bluuebunny/crossref_metadata_2025_split huggingface dataset:
1357-P: Gestational Diabetes Mellitus: Postpartum Metabolic Outcome and Risk Factors Involved
Authors: BARAN JESICA D. , ARANGUREN MARCELA I. , TAPPER MARIA X. , PAREDES MARIA S. , GENTILE MARIA BELEN , GRUD VALERIA , FERNANDEZ SANCHEZ MARY R. , NOGUEIRA JUAN PATRICIO , BOQUETE HUGO R. 
Published: June 2020

Gestational diabetes mellitus (GDM) is a highly prevalent clinical entity that prospectively allows to identify a population of women with a high risk of developing type 2 diabetes mellitus (T2DM). The rate of persistent metabolic abnormalities after delivery and the evidence regarding risk factors related are limited and variable.
Objectives: 1) To describe the prevalence of carbohydrate metabolism (CHM) abnormalities after childbirth in Argentine women with GDM. 2) To categorize risk factors involved in such abnormalities.
Methods: During the last 5 years, 165 women with diagnosis of GDM (according to ADA criteria) were evaluated. Patients with diagnosed or suspected pregestational diabetes, clinical relevance comorbidities and those in treatment with hyperglycemic drugs were excluded. FPG and 2-hours plasma glucose during a 75-g OGTT were performed from 6 weeks postpartum.
Results: In the reassessment, 106 women (64.2%) had normal parameters (NP) and 59 (35.8%) showed impared glucemic metabolism (IGM): IGT in 18, IFG in 25, both abnormalities in 13 and 3 developed T2DM. In the IGM group, 74.6% were 30 yr or older while in the NP group only 52.8% (p=0.006). In women with pathologic reevaluation, 18.5% had a history of previous GDM compared to 4.8% in the other group (p=0.005). In patients with IGM, 62.5% showed pre-pregnancy BMI ≥ 27 vs. 44.3% in those with NP (p=0,039). A logistic regression analysis was performed to identify the pregnancy factors that independently predict IGM. As expected, age ≥ 30 yr (OR 4.05, 95%CI 1.01-15.08) and previous GDM (OR 11.35, 95%CI 1.22-104.86) were associated significantly (p=0.037).
Conclusions: In our population, the analysis showed a high prevalence of CHM abnormalities following GDM. We found a higher risk for IGM in patients who had a history of previous GDM, age ≥ 30 yr and BMI ≥ 27. We therefore believe it is important to categorize risk factors in order to establish preventive therapeutic actions, particularly in cases with greater vulnerability.

Disclosure
J.D. Baran: None. M.I. Aranguren: None. M.X. Tapper: None. M.S. Paredes: None. M. Gentile: None. V. Grud: None. M.R. Fernandez Sanchez: None. J. Nogueira: None. H.R. Boquete: None.
1360-P: Infertility Is Not Associated with Clinical Factors in Women with Type 1 Diabetes (T1D)
Authors: ERKIN-CAKMAK AYCA , BAILEY RYAN , CALHOUN PETER , CAKMAK HAKAN , WONG JENISE C. 
Published: June 2020

Previous studies have shown adolescents with T1D diagnosed prior to menarche have an older age of menarche compared with those diagnosed after menarche and to the general population, and menstrual irregularity in women with T1D is more common than in those without T1D, suggesting that T1D may be associated with reproductive abnormalities. In this study, multiple regression models were used to explore the relationship between clinical factors and markers of reproductive health in 3528 women &gt;18 years (mean age 39±17 years) in the T1D Exchange Clinic Registry who had a 5-year follow-up. Average age of menarche was 13±2 years, and 13% reported irregular menstrual periods unrelated to pregnancy or menopause. Younger age at T1D diagnosis was significantly associated with older age at menarche (p=0.001) after adjustment for race/ethnicity, current BMI, and report of severe hypoglycemia (SH). Having an evaluation for infertility was reported by 6% of participants and was associated with lower mean hemoglobin A1c (A1c; OR 0.79, 95% CI 0.67-0.91 for a 1% increase in A1c) and current use of continuous glucose monitoring (CGM, OR 1.58, 95% CI 1.16-2.16). Seeking an infertility evaluation was not significantly associated with age at T1D diagnosis, autoantibody status, or current menstrual regularity. Additionally, having an abnormal infertility evaluation was not associated with mean A1c (OR 0.85, 95% CI 0.62-1.17) or current use of CGM (OR 1.62, 95% CI 0.91-2.91). There were also no factors that were both clinically and statistically significantly associated with miscarriage or problems conceiving a child. These results suggest that women with T1D who are likely to seek infertility evaluations may be more determined to maintain optimal glycemic control with technology such as CGM, or that concern about fertility may drive the decision to use CGM and lower A1c. This study highlights the need for prospective studies to assess the impact of T1D on fertility in women.

