASQUES ANA CAROLINA J. , NETO BRUNO G. , MAROSTICA JUNIOR MARIO R. 
Published: June 2020

Introduction: The effects of jabuticaba on health, particularly on glucose metabolism and GLP-1 deserve further clinical investigation.
Objective: The objective was to evaluate whether consumption of a jabuticaba juice preload containing 503 mg gallic acid equivalent and 2g of fibers would exert any effect on postprandial glycaemia, insulin, C-peptide, GLP-1, and appetite sensations.
Methods: Sixteen healthy subjects (11 women; 5 men; 28.4 ± 3.8 years; BMI 21.7 ± 2.3 kg m−2) completed a randomized, crossover intervention study. Jabuticaba or control beverage was consumed before a white wheat bread (WWB) challenge meal. Blood samples were taken frequently over the following 2 h. Blood glucose, serum insulin, C-peptide, and antioxidant capacity, plasma GLP-1, and appetite sensations were evaluated.
Results: Postprandial GLP-1 response as AUC, was higher after consumption of jabuticaba juice compared with control (95.6±41.4 vs. 82.7±24.6 ng/mL; p = 0.03). The GLP-1 significantly increased after jabuticaba juice, peaking at 60 min (1.21±0.5 vs. 0.71±0.2 ng/mL; p = 0,019). The AUC of antioxidant capacity was higher for jabuticaba juice vs. control (37.9±19.4 mmol TE/mL vs. 32.4±8.4; p = 0.005). Postprandial glucose, insulin, C-peptide levels, and appetite sensations were not significantly different between groups.
Conclusion: Inclusion of jabuticaba juice before a WWB challenge meal might be beneficial for antioxidant status and GLP-1 concentrations, but we did not find supporting evidence in glycaemia, C-peptide, insulin, insulin sensitivity and appetite sensations in healthy subjects.

Disclosure
M.V. Geraldi: None. C.B.B. Cazarin: None. A.J. Vasques: None. B.G. Neto: None. M.R. Marostica Junior: None.

Funding
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES) (001); CNPq (403328/2016-0; 301108/2016-1); FAPESP (2015/50333-1)
2169-PUB: Premeal Consumption of a Small, Ready-to-Drink Whey Protein Shot Suppresses Postprandial Hyperglycemia in Adults with Type 2 Diabetes
Authors: SMITH KIERAN , TAYLOR GUY S. , BOWDEN DAVIES KELLY A. , BRUNSGAARD LISE H. , JENSEN ERIK , WALKER MARK , STEVENSON EMMA J. , WEST DANIEL J. 
Published: June 2020

Background: The consumption of large (∼50g) doses of whey protein [WP] before meals (i.e., preload) has been shown to improve postprandial glycemic [PPG] excursions in people with type 2 diabetes [T2D]. Yet, studies to date have not accounted for treatment palatability, the energy associated with large WP doses, or the burden allied with preload preparation, limiting its ecological translation. Herein, we examined the PPG responses to a mixed-meal tolerance test [MMTT] following prior consumption of a low dose of WP from a novel, pre-made shot in people with T2D.
Methods: Nine adults with T2D (8M/1F; HbA1c 57.6±10.1 mmol∙mol) attended the laboratory on two occasions, ∼14d apart. After an overnight fast, subjects randomly consumed a bespoke, ready-to-drink WP (15g) or placebo [PLA] shot (100ml) 10min prior to a 4hr MMTT (387kcal; 58% CHO). At 4hr, a further shot was consumed 10min before an ad libitum lunch. Subjective appetite and preload palatability were assessed by visual analog scales. Interstitial glucose was measured throughout. Data (mean±SD) were analyzed by a two-way repeated measures ANOVA.
Results: Compared to PLA, WP attenuated early [0-60min] (-48.9±35.9%; p=0.01) and total [0-240min] PPG area under the curve (-22.7±17.5%; p&lt;0.001). During both trials, peak PPG occurred ∼80min post-MMTT and was reduced following WP (-13.8±7.8% [range: -23.0 to +2.1%]; p&lt;0.01). The peak incremental change in PPG was 1.36±1.08 mmol∙L less following WP vs. PLA (p&lt;0.01). Subjective appetite (p&gt;0.05) and ad libitum energy intake were similar between trials (p=0.48). Both preloads were rated highly palatable.
Conclusion: Consuming a small, bespoke WP shot lowers post-meal hyperglycemia in people with T2D without affecting satiety and satiation. We highlight the potential for small, contemporary WP beverages that encompass both glycemic benefit but also patient taste and convenience, which may have lasting clinical value beyond formal research studies.

