bluuebunny/crossref_metadata_2025_split huggingface dataset:
1380-P: Pregravid A1C and Glucose Measurements to Rule Out Gestational Diabetes and Reduce the Need for Oral Glucose Tolerance Testing in Pregnancy
Authors: RETNAKARAN RAVI , SHAH BAIJU R. 
Published: June 2020

The recommendation of universal screening for gestational diabetes (GDM) by oral glucose tolerance test (OGTT) in pregnancy may pose a resource challenge for healthcare systems. In light of growing recognition that women who develop GDM have chronic metabolic dysfunction that predates their pregnancy, we hypothesized that pre-gravid measurement of A1c and glucose may provide the capacity to rule out GDM in low-risk women and thereby reduce the overall OGTT burden in pregnancy. To test this hypothesis, we identified all women in Ontario, Canada, with singleton live-birth pregnancies between January 2008 and December 2015 (n=1,001,006, of which 47,180 had GDM), and created derivation and validation cohorts (each n=500,503). In the derivation cohort, pre-gravid A1c (OR=9.72, 95%CI 8.76-10.79), fasting glucose (OR=3.32, 95%CI 3.13-3.51) and random glucose (OR=1.70, 95%CI 1.65-1.75) each predicted subsequent GDM. Area-under-receiver-operating-characteristic curve (AROC) was higher for A1c (0.684) than for fasting glucose (0.647) or random glucose (0.625). Test characteristics revealed that the negative predictive value (NPV) for ruling out GDM was optimized (NPV=98.7%) at pre-gravid A1c ≤4.3%. However, when evaluated in the validation cohort, this pre-gravid A1c threshold would only reduce the need for antepartum OGTT in 0.11% of women. Conversely, if test sensitivity for predicting GDM were set at 95.1% in the derivation cohort, the resultant threshold of pre-gravid A1c ≤5.0% would reduce the need for antepartum OGTT in 7.2% of women but at the cost of missing 2.5% of GDM diagnoses in the validation cohort.
In conclusion, pre-gravid A1c and glucose levels can predict a woman’s future risk of GDM. However, their test characteristics are clinically not acceptable for reducing the need for GDM screening by OGTT in pregnancy.

Disclosure
R. Retnakaran: Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc., Sanofi. Research Support; Self; Boehringer Ingelheim International GmbH, Novo Nordisk Inc. B.R. Shah: None.
1381-P: Association of Implementation of a Comprehensive Peripregnancy Management Plan with Pregnancy Outcomes among Chinese Pregnant Women with Type 1 Diabetes
Authors: ZHENG XUEYING , YANG DAIZHI , LUO SIHUI , YAN JINHUA , WENG JIANPING 
Published: June 2020

Background: Risk of adverse pregnancy outcomes (APOs) remains high among pregnant women with type 1 diabetes (T1D). We aimed to investigate whether implementation of a comprehensive evidence-based peri-pregnancy management plan was associated with lower rates of APOs among these women.
Methods: This is a nationwide observational cohort study. A comprehensive evidence-based peri-pregnancy management plan for T1D was launched in 11 centers from 8 cities in China. During 2015-2017 we prospectively collected data from all pregnant women with T1D attending these centers. We compared pregnancy outcomes in this prospective cohort (PC) with two comparison populations. These populations were constructed by compiling data from medical records: the first was a retrospective cohort (RC) of pregnant women with T1D attending the same centers during 2012-2014 before the management plan, and the second was a comparison cohort (CC) of pregnant women with T1D receiving routine care during 2015-2017 in the comparison centers. The comparison centers were another 11 centers from 7 cities with matched socio-economic variables and medical facilities. The main outcome was severe APO comprising maternal mortality, neonatal death, congenital malformation(s), miscarriage in the 2nd trimester, and stillbirth.
Results: We included a PC of 133 pregnant women with TID who received the comprehensive management during 2015-2017; a RC of 153 TID pregnancies out of 137544 pregnancies during 2012-2014; and a CC of 116 TID pregnancies out of 165493 pregnancies during 2015-2017. The rate of severe APO was significantly lower in the PC (6.02%) than either the RC (18.30%, adjusted odds ratio[aOR] 0.31, 95% CI 0.13-0.74, P&lt;0.01) or the CC (25.00%, aOR 0.22, 95% CI 0.09-0.52, P&lt;0.001).
Conclusions: Implementation of the comprehensive evidence-based peri-pregnancy management plan is associated with lower risk of APOs among Chinese pregnant women with T1D.

