bluuebunny/crossref_metadata_2025_split huggingface dataset:
1516-P: Microvascular Burden Predicts All-Cause Mortality, Major Vascular Outcomes, and ESRD in Type 2 Diabetes
Authors: GAROFOLO MONIA , GUALDANI ELISA , GIANNARELLI ROSA , LUCCHESI DANIELA , MICCOLI ROBERTO , FRANCESCONI PAOLO , PRATO STEFANO DEL , PENNO GIUSEPPE 
Published: June 2020

Microvascular complications (MC) affect CV risk and mortality in T2D. We explored the association of cumulative burden of retinopathy, nephropathy and peripheral neuropathy with mortality, CV events and ESRD in a single-centre, observational study involving 986 T2D over a 12.9±2.7 yrs follow-up. Vital status and rates of outcomes were censored on December 2017. The cohort included 491 (49.8%), 318 (32.3%), 135 (13.7%) and 42 (4.3%) people with no, 1, 2 or 3 MC. All-cause mortality (23.3%) increased from no-MC (15.3%) to 1 MC (23.3%, HR 1.60; 95%CI 1.16-2.20), 2 MC (41.5%, 3.19; 2.25-4.51) and 3 MC (59.5%, 5.32; 3.38-8.36; p&lt;0.0001). After adjustments, HRs were: 1 MC, 1.21 (0.87-1.69); 2 MC, 1.72 (1.15-2.56) and 3 MC, 3.17 (1.89-5.33, p&lt;0.0001). Irrespective of number of baseline CV risk factors not at target (HbA1c ≥7%, LDL ≥100 mg/dl, BP ≥140/90 mmHg), age and sex adjusted HRs raised with MC (p&lt;0.0001). CV events occurred in 276 T2D (28.4%). Incidence raised with MC: no-MC, 20.8%; 1 MC, 31.3% (HR 1.65; 1-25-2.18); 2 MC, 42.7% (2.77; 2.00-3.85); 3 MC, 50.0% (3.78; 2.36-6.05, p&lt;0.0001). After adjustments, HRs for CV events were: 1 MC, 1.37 (1.03-1.82); 2 MC, 1.61 (1.12-2.30) and 3 MC, 2.42 (1.48-3.99, p&lt;0.0001). Rate of heart failure hospitalization (hHF) was 3.3% in no-MC, 11.5% in 1 MC (HR 3.19; 1.83-5.56), 17.6% in 2 MC (5.68; 3.09-10.45) and 14.3% (5.00; 2.00-12.54) in 3 MC (p&lt;0.0001). After adjustments, rate of hHF raised in 1 MC (2.28; 1.30-4.01), 2 MC (3.38; 1.79-6.40) and 3 MC (3.02; 1.19-7.65). Also ESRD raised with MC: no-MC, 4.9%; 1 MC, 6.7% (HR 1.44; 0.80-2.59); 2 MC, 11.5% (2.76; 1.45-5.27); 3 MC, 26.2% (7.67; 3.75-15.70; p&lt;0.0001). After adjustments, ESRD raised with 2 MC (HR 2.34; 1.21-4.53) and 3 MC (6.41; 3.19-13.16, p&lt;0.0001). Incidence of CV events, hHF, and ESRD raised with number of MC after stratification for risk factors not at target (p&lt;0.0001). In T2D, the cumulative burden of MC predicts mortality, CV events, hHF and ESRD, offering an accessible tool for improving risk prediction.

Disclosure
M. Garofolo: None. E. Gualdani: None. R. Giannarelli: None. D. Lucchesi: None. R. Miccoli: None. P. Francesconi: None. S. Del Prato: Advisory Panel; Self; Applied Therapeutics, AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis Pharmaceuticals Corporation, Novo Nordisk A/S. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Takeda Pharmaceutical Company Limited. G. Penno: None.
1520-P: Developing New Risk Equations to Predict Diabetes-Related Complications and Mortality in U.S. Adults with Type 2 Diabetes
Authors: HOERGER THOMAS J. , KAUFMANN MATTHEW , NEUWAHL SIMON , SHAO HUI , CHEN HAIYING , LAXY MICHAEL , CHENG YILING J. , BENOIT STEPHEN R. , ANDERSON ANDREA M. , CRAVEN TIMOTHY , ZHANG PING 
Published: June 2020