Disclosure
K. Smith: None. G.S. Taylor: None. K.A. Bowden Davies: None. L.H. Brunsgaard: None. E. Jensen: Employee; Self; Arla Foods Ingredients. M. Walker: None. E.J. Stevenson: None. D.J. West: None.

Funding
Arla Foods Ingredients Group P/S
2189-PUB: Insulin Pen Injection Techniques in Patients with Type 2 Diabetes in China
Authors: LI FAN , FISH ANNE , TOKAC UMIT 
Published: June 2020

Background and Objective: In the midst of a type 2 diabetes epidemic in China where hemoglobin A1C needs to be better controlled, clinicians strive to examine and work to correct patients’ poor insulin pen injection practices. We explored insulin injection techniques, injection site problems, and A1C.
Methods: In a large cross-sectional study of adult patients with type 2 diabetes (n=455) from 10 medical centers, patients answered an in-depth questionnaire and had their insulin injection technique observed. Researchers assessed for lipohypertrophy (LH) by observing and palpating injection sites. Logistic regression and linear regression were used to examine factors related to presence of LH and A1C.
Results: Mean years taking insulin was 5.20, and 83.30% injected insulin ≥2 times/day. Mean needle reuse was 8.95 times (range 1-59), but was not correlated with LH or A1C. Percent with incorrect site rotation was 22.80% and presence of LH was 11.14%. A1C was 9.03±2.13%. Presence of LH was significantly associated with longer duration of insulin injection (OR=1.10, p=0.01, 95% CI [1.02, 1.17]) and total number of insulin injections/day (OR=2.27, p&lt;0.001, 95% CI [1.49, 3.44]), but not with incorrect site rotation (OR=0.45, p=0.07, 95% CI [0.19, 1.06]). Odds of presence of LH in participants using 5 mm needles were 3.95 times (p=0.01, 95% CI [1.48, 10.54]) that of 4 mm needles. Higher A1C was significantly associated with the presence of LH (ß=0.54, p&lt;0.01, 95% CI [0.20, 0.88]).
Conclusion: Needle reuse is a major problem in Chinese patients with type 2 diabetes, and A1C is poorly controlled. Patients with LH are more likely to have higher A1C. Given the diabetes epidemic in China, immediate measures must be implemented to improve insulin injection techniques and prevent LH for better glycemic control. This study indicated that 4 mm needles may have an advantage over 5 mm needles in regard to the presence of LH, yet further studies are needed to examine this relationship.

Disclosure
F. Li: None. A. Fish: None. U. Tokac: None.
219-OR: Comparison of the Impact of Autologous Cell Therapy and Conservative Treatment on Chronic Limb-Threatening Ischemia in Patients with Diabetic Foot: A Randomized Controlled Trial
Authors: DUBSKY MICHAL , BEM ROBERT , NEMCOVA ANDREA , HUSÁKOVÁ JITKA , FEJFAROVA VLADIMIRA , JIRKOVSKA ALEXANDRA , SUTORIS KAROL 
Published: June 2020

Background: Autologous cell-therapy (ACT) is a new treatment method for patients with diabetes and no-option chronic limb-threatening ischemia (NO-CLTI). We aimed to assess the impact of ACT on CLTI in comparison with standard treatment (ST) in a randomized controlled trial.
Methods: Forty diabetic patients with NO-CLTI were randomized to receive either cell therapy (n=20) or standard conservative therapy (n=16); 4 patients dropped out of the study. After 3 months, those in the ST group were switched to ACT (cell therapy crossover). The effect on ischemia and diabetic foot was assessed by changes in transcutaneous oxygen pressure (TcPO2) and the number of healed patients at 3 months. Amputation rates and amputation-free survival (AFS) were assessed at 3 months and then during 12-month follow-up.
Results: TcPO2 increased significantly in the ACT group after 1 and 3 months (both p&lt;0.001) whereas TcPO2 in the control group remained unchanged (NS). After the crossover to cell therapy in patients of the ST group, we observed a significant increase in TcPO2 at 1 and 3 months after the injection of ACT (p=0.036 and p&lt;0.001, respectively). We also observed significantly more healed patients at 3 months in the ACT group compared to the ST group (p=0.01). The rates of major amputation and AFS at 3 months were not significantly different between the ACT and ST groups (both NS). In Kaplan-Meier estimate, patients treated initially by ACT showed a trend towards higher AFS rates compared to those treated initially by ST who received ACT after the 3-month delay, but without a significant difference (65 vs. 43.8%).
Conclusions: Our study showed that ACT in patients with no-option CLTI and diabetic foot significantly improved limb ischemia and wound healing when compared to standard conservative therapy, without influencing amputation rates and with a trend to higher 1-year AFS in comparison with delayed ACT treatment in ST group.

