bluuebunny/crossref_metadata_2025_split huggingface dataset:
57-OR: A Novel School-Based Obesity Prevention Program Improves Healthy Eating/Lifestyle among 5- to 7-Year-Olds
Authors: SENEVIRATNE SUMUDU N. , SACHCHITHANANTHAN SANATHANEE , ANGULUGAHA GAMAGE PAVITHRA S. , RAMAMOORTHY SAHANA , PEIRIS RENUKA , WICKRAMASINGHE VITHANAGE P. , SOMASUNDARAM NOEL 
Published: June 2020

Background: The foundation for lifelong good health is laid in childhood. Schools can play a pivotal role in preventing obesity/type 2 diabetes with effective interventions.
Methods: We devised a novel school-based program using a sticker based food diary (FD) and colorful 12-page story book to motivate young school children to adopt a healthier diet/lifestyle. This study to conducted among 1500 grade 1 and 2 students from 4 schools between March 2018- April 2019, to evaluate its effectiveness. During the first week(W1), each child self-monitored his/her food intake daily at home for a week, using the FD, and received a Smiley Face based Score (SFS) based on the healthiness of each meal. In the second week, class teachers read the story book (illustrating the physical and psychosocial effects of obesity and benefits of healthy lifestyle in a child friendly manner). In the third week(W3) children completed the FD again. Effectiveness of the program to improve healthy eating/lifestyle was assessed by comparing mean SFS between W1 and W3, and by anonymized graded-response and open response questionnaires completed by parents and class teachers.
Results: Completed FDs were returned by 1029 students. Overall there was an improvement in healthy eating, with mean SFS increasing by 11.7% from W1 to W3 (51.3 ± 22.9 vs. 63.1 ± 24.2, p&lt; 0.001). SFS improved &gt;10% in all BMI categories. SFS improvement was more in boys (13.0 vs. 9.7, p=0.02), and in 2nd graders compared to 1st graders (13.1 vs. 10.3, p=0.045). Majority of responding parents (&gt; 90%) and teachers (95%) strongly agreed/agreed that this program motivated children towards a healthier lifestyle and led to an observable improvement in food habits.
Conclusion: This novel program led to a demonstrable improvement in healthy lifestyle among 5-7 year olds and was received favorably by parents and teachers. Based on these results and positive (ongoing) longer-term follow up data, wider implementation involving 750,000 children is planned for mid 2020.

Disclosure
S.N. Seneviratne: None. S. Sachchithananthan: None. P.S. Angulugaha Gamage: None. S. Ramamoorthy: None. R. Peiris: None. V.P. Wickramasinghe: None. N. Somasundaram: None.

Funding
World Diabetes Foundation (WDF15-1291)
571-P: A Cross-Sectional Observational Study on Correlation between the Central Corneal Thickness and Diabetic Retinopathy
Authors: BAIDYA ARJUN , WAHEED QUAZI SHEHNAZ , DEY SARKAR AJOY 
Published: June 2020

Introduction: In the recent years, several papers have evaluated the changes in central corneal thickness (CCT) associated with diabetes mellitus (DM) with conflicting results.
Aims: To compare the CCT of subjects with DM with age and sex matched healthy subjects and to determine the correlation of CCT with duration of DM and severity of diabetic retinopathy (DR).
Methods: In this cross-sectional, observational study 124 subjects with DM and 65 age matched healthy controls were studied. CCT was measured by pulsair non- contact tonometer. According to retinopathy status based on the ETDRS subjects with diabetes were categorized as PDR (Gr III), NPDR (Gr II) and NO DR (Gr I). Nondiabetic healthy control subjects were categorized as Group IV.
Results: The mean CCT for the study group was 547.02±2.34 and for the control group was 504.6±3.14(p=0.02).Mean CCT in subjects with diabetes with duration &gt;10 years was higher (557.71±19.44) as compared to those having it for less than 10 years (534.05±27.30) (p=0.178). Patients with PDR had higher mean CCT (572.13±17.50) compared to NPDR (553.78±8.80). Patients with DM but no DR had lesser mean CCT than NPDR thus implying positive correlation of CCT with severity of DR.
Conclusion: CCT is significantly greater in subjects with diabetes compared to healthy control. It is positively correlated with severity of DR and duration of DM.

