bluuebunny/crossref_metadata_2025_split huggingface dataset:
1110-P: Effect of Raised Alanine Transaminase (ALT) Levels on HbA1c in the Association of British Clinical Diabetologists (ABCD) Nationwide Audits of SGLT2 Inhibitors (SGLT2i)
Authors: DESHMUKH HARSHAL , BICKERTON ALEX , PHILLIPS SUZANNE M. , EVANS ALISON , RAGHAVAN RAJEEV P. , SENNIK DEVESH K. , ROHILLA ANURITA , ADAMSON KAREN , YADAGIRI MAHENDER , GALLEN IAN W. , RYDER ROBERT E. , SATHYAPALAN THOZHUKAT 
Published: June 2020

Introduction: Alanine transaminase (ALT) is an important marker for Nonalcoholic Fatty Liver Disease (NAFLD), and its levels are reduced following treatment with SGLT2i. However, how raised ALT levels and hence NAFLD affects HbA1c response to SGLT2i is not known.
Methods: Data for this study was obtained from the ABCD nationwide audits of patients with type 2 diabetes started on SGLT2i. We used a gradient boosting machine learning algorithm (GBM) to identify if ALT is an important predictor of glycaemic response to SGLT2i. The results of the GBM model were confirmed using linear regression analysis where the absolute drop in HbA1c was modelled as a dependent variable with baseline ALT as independent variable adjusted for relevant covariates.
Results: We studied 9,609 patients initiated on Empagliflozin (n=5061), Dapagliflozin (n=3711) or Canagliflozin (n=837). The mean age of the study population was 59(±10.3), 62% male with a mean weight of 96.6(±18.8), baseline eGFR 81(±11) and baseline HbA1c 9.06% (±1.62). At a median 5.8 months follow-up, the mean HbA1c drop was 0.81% and was similar in all three types of SGLT2i. The drop in HbA1c was 0.62%, 0.78% and 1.01% in 1st 2nd and 3rd quartiles of baseline ALT, respectively (P-Anova &lt;0.0001). In the GBM analysis the important predictors of glycaemic response were baseline weight (relative influence (RI)=71%), and baseline HbA1c (RI= 7.2%), baseline ALT (RI= 5.6%) baseline creatinine (RI= 4.9%). The model accuracy was 0.73 (0.71-0.75) and area under the curve was 0.83. In the linear regression model, higher baseline ALT was associated with a larger drop in HbA1c (beta=0.007, P&lt;0.0001) after adjustments for baseline weight, weight loss, baseline HbA1c, and duration of diabetes.
Conclusion: Higher baseline ALT levels are associated with a more significant SGLT2 induced HbA1c drop and SGLT2 inhibitors and are likely to be more effective in those with NAFLD.

Disclosure
H. Deshmukh: None. A. Bickerton: None. S.M. Phillips: None. A. Evans: Other Relationship; Self; AstraZeneca. R.P. Raghavan: Research Support; Self; Allergan plc. Speaker’s Bureau; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Napp Pharmaceuticals, Takeda UK. Other Relationship; Self; Napp Pharmaceuticals. D.K. Sennik: Speaker’s Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi. A. Rohilla: None. K. Adamson: None. M. Yadagiri: None. I.W. Gallen: None. R.E. Ryder: Consultant; Self; GI Dynamics Inc. Other Relationship; Self; Novo Nordisk A/S. T. Sathyapalan: Research Support; Self; Amgen, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk A/S. Other Relationship; Self; Ipsen Biopharmaceuticals.
1121-P: Effectiveness of Sodium–Glucose Cotransporter 2 Inhibitors on Coronary Heart Disease Compared with Other Glucose Lowering Drugs
Authors: SHEN YUN , ZHOU JIAN , SHI LIZHENG , NAUMAN ELIZABETH , KATZMARZYK PETER T. , PRICE-HAYWOOD EBONI G. , CHU SAN , YANG SHENGPING , BAZZANO ALESSANDRA N. , NIGAM SOMESH , HU GANG 
Published: June 2020

