bluuebunny/crossref_metadata_2025_split huggingface dataset:
1537-P: Lifetime Risk of Diabetes in Metropolitan India: Striking in All BMI Groups
Authors: LUHAR SHAMMI , KINRA SANJAY , MOHAN VISWANATHAN , KONDAL DIMPLE , ANJANA RANJIT MOHAN , PATEL SHIVANI A. , ALI MOHAMMED K. , PRABHAKARAN DORAIRAJ , TANDON NIKHIL , T NARAYAN K.M. VENKA 
Published: June 2020

Background: To our knowledge, no estimates of lifetime risk of diabetes have been produced for India, a country with a high propensity to developing diabetes and a low overall body weight compared to high-income countries.
Data: We estimated the lifetime risk of diabetes in metropolitan India, and its variation by sex, age and BMI. We used government mortality statistics, diabetes prevalence from the Indian Council for Medical Research INdia DIABetes study (2008-15) and incidence from the Centre for Cardiometabolic Risk Reduction in South Asia (2010-2018). We limited estimates Indians aged 20 or more years.
Results: Overall lifetime risk of diabetes in women in metropolitan cities aged 20 was 74.7% (95%CI: 65.4-83.3%), and 69.0% (95%CI: 58.9-78.7%) in men. Remaining risk is highest among the obese (92.9% (95%CI: 88.0-96.0%) in women and 92.4% (95%CI: 86.6-96.1%) in men aged 20) and is lowest among underweight/normal weight people (56.4% (95%CI: 46.9-66.3%) in women and 54.2% (95%CI: 44.5-64.6%) in men). Lifetime risk declines with age (to 67.3% (95%CI: 57.4-77.1%) in women aged 40 to 42.5% (95%CI: 33.8-52.9%) at age 60).
Conclusion: In metropolitan India, 1 in 2 underweight/normal weight, and 9 in 10 obese, people aged 20 are projected to develop diabetes during their life. This portends a serious epidemic and indicates what may develop elsewhere in India in the absence of urgent action.
Table. Lifetime risk of diabetes by sex, age and BMI

Disclosure
S. Luhar: None. S. Kinra: None. V. Mohan: None. D. Kondal: None. R. Anjana: None. S.A. Patel: None. M.K. Ali: Research Support; Self; Merck & Co., Inc. D. Prabhakaran: None. N. Tandon: None. K. Narayan: None.

Funding
Economic and Social Research Council (ES/J500021/1)
1542-P: Associations of Dietary Patterns with Glycemia in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) Study
Authors: BASU ARPITA , ALMAN AMY C. , SNELL-BERGEON JANET K. 
Published: June 2020

Background: Among the modifiable risk factors, diet plays an important role in the risks and progression of poor glycemic control in diabetes. However, few studies have examined this association in people who have type 1 diabetes (T1D), who are at a greater risk of developing cardiovascular diseases than people without diabetes.
Methods: We conducted cross-sectional and longitudinal analyses of data from CACTI study [n=1257; T1D: n=568; nondiabetic controls: n=689] collected between March 2000 and April 2002. Participants completed a validated food frequency questionnaire, a physical examination and fasting biochemical analyses (12h fast). At baseline, dietary patterns based on variations in food group intake were created with principal components analysis (PCA). Linear regression was used to examine associations of dietary patterns with HbA1c in a model adjusted for age and sex and stratified by diabetes status.
Results: Three dietary patterns were identified using PCA as follows: ’fruits, veggies, meats, cereal’, ’baked desserts’ and ’convenience foods and alcohol’ patterns. At baseline, higher intake of ’baked dessert’ pattern was significantly associated with higher HbA1c in T1D (β±SE: 0.10±0.05, p=0.03), but not in nondiabetic controls (0.06±0.04, p=0.21) when adjusted for age, sex and baseline total calories, as well as diabetes duration for T1D. At year-6, baseline higher intake of ’baked dessert’ pattern tended to be associated with increasing HbA1c in T1D (β±SE: 0.11±0.06, p=0.06), but not in nondiabetic controls (0.01±0.04, p=0.68) when adjusted for the same covariates.
Conclusions: Habitual intake of a dietary pattern that is characterized by an increased intake of added sugar and saturated fats, such as in baked desserts may increase risks of poor glycemic control in T1D.