Disclosure
A. Baidya: None. Q. Waheed: None. A. Sarkar: None.
572-P: Association of Sight-Threatening Diabetic Retinopathy in Type 1 Diabetes with Subclinical Atherosclerosis Disease Burden: Five-Year Indian Study
Authors: SHAH KIRAN , SUNDARAM NATARAJAN , PUROHIT LOTIKA S. , TOTH PETER P. , KOTHARI AKSHAY R. , GUPTA SUNIL 
Published: June 2020

We conducted a cross sectional study in 314 T1DM patients (50% with Sight Threatening Diabetic Retinopathy (STDR). B-mode carotid ultrasound, CT coronary angiogram was done after excluding history of CV disease and CKD. Table summarizes demographic, biochemical and imaging parameters. The plaque burden, Carotid Intima Media Thickness (CIMT) and Coronary Calcium (CAC) scores were significantly higher (p&lt;0.0001) in STDR group than No Diabetic Retinopathy (NDR) group. Prevalence of plaque burden was higher in STDR (68.7%) vs. NDR (4.45%). There was no significant correlation between age and CIMT (r= 0.0147). In STDR group, BMI and CIMT showed linear correlation (r=0.0318), there was a strong correlation between carotid plaques and triglycerides (TGs). High CAC scores correlated with higher cholesterol levels. CAC and CIMT had linear correlation with TGs but no correlation with LDL-C. Patients with high CAC scores had high CIMT and vice versa. Multivariate logistic regression analysis showed stronger correlation of carotid plaques with CIMT (p=0.0004) and TGs (p= 0.0295, r= 0.0157) than CAC (p= 0.0605 NS). STDR is an independent predictor of carotid plaques and is a marker of high atherosclerotic burden in T1DM. This association describes that T1DM patients with STDR are at higher CV risk and need aggressive, comprehensive follow up to prevent CV disease.

Disclosure
K. Shah: None. N. Sundaram: None. L.S. Purohit: None. P.P. Toth: Consultant; Self; Amarin Corporation, Amgen, Kowa Research Institute, Inc., Theravance Biopharma. Speaker’s Bureau; Self; Amarin Corporation, Amgen, Novo Nordisk Inc., Regeneron Pharmaceuticals, Sanofi. A.R. Kothari: None. S. Gupta: None.
58-OR: Diastolic Dysfunction, a Precursor for Heart Failure in Young Adults with Youth-Onset Type 1 and Type 2 Diabetes: The SEARCH for Diabetes in Youth Study
Authors: SHAH AMY S. , DABELEA DANA , DOLAN LAWRENCE M. , ISOM SCOTT , DAGOSTINO RALPH , WAGENKNECHT LYNNE E. , IMPERATORE GIUSEPPINA , SAYDAH SHARON , LIESE ANGELA D. , LAWRENCE JEAN M. , PIHOKER CATHERINE , URBINA ELAINE M. 
Published: June 2020