Aims: This study compares the cardiovascular benefits between SGLT2 inhibitors and other glucose-lowering drugs (oGLDs) based on electronic medical record data from a large integrated delivery health system in South Louisiana.
Materials and Methods: Demographic, anthropometric, laboratory and medication prescription information for patients with type 2 diabetes who were new users of SGLT2 inhibitors either as initial treatments or as add-on treatments were obtained from electronic health records. Mediation analysis was performed in demonstrating the association of use of SGLT2 inhibitors and changes of metabolic risk factors with the risk of incident coronary heart disease.
Results: A total of 5,338 new users of SGLT2 inhibitors were matched with 13,821 patients using oGLDs. During a mean follow up of 3.26 years, 2,303 incident cases of coronary heart disease were defined. After adjusting for multiple confounding factors, patients using SGLT2 inhibitors had a lower risk of incident coronary heart disease compared to patients using oGLDs (hazard ratio [HR] 0.63; 95% confidence interval [CI] 0.55-0.72). Patients using SGLT2 inhibitors also had a lower risk of incident coronary heart disease within 6 months (HR 0.32; 95% CI 0.23-0.43), 12 months (HR 0.38; 95% CI0.31-0.48), 24 months (HR 0.49; 95% CI 0.41-0.59) and 36 months (HR 0.59; 95% CI 0.51-0.69), respectively. Reductions in systolic blood pressure attributed the lower risk of coronary heart disease among patients using SGLT2 inhibitors.
Conclusions: Evidence from real world data indicated the contribution of SGLT2 inhibitors to reducing risk of coronary heart disease, as well as the benefits beyond glucose-lowering.

Disclosure
Y. Shen: None. J. Zhou: None. L. Shi: None. E. Nauman: None. P.T. Katzmarzyk: None. E.G. Price-Haywood: None. S. Chu: None. S. Yang: None. A.N. Bazzano: None. S. Nigam: None. G. Hu: None.
1124-P: SGLT2 Inhibitors as Adjuvant Therapy for Type 1 Diabetes: An Italian Center Experience
Authors: PIERALICE SILVIA , TUCCINARDI DARIO , KYANVASH SHADI , MAGGI DARIA , MONTE LAVINIA , BRIGANTI SILVIA IRINA , MANFRINI SILVIA , POZZILLI PAOLO 
Published: June 2020

Background and Aim: Sodium-glucose co-transporter-2 (SGLT2) inhibitors are effective in improving glycemic control in both type 2 (T2D) and type 1 diabetes (T1D). Despite dapaglifozin has been recently approved as an adjunctive therapy in T1D, its use is still limited due to the increased risk of diabetic ketoacidosis (DKA). Aim of this study was to assess the effectiveness of SGLT2 inhibitors in combination with insulin in poorly controlled T1D patients.
Methods: In this retrospective observational study, data from 46 adults [M/F 29/17] affected by T1D treated with insulin plus dapaglifozin were collected. Glycated hemoglobin (A1c), anthropometrics, insulin daily requirement and time in range (TIR) were studied at baseline, 3 and 6 months after starting of treatment.
Results: At baseline, mean ± SD age was 32.7 ± 10.2 years, disease duration was 21.4 ± 9.3 years, A1c was 8.3 % ± 1.6. Insulin daily requirement was 0.9 ± 0.38 UI/Kg, whereas BMI was 26.7 ± 1.6 Kg/m2. After 6 months, Dapaglifozin 5 mg/day had significantly decreased A1c levels (change [Δ] -0.86%, p &lt; 0.01), body weight (Δ -2.5 kg, p &lt; 0.001) and insulin daily requirement (Δ -0.17 UI/kg, p &lt; 0.01) from baseline. Moreover, in a subgroup of patients (n=16) using continuous glucose monitoring (CGM) systems, statistically significant improvement of TIR (Δ +9%, p &lt; 0.01) has been observed, while time spent in hypoglycaemia did not change. No significant changes in C-peptide levels was observed (p = 0.09). No serious adverse events occurred during the study period. Discontinuation (10%) was mainly related to genitourinary infections, polyuria or limited effectiveness perceived.
Conclusion: Our real world experience confirms clinical benefits of SGLT2 inhibitors as an adjunctive therapy in poorly controlled T1D patients, ameliorating overall glycometabolic control as well as glycemic variability. Clinical characterization and proper education remain essential in order to identify the right candidate and to minimize DKA risk.

