bluuebunny/crossref_metadata_2025_split huggingface dataset:
1529-P: State-Level Prevalence of ABC Control among Adults with Self-Reported Diabetes in 2013-2016
Authors: CHEN YU , ROLKA DEBORAH B. , XIE HUI , SAYDAH SHARON 
Published: June 2020

Individuals with diabetes (DM) are at high risk of heart attack and other diabetes complications. Control of Hemoglobin A1c, Blood Pressure, and Cholesterol (ABC) can be effective in preventing these complications. However, studies that assess the state-level prevalence of ABC control within the DM population are lacking. This study aims to estimate the state-level proportions of adults with self-reported diagnosed DM meeting the goals of ABC control in the 50 U.S. states and the District of Columbia. We applied weighting adjustments to data from 2013-2016 National Health and Nutrition Examination Survey (NHANES), 2016 American Community Survey (ACS), and 2016 Behavioral Risk Factor Surveillance System (BRFSS) to create state-level estimates. To adjust NHANES national weights to reflect the demographic characteristics of states, we used raking to adjust BRFSS weights to the ACS on age, sex, race, health insurance status, education and income, and then used the propensity score method to adjust NHANES to the ACS-adjusted BRFSS on these variables plus self-reported overall health status. We defined ABC control as A1C &lt; 9%, blood pressure (BP) &lt; 140/90 mmHg, and non-HDL cholesterol (non-HDL-C) &lt; 130 mg/dL. Among adults with DM, 38% (95% CI 30.8%-45.2%) of patients met the goal of ABC control, with the highest rate of 43.7% (36.1%-51.3%) in South Dakota and the lowest rate of 32.9% (27.3%-38.5%) in the District of Columbia. Control rates of A1C were highest in each state, followed by BP and non-HDL-C. Overall, 86.6% (82.3%-90.9%) of patients had controlled A1C, 72.6% (67.0%-78.2%) had controlled BP, and 58.7% (52.9%-64.5%) had controlled non-HDL-C. Control rates for each individual goal varied by state. ABC control is suboptimal among adults with DM and varies by state. Our estimates provide data that public health departments could use in their planning efforts to improve ABC control and thus reduce DM-related complications at the state level.

Disclosure
Y. Chen: None. D.B. Rolka: None. H. Xie: None. S. Saydah: None.
1532-P: Investigating Biomarkers of the Immune Response and Tissue Remodeling in Patients with Type 2 Diabetes with Microalbuminuria
Authors: RASMUSSEN DANIEL G.K. , HANSEN TINE W. , MØLLER ALEXANDRA , FRIMODT-MØLLER MARIE , VON SCHOLTEN BERNT JOHAN , JACOBSEN PETER K. , PARVING HANS-HENRIK D. , KARSDAL MORTEN A. , ROSSING PETER 
Published: June 2020

Type 2 diabetes (T2D) is a common risk factor for the development of renal fibrosis and chronic kidney disease. Owing to the nature of diabetes, an increased inflammation and an altered turnover of extracellular matrix (ECM) proteins is seen. Despite ample evidence, few studies have focused on an integrated comparison of various biomarkers of the immune response, growth factors and ECM turnover. We evaluated a comprehensive list of biomarkers including interleukin-1, 6, and 8, VCAM-1, ICAM-1, TNFα, E- and P-selectin, FGF23, YKL40, NT-proBNP, type III collagen degradation (C3M) and type VI collagen deposition (PRO-C6) in 190 patients with T2D with microalbuminuria followed for 6.1 years. Investigated endpoints included all-cause mortality (n=26), a composite of cardiovascular events (CVE; n=37), and decline in eGFR of &gt;30% (deGFR, n=41). Using forward selection in Cox proportional hazard analysis we investigated which biomarkers and traditional risk factors (sex, age, systolic blood pressure, LDL-cholesterol, smoking, HbA1c, creatinine and urinary albumin excretion rate) that were retained in the final model for predicting the outcomes. Hazard ratios with 95% confidence intervals are presented per one standard deviation. For all-cause mortality, smoking (3.85 [1.68-8.83], p=0.002), PRO-C6 (1.53 [1.15-2.03], p=0.004), NT-proBNP (1.59 [1.22-2.08], p=0.0006) and ICAM-1 (1.36 [1.06-1.73], p=0.014) were retained in the final model. For CVEs, age (2.00 [1.21-3.30], p=0.007), LDL (1.37 [1.05-1.78], p=0.02), NT-proBNP (1.42 [1.11-1.81], p=0.006) and TNFα (1.35 [1.13-1.60], p=0.0007) were retained. For deGFR, urinary albumin excretion rate (1.31 [1.00-1.71], p=0.049), PRO-C6 (1.41 [1.09-1.83], p=0.009) and NT-proBNP (2.05 [1.54-2.74], p&lt;0.0001) were retained.
In conclusion, our investigations highlight that the best models for predicting outcome may be found by combining biomarkers of cardiac injury, ECM remodeling and the immune response.