Disclosure
A. Erkin-Cakmak: None. R. Bailey: None. P. Calhoun: Stock/Shareholder; Self; Dexcom, Inc. H. Cakmak: None. J.C. Wong: Consultant; Self; pH Pharma. Research Support; Self; Dexcom, Inc.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust (G-2016PG-T1D053)
1362-P: Influence of Ethnicity on the Association between Body Mass Index and Prevalence of Gestational Diabetes
Authors: READ STEPHANIE , BERGER HOWARD , FEIG DENICE , FLEMING KAREN , RAY JOEL G. , SHAH BAIJU R. , LIPSCOMBE LORRAINE 
Published: June 2020

Gestational diabetes (GDM) prevalence increases with increasing body mass index (BMI), and evidence suggests that the association may vary by ethnicity. Using a cross-sectional study, we examined the association between BMI and GDM by ethnicity. Data were obtained from administrative health datasets for all of Ontario, Canada. Using a validated algorithm, we identified Chinese and South Asian maternal ethnicity; all others were categorized as the general population. GDM was ascertained through hospital and claims records. The study population consisted of women without pre-existing diabetes who had a livebirth between April 2012 and March 2014. The relation between pre-pregnancy BMI and GDM was modeled using adjusted logistic regression, stratified by ethnicity. The study population consisted of 231,618 women, of whom 10,895 (4.7%) developed GDM. The prevalence of GDM was 9.9% among South Asians, 8.2% among Chinese and 4.3% of the general population of women. Compared to a normal BMI, having an overweight BMI (25-30 kg/m2) was associated with a higher aOR of GDM among Chinese (1.96, 95% CI: 1.50-2.56), South Asian (1.87, 1.47-2.36) and the general population of women (1.84, 1.69-2.01) (Figure). GDM prevalence is considerably higher across all levels of BMI in South Asian and Chinese women compared with the general population, suggesting the need for an ethnicity-specific screening approach for GDM.

Disclosure
S. Read: None. H. Berger: None. D. Feig: Advisory Panel; Self; Novo Nordisk A/S. Speaker’s Bureau; Self; Medtronic. K. Fleming: None. J.G. Ray: None. B.R. Shah: None. L. Lipscombe: None.

Funding
Diabetes Action Canada (PSI19-23)
1365-P: Type 2 Diabetes after Gestational Diabetes, a High-Risk Population
Authors: WOOD ANNA , BOYLE JACQUELINE , BARZI FEDERICA , BARR ELIZABETH L. , HARE MATTHEW J.I. , TITMUSS ANGELA , DEATH ELIZABETH , KIRKWOOD MARIE , SIMMONDS ALISON , MOORE ELIZABETH M. , OATS JEREMY , MCINTYRE DAVID , ZIMMET PAUL Z. ,   ESQ., BROWN ALEX D. , SHAW JONATHAN E. , MAPLE-BROWN LOUISE J. 
Published: June 2020