Risk equations to predict diabetes-related complications and mortality in most type 2 diabetes simulation models were based on data from the UK Prospective Diabetes Study. Two recently completed U.S. diabetes trials, the Action to Control Cardiovascular Risk in Diabetes and the Action for Health in Diabetes and their follow-up studies with &gt;15,000 participants and &gt;7 years follow-up, provide a unique source for developing new risk equations. We estimated parametric hazard models for cardiovascular, neuropathy, nephropathy, vision, and hypoglycemia complications and mortality in persons with type 2 diabetes using longitudinal data from the trials. We included demographic variables, time-varying risk factors, and histories of complications. Variable selection was based on backwards stepwise regression and expert opinion.
We estimated 17 complication and 3 mortality equations. HbA1c was selected in all but one complication/mortality equation, with hazard ratios ranging from 1.09 for stage 3 chronic kidney disease to 1.85 for amputation per 1% increase. Other risk factors were selected less frequently. For mortality, smoking was the risk factor with the largest hazard ratio. At least one lagged complication was selected for every complication/mortality equation. Previous congestive heart failure was associated with increased risk for 13 complications, with hazard ratios as high as 2.6 for amputation. Other lagged complications selected for over half of the complications included microalbuminuria, previous revascularization, macroalbuminuria, and previous stroke. Congestive heart failure, myocardial infarction, and stroke increased mortality in persons with current or previous cardiovascular disease. Kidney-related complications also increased mortality.
Our equations can be used in type 2 diabetes simulation models to estimate costs, outcomes, and cost-effectiveness of interventions for type 2 diabetes, particularly in U.S.-based models.

Disclosure
T.J. Hoerger: Research Support; Self; Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services. M. Kaufmann: None. S. Neuwahl: None. H. Shao: None. H. Chen: None. M. Laxy: None. Y.J. Cheng: None. S.R. Benoit: None. A.M. Anderson: None. T. Craven: None. P. Zhang: None.

Funding
Centers for Disease Control and Prevention (200-2016-92270)
1521-P: State-Level Trends in Lower Extremity Amputations among U.S. Medicare Beneficiaries with Diabetes, 2000-2017
Authors: ANDES LINDA J. , HARDING JESSICA , ROLKA DEBORAH B. , IMPERATORE GIUSEPPINA , LI YANFENG , GREGG EDWARD W. , ALBRIGHT ANN L. 
Published: June 2020

Non-traumatic lower extremity amputations (NLEA) are an important complication of diabetes. After a period of decline, some national U.S. data show that rates of diabetes-related NLEA have recently increased. Whether this varies by state is unknown. We used 100% Medicare claims for beneficiaries enrolled in Parts A and B during 2000-2017 to examine state-specific NLEA trends among adults ≥67 years with diabetes. NLEA was defined as the highest-level amputation per patient per calendar year. All rates were age-sex standardized to the 2000 study population. Trends were assessed using Joinpoint regression. National diabetes-related NLEA rates (per 1,000 persons) decreased from 8.5 in 2000 to 4.4 in 2009 (APC - 7.9, p&lt;0.001), and then increased to 4.8 in 2017 (APC 1.2, p&lt;0.001). However, standardized state-specific rates varied considerably over the entire time period from a maximum of 12.5 in Louisiana to a minimum of 2.6 in Hawaii. Many states showed an initial decline followed by an increase after 2009. Other states did not experience a similar increase. Our findings suggest that the recent national increase in NLEAs may be driven by only some states, while others have been able to maintain low rates. Determining reasons for the increase in some states and not others could help identify interventions to reverse the trend.

Disclosure
L.J. Andes: None. J. Harding: None. D.B. Rolka: None. G. Imperatore: None. Y. Li: None. E.W. Gregg: None. A.L. Albright: None.
1523-P: Chinese T2DM Females Are Prone to Diabetic Retinopathy: Based on a Cross-Sectional Study in Twelve Provinces
Authors: LI MEI , MU PAN-WEI , TAN YING , CHEN YANMING 
Published: June 2020