Disclosure
A. Basu: None. A.C. Alman: None. J.K. Snell-Bergeon: Stock/Shareholder; Self; GlaxoSmithKline plc.

Funding
American Diabetes Association (7-13-CD-10 to J.K.S-B.)
155-LB: Understanding Determinants of Caffeinated Sugar-Sweetened Beverage Consumption among Children: A Concept-Mapping Approach
Authors: HALBERG SABRINA E. , VISEK AMANDA J. , BLAKE EMILY F. , SACHECK JENNIFER M. , SYLVETSKY ALLISON 
Published: June 2020

Background: Excess sugar-sweetened beverage (SSB) consumption is associated with type 2 diabetes, obesity, and cardiometabolic disease. In addition to having high added sugar content, caffeinated sugar-sweetened beverages (CSSBs) are the predominant source of caffeine among children. However, the extent to which the caffeine and sugar in CSSBs promote continued CSSB intake among children has not been rigorously studied.
Aim: To develop a conceptual framework of children’s CSSB consumption using group concept mapping.
Methods: Children, ages 8-14, recruited from the Washington, D.C. area who reported consuming ≥ 12 ounces of CSSBs per day participated in concept mapping, an applied social research multimethodology. Concept mapping involved 3 participant-driven activities, including: (1) brainstorming (n=51), during which children reported reasons or determinants for their CSSB consumption, from which 58 unique determinants were identified, (2) sorting (n=72), during which children categorized each of the determinants and named each category, and (3) rating (n=74), during which children rated the influence of each determinant on their own consumption (Likert scale, 1-5). Similarity matrices, multidimensional scaling, and hierarchical cluster analysis were applied to generate concept maps.
Results: The concept maps generated from this study displayed the 58 determinants in a 9-cluster solution, reflective of 3 overarching motives: Perceived Mental and Physical Benefits, Energy and Function, and Preference and Palatability. Among the 58 determinants, the greatest drivers of consumption related to Energy and Function and Preference and Palatability.
Conclusions: The use of concept maps to illuminate the importance of certain determinants, such as energy improvements or taste preferences related to caffeine and/or sugar, as drivers of consumption will inform the development of tailored interventions to reduce CSSB consumption.

Disclosure
S.E. Halberg: None. A.J. Visek: None. E.F. Blake: None. J.M. Sacheck: None. A. Sylvetsky: None.
1574-P: Insulin Resistance, but Not Impaired Beta-Cell Function, at Type 2 Diabetes Diagnosis Is Associated with Mortality
Authors: OTTEN JULIA , TAVELIN BJÖRN , SÖDERBERG STEFAN , ROLANDSSON OLOV 
Published: June 2020

We hypothesized that individuals with type 2 diabetes and low insulin resistance in combination with impaired beta cell function at diabetes diagnosis have lower mortality compared to those with high insulin resistance in combination with preserved beta cell function.
In this prospective cohort study, 864 individuals with type 2 diabetes (median age 60 years) had fasting glucose and fasting C-peptide measured at the time of diabetes diagnosis or up to five years before diagnosis. Insulin resistance was estimated with HOMA-%S and beta cell function with HOMA-%B. Four groups based on the median of HOMA-%S and HOMA-%B were formed: 1) low HOMA-%S and high HOMA-%B, 2) low HOMA-%S and low HOMA-%B, 3) high HOMA-%S and high HOMA-%B, and 4) high HOMA-%S and low HOMA-%B (reference group). Mortality was registered during a median follow up of 15 years after diabetes diagnosis, and the associations between the four groups and mortality was estimated with Cox regression adjusted for gender and age at diabetes diagnosis (model 1) and adjusted for gender, age at diabetes diagnosis, smoking, hypertension, BMI and total cholesterol (model 2).
Group 1 had higher total mortality (model 2: HR 1.58, 95% CI 1.06−2.36) compared to the reference group 4. Group 1 was also associated with higher cardiovascular mortality (model 1: HR 2.24, 95% CI 1.08−4.66), but this difference was no longer significant in model 2.
Insulin resistance in combination with preserved beta cell function at the time of diabetes diagnosis is an independent risk factor for total mortality. Insulin resistance in combination with preserved beta cell function increases the risk for cardiovascular mortality but not independent of conventional risk factors. Thus, treatment of type 2 diabetes should focus not only on normalizing blood glucose levels but also improve insulin resistance.