Aboriginal and Torres Strait Islander women have high rates of gestational diabetes (GDM). The Pregnancy And Neonatal Diabetes Outcomes in Remote Australia (PANDORA) study is a prospective longitudinal cohort of women with type 2 diabetes (T2D), GDM or normoglycemia in pregnancy in the Northern Territory, Australia. In this analysis we report progression to prediabetes and T2D at 2.5 years [range 2.1, 3] postpartum in a subgroup of Aboriginal and Europid women with GDM and normoglycemia in pregnancy (n=337). Women with pre-existing T2D were excluded. Data were analysed using Fisher’s exact tests. Among Aboriginal women with GDM we assessed predictions for progression using multivariate logistic regression. Aboriginal women with GDM (n=111) were younger than Europid women with GDM (n=104) (29 years (SD 5.9) vs. 32 (5.6) p&lt;0.01), with similar first trimester BMI (28.9 kg/m2 (SD 7.2) vs. 28.5 (6.7) p=0.64). Of Aboriginal women with GDM, 24 (22%) progressed to T2D and 12 (11%) to prediabetes. Of Aboriginal women with normoglycemia (n=60), 1 (2%) progressed to T2D and 1 (2%) to prediabetes (p&lt;0.01 for combined outcome vs. GDM women). Of Europid women with GDM, none progressed to T2D and 4 (4%) to prediabetes and of those with normoglycemia (n=62) none progressed to diabetes or prediabetes (p=0.09 vs. GDM women). Among Aboriginal women with GDM, factors associated with postpartum diabetes or prediabetes were age (OR 1.11, 1.03-1.2) and, after adjusting for age: severity of GDM (higher fasting plasma glucose (per 1 mmol/L OR 2.11, 1.23-3.62), use of insulin (OR 3.20, 1.35-7.6)) and higher first trimester BMI (per 3 kg/m2 OR 1.22, 1.01-1.47). Not smoking was protective (OR 0.35, 0.14-0.90), although any breastfeeding at 6-months postpartum was not (OR 0.95, 0.36-2.47). To our knowledge this is the only prospective study of Aboriginal and Torres Strait Islander women with GDM. We report the highest rates in the world of T2D after GDM at 2.5 years postpartum, highlighting a need for targeted interventions in this high-risk population.

Disclosure
A. Wood: None. J. Boyle: None. F. Barzi: None. E.L. Barr: None. M.J.I. Hare: None. A. Titmuss: None. E. Death: None. M. Kirkwood: None. A. Simmonds: None. E.M. Moore: None. J. Oats: None. D. McIntyre: Other Relationship; Self; Novo Nordisk A/S. P.Z. Zimmet: None. A.D. Brown: None. J.E. Shaw: Advisory Panel; Self; AstraZeneca, Merck Sharp & Dohme Corp., Mylan, Sanofi. Research Support; Self; AstraZeneca. Speaker’s Bureau; Self; Eli Lilly and Company, Mylan. L.J. Maple-Brown: None.
1367-P: Risk and Indications for Cesarean Delivery among Women with Diabetes in the United States
Authors: GRASCH JENNIFER , MILLER KATHERINE , HAAS DAVID , TUULI METHODIUS , SCIFRES CHRISTINA M. 
Published: June 2020

Women with diabetes are at increased risk for cesarean delivery, but there is a paucity of data examining practice patterns associated with indication for cesarean delivery among women with and without diabetes. We conducted a secondary analysis of the Consortium on Safe Labor data to evaluate cesarean delivery practices among women with gestational diabetes (GDM) and pregestational diabetes in a large U.S. cohort.
Of the 191,174 women, 9,791 (5.1%) had GDM and 2,792 (1.4%) had pregestational diabetes. The overall cohort cesarean delivery rate was 30%. After adjusting for covariates, cesarean delivery rates were higher for women with GDM (28 vs. 45%, aOR 1.44, 95% CI 1.36-1.54) and pregestational diabetes (28 vs. 59%, aOR 2.21, 95% CI 1.99-2.46). Women with GDM and pregestational diabetes were more likely to undergo pre-labor cesarean delivery. Because indications for cesarean delivery may differ by maternal parity, stratified analyses were performed in nulliparous and multiparous women by diabetes type. Elective cesarean delivery and cesarean delivery for macrosomia were more common among women with diabetes, while cesarean delivery for failure to progress was less likely (Table). These data suggest that encouraging an attempt of vaginal delivery in women with diabetes and no contraindications may be one strategy to reduce the risk for cesarean delivery in this high-risk population.