Aims: To investigate if the gender is a risk factor of the prevalence of diabetic retinopathy (DR) among type 2 diabetic patients, we designed and performed a cross-sectional study in twelve provinces in the mainland of China.
Methods: Patients with type 2 diabetes, age of 18 years or older, were recruited from 76 cities/counties of 12 provinces in the mainland of China, during January 2015 to December 2018. All participants received a standard interview, eye examinations and digital fundus photography. The presence and severity of DR were diagnosed and graded by retinal specialists according to the DR domestic typing method.
Results: A total of 12,766 eligible participants (5963 males and 6803 females) were included in this study. The overall prevalence of DR was 30.1%. Females exhibited a significantly higher prevalence of DR than males (31.1%% vs. 29.0%, P=0.011). A multivariate logistic regression analysis confirmed that the female sex was an independent predictor for higher prevalence of DR after adjusting for age, duration of diabetes, economic status and presence of hypertension (OR: 1.096, 95% CI: 1.013-1.186, P=0.023). Even after stratification by diabetic duration, age and economic status, the female sex was still independently associated with the presence of DR in patients whose T2DM history was more than 10 years (OR 1.150, 95% CI:1.012-1.306, P=0.032), whose ages were over 60 years (OR 1.141,95% CI:1.031-1.262, P=0.010) or who were in a relatively intermediate economic area (OR 1.123, 95% CI: 1.001-1.259, P=0.048).
Conclusion: Chinese T2DM females had a higher prevalence of DR than T2DM males. In addition, the female sex remains as an independent predictor for DR in patients with diabetes for more than 10 years, ages over 60 years or a relatively intermediate economic status.

Disclosure
M. Li: None. P. Mu: None. Y. Tan: None. Y. Chen: None.

Funding
Research and Development Plans in Key Areas of Guangdong Province (2019B020227003); National Natural Science Foundation of China (81770826); National Key Research and Development Program of China (2017YFA0105803)
1525-P: Serum Uric Acid Level Is an Independent Risk Factor for Glomerular Filtration Rate Decline in Patients with Untreated Type 2 Diabetes
Authors: OKADA YUKI , SATO KYOKO K. , SHIBATA MIKIKO , UEHARA SHINICHIRO , KOH HIDEO , OUE KEIKO , KAMBE HIROSHI , MORIMOTO MICHIO , HAYASHI TOMOSHIGE 
Published: June 2020

Decline in kidney function is a major concern for patients with type 2 diabetes. The importance of serum uric acid level as the risk factor for chronic kidney disease (CKD) remains unconfirmed. We therefore evaluated the relationship between baseline serum uric acid level and the risk of incident CKD among men with untreated type 2 diabetes at baseline examination in a 10-11 years prospective cohort study. We included 717 middle-aged Japanese subjects with fasting plasma glucose level ≥126 mg/dL or HbA1c ≥6.5% at baseline who were not taking hypoglycemic medications nor insulin, who had an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2, who did not have proteinuria nor malignant tumors, and who were not taking anti-hypertensive medications nor urate-lowering medications at baseline. CKD was defined as eGFR &lt;60 ml/min/1.73 m2. Cox proportional hazards models were used in the multivariate analysis.
During the 5961 person-years follow-up period, 87 subjects developed CKD. Higher serum uric acid level was associated with an increased risk of CKD after adjustment for age, body mass index, systolic blood pressure, diastolic blood pressure, HbA1c, smoking habits (nonsmokers, past smokers, and current smokers), regular leisure-time physical activity (yes/no), daily alcohol consumption (g ethanol/day), and eGFR at baseline. Multiple-adjusted hazard ratios of CKD for quintile 4 (6.2-6.9 mg/dL) and quintile 5 (≥7.0 mg/dL) of serum uric acid levels were 1.30 (95% CI, 0.73-2.30) and 1.80 (95% CI, 1.04-3.11), respectively, compared with quintile 1 to 3 (0.7-6.1 mg/dL). Moreover, when we modeled serum uric acid level as a continuous variable, serum uric acid level per 1.0 mg/dL increase was significantly associated with a 25% increased risk of incident CKD.
In conclusion, higher serum uric acid level is independently and significantly associated with an increased risk of CKD in patients with untreated type 2 diabetes.

