bluuebunny/crossref_metadata_2025_split huggingface dataset:
1437-P: A Newly Developed Diabetes Risk Index, Based on Lipoprotein Subfractions and Branched-Chain Amino Acids, Is Associated with Incident Type 2 Diabetes Mellitus in the PREVEND Cohort
Authors: FLORES-GUERRERO JOSE LUIS , CONNELLY MARGERY A. , SHALAUROVA IRINA Y. , GRUPPEN EKE G. , OTVOS JAMES D. , DULLAART ROBIN P.F. , BAKKER STEPHAN J.I. 
Published: June 2020

Objective: Evaluate the ability of the Diabetes Risk Index (DRI) to predict incident type 2 diabetes mellitus (T2DM) in a large cohort.
Methods: The DRI was developed by combining the 6 lipoprotein subfractions in the Lipoprotein Insulin Resistance Index (LP-IR) and the branched chain amino acids valine and leucine, all of which have been shown previously to be associated with future T2DM. DRI scores were calculated in a total of 6134 nondiabetic men and women in the Prevention of Renal and Vascular End-Stage Disease (PREVEND) Study. Cox proportional hazards regression was used to evaluate the association of DRI scores with incident T2DM.
Results: During a median follow-up of 8.5 years, 306 new T2DM cases were ascertained. In analyses adjusted for age and sex, there was a significant association between DRI scores and incident T2DM with the hazard ratio (HR) for the highest versus lowest tertile being 7.49 (95% confidence interval: 5.01-11.19), P &lt;0.001. After additional adjustment for BMI, family history of T2DM, alcohol consumption, diastolic blood pressure, total cholesterol, triglycerides, HDL cholesterol and HOMA-IR, the HR was attenuated but remained significant (HR 1.67 [1.01-2.76], P = 0.04). Similar results were obtained when DRI was analyzed as HR per 1 SD increase (HR 1.37 [1.14-1.65], P = 0.001). The Kaplan-Meier plot demonstrated that patients in the highest tertile of DRI scores presented at higher risk (p-value for log-rank test &lt;0.001).
Conclusions: Higher DRI scores are associated with an increased risk of T2DM. The association is independent of clinical risk factors for T2DM including HOMA-IR, BMI and conventional lipids.

Disclosure
J. Flores-Guerrero: None. M.A. Connelly: Employee; Self; LabCorp. I.Y. Shalaurova: None. E.G. Gruppen: None. J.D. Otvos: Employee; Self; LabCorp. R.P.F. Dullaart: None. S.J.I. Bakker: None.
1439-P: One-Hour Postload Plasma Glucose Level Predicts Future Type 2 Diabetes in Hong Kong Chinese: A 12-Year Follow-Up Analysis
Authors: LUK ANDREA , LAU ERIC S. , KONG ALICE P. , CHOW ELAINE , MA RONALD C. , CHAN JULIANA C. 
Published: June 2020

Background: There is a resurgence of interest in the role of 1-hour post-load plasma glucose (PG) in risk stratification for type 2 diabetes and a cut-off of 8.6 mmol/L has been proposed to define dysglycaemia in addition to other existing criteria of prediabetes. We examined the efficacy of 1-hour PG level in predicting future type 2 diabetes in a longitudinal community-based cohort of Hong Kong Chinese.
Methods: Between 2001-2003, 489 adults without diabetes underwent 75-gram oral glucose tolerance test (OGTT). Blood samples were collected at 0, 15, 30, 60 and 120 minutes for measurement of plasma glucose and insulin levels. Between 2012-2014, progression to diabetes was ascertained either by reviewing medical records or by repeating OGTT and HbA1c. Area under the receiver-operating characteristic (ROC) curve was calculated to assess the discrimination of each parameter (fasting PG, 1-hour PG, 2-hour PG, disposition index) for development of diabetes. High 1-hour PG was defined using threshold of 8.6 mmol/L.
Results: Over 12-year follow-up, 46 people (9.4%) developed diabetes. The area under ROC curve were 0.79 (95% CI 0.71, 0.86) for fasting PG, 0.84 (95% CI 0.78, 0.89) for 1-hour PG, 0.79 (95% CI 0.72, 0.86) for 2-hour PG, and 0.78 (95% CI 0.71, 0.85) for disposition index with no difference between each parameter. In multivariate logistic regression, high 1-hour PG was associated with new-onset diabetes with odds ratio (OR) 4.87 (95% CI 1.91, 14.1, p=0.002), independent of impaired fasting glucose (OR 2.19 [95% CI 0.87, 5.32, p=NA), impaired glucose tolerance (OR 3.69 [95% CI 1.67, 8.27, p=0.001]) and other clinical variables including age, sex, smoking, family history of diabetes, history of gestational diabetes, waist and blood pressure.
Conclusions: One-hour PG is similar to fasting and 2-hour PG in prediction of type 2 diabetes. High 1-hour PG identifies people with high risk of diabetes independent of other criteria of prediabetes and clinical risk factors.