Disclosure
J. Grasch: None. K. Miller: None. D. Haas: None. M. Tuuli: None. C.M. Scifres: None.
1375-P: Gestational Diabetes–Associated Changes in the Circulating Exosomes in Fetal Circulation Revealed a Potential Role of These Nanovesicles in Fetal Growth and Metabolism
Authors: ORMAZABAL VALESKA , SCHOLZ-ROMERO KATHERIN , NAIR SOUMYALEKSHMI , GUANZON DOMINIC , ZUNIGA FELIPE , MCINTYRE DAVID , LAPPAS MARTHA , SALOMON CARLOS 
Published: June 2020

The link between metabolic disorders during pregnancy and high risk of developing chronic noncommunicable diseases in later life has been well established. However, why the fetuses exposed to GDM have a higher risk of abnormal glucose homeostasis in later life, is still not fully understood. Exosomes have been well characterised in maternal circulation in normal and gestational diabetes pregnancies, however, the little is known about the profile of exosomes in fetal circulation. In this study, we isolated exosomes from cord-blood from women with normal tolerance glucose (NGT, n=35) and GDM (n=40) at the time of delivery. The miRNA content of exosomes was determined using a small RNA sequencing. The levels of circulating exosomes were significantly higher in GDM compared to NGT (p&lt;0.05). Linear regression analysis identified a positive association between fetal length, maternal BMI and the levels of circulating exosomes in GDM, while no significant association was observed for NGT. Analysis of the miRNA within exosomes identified a range of miRNAs differentially expressed between NGT and GDM samples. Principal component analysis reveals a separation of the groups based on their miRNA profile. The miRNA contributing the most to this separation between normal and GDM conditions is miR-22-3p, thus this miRNA may be a key candidate for future GDM diagnostic strategies. Gene Ontology analysis shows that the miRNAs identified in exosomes regulate genes involved in insulin secretion in response to glucose stimulus, insulin receptor signalling, and glucose homeostasis. Thus, these data suggest that exosomes may alter gene expression and ultimately the cell phenotype by transferring specific miRNAs to target cells.

Disclosure
V. Ormazabal: None. S. Nair: None. D. Guanzon: None. F. Zuniga: None. D. McIntyre: Other Relationship; Self; Novo Nordisk A/S. M. Lappas: None. C. Salomon: None.

Funding
Diabetes Australia; Fondo Nacional de Desarrollo Científico y Tecnológico (1170809, 1190522)
138-LB: First-in-Human Study of YG1699, an SGLT1 and SGLT2 Dual Transporter Inhibitor
Authors: LI CHENGHAI , LI TONG , LEE FRANK , XU ROGER H. , WANG HELEN 
Published: June 2020

YG1699 is an orally-delivered, small molecule drug candidate that inhibits both the sodium glucose transporter 1 (SGLT1, IC50 = 16.6 nM) and the sodium glucose transorter 2 (SGLT2, IC50 = 1.49 nM). In the preclinical studies, YG1699 could suppress plasma glucose increases following acute glucose challenges in rat oral glucose tolerance tests, and decrease plasma glucose levels in db/db mice in a dose dependent manner. YG1699 can suppress intestinal glucose absorbance and increase both urine and fecal glucose excretion. In addition, YG1699 could significantly increase plasma GLP-1 and PYY levels in animal models. In this upcoming conference, we would like to report our first-in-human clinical trial for YG1699. This clinical study was conducted in USA (Identifier: NCT03953092) with 64 healthy volunteers participated in this single ascending dose (SAD) and multiple ascending dose (MAD) as well as food effect studies. In this Phase 1 clinical trial, YG1699 was well tolerated at all dose levels and produced a dose-dependent increase in urinary glucose excretion in both SAD and MAD studies. YG1699 also demonstrated a very good pharmacokinetic profile with linear, and dose-dependent exposure. The data also show that YG1699 has adequate half-life that can support once daily dosing in Phase II clinical trials. Adverse events were low and generally mild and no SAEs were observed.

Disclosure
C. Li: None. T. Li: None. F. Lee: None. R.H. Xu: None. H. Wang: Board Member; Self; Youngene Therapeutics. Stock/Shareholder; Self; Youngene Therapeutics.
138-OR: Elevated Triglycerides as a Risk Factor for Postpartum Abnormal Glucose Metabolism in Chinese Women with Previous Gestational Diabetes
Authors: LAI MENGYU , FANG FANG , WANG YUFAN 
Published: June 2020