Disclosure
Y. Okada: None. K.K. Sato: None. M. Shibata: None. S. Uehara: None. H. Koh: None. K. Oue: None. H. Kambe: None. M. Morimoto: None. T. Hayashi: None.
1533-P: Lower Protein Intake Is Associated with Higher Intakes of Carbohydrate and Lower Diet Quality in Adults with Diabetes: A 2005-2016 NHANES Analysis
Authors: THOMAS SARA , FANELLI STEPHANIE M. , KELLY OWEN , KROK-SCHOEN JESSICA L. , TAYLOR CHRISTOPHER A. 
Published: June 2020

Hyperglycemia is associated with an increased risk for sarcopenia. The concurrence of hyperglycemia and sarcopenia may inflate the risk for falls, fractures, and mortality. On average, Americans consume more than the individual protein recommendation (0.8 g/kg/d); however, a large proportion of adults still consume less than recommended levels, which may have negative health implications. Therefore, this study examined the individual protein intake in a nationally representative sample of adults (31+ years) with and without type 2 diabetes to explore protein intakes (g/d) and diet quality (Healthy Eating Index-2015). Data were examined from 23,487 non-institutionalized adults from the 2005-2016 National Health and Nutrition Examination Survey (NHANES). Hemoglobin A1c (%) was used to classify glycemic status: nondiabetes (&lt;5.7%); prediabetes (5.7-6.4%); diabetes (≥6.5%). Dietary data were collected using 24-hour dietary recalls. Participants were further categorized by mean individual protein intake and either ’met’ or ’did not meet’ the protein recommendation of 0.8 g/kg/d. For those without diabetes, 35.9% did not meet protein recommendations, with more adults with prediabetes (46.8%) and diabetes (51.3%) below recommended intakes on the day of record. Adults below the protein recommendation consumed significantly more carbohydrates (13-14 g more across all glycemic groups; p &lt; 0.001) and had worse HEI-2015 diet quality scores across all glycemic groups (nondiabetes: 50.4 v 53.5; prediabetes: 49.9 v 52.8; diabetes: 49.9 v 52.6) compared to those who met the protein recommendation (p &lt; 0.001). Adults with diabetes may have an increased risk for muscle loss, thus assessing and addressing patterns of gaps in protein intakes during patient interactions may help prevent sarcopenia and its associated complications.

Disclosure
S. Thomas: Employee; Self; Abbott. S.M. Fanelli: None. O. Kelly: Employee; Self; Abbott. Employee; Spouse/Partner; Abbott. J.L. Krok-Schoen: None. C.A. Taylor: Research Support; Self; Abbott Laboratories.

Funding
Abbott Nutrition
1536-P: Trends in Eating Patterns among U.S. Adults with Diagnosed Diabetes
Authors: SIEGEL KAREN R. , BULLARD KAI M. , SAYDAH SHARON , MERCADO CARLA , ALI MOHAMMED K. , ALBRIGHT ANN L. , IMPERATORE GIUSEPPINA 
Published: June 2020

In 2019, the American Diabetes Association published a consensus report on nutrition therapy for individuals with diabetes (DM), which included a section on five recommended eating patterns: Mediterranean-style, Dietary Approaches to Stop Hypertension, low-fat, low-carbohydrate, and vegetarian. Using data from 4,718 non-pregnant adults aged ≥20 years with self-reported diagnosed DM and complete dietary data (i.e., one day of 24-hour recall) in the National Health and Nutrition Examination Surveys 2001-2016, we examined the proportion who followed each of the recommended eating patterns (including achieving different components/levels of the eating patterns), and whether this has changed over time. We used age-standardized descriptive statistics to calculate the proportion of individuals following each eating pattern across four 4-year time periods, and calculated p-values for trend across the time periods. Overall, the proportion of individuals following the recommended eating patterns was low and did not change significantly over time, although the decline in following the Mediterranean-style diet from the 2001-2004 to the 2013-2016 time period was significant (p=0.04 and p=0.046 for the highest and lowest categories, respectively) (Table). These results suggest more efforts may be considered for improving eating patterns among adults with DM in the United States.