Individuals with diabetes are at high risk for heart failure with preserved ejection fraction due to diabetic cardiomyopathy (DCM), defined as abnormal myocardial structure and function in the absence of overt coronary artery disease. DCM leads to myocardial fibrosis and remodeling with one of the first signs being left ventricular (LV) diastolic dysfunction. The objective was to compare the prevalence of diastolic dysfunction among young adults with type 1 diabetes (T1D) vs. type 2 diabetes (T2D) with diabetes diagnosed in childhood. Participants had T1D or T2D and were enrolled in the SEARCH for Diabetes in Youth Study. Cardiovascular risk factors and diastolic function via echocardiography were measured at an in-person visit, after an average disease duration of 10.9 years (both groups). Unadjusted means were compared between those with T1D and T2D, p &lt;0.05 indicating significance. Diastolic dysfunction was defined as abnormal LV filling volume, LV pressure, or transmitral velocity, based on published norms for age. Of 458 eligible participants, 255 had T1D (mean age 21.2±5.2 years, 60.8% non-Hispanic white, 54.1% female, mean A1c 9.0±1.9%), and 203 had T2D (mean age 24.3±4.3 years, 24.1% non-Hispanic white, 75.4% female, mean A1c 9.6±3.0%). Participants with T2D had a worse cardiovascular risk profile (higher BMI, systolic and diastolic BP, triglycerides, LDL-C, A1c and lower HDL-C) than those with T1D, all p&lt;0.05. Participants with T2D also had lower LV filling volume, transmitral velocity and higher LV pressure, all p&lt;0.05, than those with T1D, suggesting worse diastolic function. The unadjusted prevalence of diastolic dysfunction was high in both groups (57.7% in T2D vs. 47.2% in T1D; p&lt;0.05). Diastolic function is worse in individuals with T2D compared to T1D, but diastolic dysfunction is high in both groups. These findings support monitoring of young adults with diabetes for development of heart-related complications.

Disclosure
A.S. Shah: None. D. Dabelea: None. L.M. Dolan: None. S. Isom: None. R. Dagostino: Consultant; Self; Amgen, AstraZeneca, Celgene, Daiichi Sankyo. L.E. Wagenknecht: None. G. Imperatore: None. S. Saydah: None. A.D. Liese: None. J.M. Lawrence: None. C. Pihoker: None. E.M. Urbina: None.

Funding
Centers for Disease Control and Prevention (1U18DP006131, U18DP006133, U18DP006134, U18DP006136, U18DP006138, U18DP006139); National Institutes of Health (1UC4DK108173)
585-P: Effect of Hydroxychloroquine on HbA1c and Lipid Parameters in T2DM Subjects with Diabetic Neuropathy Who Are on Statins
Authors: BAIDYA ARJUN , GUHA SHIBAL , KUMAR SUBHASH , SHANKAR ANAND 
Published: June 2020

Aim: We decided to explore the effects of HCQ in combination with rosuvastatin on Lipid profile and HbA1c of patients with DKD.
Method: This is a real world study. T2DM (N=67, Age 52± 09), HbA1c ≥ 7%, with clinical evidence of DKD) were selected and alternatively divided into two groups with one group taking HCQ 400 mg in addition to their regular medications and other group without HCQ. Both groups were followed for next 3 months and changes in their serum creatinine(S.Cr), eGFR, Urine ACR, HbA1C,FPG, PPG, LDL, HDL, TG were noted. All patients were on DPP-4i and metformin along with short acting insulin with dosage modified according to daily insulin need and changes in insulin requirement with changing renal function for at least 3months prior to the study.
Results: TG levels were reduced by 25.01% and 10.69% in the HCQ and Non - HCQ Gr respectively, LDL-cholesterol levels were reduced in HCQ while it increase in the Non HCQ. TC declined more with HCQ and significant increase in HDL. SCr. was decline in HCQ Gr, while it increased in Non-HCQ. Similarly, eGFR was rising in the HCQ and decreased in the Non-HCQ. Also, Urinary ACR decreased with HCQ, but continued to increase in Non-HCQ.
Conclusion: Therefore, we concluded that HCQ can be an option in patients of early stages of DKD in such patients and it may be combined with rosuvastatin for better lowering of lipid levels and better control of HbA1c.