Background: Whether elevated triglyceride (TG) levels during pregnancy can affect postpartum glucose metabolism in women with previous gestational diabetes mellitus (GDM) remained unknown. The aim of this study was to investigate the association between TG levels during the second trimester and postpartum abnormal glucose metabolism (AGM) in GDM women.
Methods: This was a retrospective cohort study including 513 GDM women. A 75 g oral glucose tolerance test (OGTT) was performed, and lipid levels were determined during pregnancy and the postpartum period. GDM patients were categorized into tertiles according to their TG levels at 24-28 weeks of gestation (TG&lt;2.14 mmol/L, TG: 2.14-2.89 mmol/L and TG&gt;2.89 mmol/L). A logistic regression model was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs).
Results: During pregnancy, women in the high TG tertile showed higher HbA1c levels (5.47±0.58% versus 5.28±0.49%, p=0.006), higher total cholesterol (TC) levels (5.85±1.23 mmol/L versus 5.15±0.97 mmol/L, p=0.026) and higher HOMA-IR [2.36 (1.62-3.45) versus 1.49 (0.97-2.33), p&lt;0.001] than the participants in the low TG tertile. After delivery, the prevalence rates of postpartum AGM based on above tertiles of TG levels during pregnancy were 26.90%, 33.33% and 43.27%, respectively (p=0.006). High TG tertile during the second trimester was associated with postpartum AGM (adjusted OR: 1.869, 95% CI: 1.104-3.165, p=0.020).
Conclusions: The elevated TG levels during pregnancy were not only accompanied by higher glucose and lipid levels and more severe insulin resistance at the time of the measurement, but were risk factors for postpartum AGM as well.

Disclosure
M. Lai: None. F. Fang: None. Y. Wang: None.

Funding
National Natural Science Foundation of China (81870610); Shanghai Science and Technology Commission Foundation (18411968800); Shanghai General Hospital (CTCCR-2018C13)
1384-P: Changes in OGTT-Based Measures of Insulin Secretory Response across Pregnancy
Authors: POWE CAMILLE E. , LOCASCIO JOSEPH J. , CATALANO PATRICK 
Published: June 2020

Background: We previously showed that insulin response to an IV glucose load increases in early pregnancy, independent of changes in insulin sensitivity. It is unknown whether oral glucose tolerance test (OGTT)-based measures of insulin secretory response (ISR) capture the same phenomenon.
Methods: This is a secondary analysis of a longitudinal study. Participants (N=31) were studied pre-pregnancy and in early (12-14 wks) and late (34-36 wks) gestation. On separate days, after overnight fasts, an OGTT (75g pre-pregnancy/100g in pregnancy) and an hyperinsulinemic-euglycemic clamp were performed. We calculated Insulinogenic index (IGI), Corrected insulin response (CIR), insulin/glucose area under the curve (AUCins/AUCglu), and Stumvoll 1st Phase Estimate (Stumvoll) from OGTT insulin and glucose levels. Linear mixed effects models examined ISR in early as compared to pre- and late pregnancy; we adjusted p-values for 2 comparisons. Adjusted models included insulin sensitivity, measured with the clamp, as a time-dependent covariate.
Results: IGI (adjusted mean ± SEM) increased between pre- and early pregnancy (1.25 ± 0.13 vs. 1.52 ± 0.15, P&lt;0.05) and remained stable between early and late pregnancy (1.41 ± 0.14, P=0.42). Findings did not change after adjustment for insulin sensitivity (pre:1.29 ± 0.13 vs. early: 1.59 ± 0.16, P=0.03; early vs. late: 1.31 ± 0.16, P=0.32). Changes in CIR were similar. AUCins/AUCglu increased from pre- to early pregnancy (0.47 ± 0.05 vs. 0.55 ± 0.05 P=0.03) and increased further from early to late pregnancy (0.79 ± 0.07, P&lt;0.01). The increase in AUCins/AUCglu between pre- and early pregnancy was independent of changes in insulin sensitivity (0.50 ± 0.04 vs. 0.66 ± 0.05, P&lt;0.01), but the increase between early and late pregnancy (0.65 ± 0.07) was not apparent after adjusting for insulin sensitivity (P&gt;0.99). The results for Stumvoll were similar.
Conclusion: OGTT-based ISR indices capture an insulin sensitivity-independent augmentation of insulin secretion in early pregnancy.

Disclosure
C.E. Powe: None. J.J. Locascio: None. P. Catalano: None.