Disclosure
M. Dubsky: None. R. Bem: None. A. Nemcova: None. J. Husáková: None. V. Fejfarova: None. A. Jirkovska: None. K. Sutoris: None.

Funding
Ministry of Health of the Czech Republic (16-27262A, 00023001)
2191-PUB: Challenging the 50%/50% Basal/Bolus Insulin Ratio Rule: Have We Been Wrong? A Cross-Sectional Study
Authors: HODISH ISRAEL , WILLIS MARK , SRITHARAN SAJITHA , BASHAN ERAN 
Published: June 2020

There is a generally-held belief that the ratio between basal and bolus insulin requirements in patients using insulin therapy should be 50%/50%. Yet, it appears this belief was based on a small study with healthy individuals, which may not be applicable to patients with insulin deficiency. To assess the validity of the rule we followed patients with type 2 diabetes treated with basal-bolus insulin therapy that has been frequently adjusted by a technology-based titration service. To keep glycemia stable, the service adjusts insulin dosage at least weekly and thus treatment closely tracks insulin requirements. We performed a cross-sectional study, accumulating data on N=306 patients over an average±SD period of 3.4±1.7 years. Insulin titrations occurred every 6.8±1.5 days to enable HbA1c maintenance at 7.2±0.7%. In 74.8% of the patients the average basal insulin fraction was less than 50% of total daily dose of insulin, and in about a third it was less than 38% (Figure). Additionally, the basal fraction did not remain stable in each patient over time (Figure). In 79.7% of the patients, it changed more than 20% and in 50% more than 29.8% (e.g., basal fraction changes in a single patient would range between 20% and 50% over time). In patients with type 2 diabetes treated with insulin, basal-bolus ratio is not 50%/50% and it changes over time. Thus, this ratio should not be used as a treatment guide.

Disclosure
I. Hodish: Stock/Shareholder; Self; Hygieia. M. Willis: Employee; Self; Hygieia. S. Sritharan: None. E. Bashan: Employee; Self; Hygieia. Stock/Shareholder; Self; Hygieia.
2196-PUB: The Influence of Insulin Degludec on Type 2 Diabetes Mellitus Regulation and Patient Quality of Life Compared with Insulin Glargine in Low-Income Patients
Authors: KOUTSOVASILIS ANASTASIOS , SOTIROPOULOS ALEXIOS , PAPPA MARIA , BOUSBOULAS STAVROS , PEPPAS THEODOROS 
Published: June 2020

Background: Insulin glargine is a well known long-acting insulin analog in the contemporary treatment of type 2 diabetes mellitus (T2DM). A new long-acting, but more expensive insulin, degludec, shows greater duration compared to already existing long-acting insulins.
Aim: The aim of the study is to examine the effect of insulin degludec on T2DM glycaemic control and patient quality of life in low-income patients compared with insulin glargine. Material and Methods: 116 T2DM patients were enrolled in the study. 41 were insulin naïve treated with degludec (Group A), 40 were insulin naïve treated with insulin glargine (Group B) and 36 patients who were on glargine without satisfactory glycemic control were treated with degludec instead of glargine (Group C). Three and six months later, their glycemic control, insulin units, quality of life (SF-36), as well as flexibility in insulin use were assessed. All patients answered the PHQ-9 questionnaire
Results: The mean HbA1c for all patients was 8.42±1.23 (p=0.251). The reduction in HbA1c was similar between the three groups (p=0.182). Hypoglycemias became less frequent after the transition from insulin glargine to degludec (p=0.059). Patients in Group A showed less hypoglycemias in 3 months (p=0.036) and six months (p=0.033). Hypoglycemias were significantly reduced for Group B after the first 3 months (p=0.087). All three groups showed a significant improvement in quality of life but patients in Group A achieved the better score in physical (56.2±10.6 vs. 50.8±9.7 vs. 52.7±10.4, p=0.059) and mental (46.2±8.4 vs. 42.5±7.7 vs. 44.5±8.5, p=0.064) health summary compared to Group B and C respectively. Patients in Group A used fewer units compared to Group B and Group C (p=0.067)).
Conclusion: The use of degludec is associated with a lower rate of hypoglycemias and a good quality of life while many patients availed themselves of the possibility of degludec insulin’s flexible use.