Disclosure
X. Zheng: None. D. Yang: None. S. Luo: None. J. Yan: None. J. Weng: None.

Funding
National Health and Family Planning Commission of the People’s Republic of China; Foundation for Public Welfare Industry Research Project (201502011); World Diabetes Foundation (WDF14-921)
139-OR: Superior Effect of 1-Year Treatment with GLP-1 Receptor Agonist and Exercise on Weight Loss Maintenance and Body Composition after a Very Low-Calorie Diet: The S-LITE Randomized Trial
Authors: JANUS CHARLOTTE , LUNDGREN JULIE R. , JENSEN SIMON , OLSEN LISA M. , JUHL CHRISTIAN RIMER , BLOND MARTIN B. , CHRISTENSEN RASMUS M. , BOJSEN-MOLLER KIRSTINE N. , SVANE MARIA S. , BANDHOLM THOMAS , JENSEN JENS-ERIK B. , STALLKNECHT BENTE , HOLST JENS J. , MADSBAD STEN , TOREKOV SIGNE S. 
Published: June 2020

Background: Weight loss decreases energy expenditure and increases appetite, leading to weight regain. Energy expenditure can be targeted with exercise, and appetite with the glucagon-like peptide-1 (GLP-1) receptor agonist, liraglutide.The objective was to investigate 1-year weight loss maintenance and change in body composition with liraglutide, exercise, and the combination in individuals with obesity after a very low-calorie diet (VLCD).
Methods: Double-blinded, randomized placebo-controlled trial. Following 8-weeks of VLCD (800 kcal/day), inducing a body weight loss of ≥ 5%, the participants were randomized to 1-year of treatment with 1) liraglutide 3.0 mg/day (LIRA), 2) exercise 150 min/week + placebo (EX), 3) exercise 150 min/week + liraglutide 3.0 mg/day (LIRA + EX), or 4) placebo (PLA).
Results: Participants with obesity were included (n = 215, 64% women, age 42 years (IQR 30.7 to 51.9), BMI 36.6 kg/m2 (34.5 to 39.2)). See Table 1 for all results.
Conclusion: The combination of liraglutide and exercise was superior to placebo and exercise alone, and numerically better to liraglutide, in weight loss maintenance and further weight reduction. Fat percentage loss with the combination treatment was superior to liraglutide and exercise alone, supporting the combined treatment for healthy weight loss maintenance.

Disclosure
C. Janus: Research Support; Spouse/Partner; Mercodia, Novo Nordisk A/S. Research Support; Self; Novo Nordisk Foundation. Research Support; Spouse/Partner; Novo Nordisk Foundation. Speaker’s Bureau; Spouse/Partner; Merck Sharp & Dohme Corp. J.R. Lundgren: None. S. Jensen: None. L.M. Olsen: None. C. Juhl: None. M.B. Blond: None. R.M. Christensen: None. K.N. Bojsen-Moller: None. M.S. Svane: None. T. Bandholm: Employee; Spouse/Partner; Novo Nordisk A/S. Stock/Shareholder; Spouse/Partner; Novo Nordisk A/S. J.B. Jensen: None. B. Stallknecht: None. J.J. Holst: Advisory Panel; Self; AstraZeneca, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Zealand Pharma A/S. Other Relationship; Spouse/Partner; Antag Therapeutics. S. Madsbad: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi-Aventis. Research Support; Self; Boehringer Ingelheim International GmbH, Novo Nordisk A/S. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S. S.S. Torekov: Research Support; Self; Novo Nordisk Inc.