Disclosure
S. Pieralice: None. D. Tuccinardi: None. S. Kyanvash: None. D. Maggi: None. L. Monte: None. S. Briganti: None. S. Manfrini: None. P. Pozzilli: Advisory Panel; Self; Abbott, AstraZeneca, Eli Lilly and Company. Research Support; Self; Medtronic, Sanofi.
1125-P: Association of Plasma Volume with Body Weight and BNP after Long-Term Administration and Subsequent Withdrawal of the SGLT2 Inhibitor Tofogliflozin
Authors: MATSUBAYASHI YASUHIRO , YOSHIDA AKIHIRO , NOJIMA TOSHIAKI , SUGANAMI HIDEKI , FUJIHARA KAZUYA , KAKU KOHEI , SONE HIROHITO 
Published: June 2020

SGLT2 inhibitors (SGLT2is) promote diuresis and reduce plasma volume (PV). However, the impact of long-term administration and subsequent withdrawal of SGLT2is on PV is little known. This study investigated the effect of long-term administration and then withdrawal of the SGLT2i, tofogliflozin (TOFO), on PV and explored correlations with variables in type 2 diabetes mellitus (T2DM).
Analyzed were 166 T2DM patients who received TOFO for 52 weeks as initial monotherapy and underwent 2 weeks of withdrawal (week 54) in a phase-3 study. Percent change in estimated PV (%ΔePV) was calculated by the Strauss formula: {100*(pre Hb/post Hb)*[(100 - pre Ht)/(100 - post Ht)] - 100}. Baseline characteristics were: male (66%), age (mean: 58 y), HbA1c (8%), BMI (26kg/m2), BNP (12pg/mL) and eGFR (84mL/min/1.73m2). Paired t-tests analyzed differences from baseline to week 52 and from week 52 to 54. Correlation analysis was performed by Pearson’s product-moment correlation coefficients. Multivariate analysis explored predictors for %ΔePV.
Body weight (BW) [mean, -3kg (-5%)*; * p&lt;0.01 vs. baseline], ePV (-2.7%*) and ln-transformed BNP [ln-BNP: -0.1ln(pg/mL)*] had significantly decreased by week 52. %ΔBW was not significantly correlated with %ΔePV (r=-0.06) and Δln-BNP (r=0.13) while %ΔePV was significantly correlated with Δln-BNP (r=0.35). Higher baseline ln-BNP levels were independently correlated with greater reductions in %ΔePV. After 2 weeks of withdrawal, BW [+0.9kg (+1.3%)†, † p&lt;0.001 vs. week 52], ePV (+6.5%†) and ln-BNP [+0.3ln(pg/mL) †] were significantly increased. %ΔBW was significantly correlated with %ΔePV (r=0.22) and Δln-BNP (r=0.32). Also, %ΔePV was significantly correlated with Δln-BNP (r=0.30).
After long-term TOFO therapy, reduced PV might be correlated not with weight loss but with reduced BNP indicating fluid loss and baseline BNP might predict changed PV. Weight gain after TOFO withdrawal might be caused by fluid gain.

Disclosure
Y. Matsubayashi: None. A. Yoshida: Employee; Self; Kowa Company, Ltd. T. Nojima: Employee; Self; Kowa Company, Ltd. H. Suganami: Employee; Self; Kowa Company, Ltd. K. Fujihara: None. K. Kaku: Advisory Panel; Self; Nippon Boehringer Ingelheim Co. Ltd., Novo Nordisk Inc. Consultant; Self; Sanwa Kagaku Kenkyusho. Research Support; Self; Taisho Pharmaceutical Co., Ltd. Speaker’s Bureau; Self; Astellas Pharma Inc., AstraZeneca, Daiichi Sankyo, Eli Lilly Japan K.K., Kowa Company, Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Kyowa Hakko Kirin Co., Ltd., Novartis AG, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co.
1129-P: Effect of Sotagliflozin Added to Insulin Therapy on Beta-Hydroxybutyrate in Patients with Type 1 Diabetes
Authors: PETERS ANNE L. , DANNE THOMAS , SAWHNEY SANGEETA , BANKS PHILLIP L. , DAVIES MICHAEL J. , LAPUERTA PABLO 
Published: June 2020