Disclosure
D.G.K. Rasmussen: Employee; Self; Nordic Bioscience. T.W. Hansen: None. A. Møller: None. M. Frimodt-Møller: None. B. von Scholten: Employee; Self; Novo Nordisk A/S. P.K. Jacobsen: None. H.D. Parving: None. M.A. Karsdal: Stock/Shareholder; Self; Nordic Bioscience. P. Rossing: Advisory Panel; Self; Sanofi. Consultant; Self; Astellas Pharma Inc., AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Boehringer Ingelheim International GmbH, Gilead Sciences, Inc., Novo Nordisk A/S. Research Support; Self; Novo Nordisk A/S. Speaker’s Bureau; Self; Eli Lilly and Company. Stock/Shareholder; Self; Novo Nordisk A/S.

Funding
Danish Research Foundation
1544-P: Associations between Dietary Factors and Serum Aryl Hydrocarbon Receptor Bioactivity as a Biomarker of Persistent Organic Pollutants in Prediabetic Population
Authors: CHON SUK , LIM HYUNJUNG , KIM JIEUN , OH SEUNGJOON 
Published: June 2020

Aim: Many studies suggest that the persistent organic pollutants (POPs) is a risk factor of type 2 diabetes. The relationship between dietary factors and POPs has been explored recently. POPs are fat-soluble substances that accumulate through the consumption of high fat diets, fish, meat and dairy products. Vegetables and fruits are known to prevent the accumulation of POPs. We aimed to examine the associations between dietary factors and serum cumulative bioactivity of AhR ligand mixture (AhRB) as a biomarker of POPs in subjects at high risk for type 2 diabetes.
Methods: We performed a cross-sectional analysis of 304 prediabetic subjects using the Korea National Diabetes Program cohort data. AhRB was divided into quartiles according to the concentrations. (Q1 (the lowest quartile): (Q1 (the lowest quartile): 1.7±0.3, Q2: 2.4±0.2, Q3:3.1±0.2, Q4 (the highest quartile): 3.9±0.2). Socio-demographic, health related-behaviors, and dietary factors were assessed. Dietary factors were collected from the 3-day dietary records and food frequency questionnaire.
Results: Starting with the Q1 of AhRB, adjusted mean concentrations of serum triglycerides were 147.06±12.97, 151.30±12.64, 125.80±13.19 and 166.78±13.76 mg/dL for ascending quartiles, respectively (P&lt; 0.05). In the 3Q of AhRB, the highest consumption of sugars (Q3: 13.6±11.6g, P=0.016) and dairy products (Q3: 117.0±126.6g, P=0.032) were shown compared to those of other three groups. On multiple linear regression analysis, high consumption of dairy products (P&lt; 0.05) and fried fish with oil (P &lt; 0.05) were significantly positive associated with serum AhRB concentration after adjusting covariates.
Conclusion: This study found an association between dietary factors and AhRB level, however, further longitudinal studies are needed to clarify the effects of these dietary factors on POP levels.