Funding
Novo Nordisk Foundation (NNF16OC0019968); Novo Nordisk Center for Metabolic Research; Helsefonden
1391-P: Geographic Disparities in the Receipt of Reproductive Health Care among Young Women with Diabetes
Authors: WISK LAUREN E. , NOURBAKHSH POURANDOKHT S. , KRANSDORF LISA N. 
Published: June 2020

We sought to examine disparities in realized access to guideline-recommended reproductive health services (e.g., preconception counseling) for young women with type 1 or 2 diabetes mellitus (DM) compared to peers without DM and to determine if/how such disparities varied by geography. We included over 1 million young women (ages 13-39) both with and without DM, using over 2 million person-years of data from Virginia’s All-Payer Claims Data (covering 40% of commercially and 95% of publicly insured people in the state) from 2016-2018. Multivariate regression modeled receipt of reproductive care by DM status and county of residence, adjusting for age, payer, race/ethnicity, and year. We identified 2.4 million visits for reproductive care (mean of 1.17 visits per person per year), including 657K for routine gynecological exams, 824K for contraception management, and 1.05M for STI screening and treatment. Compared to women with DM, those without DM had higher odds of receiving routine gynecological exams (OR:1.20, 95%CI: 1.18-1.22) and visits for contraceptive management (OR:1.05, 95%CI: 1.04-1.07); but among those receiving care, women with DM averaged slightly more visit per year (gynecological exam β=0.06, p&lt;0.01; contraception management β=0.09, p&lt;0.01). County-specific prevalence of DM ranged from 5% to 17% and DM prevalence was higher in smaller counties (pop&lt;20K) compared to medium (20-100K) or large counties (pop&gt;100K). Overall, there were no differences in receipt of reproductive care by DM status in large counties but disparities manifested for those living in medium and smaller counties. Differences by payer and race/ethnicity were also identified. Given the acute health threats for women with DM who do not receive appropriate preventive reproductive services, observed disparities are worrisome. As disparities were exacerbated in counties with the highest prevalence of DM, more work needs to be done to ensure equitable access to care in areas that have a higher disease burden.

Disclosure
L.E. Wisk: None. P.S. Nourbakhsh: None. L.N. Kransdorf: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (1K01DK116932-01 to L.E.W.); University of California, Los Angeles (to L.E.W.)
1395-P: Practical Triage in Women with Gestational Diabetes According to Their Risk Category for Insulin Therapy
Authors: YAMASHITA HIROSHI , YASUHI ICHIRO , SUGA SACHE , ISOKAWA SATOSHI , FUKUOKA MISAO , KOGA MEGUMI , YAMAGUCHI JUNKO , SUGIMI SO , UMEZAKI YASUSHI , FUKUDA MASASHI , KUSUDA NOBUKO 
Published: June 2020

Objective: We investigated efficacy of the risk category system in the triage of patients to insulin therapy in a prospective cohort of women with gestational diabetes (GDM).
Study Design: In a previous retrospective study, we developed a risk category system for insulin therapy (≥20 U/day), in which we found two risk factors including prepregnancy BMI ≥24 and fasting plasma glucose ≥84 mg/dl. In the current study, we investigated the validity of the risk categories for triage to insulin therapy in a new prospective cohort. We included women with GDM diagnosed at 24-32 weeks of gestation according to the IADPSG criteria in a single tertiary perinatal care center between June 2015 and March 2018. After the diagnosis, all patients underwent self-monitoring of blood glucose (SMBG) under nutrition therapy. Insulin therapy was indicated, if SMBG did not achieve 80% of the target glucose values. Multivariate analysis adjusted for confounders were performed to examine the association between risk categories and insulin therapy (≥20 U/day and ≥30 U/day).
Results: Among 240 patients with GDM, 119 (50%) had at least one risk category. Insulin therapy ≥20 U/day and ≥30 U/day was indicated in 86 (35.8%) and 61 (25.4%) patients, respectively. In comparison to women without risk factor, patients with at least one risk factor were significantly at risk for insulin therapy ≥20 and ≥30 U/day with adjusted odds ratio of 3.8 (95%CI 1.7-8.7) and 16.4 (4.9-75.6), PPV of 0.51 and 0.39, and NPV of 0.79 and 0.88, respectively.
Conclusion: With keeping SMBG triage first, the risk category system seems to be effective, especially for the triage of patients without risk categories to less intensive care, because of the high negative predictive value.