Objective: To evaluate the effect of sotagliflozin (SOTA), a dual SGLT 1 and 2 inhibitor, on beta-hydroxybutyrate (BHB) over 52 weeks in adults with type 1 diabetes (T1D) on insulin therapy.
Methods: Analyses were performed on pooled data from two, 52-week, placebo-controlled studies in 1575 adult patients with T1D on optimized insulin therapy, who were randomly assigned 1:1:1 to placebo (PBO), SOTA 200 mg, and SOTA 400 mg. Descriptive statistics were performed on serum BHB using results from scheduled visits at baseline and Weeks 4, 12, 24, and 52. A 2-sample Wilcoxon rank sum test was performed to test the distribution of change in BHB from baseline between SOTA and placebo. The proportion of patients experiencing ≥1 measurement meeting predefined limits of DKA risk based on BHB levels (≥0.6 mmol/L “ketonemia” and ≥1.5 mmol/L “impending DKA”) was assessed.
Results: Median baseline BHB was 0.13 (IQR 0.10, 0.20), 0.13 (IQR 0.10, 0.22), and 0.14 mmol/L (IQR 0.10, 0.23) in the PBO, SOTA 200-mg, and SOTA 400-mg groups, respectively. While the median change in BHB was 0 mmol/L with PBO, median BHB increased from baseline by 0.03 to 0.05 mmol/L with SOTA, and generally remained stable over 52 weeks (p&lt;0.001 vs. PBO at each time point). Per the predefined limits of DKA risk based on BHB levels, a BHB level ≥0.6 mmol/L was experienced by 19.8, 46.9, and 45.5% and a BHB level ≥1.5 mmol/L in 2.1, 6.3, and 8.2% of patients on PBO, SOTA 200 mg, and SOTA 400 mg, respectively. Approximately 2/3 of the BHB ≥0.6 mmol/L events were observed by Week 16 and ∼2/3 of the BHB ≥1.5 mmol/L events were observed by Week 24.
Conclusion: Treatment with SOTA was associated with small increases in BHB over time, which on average remained well below the clinically important level of 0.6 mmol/L. Although the DKA incidence was &lt;4% overall on SOTA, the proportions of patients with ≥1 BHB measurement ≥0.6 mmol/L (∼45-47%) or ≥1.5 mmol/L (∼6-8%) suggest many BHB elevations were recognized and managed without progression to DKA.

Disclosure
A.L. Peters: Advisory Panel; Self; Abbott, Bigfoot Biomedical, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, MannKind Corporation, Medscape, Novo Nordisk Inc., Sanofi US. Consultant; Self; Livongo Health. Research Support; Self; Dexcom, Inc., vTv Therapeutics. Other Relationship; Self; Livongo Health, Mellitus Health, Omada Health, Stability Healthcare, Whole Biome Inc. T. Danne: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Novo Nordisk A/S, Sanofi. S. Sawhney: None. P.L. Banks: Employee; Self; Lexicon Pharmaceuticals, Inc. M.J. Davies: Employee; Self; Lexicon Pharmaceuticals, Inc. P. Lapuerta: Employee; Self; Lexicon Pharmaceuticals, Inc. Stock/Shareholder; Self; Lexicon Pharmaceuticals, Inc.
1138-P: Empagliflozin Ameliorates Kidney Injury in Diabetic Nephropathy via SIRT1 and TXNIP
Authors: LIANG RIYING , WANG MEIJUN , XU FEN , CAI MENGYIN 
Published: June 2020