Disclosure
A. Luk: Research Support; Self; Bayer Healthcare Pharmaceuticals Inc., Roche Pharma. Other Relationship; Self; Merck Sharp & Dohme Corp. E.S. Lau: None. A.P. Kong: Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; AstraZeneca. Speaker’s Bureau; Self; Abbott, AstraZeneca, Sanofi. Other Relationship; Self; AstraZeneca, Novartis Pharmaceuticals Corporation, Sanofi. E. Chow: None. R.C. Ma: Advisory Panel; Self; AstraZeneca. Stock/Shareholder; Self; GemVCare. Other Relationship; Self; AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Merck & Co., Inc., Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Tricida Inc. J.C. Chan: None.
1458-P: Association of Serum Creatinine Levels and Risk of Type 2 Diabetes Mellitus in Korea
Authors: SONG DO KYEONG , LEE HYE JIN , HONG YOUNG SUN , SUNG YEON-AH 
Published: June 2020

Low skeletal muscle is known to be associated with insulin resistance and suggested as a potential risk factor for type 2 diabetes mellitus (T2DM). Serum creatinine is the primary metabolite of creatine in the skeletal muscle and used as a surrogate of muscle mass. Therefore, low serum creatinine levels may be associated with the risk of T2DM. However, there were few studies about the association between serum creatinine levels and the risk of T2DM in Korea. We aimed to evaluate the association between serum creatinine levels and the risk of T2DM in Korea. We analyzed a total of 264,832 nondiabetic adults older than 30 years of age who had undergone a national health examination from 2002 to 2012 in the Korean National Health Insurance Service Cohort. The serum creatinine was divided into four categories (&lt;0.70, 0.70∼0.89, 0.90∼1.19, ≥1.20 mg/dl for men, &lt;0.60, 0.60∼0.79, 0.80∼1.09, ≥1.10 mg/dl for women). Hazard ratios for T2DM were calculated using Cox proportional hazards models. In men, serum creatinine levels and the risk for T2DM showed an inverse J-shaped association, with the lowest risk among men with serum creatinine between 0.90 and 1.19 mg/dl. This inverse J-shaped association between serum creatinine level and the risk for T2DM was confirmed after adjustment for age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting plasma glucose. In women, subjects with highest serum creatinine level had the highest risk of T2DM. However, serum creatinine was not significantly associated with the risk of T2DM after adjustment for age, BMI, SBP, DBP, and fasting plasma glucose. Lower serum creatinine was significantly associated with an increased risk of T2DM in men with creatinine below 1.20 mg/dl even after adjustment for age, BMI, SBP, DBP, and fasting plasma glucose. Highest creatinine level was significantly associated with an increased risk of T2DM in women, however, this association disappeared after adjustment for age, BMI, SBP, DBP, and fasting plasma glucose.