Disclosure
J. Otten: None. B. Tavelin: None. S. Söderberg: None. O. Rolandsson: None.
1584-P: Lack of Prescription Medication Coverage and Poor Glycemic Control among U.S. Adults with Diagnosed Diabetes, 2005-2016
Authors: BULLARD KAI M. , BENOIT STEPHEN R. , SAYDAH SHARON , MERCADO CARLA , IMPERATORE GIUSEPPINA 
Published: June 2020

About 20 million U.S. adults with diabetes (DM) used glucose-lowering medications in 2016. We examined insurance coverage for prescription medications and its association with glycemic control in this population, overall and by age group. We used data from 3,311 adults aged ≥18y with self-reported diagnosed DM and treated with oral hypoglycemic agents or insulin in the 2005-2016 National Health and Nutrition Examination Survey. Participants reported on having health insurance that covered any part of prescription costs. Poor glycemic control (poor A1C) was defined as A1C &gt;9%. During 2005-2016, 15.3% (95%CI 13.7-17.1) of treated U.S. adults with DM lacked prescription coverage, including 8.9% (7.9-10.1) who were uninsured and 6.4% (5.2-7.8) who were insured without any prescription coverage. Compared to treated adults ≥65y, the percentage without prescription coverage was 55% higher for treated adults 18-44y (20.3%, 16.3-25.0 vs. 13.1%, 10.7-16.0) and similar for those 45-64y (15.9%, 13.7-18.4). Overall, 21.4% (17.6-25.7) of treated adults without prescription coverage and 13.5% (11.9-15.3) with prescription coverage had poor A1C (prevalence ratio 1.58 [1.25-2.00]). By age group, % poor A1C differed by coverage status for treated adults 18-44y (covered: 24.9% [18.8-32.1]; not covered: 38.9% [28.2-50.8], p=0.034) and those 45-64y (covered: 15.2% [12.8-18.1]; not covered: 25.5% [19.8-32.3], p=0.005) but not for those ≥65y (covered: 7.5% [6.1-9.1]; not covered: 6.4% [4.0-9.9], p=0.29). For those insulin-treated, % poor A1C differed by coverage status only among adults 18-44y (covered: 31.9% [23.4-41.8]; not covered: 70.0% [53.1-82.8], p&lt;0.001). Despite the high usage of medication among U.S. adults with diabetes, about 15% of the treated population has no prescription coverage. Most young adults under 45y without prescription coverage who use insulin have poor glycemic control, signifying a major public health concern.