SGLT2 inhibitor empagliflozin can slower the decline of eGFR and reduce the occurrence rate of end-stage kidney disease according to EMPA-REG OUTCOME Clinical Trail. However, the mechanism is still poorly understood. Sirtuin 1 (SIRT1) and Thioredoxin-interacting protein (TXNIP) are known to play important roles in metabolism-related disease, including diabetic nephroathy. To illustrate whether SIRT1 and TXNIP play roles in empagliflozin ameliorates high-fat diet induced kidney injury. In our study, the mouse mesangial cell SV40 MES 13 was cultured in 5.6 mmol/L glucose (NG)or 30mmol/L glucose(HG) with or without 50,250,500 or 1000nmol/L empagliflozin (HG+Empa-50; HG+Empa-250; HG+Empa-500;HG+Empa-1000) for 48 hours. Western Blot analysis showed that empaglifozin (500 nmol/L and 1000 nmol/L, respectively) could reverse the protein of Cleaved caspased3 expression induced by HG in SV40 MES 13 cells. In addition, empaglifozin significantly decreased TXNIP(50,250,500 and 1000 nmol/L, respectively) and increased SIRT1 protein levels(50,250,500 and 1000 nmol/L, respectively) in HG-induced SV40 MES 13 cells. Above all, when we treat cells with empaglifozin(500nmol/L and 1000nmol/L), the apoptosis was ameliorated and the expression of SIRT1,TXNIP was reversed that induced by HG. Collectively, the data indicates that the effect of empaglifozin on renoprotection is correlated with ameliorating the apoptosis in the kidney which may be via SIRT1 and TXNIP.

Disclosure
R. Liang: None. M. Wang: None. F. Xu: None. M. Cai: None.
1185-P: A Telemedicine-CGM Recommendation System for Personalized Population Health Management
Authors: VALLON JACQUELINE , WARD ANDREW T. , PRAHALAD PRIYA , HOOD KOREY K. , MAAHS DAVID M. , SCHEINKER DAVID 
Published: June 2020

CGM technology allows care teams to remotely monitor glucose levels of people with diabetes. Provider availability to monitor and contact people is limited. Individuals respond differently to CGM review calls; some people improve glucose control while others disengage. No mathematical framework exists to optimize population-level care while accounting for provider constraints and differences in people’s responses. We hypothesize that a care team’s call schedule can be optimized using predictive modeling and personalized recommendations.
We designed a recommendation tool that ranks people based on expected improvement in glucose management due to a call, incorporating people’s responsiveness. Individuals’ short- and long-term improvements after simulated previous calls were used to calculate the expected decrease in mean glucose due to a new call.
The tool is designed with 724,672 hours of CGM data from 120 individuals with T1D (63% new diagnosis, 57% ≤ 18 years), through Tidepool. For a daily capacity of 5 calls, the recommendation has a 29.1 mg/dL expected decrease in mean glucose in contacted people, while current practice has a 4.7 mg/dL decrease.
The tool allows for customizable care team constraints and adaptively learned responsiveness parameters. CGM and call data are currently being collected from pediatric patients with newly diagnosed T1D in our clinic, to tune and test the tool in a clinical setting.

Disclosure
J. Vallon: None. A.T. Ward: None. P. Prahalad: None. K.K. Hood: Research Support; Self; Dexcom, Inc. Speaker’s Bureau; Self; LifeScan, Inc., MedIQ. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care. D. Scheinker: None.
1189-P: Real-World Factors Associated with Use of Basal Insulin and Hypoglycemia in the Inpatient Setting
Authors: PANDYA ANJANI , NGUYEN STEFFANY , SALDIVAR VIDYA , SADHU ARCHANA R. 
Published: June 2020