Disclosure
A. Baidya: None. S. Guha: None. S. Kumar: None. A. Shankar: None.
588-P: Vitamin D Status in a Bulgarian Population with Type 2 Diabetes and Diabetic Foot Ulcers
Authors: TODOROVA ANI S. , DIMOVA RUMYANA , CHAKAROVA NEVENA , SERDAROVA MINA , GROZEVA-DAMYANOVA GRETA , TSARKOVA POLINA , TANKOVA TSVETALINA , JUDE EDWARD B. 
Published: June 2020

Aim: The aim of the study was to assess vitamin D status in patients with type 2 diabetes (T2D) and diabetic foot ulcers (DFU).
Material and Methods: A total of 224 patients with T2D, mean age 59.2±10.1 years, BMI 31.5±6.3 kg/m2 and eGFR ≥ 45 ml/min/1.73m2, not on vitamin D supplementation, were enrolled in a cross-sectional study. Subjects were divided in two groups - with DFU (n=61) and non-DFU (n=163). The non-DFU group was subdivided into groups with peripheral neuropathy (n=106) and without any complications (n=57). Neuropathy was assessed by standard clinical tests (10g monofilament and 128 Hz tuning fork). Serum 25(OH)D was assessed by ELISA method.
Results: 25(OH)D level was 12.7 ng/ml (IQR 9.35-18.1 ng/ml) in the studied cohort, which is below the sufficient range (sufficient &gt; 30 ng/ml; insufficiency - 20-30 ng/ml; deficiency 10-20 ng/ml, severe deficiency &lt; 10 ng/ml). The DFU group presented with significantly lower 25(OH)D level as compared to non-DFU group, 12.08 ng/ml (IQR 8.5-15.5 ng/ml) vs. 13.50 ng/ml (IQR 9.6-18.6 ng/ml), p=0.006; 86% of DFU patients being with vitamin D deficiency and severe deficiency. There was no difference in diabetes duration (p=0.096), whereas there was a significant difference in eGFR in DFU group as compared to non-DFU group (81±20 ml/min/1.73m² vs. 89±19 ml/min/1.73m², p=0.008). No relationship was established between 25(OH)D levels and BMI in both groups. The subanalysis of non-DFU group demonstrated significantly lower 25(OH)D level in patients with peripheral neuropathy as compared to patients without any complications - 12.5 ng/ml (IQR 9-17 ng/ml) vs. 16.2 ng/ml (IQR 10-21 ng/ml), p=0.027. There was no difference in serum calcium levels between the different groups.
Conclusion: Patients with DFU and diabetic neuropathy are at higher risk of low 25(OH)D levels probably because of poor self-care and less sunlight exposure. Therefore, this population should be screened for vitamin D deficiency as it may lead to poor wound healing.

Disclosure
A.S. Todorova: None. R. Dimova: Consultant; Self; Amgen, Boehringer Ingelheim International GmbH. Speaker’s Bureau; Self; Sanofi, Wörwag Pharma. N. Chakarova: None. M. Serdarova: None. G. Grozeva-Damyanova: None. P. Tsarkova: None. T. Tankova: Board Member; Self; Amgen, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Mundipharma International, Novo Nordisk A/S, Sanofi. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Sanofi, Servier. E.B. Jude: Speaker’s Bureau; Self; AstraZeneca, Novo Nordisk Inc., Sanofi. Other Relationship; Self; Lilly Diabetes, Menarini Group.
592-P: Epidermal Nrf2 Orchestrates Tissue Regeneration through Direction Regulation of Ccl2
Authors: VILLARREAL PONCE ALVARO P. , TIRUNEH-WORKU MELAT , LEE JASMINE , DAVID JOSHUA A. , GUERRERO-JUAREZ CHRIS , DAMMEYER KRISTEN , KUHN JOSEPH , KWONG JENNIFER , CERADINI DANIEL 
Published: June 2020