Disclosure
K.M. Bullard: None. S.R. Benoit: None. S. Saydah: None. C. Mercado: None. G. Imperatore: None.
1589-P: Testosterone (T) in Early Puberty Predicts Visceral (VAT) and Subcutaneous Adipose Tissue (SAT) in the EPOCH (Exploring Perinatal Outcomes among Children) Cohort
Authors: KIM CATHERINE , HARRALL KYLIE K. , GLUECK DEBORAH H. , DABELEA DANA 
Published: June 2020

Among adults, higher T predicts lower VAT in men and higher VAT in women, and higher E2 predicts greater SAT in women. The degree to which the association between adiposity and sex steroids is bidirectional is controversial. Using data from a cohort of adolescents, we examined whether sex steroid levels in early puberty influenced VAT and SAT deposition in adolescents. EPOCH participants (n=418, 209 girls and 209 boys) underwent sex steroid measures at visit 1 (mean age 10 years) and magnetic resonance imaging (MRI) assessments of VAT and SAT at visit 1 and visit 2 (mean age 17 years). Using mixed models, we examined whether T and E2 at visit 1 were associated with overall VAT and SAT levels from visit 1 to visit 2. Models adjusted for maternal education and income as well as children’s race, pubertal status, caloric intake, physical activity levels, insulin, leptin, and MRI-measured hepatic fat fraction. Among girls, each unit increase in T was associated with a higher overall VAT (0.16, 95% confidence interval [CI] 0.04, 0.28) and SAT (0.33, 95% CI 0.33, 1.52) levels. Each unit increase in E2 was associated with overall higher SAT (0.56, 95% CI 0.28, 0.83) levels. Among boys, undetectable T was associated with higher VAT (5.12, 95% CI 1.90, 8.36) and lower SAT (-18.85, 95% CI -36.23, -1.46) levels. We conclude that endogenous T and E2 during the pubertal transition significantly influence adolescent adipose tissue deposition in both boys and girls. Future investigations should examine how the use of exogenous sex hormones impacts adipose tissue deposition during this critical period. Additional follow-up is needed to determine how adolescent fat deposition impacts subsequent glucose tolerance in early adulthood.

Disclosure
C. Kim: Research Support; Spouse/Partner; Apple. K.K. Harrall: None. D.H. Glueck: None. D. Dabelea: None.

Funding
National Institutes of Health (R01DK068001)
1591-P: Associations of Referral to Wellness Counseling and Diabetes in Midlife Women
Authors: BADON SYLVIA E. , NANCE NERISSA , HEDDERSON MONIQUE M. , AVALOS LYNDSAY 
Published: June 2020

Wellness counseling resources have the potential to decrease diabetes risk in high risk populations. Midlife women are at high risk for diabetes because of menopause and aging, and diabetes risk is further increased in women with low levels of physical activity (PA). We determined whether referral to wellness counseling was associated with diabetes risk among midlife women with low PA levels. We identified 64,350 women members of Kaiser Permanente Northern California who were 45-55 years old, did not have diabetes, and reported &lt;10 minutes of PA on PA screening during an appointment with their primary care provider in 2015. We identified referrals to wellness counseling resources within 30 days of the index visit and diabetes diagnoses 2 years after the visit using the electronic health record. Relative risk of diabetes associated with wellness counseling referral was estimated using modified Poisson regression, adjusting for age, race/ethnicity, smoking, and comorbidities. In 2015, 1.6% (n=1029) of midlife women reporting low PA levels were referred to wellness counseling resources. Women who were referred were more likely to be Hispanic (32% vs. 24%) or non-Hispanic Black (14% vs. 9%) and have prediabetes (16% vs. 7%), hypertension (39% vs. 24%), or a cholesterol disorder (26% vs. 20%) than women who were not referred. Our preliminary analysis suggests that referral to lifestyle-related wellness counseling was associated with 2.94 times greater risk of diabetes (95% CI: 2.64, 3.27). Referral to wellness counseling resources among midlife women with low levels of PA at Kaiser Permanente Northern California is low; however, women with diabetes risk factors (minority women and women with comorbidities) were more likely to be referred, which is likely why we observed associations of referral with greater risk of diabetes. Future research should examine whether participation in lifestyle-related wellness counseling resources after referral is effective in decreasing diabetes risk in midlife women.

Disclosure
S.E. Badon: None. N. Nance: None. M.M. Hedderson: None. L. Avalos: None.