Disclosure
S. Chon: None. H. Lim: None. J. Kim: None. S. Oh: None.
1549-P: Race and Gender Differences in the Initiation of Recently Approved Diabetes Drugs by Privately-Insured U.S. Adults
Authors: MCCOY ROZALINA G. , HOUTEN HOLLY VAN , DUNLAY SHANNON M. , YAO XIAOXI , DEMPSEY TIMOTHY , NOSEWORTHY PETER , SANGARALINGHAM LINDSEY R. , LIMPER ANDREW H. , SHAH NILAY 
Published: June 2020

Three new classes of glucose-lowering drugs were introduced into practice over the past 15 years. DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors have low hypoglycemia risk, do not cause weight gain, and GLP-1RA and SGLT2i have additional cardiovascular and renal benefits. We previously found low rates of early SGLT2i use by women and black patients, but more recent data and data for other drugs were lacking. Using OptumLabs Data Warehouse, a de-identified dataset of commercially-insured and Medicare Advantage beneficiaries, we identified adults with type 2 diabetes who first started a DPP-4i (n=140,933), GLP-1RA (n=107,331), SGLT2i (n=112,892), or any other diabetes drug (n=1,743,484) between 2013-2018. Odds of starting each medication class were examined in separate logistic regression models for white women (WW), non-white men (NM), and non-white women (NW) compared to white men, adjusting for other factors affecting drug choice (Figure). Results were mixed, as depicted by the Figure. Our study design cannot identify the causes of preferential use of DPP-4i among non-white patients, or the preferential avoidance of SGLT2i among women and NM and of GLP-1RA among NW. Because these drugs have important safety and efficacy benefits, our findings call for closer examination of potential implicit biases surrounding medication prescribing and diabetes management.

Disclosure
R.G. McCoy: None. H. Van Houten: None. S.M. Dunlay: None. X. Yao: None. T. Dempsey: None. P. Noseworthy: None. L.R. Sangaralingham: None. A.H. Limper: None. N. Shah: None.

Funding
National Institutes of Health (K23DK114497)
1581-P: Circulating Metabolites Are Associated with Glycemic Measures in South Asians
Authors: GADGIL MEGHANA D. , SANDS CAROLINE , LEWIS MATTHEW R. , KANAYA ALKA M. , KANDULA NAMRATHA R. , HERRINGTON DAVID M. 
Published: June 2020

South Asians are at higher risk for diabetes (DM) than many other racial/ethnic groups. Circulating metabolites are measurable products of metabolic processes that may explain the etiology of elevated risk. We characterized metabolites associated with prevalent DM and incident glycemic measures in South Asians. We included 717 participants in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, aged 40-84 years. We used baseline fasting serum for metabolomics and demographic, behavioral, glycemic data from baseline and at 5 years. We performed LC-MS untargeted metabolomic and lipidomic analysis with targeted integration of known signals. Individual linear and ordinal logistic regression models were adjusted for age, sex, BMI, diet, exercise, alcohol, smoking and family history of DM followed by elastic net regression to identify metabolites most contributory to the outcome. There were 258 metabolites with detectable signal in &gt;98% of samples. Fifty-nine metabolites were associated with prevalent DM, 32 with fasting glucose and 45 with HbA1c at follow-up [FDR &lt; 0.05]. An elastic net model identified a subset of important metabolites (Table 1). Predominant metabolites associated with glycemic measures in South Asians were sphingomyelins, tri- and di-acylglycerols and carnitines. Future work will externally validate our findings and determine the effects of modifiable risk factors for DM.

Disclosure
M.D. Gadgil: None. C. Sands: None. M.R. Lewis: None. A.M. Kanaya: None. N.R. Kandula: None. D.M. Herrington: None.