Disclosure
K.R. Siegel: None. K.M. Bullard: None. S. Saydah: None. C. Mercado: None. M.K. Ali: Research Support; Self; Merck & Co., Inc. A.L. Albright: None. G. Imperatore: None.
1548-P: Changes in Glucose-Lowering Medication Use in the Era of Cardiovascular Outcomes Trials: Risk/Treatment Paradox Persists
Authors: MCCOY ROZALINA G. , HOUTEN HOLLY VAN , ROSS JOSEPH , KARACA-MANDIC PINAR , MONTORI VICTOR M. , SHAH NILAY 
Published: June 2020

Three new classes of glucose-lowering drugs were introduced into practice over the past 15 years: DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors. These drugs have low hypoglycemia risk, do not cause weight gain, and post-marketing outcomes trials found cardiovascular and renal benefits associated with GLP-1RA and SGLT2i use.
Our objective was to determine whether these drugs are being used by patients with type 2 diabetes most likely to benefit from them. Using OptumLabs Data Warehouse, a de-identified dataset of commercially-insured and Medicare Advantage beneficiaries, we identified adults with type 2 diabetes who first started a DPP-4i (n=140,933), GLP-1RA (n=107,331), SGLT2i (n=112,892), or any other diabetes drug (n=1,743,484) between 2013-2018. After adjustment for age, gender, race/ethnicity, insurance type, baseline medications, year, prescriber specialty, and comorbidities, we found that GLP-1RA and SGLT2i, in particular, were less likely to be started by patients most likely to benefit from them. GLP-1RA initiation was less likely among patients with prior hypoglycemia requiring ED/hospital care (OR 0.86 [95% CI 0.79-0.93]), myocardial infarction (MI; OR 0.93 [0.89-0.97], or stroke (OR 0.88 [0.85-0.91]), though more likely with nephropathy (OR 1.20 [1.17-1.23]). SGLT2i initiation was less likely with prior hypoglycemia (OR 0.81 [0.73-0.89]), nephropathy (OR 0.80 [0.78-0.0.82]), or heart failure (HF; OR 0.85 [0.82-0.87]). However, DPP-4i initiation was more likely with prior hypoglycemia (OR 1.49 [1.41-1.57]), MI (OR 1.09 [1.05-1.12]), stroke (OR 1.09 [1.06-1.11), HF (OR 1.12 [1.09-1.14]), and nephropathy (OR 1.40 [1.37-1.43]).
Our results do not explain why these drugs are not preferentially used in guideline-recommended contexts, but do highlight missed opportunities to reduce the morbidity and mortality associated with hypoglycemia, cardiovascular disease, and kidney disease in highest risk patients.

Disclosure
R.G. McCoy: None. H. Van Houten: None. J. Ross: Research Support; Self; Centers for Medicare and Medicaid Services, Janssen Pharmaceuticals, Inc., U.S. Food and Drug Administration. P. Karaca-Mandic: None. V.M. Montori: None. N. Shah: None.

Funding
National Institutes of Health (K23DK114497); Agency for Healthcare Research and Quality (1U19HS024075, R01HS025164)
1551-P: Optimizing MODY Detection in a Pediatric Diabetes Population
Authors: TOSUR MUSTAFA , REFAEY AHMAD K. , GUFFEY DANIELLE , BALASUBRAMANYAM ASHOK , REDONDO MARIA J. 
Published: June 2020

Maturity-onset diabetes of the young (MODY) is under-diagnosed or misdiagnosed as type 1 diabetes (T1D) or type 2 diabetes (T2D), in part due to lack of systematic genetic testing. We aimed to define patient characteristics that could guide the decision to conduct genetic testing for MODY diagnosis in racially/ethnically diverse youth with diabetes. In our electronic health record-based Diabetes Registry, we found 4,752 cases carrying a diagnosis of T1D (78.3%), T2D (20.4%) or MODY (1.3%) seen within the past 3 years. We then screened the Diabetes Registry in an agnostic manner for likely MODY cases (“Study Cohort”) based on: (1) diagnosis of diabetes at age &lt;25 y, (2) family history of diabetes in 3-consecutive generations, (3) absent islet autoantibodies (Ab) except GAD65 Ab. We collected data on their clinical and biochemical characteristics, and results of MODY testing if available. In the Study Cohort (n=350, 7.4% of the Diabetes Registry), 62.3% were female; 57% Hispanic, 13.8% non-Hispanic white, 26.4% non-Hispanic black and 2.9% other. 4.6% had previously received a diagnosis of MODY, 16.6% T1D and 78.8% T2D. Frequency of MODY diagnosis was 3.5 times higher in the Study Cohort than in the Diabetes Registry (p&lt;0.001). At diabetes diagnosis, mean age was 13 y (± 3.2) and HbA1c 9.8% (± 2.6). To further refine characteristics of potential MODY, we performed cluster analysis on the Study Cohort using variables commonly used to establish diabetes type at diagnosis: age, BMI-z score, glucose, C-peptide, HbA1c and islet Ab. The cluster with the highest rate of prior MODY diagnosis (25%) had the lowest age at onset (10.9 ± 2.5 y), BMI-z (0.5 ± 0.9), C-peptide (1.5 ± 1.2 ng/mL) and acanthosis nigricans frequency (12.5%) (all p&lt;0.05). Furthermore, in this cluster, molecular confirmation rate was 75% in those patients who had undergone genetic testing (1/3 of the cluster). The patient characteristics defined by this stepwise approach expands and enhances accurate MODY diagnosis and improves the yield of genetic testing for MODY.