Diabetic ulcers are costly chronic wounds and are the leading cause of lower-extremity amputations. Dysfunctional redox balance underlies a key part of diabetic wound repair pathology that results from misregulation of master antioxidant gene regulator Nrf2. While Nrf2 regulation is relevant for wound repair, how Nrf2 onsets a regenerative response is unclear. Using in-depth analyses, we uncover Nrf2 expression in keratinocytes to be vital for physiologic wound repair. In vivo spatio-temporal analysis shows deregulated nuclear translocation of Nrf2 in diabetic wound keratinocytes (WT: 96.97%±3.6%; Db: 22.50%±16.4%; p&lt;.005), which correlates with reduced activation of many antioxidant gene targets (p&lt;.005). To elucidate the role of Nrf2 in the epidermis, we utilized double transgenic mice to conditionally delete Nrf2 in keratinocytes (K14 CreER; Nrf2fl/fl; cKO) in vivo. Importantly, we find loss of epidermal Nrf2 results in a significant wound repair delay that reminisces delays observed in diabetic mice (WT: 16.0±0d; Db: 32±0d; cKO: 33±2d; p&lt;.0005). RNA-seq of cKO wound keratinocytes reveals Nrf2 regulates epidermal release of extrinsic cues that affect non-autologous responses that are critical for regeneration, most notably immune cell guidance (p&lt;.05). The magnitude of this signaling defect is shown through failure of cKO wounds to traffic monocyte/macrophages to the injury site (WT: 130.0±15.0cells/area; cKO 35.0±2.6cells/area; p&lt;.05). This defect results from reduced expression of Ccl2 in cKO wounds, which we find to possess a Nrf2-binding motif that exhibits dynamic Nrf2 binding upon wounding. Induced expression of Nrf2 in primary keratinocytes results in Ccl2 upregulation, and its application is sufficient for restoring physiologic wound regeneration in cKO and diabetic wounds (p&lt;.0001). We provide evidence describing an essential role of Nrf2 in regulating critical wound healing events and provide the basis for continued investigation on its therapeutic value.

Disclosure
A.P. Villarreal Ponce: None. M. Tiruneh-Worku: None. J. Lee: None. J.A. David: None. C. Guerrero-Juarez: None. K. Dammeyer: None. J. Kuhn: None. J. Kwong: None. D. Ceradini: None.

Funding
American Diabetes Association/Pathway to Stop Diabetes (1-16-ACE-08 to D.C.)
603-P: A Unique, Definitive, and Durable Solution for the Chronic Diabetic Foot Ulcer
Authors: FREED LEWIS 
Published: June 2020

The Problem: In spite of considerable effort and investment, definitive treatment for diabetic foot ulcers is lacking and recurrence is expected in many if not most instances. A novel treatment has been applied to this condition which employs ultrasonic energy to address the major pathophysiologic features of the condition.
Technique: An ultrasonic probe demonstrated effective in removing diseased tendon was applied to the management of the diabetic foot ulcer. Using 2-4 puncture sites the ultrasonic probe removes the thickened scar tissue that surrounds the non-healing wound crater. The probe is then introduced into the osseous prominence which is also removed using the ultrasonic probe. The scar and bone are aspirated through the hollow probe and removed from the field. The initial experience is limited to MW class 1-3 ulcers.
Materials and Methods: From Jan 2014 - Nov 2019, 105 ulcers were managed in this manner. The chronicity varied from a minimum of 3 months, to over 3 years (mean = 15 months). All patients had unsuccessfully undergone numerous traditional treatment modalities. The mean ulcer size was 20 mm and the men treatment time was 4.5 minutes. Patients were followed at weekly intervals until healed and at 3 month intervals subsequent to healing.
Results: At a mean time of 3.5 weeks (range 7- 42 days) 101/105 ulcers completely healed. At surveillance, 5 of the 101 healed ulcers recurred from 14 - 33 months. One patient developed a bacteremia and one a local cellulitis, both responding to antibiotics.
Conclusion: A single treatment with the ultrasonic probe as described has demonstrated a high rate of complete healing with a low recurrence and complication rate. The procedure is relatively inexpensive and easily learned by those experienced in managing this condition.