Funding
National Institutes of Health (K23DK113218); Robert Wood Johnson Foundation; Harold Amos Medical Faculty Development Award
1389-P: Low Muscle Mass and Risk of Development of Type 2 Diabetes in Korean Women with Previous Gestational Diabetes Mellitus
Authors: SHIN YUJIN , OH TAE JUNG , CHOI SUNGHEE , JANG HAK CHUL 
Published: June 2020

Objective: The purpose of this study is to evaluate if low muscle mass increases risk of T2D in women with previous gestational diabetes mellitus (pGDM).
Methods: A total of 378 women with pGDM (mean age: 35.6 ± 3.9 years) was prospectively evaluated for incidence of T2D. GDM was diagnosed with 75g or 100g oral glucose tolerance test (OGTT) during 24-28 week gestational age. Reclassification of glycemic status was performed with 75g OGTT at 2 months after delivery and lean body mass (LBM) was assessed with bioelectrical impedance analysis (Inbody720, Seoul, Korea). LBM was divided by BMI and this index was divided into 3 tertiles: lowest ≤0.88 (N=107), middle 0.89-0.97 (N=111), highest ≥0.98 group (N=99). The primary outcome was incidence of T2D up to 1 year follow up.
Results: The lowest muscle group developed T2D (p=0.007) more than higher muscle groups. The trend for risk developing prediabetes and T2D was significantly increased according to LBM/BMI tertiles (p for trend=0.002). After adjusting family history of T2D, extent of gestational hyperglycemia and waist circumference, lowest group demonstrated HR for developing T2D 6.6 [CI 1.36 to 32.25], p=0.01, compared to the highest group.
Conclusion: Lower muscle mass is an independent risk factor for T2D in pGDM. Therefore, it is important to examine muscle mass during risk assessment for T2D in Korean non-obese women with pGDM.

Disclosure
Y. Shin: None. T. Oh: None. S. Choi: None. H. Jang: Speaker’s Bureau; Self; Daiichi Sankyo, Handok, Pfizer Inc., Takeda Pharmaceutical Company Limited.
140-LB: Effect of Vaginal Estrogen as Hormone Replacement Therapy for Menopause on SGLT2 Inhibitor–Associated Urinary Tract Infection: A Prospective Cohort Study
Authors: GAUTAM ASHISH , AGRAWAL PRABHAT K. , PURSNANI NIKHIL , RANI RUCHI 
Published: June 2020

Introduction: Estrogen deficiency after menopause is an important predisposing factor for recurrent UTI (r UTI). Vaginal application of estrogen as “hormone replacement therapy (eHRT)” for prevention of menopause associated r UTI has moderate recommendation and evidence level grade B by AUA/CUA/SUFU guidelines 2019. Glycosuria with use of SGLT 2I among T2DM, increase risk of r UTI by 4-9%. SGLT2 I use among T2DM, post-menopausal females may further increase risk of r UTI.
Aim and Objective: This study was designed to observe (1) the Risk and frequency of UTI due to SGLT2 I among post-menopausal females with T2DM and (2) Preventive effect of vaginal e HRT for r UTI among them.
Methods: Forty-two, post-menopausal females having T2DM, using vaginal e HRT were selected as cases whereas controls were 38 matched females not using e HRT. Subjects in both groups were prescribed SGLT2 I considering eligibility and simultaneously adjusted the doses of other OHA’s or insulin to maintain the glycemic targets. They were targeted to follow for 12 months and evaluated periodically for symptomatic UTI and maintenance of glycemic targets. Diagnosis of symptomatic UTI was made using standard definition and guidelines.
Result: The 42 cases who were using vaginal e HRT (M = 2.5, SD = 1.5) compared to the 38 controls who were not using e HRT (M = 3.5, SD = 1.6) demonstrated significantly lesser frequency of UTI, t (78) = -2.56, p = .012. All the episodes of symptomatic UTI among cases were uncomplicated whereas 1 episode of UTI among 4 comparators forced for withdrawal of SGLT2 I and exclusion from observation period. The Fisher exact test statistic value is 0.0467. The result is significant at p &lt; .05.
Conclusion: Estrogen HRT after menopause significantly reduces the frequency of UTI among T2DM females using SGLT2 I. Not using eHRT in these group of subjects may significantly increase risk of complicated UTI.

Disclosure
A. Gautam: None. P.K. Agrawal: None. N. Pursnani: None. R. Rani: None.