Funding
National Institutes of Health (1K23DK119404-01A1)
159-LB: Early Introduction of Continuous Glucose Monitoring Is Well Accepted by Youth and Parents
Authors: ADDALA ANANTA , HANES SARAH , ZAHARIEVA DESSI , NEW CHRISTIN , PRAHALAD PRIYA , MAAHS DAVID M. , HOOD KOREY K. , TANENBAUM MOLLY L. 
Published: June 2020

Early introduction of continuous glucose monitoring (CGM) may be one strategy to improve glucose control in youth with type 1 diabetes. We aimed to evaluate perceptions of CGM initiated &lt;1 month after diagnosis using validated surveys and focus groups.
We conducted surveys of parents and youth before the start of CGM and conducted parent focus groups after at least three months of CGM use to evaluate perceptions of early CGM initiation. Parents completed a 21-item Diabetes Distress Scale (DDS) parent. Youth aged ≥11 years completed the DDS-2, diabetes technology attitudes (DTA), PROMIS Global Health (PGH), and CGM benefits (BenCGM) and burdens (BurCGM) surveys.
Before starting CGM, parents (n=7, 2 male, age 45.63.4 years, 4 non-Hispanic white) and youth (n=16; 8 male; age 15.3±2.0 years, diabetes duration 11.5±6.9 days, 6 non-Hispanic white) reported low levels of diabetes distress (DDS parent 0.7±0.5, DDS-2 1.7±0.8). Youth reported good global health (PGH 25.6±3.4), few barriers to CGM use (BurCGM 1.9±0.7), positive attitudes towards CGM (BenCGM 3.8±1.3) and diabetes technology (DTA 18.5±2.2). In focus groups, 9 parents (1 male, child’s age 11.7±4.4 years, child’s diabetes duration 11.3±5.1 months) reported overwhelmingly positive attitudes toward CGM technology generally and with starting their child on CGM soon after diagnosis. Parents differed in their preferences on the optimal number of days after diagnosis to start CGM, with some advocating starting immediately and others preferring a week to adjust to the diagnosis and learn basic diabetes management. Parents wanted additional support for the first sensor change at home as well as the timing and method of follow up education. Finally, the majority endorsed decreased stress and worry as a result of using CGM, particularly overnight.
These data provide initial evidence that parents and youth newly diagnosed with type 1 diabetes demonstrate a readiness to start CGM shortly after diagnosis and perceive a sustained benefit from the use of CGM.

Disclosure
A. Addala: None. S. Hanes: None. D. Zaharieva: Speaker’s Bureau; Self; Ascensia Diabetes Care, Insulet Corporation, Medtronic. C. New: None. P. Prahalad: None. 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. K.K. Hood: Research Support; Self; Dexcom, Inc. Speaker’s Bureau; Self; LifeScan, Inc., MedIQ. M.L. Tanenbaum: None.
161-OR: Association of Frequency of Hypoglycemic Episodes with Incident Cardiovascular Events in Adults with Type 2 Diabetes Mellitus: A National Database Study
Authors: ALABER OMAR A. , CHANDAR APOORVA K. , DAHASH BASMA A. , ZUZEK ALEONA C. , RAJPAL AMAN 
Published: June 2020

Introduction: Hypoglycemia has been linked to increased cardiovascular (CV) events, however there is limited data about frequency of hypoglycemic episodes and CV outcomes. We aimed to evaluate the association of frequent hypoglycemic episodes (&gt; 5/year) with incident CV events in adults with type 2 diabetes mellitus (T2DM).
Methods: We queried a national database (IBM Explorys Solutions, IBM, Inc.) for adults with T2DM who had &gt;5 hypoglycemic episodes (cases) vs. 1 to 5 hypoglycemic episodes (controls) in one year. Primary outcomes were overall CV adverse events, acute myocardial infarction (MI), cerebrovascular accident (CVA) and cardiac arrhythmias. Odds ratios (OR) and 95% confidence interval (CI) for the OR were calculated for the risk of association between number of hypoglycemic episodes and incident CV events.
Results: Out of a total of 61,917,780 patients in Explorys, 4,882,710 had T2DM. Patients with &gt;5 hypoglycemic episodes in 1 year (cases) had a higher incident risk of overall CV adverse events when compared to controls (OR: 1.61, 95% CI: 1.558, 1.663). In the stratified analysis, patients with frequent hypoglycemic episodes had a significantly higher incidence of cardiac arrhythmias, acute MI, and CVA (Table 1).
Conclusion: Adults with T2DM with frequent hypoglycemic episodes (&gt;5/year) tend to have higher incidence of adverse CV events.