Funding
Kaiser Permanente; National Institutes of Health (T32DK116684)
1630-P: Receipt of Type 1 Diabetes Care by Physician Specialty during Adolescence and Young Adulthood
Authors: WISK LAUREN E. , LANDRUM MARY BETH , FU CHRISTINA , CHIEN ALYNA 
Published: June 2020

For a sample of continuously-insured adolescents/young adults (AYA, ages 13-26) with T1D enrolled in a national managed care plan from 2013-2016 (16,500 person-years among 8,694 AYA), we describe frequency of medical visits, types of physicians (specialist vs. primary care; pediatric vs. adult) delivering care, and receipt of recommended diabetes monitoring tests. Over 75% of all outpatient visits for 13 year olds (yo) were to pediatric physicians, declining to 2.5% of visits for 26yo; access to specialty care declined from 82% of 13yo to 68% of 26yo. Those receiving ≥twice yearly A1c tests declined from 83% of 13yo to 60% of 26yo, while receiving annual LDL or microalbumin tests rose from 51% of 13yo to 60% of 26yo. Those not accessing specialty care were the least likely to receive recommended tests (A1c odds ratio [OR]:0.26, 95%CI:0.23-0.29; LDL OR:0.61, 95%CI:0.55-0.67; microalbumin OR:0.50, 95%CI:0.46-0.56). Those receiving the majority of care from adult specialists had lower odds of receiving recommended tests (A1c OR:0.61, 95%CI:0.54-0.69; microalbumin OR:0.90, 95%CI:0.82-0.99) compared to those receiving care from pediatric specialists. Despite continuous insurance, many AYA don’t access any specialty care and are less likely to receive routine diabetes monitoring tests as a result. There is large variation in physician types visited by AYA and measurable differences in testing by specialty type.

Disclosure
L.E. Wisk: None. M. Landrum: None. C. Fu: None. A. Chien: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (K01DK116932 to L.E.W.); Agency for Healthcare Research and Quality (U19HS024072 to A.C.)
1642-P: Colocalization Analyses of Genetic Associations of Type 2 Diabetes with DNA Methylation on Chromosome 11p in American Indians
Authors: HANSON ROBERT L. , KOBES SAYUKO , HSUEH WEN-CHI , MULLER YUNHUA L. , KNOWLER WILLIAM C. , BAIER LESLIE 
Published: June 2020

Our recent genome-wide association study (GWAS) identified variants strongly associated with type 2 diabetes (T2D) on chromosome 11p15 in American Indians at KCNQ1 (index variant rs2237895, P=2.5×10-8) and TH (rs11564707, P=3.8×10-8). To assess whether these variants influence epigenetic variation we analyzed associations with DNA methylation. Participants included 7659 American Indians (33% with T2D) who had participated in the GWAS, 842 of whom had DNA methylation measured in peripheral blood. Methylation was measured with the Infinium 450k array (Illumina, San Diego, CA). To identify local CpG sites associated with index variants, we analyzed associations for sites within 1 Mb of each gene (2162 sites for KCNQ1, 2325 for TH). Strong associations were identified: the diabetes risk allele at rs2237895 associated with decreased methylation at cg14637411 (β= 1.35 SD per copy, P=2.6×10-169), and the risk allele at rs11564707 associated with increased methylation at cg19878200 (β=0.46 SD, P=1.1×10-21). We further conducted Bayesian functional fine-mapping association of T2D and statistical colocalization of association of methylation at these sites with T2D using CAVIAR- including 1943 variants for KCNQ1 and 2954 variants for TH. Potentially causal variants for T2D were identified for each gene (30 for KCNQ1 and 33 for TH with posterior probability of causality &gt;0.01); all were in strong linkage disequilibrium with the index variant. Strong evidence for colocalization of the association of T2D with methylation at cg14637411 (colocalization posterior probability &gt;0.01, suggesting both traits are influenced by the same causal variants) was seen with 4 KCNQ1 variants: rs60808706, rs2299620, rs2237896 and rs2237897. Evidence for colocalization was weak for cg19878200 and T2D at TH variants. These results support the notion that KCNQ1 variants may influence T2D risk via an epigenetic effect, and they identify candidate functional variants.