Disclosure
H. Yamashita: None. I. Yasuhi: None. S. Suga: None. S. Isokawa: None. M. Fukuoka: None. M. Koga: None. J. Yamaguchi: None. S. Sugimi: None. Y. Umezaki: None. M. Fukuda: None. N. Kusuda: None.
14-LB: Overnight Hypoglycemia Prediction for CGM Users
Authors: WEXLER YDO , GOLDNER DAN , MERCHANT GINA , HIRSCH ASHLEY , HUDDLESTON BRIAN , DACHIS JEFF 
Published: June 2020

Background: Knowing at bedtime whether hypoglycemia is likely to occur while sleeping could empower people with diabetes to take preventive action, and could reduce concerns about either being awoken by a continuous glucose monitor (CGM) alarm, or sleeping through the alarm and not being able to respond. We used CGM and self-care data collected in the One Drop app to predict the occurrence of overnight hyperglycemia.
Method: Over 500,000 person-nights of sleep, blood glucose (BG), self-care and contextual data from over 3000 app users with CGMs were pooled and used to train and test a supervised learning model to predict, as of bedtime, the minimum BG value for the coming night. A related model was trained to predict the probability of any BG value being lower than 70 mg/dL during the night.
Results: Test-set predictions of minimum overnight BG value had a mean absolute relative deviation (MARD) of 18.6%. For test-set predictions of the probability of BG lower than 70 mg/dL, the area under the receiver operating characteristic curve (AUC) was 82.2%. About 30% of predictions could be identified at prediction time as having higher accuracy. For those, test-set minimum BG prediction MARD was 15.4%, and probability of BG lower than 70 mg/dL prediction AUC was 87.0%.
Conclusion: Pooling sleep, BG, behavioral and self-care data from thousands of One Drop app users who also use CGM accurately predicts the probability of overnight hypoglycemia. Having such predictions at bedtime can facilitate preventative action, reduce anxiety and improve both sleep and quality of life.

Disclosure
Y. Wexler: Employee; Self; One Drop. D. Goldner: Employee; Self; One Drop. G. Merchant: Employee; Self; One Drop. A. Hirsch: Employee; Self; Informed Data Systems Inc. B. Huddleston: Employee; Self; One Drop. Stock/Shareholder; Self; One Drop. J. Dachis: Board Member; Self; One Drop. Employee; Self; One Drop. Stock/Shareholder; Self; One Drop.
14-OR: Piloting a Video-Based Telehealth Intervention to Reduce Distress and Depression in Parents of Schoolagers with Type 1 Diabetes (T1D)
Authors: PATTON SUSANA R. , MARKER ARWEN M. , MONZON ALEXANDRA , NELSON EVE-LYNN , CLEMENTS MARK A. 
Published: June 2020

Parents of school-agers (5-12 years) with T1D play an important role in their child’s T1D management and may be vulnerable to T1D distress and depressive symptoms. We present pilot data from a new group-based video telehealth intervention to reduce depressive symptoms and distress in parents of youth with T1D. Currently, 40 families enrolled in the Cognitive Adaptations to Reduce Emotional Stress (CARES) intervention and 27 completed treatment (both parents participated from two families for N=29; Age = 41.1±6.7 years; Child age = 10.1±1.5 years, 48% girls). CARES uses a cognitive behavioral framework to help parents identify maladaptive thoughts and promote healthy coping through behavioral activation and mindfulness. Parents participated in weekly CARES sessions via a HIPAA-compliant video-based telehealth platform. We measured feasibility and acceptability of 12-session and 8-session versions of the CARES intervention. We used paired t-tests to assess preliminary efficacy based on pre- and post-intervention changes in parent T1D-Distress (PAID-PR) and depressive symptoms (CESD-R), and exploratory changes in child HbA1c. Parents attended 89% of the 12-version sessions (N=14) and 84% of the 8-version sessions (N=15), suggesting adequate feasibility. Parents reported satisfaction with CARES across both versions. In the 12-session version, parents noted significant reductions in CESD-R scores (p=0.046) and T1D-Distress (immediate, p=0.007; theory, p=0.004), whereas in the 8-session version parents only noted reductions in T1D-Distress (immediate, p=0.018; theory, p=0.024). For both the 12- and 8-session versions, we found no difference in child HbA1c (p=0.497 and p=0.146, respectively). Our preliminary data suggest feasibility and efficacy for using video-based telehealth to deliver a group-based intervention to reduce parent distress, but only our 12-session version achieved a significant reduction in parent depression.