Disclosure
L. Freed: Stock/Shareholder; Self; Tenex Health.
62-LB: Psychosocial and Socioeconomic Well-Being as Determinants of Quality of Life and Glycemic Control in Haitian Youth with Diabetes
Authors: VINCENT ROSEMARIE , KAMAL ZAHRA , CORIOLAN BIDJINIE-STEFFY , ALTENOR KETLY , VON OETTINGEN JULIA E. 
Published: June 2020

In low- and middle-income countries (LMIC), youth with diabetes suffer from poor glycemic control even if free insulin and diabetes care are provided. In Haiti, health-related quality of life (HRQL) among youth with diabetes is low. We validated depression, self-esteem and self-management scales (Table 1) in Haitian youth with diabetes and evaluated them as well as perceived health, subjective and objective social status as determinants of glycemic control and HRQL. In 85 participants (59% female, mean age 17.5±5 years, mean diabetes duration 3.7±3.5 years, mean HbA1c 11.3±2.6%, mean HRQL 61±16 out of 100, mean satisfaction score 64±20 out of 100) mild, moderate and moderately-severe depression rates were 38%, 21% and 7% respectively, self-esteem score was 61±12 on a scale of 0 to 100 and perceived self-management score was 45±17 on a scale of 0 to 100. No measure predicted glycemic control (p&gt;0.05 for all). When adjusted for age, sex and diabetes duration, higher self-esteem (p=0.003), higher subjective SES (p=0.04) and lower depression score (p&lt;0.05) remained significant determinants of HRQL. Higher objective SES (p=0.01) and lower depression score (p=0.04) remained determinants of satisfaction. Depression and objective SES emerge as intervention targets while subjective psychosocial health emerges as a resilience worth nurturing to improve HRQL and life satisfaction.

Disclosure
R. Vincent: None. Z. Kamal: None. B. Coriolan: None. K. Altenor: None. J.E. von Oettingen: None.
621-P: Digital Diabetes Education Program Improves Knowledge, Self-Efficacy, and Health Behaviors among People with Type 2 Diabetes
Authors: WHITE ZACHARY , WOOLLEY RYAN , AMANAT SHEILA , MUELLER KELLY 
Published: June 2020

An estimated 21 million Americans, 8.6% of the U.S. population, self-report as having been diagnosed with type 2 diabetes. Diabetes is a disease that comes with confusion and uncertainties, especially at the time of diagnosis. The American Diabetes Association created a free, 12-month diabetes education program to help people with type 2 diabetes (PWD) learn more about their disease and how to improve their overall health and reduce their risk of complications. This digital program provides 6 e-booklets, monthly e-newsletters, a year subscription to the American Diabetes Association’s Diabetes Forecast magazine, and access to an online community and local events. Program content of the e-booklets includes information on diabetes management including medication, physical activity, and nutrition.
A study was conducted to assess program impact on 1) knowledge of diabetes 2) self-efficacy, and 3) health behaviors. An online survey was sent to participants at registration and again at the end of the 12-month program. Paired samples analysis was conducted to assess the individual level change across those who completed both surveys (N= 897).
After the program, an average of 58% of participants increased their knowledge of diabetes-related topics such as complications and healthy eating (p ≤ 0.001) and 46% of participants increased their confidence to manage their diabetes (p ≤ 0.001). In addition, self-reported participation in diabetes education classes increased 34% among participants (p ≤ 0.001).
This evidence demonstrates that a digital education program effectively increases PWD’s knowledge and confidence to manage their diabetes. A digital education platform can serve as an important resource for PWD, especially those who may face barriers to receiving formal diabetes education.

Disclosure
Z. White: Employee; Self; American Diabetes Association. R. Woolley: Employee; Self; American Diabetes Association. S. Amanat: None. K. Mueller: None.