Disclosure
A. Koutsovasilis: None. A. Sotiropoulos: None. M. Pappa: None. S. Bousboulas: None. T. Peppas: None.
2204-PUB: The Efficacy of Da Chaihu Decoction with Metformin Tablets for Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis
Authors: WANG JIABIN , WANG MENG , HUANG PEIYAO , WANG YANXIA , QIU JIE 
Published: June 2020

Ethnopharmacological Relevance: Da Chaihu decoction (DCHD) is a traditional Chinese herbal formula commonly used for the treatment of type 2 diabetes mellitus.
Objective: To assess the efficacy of DCHD combined with Metformin Tablets for type 2 diabetes mellitus (T2DM).
Methods: A review of all relevant studies retrieved from a search of the following databases were conducted without any language restriction: Excerpt Medica Database (EMBASE), Google Scholar, PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP Information, Wanfang Data, and the Chinese Biomedical Literature Database(CBM). Papers published until December 2019 were taken into consideration. The analysis was performed using the Cochrane software Revman 5.3.
Results: Seven randomized controlled trials comprising 579 participants were included in the systematic review and meta-analysis. The results of meta-analysis showed that there was statistical difference of 7 RCTs between Da Chaihu decoction with Metformin Tablets group and was superior to Metformin Tablets group in fasting plasma glucose(FBG)(−0.71 mmol/L; 95% CI [−1.27,−0.15]) , plasma glucose 2 Hours after Meal (PBG) (−1.21 mmol/L; 95% CI [−1.88, −0.53]) and there was 3 RCTs in Triglyceride(TG) (−0.63 mmol/L; 95% CI [−1.08, −0.17]). There was no statistical difference of 3 RCTs in Total Cholesterol (TC) (−0.63 mmol/L; 95% CI [−1.08, −0.17]).
Conclusions: Current evidence shows that Da Chaihu decoction combined with Metformin Tablets exert certain efficacy and safety for the treatment of T2DM. However, due to the low quality of the included studies, the conclusion still needs more high-quality, multi-center randomized double-blind controlled trials to verify.

Disclosure
J. Wang: None. M. Wang: None. P. Huang: None. Y. Wang: None. J. Qiu: None.
2208-PUB: Effect of Pioglitazone on HOMA-IR, C-Peptide, HbA1c, and Weight
Authors: SHETH SHRUTI V. , PAREKH MALAY N. , PANCHAL DHARMENDRA 
Published: June 2020

Aim: To observe the effect of Pioglitazone on improving HOMA-IR, c-peptide status, HbA1c and Weight.
Materials and Methods: Inclusion Criteria: Persons with type 2 diabetes since &gt;5 years duration of age 18-50 years, on dual OAD therapy
Exclusion Criteria: Other forms of diabetes, pregnant patients or planning for pregnancy.
For the study, 116 patients were identified and screened. Baseline investigations and anthropometry was recorded.
Pioglitazone was added to the ongoing regimen of single or dual combination therapy for a period of 24 weeks. All patients were called for a total of 6 visits during the study period wherein their glycemic control, hypoglycemia events and medications were reviewed.
At the end of 24 weeks, anthropometry, investigations and glycemic control was reviewed.
Results: The average c-peptide, HOMA-IR and HbA1c levels had reduced significantly after the addition of Pioglitazone. Those patients who were on dual therapy of metformin with an SGLT2 inhibitor showed no significant weight changes at the end of the study. Other patients who were on monotherapy with metformin, dual therapy with metformin plus other OADs showed weight gain.
Conclusion: Pioglitazone is a very effective tool in diabetes management. It shows significant reduction in glycemia. Appropriate combination therapy with SGLT2 inhibitors may curb its issue of weight gain.