Disclosure
R.L. Hanson: None. S. Kobes: None. W. Hsueh: None. Y.L. Muller: None. W.C. Knowler: None. L. Baier: None.

Funding
American Diabetes Association (1-12-DNP-01 to R.L.H.)
1657-P: Patatin-Like Phospholipase Domain-Containing 3 Gene Indirectly Modulates Hepatocellular Lipid Content in Severe Insulin Resistant Diabetes
Authors: ZAHARIA OANA P. , STRASSBURGER KLAUS , KNEBEL BIRGIT , KUPRIYANOVA YULIYA , KARUSHEVA YANISLAVA , BODIS KALMAN , WOLKERSDORFER MARTIN , MARKGRAF DANIEL F. , BURKART VOLKER , HWANG JONG-HEE , KOTZKA JÖRG , AL-HASANI HADI , SZENDROEDI JULIA , RODEN MICHAEL ,   GDS GROUP
Published: June 2020

The G-allele in the single-nucleotide polymorphism (SNP) rs738409 in the patatin-like phospholipase domain containing 3 (PNPLA3) gene associates with increased risk of nonalcoholic fatty liver disease (NAFLD) and its progression. As the recently-described severe insulin resistant diabetes (SIRD) cluster specifically relates to NAFLD, the present study examined whether this SNP differently associates with insulin sensitivity and hepatic lipid content (HCL) in clusters of new-onset diabetes patients. Participants (n=917) of the prospective German Diabetes Study underwent genotyping, hyperinsulinemic-euglycemic clamps and magnetic resonance spectroscopy. SIRD had the lowest whole-body insulin sensitivity compared to severe insulin deficient (SIDD), moderate obesity-related (MOD), moderate age-related (MARD) and severe autoimmune diabetes clusters (SAID; all p&lt;0.001). Interestingly, SIRD presented with higher prevalence of the G-allele compared to other clusters and the glucose tolerant controls (p&lt;0.05). Also, HCL was higher in SIRD [13.6 (5.8;19.1)%] compared to MOD [6.4 (2.1;12.4)%], MARD [3.0 (1.0;7.9)%], SAID [0.4 (0.0;1.5)%] and the glucose tolerant group [0.9 (0.4;4.9)%] (all p&lt;0.05). Although the PNPLA3 polymorphism did not directly associate with whole-body insulin sensitivity or HCL in SIRD, G-allele carriers of this cluster had higher free fatty acids and greater adipose-tissue insulin resistance than non-carriers.
In conclusion, SIRD patients are more frequently carriers of the G-allele which is associated with adipose-tissue insulin resistance and lipolysis. Together, these alterations may mutually accelerate NAFLD and progression of SIRD.

Disclosure
O.P. Zaharia: None. K. Strassburger: None. B. Knebel: None. Y. Kupriyanova: None. Y. Karusheva: None. K. Bodis: None. M. Wolkersdorfer: None. D.F. Markgraf: None. V. Burkart: None. J. Hwang: None. J. Kotzka: None. H. Al-Hasani: Consultant; Self; Bayer AG. J. Szendroedi: None. M. Roden: Advisory Panel; Self; Servier. Board Member; Self; Poxel SA. Consultant; Self; Eli Lilly and Company, Gilead Sciences, Inc., ProSciento, TARGET PharmaSolutions. Research Support; Self; Boehringer Ingelheim International GmbH, Novartis Pharma K.K., Sanofi US. Speaker’s Bureau; Self; Novo Nordisk A/S.

Funding
German Federal Ministry of Health; Ministry of Culture and Science of North Rhine-Westphalia; German Federal Ministry of Education and Research; German Center for Diabetes Research