Disclosure
S.R. Patton: None. A.M. Marker: None. A. Monzon: None. E. Nelson: None. M.A. Clements: Consultant; Self; Glooko, Inc. Other Relationship; Self; Glooko, Inc.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100779)
1402-P: Impact of Diabetes Duration on Functional and Clinical Status in Older Adults with Type 1 Diabetes
Authors: MUNSHI MEDHA , SLYNE CHRISTINE , SIFRE KAYLA , O’DONNELL RACHEL , ATAKOV-CASTILLO ASTRID , TOSCHI ELENA 
Published: June 2020

Background: Adults with type 1 diabetes (T1D) are aging more successfully than ever. However, in this older, heterogeneous population, diabetes duration can vary widely, as people may have been diagnosed many decades ago in early childhood or as recently as late adulthood. There is little information about the impact of diabetes duration on psychosocial factors and functional status as patients with T1D age.
Methods: We evaluated a cohort of older adults (age≥65 years) with T1D. All participants completed surveys regarding demographics, medical history, overall health (Short Form 36; SF-36), hypoglycemia awareness (Clarke Score), and hypoglycemia fear (HFSII). Laboratory A1C was measured, and Montreal Cognitive Assessment (MoCA) was performed to assess cognitive function.
Results: We evaluated 148 older adults, mean age 71 ± 5 years, 55% female, 97% white, mean A1C 7.4 ± 0.9%, mean diabetes duration 39 ± 17 years, with 20% of participants living alone. The participants were divided into tertiles of diabetes duration; ≤30 years (n=48), 31-49 years (n=54) years, and ≥50 years (n=46). Comparison of the shortest and longest tertiles of diabetes duration showed that participants of the group with the shortest duration had significantly less depression (35% vs. 59%; p=0.02), less hypoglycemia unawareness (31% vs. 61%; p=0.008), fewer recent falls in the prior 6 months (5 vs. 12; p=0.05), fewer daily medications (9 vs. 11; p=0.02), and fewer comorbidities (8 vs. 9; p=0.05). Additionally, the overall health survey (SF-36) showed that the group with longer duration reported more difficulty and limitation in daily activities due to physical health. The two groups did not differ in age, A1C, cognitive dysfunction (MoCA score &lt;26), or hypoglycemia fear.
Conclusion: In older adults with T1D, duration of diabetes impacts clinical and functional status, and should be kept in consideration when developing management strategies for maximum safety and success.

Disclosure
M. Munshi: Consultant; Self; Eli Lilly and Company, Sanofi. C. Slyne: None. K. Sifre: None. R. O’Donnell: None. A. Atakov-Castillo: None. E. Toschi: None.

Funding
National Institutes of Health (1DP3DK112214-01)
1411-P: Dysfunction of Adipose Tissue and Testosterone Deficiency in Men with Type 2 Diabetes Mellitus
Authors: KHRIPUN IRINA A. , VOROBYEV SERGEY V. , BOVA ELENA V. 
Published: June 2020