Disclosure
S.V. Sheth: None. M.N. Parekh: None. D. Panchal: None.
2238-PUB: A Diabetes Prevention Evaluation Model for Health Care Organizations: Pilot Results for Target Population
Authors: KHAN TAMKEEN , HUGHES ALEJANDRO , SACHDEV NEHA , BALAN ANITA , PERE DANIELLE 
Published: June 2020

Health care organizations play a critical role in diabetes prevention by identifying and managing individuals with prediabetes. This project piloted a systematic diabetes prevention evaluation ’M.A.P. model’. The framework’s key components includes the ’M’ related to ’measuring accurately’ by identifying adults with prediabetes; the ’A’ related to ’acting rapidly’ by initiating treatment specifically, referral to a National Diabetes Prevention Program (DPP) lifestyle change program (LCP); and the ’P’ related to ’partnering with patients’ to support treatment participation in a LCP. The model was implemented at 3 grantee sites focused on building capacity to address diabetes prevention in a target disparate population of women who identify as Black and/or Hispanic. Aggregate data for a 12-month baseline period for the ’M’ metric found that the total number of adults at risk for abnormal glucose with laboratory tests ordered averaged only 57% (39-69%) of those eligible and 61% (39-69%) for those sites participating in the intervention. Documentation of a prediabetes diagnosis with an ICD-10 code was 51% (42-65%) for the total and 58% (42-65%) among the participating sites. The ’A’ metric submitted by 2 sites to date found only 8% (7-9%) of all patients and 10% (9-42%) of target population patients eligible for the LCP had a clinical referral order. Data for the ’P’ metric submitted by 1 site to date reported a 25% enrollment rate, of which 86% consisted of the target population, and 91% were referred from a primary care provider rather than a self-referral. The findings highlight that tracking metrics related to diabetes prevention in health care organizations is feasible. The initial results suggest that a structured evaluation model can help organizations and clinical care teams identify opportunities for improvement and guide targeted activities to increase prediabetes patient identification, National DPP LCP referrals, and program enrollment and completion rates.

Disclosure
T. Khan: None. A. Hughes: None. N. Sachdev: None. A. Balan: None. D. Pere: None.

Funding
Centers for Disease Control and Prevention (6NU38OT000289-01-01)
224-LB: Role of the Mitochondrial Calcium Uniporter in the Regulation of Hepatic Mitochondrial Metabolism and Gluconeogenesis
Authors: LAMOIA TRACI E. , LEE JI EUN , GUERRA MATEUS , GOODMAN RUSSELL , SHULMAN GERALD I. 
Published: June 2020

The mitochondrial calcium uniporter (MCU) is a key regulator of mitochondrial calcium, however, the role of MCU in mediating hepatic mitochondrial metabolism and gluconeogenesis has received limited attention. In order to address these questions, we examined rates of mitochondrial oxidation in both liver slices and in awake liver-specific MCU knockout (MCU KO) mice. We found that deletion of MCU significantly increases glucagon-induced intrahepatic lipolysis (p&lt;0.04) and glucose production (p&lt;0.04) in ex vivo liver slices. We also observed significantly reduced liver triglyceride accumulation (p&lt;0.05) and increased hepatic long chain acyl-CoA (p&lt;0.02) and acetyl-CoA (p=0.05) content in MCU KO mice, consistent with increased intrahepatic lipolysis and fat oxidation. This effect was not due to changes in white adipose tissue lipolysis. Deletion of MCU also impaired glucose tolerance in chow-fed mice, indicating dysregulated hepatic glucose production in these mice. These metabolic alterations could be attributed to reduced mitochondrial buffering of cytoplasmic calcium, leading to a 77% increase in cytoplasmic calcium (p&lt;0.0001). This led to activation of CAMKII (p&lt;0.04) and subsequent increase in ATGL phosphorylation (p&lt;0.04) in hepatocytes lacking MCU.
In conclusion, these results demonstrate a critical role for MCU in mediating hepatic mitochondrial oxidation and hepatic gluconeogenesis.

Disclosure
T.E. LaMoia: None. J. Lee: None. M. Guerra: None. R. Goodman: None. G.I. Shulman: Advisory Panel; Self; AstraZeneca, Janssen Research & Development, LLC, Merck & Co., Inc. Advisory Panel; Spouse/Partner; Merck & Co., Inc. Consultant; Self; Novo Nordisk A/S. Consultant; Spouse/Partner; Novo Nordisk A/S. Other Relationship; Self; Gilead Sciences, Inc., iMetabolic Biopharma Corporation. Other Relationship; Spouse/Partner; iMetabolic Biopharma Corporation. Other Relationship; Self; Maze Therapeutics.

Funding
National Institutes of Health (T32GM0007324)