Disclosure
O.A. Alaber: None. A.K. Chandar: None. B.A. Dahash: None. A.C. Zuzek: None. A. Rajpal: None.
1611-P: Mortality in Patients with Glucose Derangements after ICU Admission
Authors: ZAMAN ADNIN , MCDERMOTT MICHAEL T. , MANSFIELD VICTORIA V. , WANG CECILIA C. LOW 
Published: June 2020

Objective: Dysglycemia during an intensive care unit (ICU) stay has been correlated with hospital complications and increased mortality. The objective of this study was to examine how glucose derangements during an ICU admission affect length of stay (LOS) and mortality in patients with and without diabetes mellitus.
Methods: Patient-level data for adults (&gt;/=18 years old) admitted to any ICU within our hospital system for at least 24 hours between 5/5/2011 to 11/6/2017 (6.5 years) were pulled from the electronic database. Patients were categorized into four glucose groups: 1) no hyper/hypoglycemia, 2) hyperglycemia only (blood glucose [BG] &gt;180mg/dL), 3) hypoglycemia only (BG &lt;70mg/dL), and 4) both hyper/hypoglycemia. Diabetes status was determined from diagnosis codes prior to the ICU stay. Dates of hospitalization were used to calculate LOS in days. Mortality was examined through the end of the analysis period.
Results: A total of 16,345 encounters were included in this analysis (mean age 57.7 years); only a few patients had multiple encounters. Over one-quarter of patients had diabetes (26.1%). A majority of encounters involved some form of dysglycemia: 16.4% hypoglycemia, 42.4% hyperglycemia, and 12.0% with both hyper/hypoglycemia. The overall average LOS was 6.03 days. Patients without diabetes but with any form of dysglycemia had longer LOS and higher mortality compared to patients with diabetes. Patients with both hyper/hypoglycemia had the least favorable outcomes (no diabetes vs. diabetes, LOS mean±SD: 16.2±23.5 vs. 12.9±16.3 days, p &lt;0.01; mortality: 64.9% vs. 43.6%, p &lt;0.01). Conversely, those with diabetes without any dysglycemia had the shortest LOS and lowest mortality (LOS 2.5±3.2; mortality 11.3%).
Conclusion: Glucose derangements in the ICU were associated with longer LOS in all patients. However, ICU patients without diabetes but with dysglycemia had longer LOS and higher mortality compared to patients with diabetes.

Disclosure
A. Zaman: None. M.T. McDermott: Advisory Panel; Self; Novo Nordisk Inc., Savvy Sherpa. V.V. Mansfield: Employee; Self; UnitedHealth Group. C.C. Low Wang: Research Support; Self; CellResearch Corporation.

Funding
UnitedHealth Group; University of Colorado Health Care Innovation Center
1628-P: Extreme Survival in a Low SES Population with Early-Onset Diabetes
Authors: CAMPOS ERIC , KEENAN HILLARY A. , LOPES-VIRELLA MARIA F. , BLOT WILLIAM J. , CONWAY BAQIYYAH 
Published: June 2020