Disclosure
M. Tosur: None. A.K. Refaey: None. D. Guffey: None. A. Balasubramanyam: None. M.J. Redondo: None.

Funding
Mike Hogg Fund
157-OR: People with Type 1 Diabetes and Impaired Awareness of Hypoglycemia Have a Delayed Reaction to Perform a Glucose Scan during Hypoglycemia: A Prospective Observational Study
Authors: MOSER OTHMAR , ZIKO HARIS , ELSAYED HESHAM , HOCHFELLNER DANIEL A. , POETTLER TINA , MUELLER ALEXANDER , ECKSTEIN MAX L. , KNOLL LISA , SOURIJ HARALD , MADER JULIA K. 
Published: June 2020

Background: Considering that people with type 1 diabetes (T1D) and impaired awareness of hypoglycemia (IAH) have a delayed perception of hypoglycemia, the question arises if they perform scans later in case of hypoglycemia compared to those with normal hypoglycemia awareness (non-IAH). We assessed if the time until performing a scan after reaching hypoglycemia while using a flash glucose monitoring (Flash GM) system is different in people with T1D and IAH compared to people with T1D and non-IAH.
Material and Methods: 92 people with T1D (age of 42±14 years, BMI 25.1±4.0 kg/m2, HbA1c 57±9 mmol/mol (7.3±0.8%), 73 MDI/19 CSII) using a Flash GM system for 3 months were included. Flash GM data were downloaded and assessed for time until scan after reaching hypoglycemia level 1 (&lt;70 mg/dL) and level 2 (&lt;54 mg/dL) and compared for T1D with IAH versus non-IAH via unpaired t-test or Mann-Whitney-U test (p&lt;0.05). IAH was routinely assessed by means of Gold, Clarke and Pedersen-Bjergaard Score.
Results: Significant differences were only found for the delay between reaching hypoglycemia and scan between IAH and non-IAH for both Gold Score (hypoglycemia level 1: IAH 78 min [51-105] vs. non-IAH 63 min [42-89], p=0.03; nighttime hypoglycemia level 2: IAH 140 min [107-227] vs. non-IAH 96 min [41-155], p=0.004) and Pedersen-Bjergaard Score (hypoglycemia level 1: IAH 76 min [52-97] vs. non-IAH 54 min [38-71], p=0.01; nighttime hypoglycemia level 1: IAH 132 min [79-209] vs. non-IAH 89 min [59-143], p=0.01; nighttime hypoglycemia level 2: IAH 134 min [66-212] vs. non-IAH 80 min [37-131], p=0.002).
Conclusion: These preliminary data suggest that the time until scan after reaching hypoglycemia may serve as an objective assessment tool for IAH in people with T1D.

Disclosure
O. Moser: Other Relationship; Self; Dexcom, Inc., Novo Nordisk A/S, Sanofi. H. Ziko: None. H. Elsayed: None. D.A. Hochfellner: None. T. Poettler: None. A. Mueller: None. M.L. Eckstein: Research Support; Self; Dexcom, Inc., Novo Nordisk A/S, Sanofi-Aventis. L. Knoll: None. H. Sourij: Advisory Panel; Self; Amgen, AstraZeneca, Boehringer Ingelheim International GmbH, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. Research Support; Self; Boehringer Ingelheim International GmbH, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. Speaker’s Bureau; Self; Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi. J.K. Mader: Advisory Panel; Self; Becton, Dickinson and Company, Eli Lilly and Company, Medtronic, Prediktor Medical, Sanofi-Aventis. Speaker’s Bureau; Self; Abbott, Eli Lilly and Company, Medtronic, Novo Nordisk A/S, Roche Diabetes Care, Sanofi-Aventis.