Per current guidelines, our institution advocates using basal-bolus insulin regimens for inpatient hyperglycemia. However, it is a challenging practice in the real-world setting. Hypoglycemia is an unwanted consequence and a national quality metric for hospitals. We sought to characterize the factors around use of basal insulin and hypoglycemic events (HE) in our hospital system for quality improvement and to develop preventative strategies.
Between April-June 2018, 4130 admissions receiving basal insulin (glargine, NPH, or Mixed 70/30, 75/25) were retrospectively reviewed for HE, defined as glucose &lt;70 mg/dl. ICU and non-ICU patients were included. Insulin infusion or insulin pump therapy was excluded. Median age was 66 years, 48% were male and median A1C was 7.8%. In the entire cohort, 22% (923) had &gt;/= 1 HE. Of those, 76% had 1-3 HE and 24% had &gt;/= 4 HE per admission. The frequency of basal insulins were 75% glargine, 18% NPH, and 6% Mixed. Within 24 hours of the first HE, insulin dose was decreased in 42% receiving glargine, 66% NPH, and 59% mixed insulin by an average of 23%, 23% and 11%, respectively. Oral antidiabetic agents (OADs) were used concurrently in 16% of admissions with HE, of which sulfonylureas (SU) represented 43%, metformin 25%, and DPP-4i 26%. At the time of the HE, patients were on an oral diet in 73% of admissions, TPN or tube feeds in 6%, and NPO in 12%. In 75% of the HE, basal insulin was administered without the use of guideline-based hospital order sets and 83% of HE did not have an endocrinology consultation.
Our analysis demonstrates several key issues that need to be addressed around the recommended practice of basal insulin in the hospital setting. Among them, inadequate response in dose reduction after the first HE, underutilization of standardized order sets, concurrent use of OADs, particularly SU, add risk for HE. Endocrinology consultation is low, and the complicated nature of a basal-bolus insulin regimen as well as the many variables involved remain real world challenges.

Disclosure
A. Pandya: None. S. Nguyen: None. V. Saldivar: None. A.R. Sadhu: None.
120-LB: Small Molecule Activator of Pyruvate Kinase Regulates In Vivo Glucose Homeostasis
Authors: ABULIZI ABUDUKADIER , CARDONE REBECCA L. , SIEBEL STEPHAN , KUNG CHARLES , KIBBEY RICHARD 
Published: June 2020

Background: Nonalcoholic fatty liver disease (NAFLD) is a major factor in the pathogenesis of type-2 diabetes (T2D). Liver pyruvate kinase (PK) inactivating mutations are associated with diabetes in human subjects and PK deficiency associated with severe liver dysfunction and fat accumulation.
Aim: To determine whether small molecule activators of PK (PKa) could improve liver metabolism in rats fed a high fat diet.
Methods: Sprague Dawley regular chow (RC) or high fat diet (HFD) rats were either treated acutely (IV bolus 11mg/kg/min then primed continuous 0.06 mg/kg/min) or chronically (50 mg/kg/day x 3 weeks). Insulin sensitivity was assessed by hyperinsulinemic-euglycemic clamp studies.
Results: PKa dose dependently suppressed glucose production from primary rat hepatocytes. Acute PKa infusion suppressed endogenous glucose production (EGP) by 20% in RC rats. Chronic PKa exposure did not affect body weight in HFD-fed rats. Three-week PKa treatment did not change activity, food intake, whole-body energy expenditure, or body weight in HFD-fed mice. Nevertheless, PKa improved whole-body insulin sensitivity compared with control HFD-fed rats (glucose infusion rate: control 11.8±1.4 vs. PKa 15.3±0.7 mg/(kg-min), P&lt;0.05). Differences in whole-body insulin sensitivity were accounted for by a 15% reduction in EGP and increased insulin-stimulated peripheral glucose uptake (21.2±0.6 vs. 26.4±1.7 mg/(kg-min), P&lt;0.05). Insulin-stimulated hepatic AKT phosphorylation was also significantly improved. Consistent with improving of peripheral insulin sensitivity, liver and muscle triglyceride content (liver: 27.2±2.6 vs. 16.9±1.5 mg/g, P&lt;0.05. muscle: 9.8 ±1.4 vs. 6.7±1.0 mg/g, P&lt;0.05) were improved in PKa-treated rats.
In conclusion, activation of pyruvate kinase in rodents protects against HFD-induced insulin resistance. By reducing EGP and insulin resistance, activation of PK may be an exciting potential therapeutic target for T2D.

Disclosure
A. Abulizi: None. R.L. Cardone: None. S. Siebel: None. C. Kung: Employee; Self; Agios Pharmaceuticals. Stock/Shareholder; Self; Agios Pharmaceuticals. R. Kibbey: None.

Funding
American Diabetes Association (1-16-IBS-158 to R.K.); National Institutes of Health (R01DK108283-01A1)