Low-income African Americans (AA) and Whites with extreme duration of young-onset diabetes (YODM) are a unique population. Traits of this population surviving w/DM for 50 yrs can provide clues to longevity in YODM, particularly in the poor and underserved. Persons ≥50 yrs old (59% female, 60% AA) from the Southern Community Cohort Study diagnosed w/DM &lt; age 30 (n=649), classified by DM duration ≥ 50 yrs (extreme duration, n=96) or &lt;50 yrs (shorter duration, n=553), or w/o DM (n=33,939) at cohort entry were included. We used multinomial logistic regression (OR, 95% CI) to compare traits across groups and Cox models (HR, 95% CI) to assess mortality risk and factors linked w/survival after cohort entry. Mean age was 63, 54, and 57 in those w/extreme, shorter and no DM, respectively. Mean age at DM diagnosis was 5 and 23 in those w/extreme and shorter duration. Compared to shorter duration, those w/extreme duration had a lower BMI at age 21 (OR=0.93, 0.89-0.98) but higher BMI (OR=1.04, 1.01-1.08) at study entry. They were 40 to 50% less likely to have glaucoma and cataracts, but no difference in hx of stroke or CAD. By contrast, they had 1.5 to 3-fold greater risk vs. those w/o DM. In Cox models, those w/shorter duration YODM were at 3.2 times greater mortality risk vs. those w/o DM (HR=3.23, 2.76-3.77), but risk increased only marginally in extreme duration vs. those w/o DM (HR=1.39, 0.98-1.98). No racial difference in survival was seen in extreme (HR=1.04, 0.39-2.77) or shorter duration DM (HR=1.04, 0.72-1.49), though AA w/o DM were at slightly increased mortality risk vs. Whites (HR=1.09, 1.03-1.16). In YODM, diagnosis before age 6 was linked w/lower mortality (HR=0.57, 0.33-0.96) vs. those ≥ age 6. This low-income population w/extreme duration of YODM diagnosed mainly in very early childhood is characterized by a relatively lean BMI in young-but not later adulthood, and appear relatively protected from certain DM and age-related complications. Our data also suggests that in the low SES, AA are not any less likely to survive ≥50 yrs w/DM than Whites.

Disclosure
E. Campos: None. H.A. Keenan: None. M.F. Lopes-Virella: None. W.J. Blot: None. B. Conway: None.

Funding
5U01CA202979-04
1632-P: Increasing Incidence of Type 1 Diabetes in Children in Poland
Authors: NIECHCIAL ELZBIETA , MICHALAK MICHAL , FICHNA PIOTR 
Published: June 2020

Objective: The purpose of this study was to describe the incidence of T1D in children in Wielkopolska province (Poland) from 2006 to 2018 and compare these data with previous data recorded between 1998-2003.
Research Design: Diabetes cases were obtained through a retrospective population-based registry. Hospital inpatient records were reviewed and met the following criteria: newly diagnosed T1D age 0-14 years, residing in Wielkopolska province at the time of diagnosis, and diagnosed from 1 January 2006 to 31 December 2018. The secondary source of validation were Diabetes Outpatient Clinics located in different parts of Wielkopolska province. Incidence rates were compared with 1998-2003 cohorts.
Results: A total of 1484 case subjects were identified during the study period, and the registry was determined to be 95% complete. In study period, a significant upward trend in the incidence of T1D was observed from 9.2/100,000/year in 2006 to 30.8/100,000/year in 2018. The peak incidence of 35.2/100,000/year was recorded in 2008. The mean age-specific incidence was greatest in children aged 5-9 years 22.6/100,000/year, while lowest in those aged 0-4 years 13.7/100,000/year. In youth aged 10-14 years, the predominance in males was documented (p=0.0007). Children aged 0-4 were characterized by different seasonal pattern at diabetes onset (mostly diagnosed in spring/summer months) than individuals over age of 10 years who were diagnosed mostly during the winter and autumn months. In a 20-year period, the incidence of T1D increased 3.5-fold from 8.4/100,000/year in 1998 to 30.8/100,000/year in 2018.
Conclusions: The incidence of T1D in Wielkopolska province is increasing. The etiology of the marked increase in incidence in the polish population is unknown, however, such rapid increase in a very short period rather is associated with environmental factors than changing in genetic background. Seasonality of the disease is not a regular occurrence, which suggests increasing role of non-seasonal factors in the growing incidence.

Disclosure
E. Niechcial: None. M. Michalak: None. P. Fichna: None.