The prevalence of hypogonadism in men with type 2 diabetes mellitus (T2DM) is higher than in population. Though, the function of adipose tissue in men with hypogonadism and T2DM is still unclear.
Aim: To study the function of adipose tissue in men with T2DM and functional hypogonadism.
Materials and Methods: We examined 272 men with T2DM (mean age 53.8±2.7 years). Randomization: 1 group - 148 men with hypogonadism, according to the European Association of Urology criteria 2015; 2 group - 124 patients, not having hypogonadism. The groups were comparable by age and treatment of diabetes. Patients underwent clinical examination, analysis of carbohydrate metabolism and markers of adipose tissue function, such as resistin, leptin, adiponectin. Statistical analysis was carried out using the Mann Whitney U-test.
Results: The analysis demonstrated that hypogonadal patients had a significantly higher body mass index, waist and hip circumferences. Levels of fasting glucose and HbA1c weren’t statistically different in two groups. At the same time, patients with hypogonadism had more pronounced hyperinsulinemia (16,2 [10,5; 30,2] vs. 12,7 [8,4; 21] μU/ml, p=0,002) and insulin resistance, calculated as HOMA-IR (6,2 [3,8; 11,0] vs. 4,6 [2,8; 7,0], p&lt;0,001), compared to eugonadal men. The analysis revealed an increase in leptin (10,8 [7,2; 17,5] vs. 9,2 [5,8; 14,9] ng/ml, p=0,03) and resistin levels (7,5 [2,9; 13,3] vs. 3,8 [1,8; 6,5] ng/ml, p&lt;0,001) in the 1st group compared to the 2nd. Contrary, levels of adiponectin (2,8 [0,5; 5,7] vs. 4,7 [0,8; 7,9] μg/ml, p=0.006) were higher in group 2 compared to the 1st one. Thus, despite the equal fasting glucose and HbA1c levels, men with T deficiency have more pronounced adipose tissue dysfunction compared to eugonadal men having T2DM.
Conclusion: T deficiency leads to adipose tissue dysfunction in men with T2DM.

Disclosure
I.A. Khripun: None. S.V. Vorobyev: None. E.V. Bova: None.

Funding
Russian Science Foundation (14-25-00052)
1428-P: Cardiovascular Outcomes with Dulaglutide vs. Liraglutide
Authors: BOWE ANDY , POONAWALLA INSIYA , TINDAL MICHAEL , MEAH YUNUS A. , SCHWAB PHIL 
Published: June 2020

While emerging evidence shows cardiovascular (CV) benefits associated with use of specific glucagon-like peptide-1 (GLP-1) agonists, there is limited data on how outcomes compare between agents in the same drug class. This retrospective cohort study compared once-weekly dulaglutide and once-daily liraglutide on CV outcomes, treatment persistence/discontinuation, healthcare utilization and costs. Using administrative claims data from a large commercial and Medicare Advantage Prescription Drug health plan, new users of liraglutide or dulaglutide from January 2015 to June 2017 were identified. Eligible patients were 19-89 years, with at least 12 months of continuous enrollment pre- and post-index date (i.e., date of first new prescription). Patients who had prescription claims for other GLP-1 agonists were excluded. Propensity score matching (1:1) resulted in 2,245 patients in each treatment arm. The risk of primary composite CV outcome (myocardial infarction [MI] or stroke or mortality) and secondary CV outcome (heart failure [HF] or mortality) was similar across treatment groups, but patients indexed to dulaglutide were less likely to encounter a MI (relative risk [RR] 0.80, P=0.028) or HF (RR 0.81, P=0.001) event. Treatment discontinuation was lower in patients who used dulaglutide vs. liraglutide (57.8% vs. 63.2%, P&lt;0.0001; hazard ratio 0.85, 95% confidence interval 0.79-0.92). The average per-person per-month pharmacy cost was higher for dulaglutide compared to the liraglutide cohort ($1,027 vs. 954, P=0.047). Total and medical costs, inpatient hospitalization stays, emergency department visits and outpatient service visits were similar across cohorts. Despite a lack of significant effect on the study’s composite CV outcomes, this real-world study showed longer treatment persistence with the use of dulaglutide that may be associated with lower MI and HF events. Findings may be useful to providers, especially in the treatment of patients who prefer once-weekly versus once-daily subcutaneous injection.

Disclosure
A. Bowe: Employee; Self; Humana. I. Poonawalla: None. M. Tindal: None. Y.A. Meah: None. P. Schwab: Employee; Self; Humana. Employee; Spouse/Partner; Humana.