Disclosure
D. Song: None. H. Lee: None. Y. Hong: None. Y. Sung: None.
1466-P: Prevalence of Glucose Intolerance in the Roma Population from a Rural Area in the South Part of Romania: Călărași County
Authors: RUSU EMILIA , ENACHE GEORGIANA M. , RUSU FLORIN , COSOREANU ANDRADA , CIRSTEA CATALINA , BALEANU MARIA C. , RADULIAN GABRIELA 
Published: June 2020

Background and Aim: The aim of this study was to evaluate the prevalence of glucose intolerance (diabetes, prediabetes) in Roma population living in rural settlements from Călărași County in the south part of Romania.
Methods: This cross-sectional, epidemiological, non-interventional study was conducted from March 2014 to May 2017 in several settlements from Călărași County, in Romania. We included 603 patients, 448 Roma (320 females/128 males) and 155 Romanian Caucasians (104 females/51 males), aged between 18 and 88 yr. Glucose intolerance was defined using American Diabetes Association criteria. Body mass index was classified using the definition of World Health Organization. Metabolic waist was defined as waist circumference over 80 cm in women and 94 cm in men.
Results: Prevalence of diabetes (newly diagnosed diabetes and known diabetes) was greater in Romanian Caucasians group, but in both groups larger than the published national data (34.8% vs. 23.6%, p=0.008). Obesity was present in 43.2% (n=67) of the Romanian Caucasians and 43.3% (n=194) of the Roma population (p=0.97). The average age was lower in Roma population (49.91±16.97 vs. 56.43±13.36 years, p&lt;0.001). In Roma population group, the prevalence of prediabetes, newly diagnosed diabetes and known diabetes was 12.5% (n=56), 13.6% (n=61) and 10% (n=45) respectively. In Romanian Caucasians group, the prevalence of prediabetes, newly diagnosed diabetes and known diabetes was 12.9% (n=20), 14.8% (n=23), and 20% (n=31) respectively.
Conclusions: The study revealed a high prevalence of diabetes and obesity among the Romanian Caucasians and Roma population in the south part of Romania, Călărași County. Independent risk factors for diabetes in the Roma population were the metabolic waist (OR=2.539; 95% CI 1.309-4.925) and physical activity less than 30 minutes/day (OR=2.099; 95% CI 1.279-3.444).

Disclosure
E. Rusu: None. G.M. Enache: None. F. Rusu: None. M.C. Baleanu: None. G. Radulian: None.
1489-P: Racial/Ethnic Disparities in Deaths Due to Diabetes, Diabetes Ketoacidosis, and Diabetic Coma among Those Aged 1-44 Years: 1999-2017, United States
Authors: SHAYDAH SHARON , IMPERATORE GIUSEPPINA , MERCADO CARLA , BULLARD KAI M. , BENOIT STEPHEN R. 
Published: June 2020

Although previous studies have reported disparities in diabetes mortality by race/ethnicity, little is known about deaths due to diabetes, diabetes ketoacidosis (DKA) or diabetic coma by race/ethnicity among the younger population in the U.S. We used National Vital Statistics System data for individuals aged 1-44 years from 1999 to 2017 filed in all 50 states and the District of Columbia obtained from CDC Wonder (wonder.cdc.gov). Diabetes-related deaths were based on any listed ICD-10 codes E10-E14. DKA or diabetic coma deaths were based on any listed ICD-10 codes E10-E14 with X.1 or X.0. Race/ethnicity was reported on death certificates and categorized as Hispanic, non-Hispanic (NH) Asian/Pacific Islander (API), NH black (B), or NH white (W). Results were age standardized to the 2000 U.S. population by 10 year age groups. In 2013-2017, DM-related deaths were lowest among NH APIs (1.4, 95% CI 1.3, 1.5) followed by Hispanics (2.8, 95% CI 2.5, 2.7) and NHWs (3.2, 95% CI 3.0, 3.2), and highest among NHBs (7.7, 95% CI 7.5, 7.8) (Figure). Diabetes-related death rates increased for all groups from 1999-2002 to 2013-2017 (p &lt; 0.05); DKA or diabetic coma rates increased among NHWs and NHBs (p &lt; 0.05). Exploring reasons for increased diabetes-related mortality among youth and young adults may help reduce disparities and prevent deaths.

Disclosure
S. Shaydah: None. G. Imperatore: None. C. Mercado: None. K.M. Bullard: None. S.R. Benoit: None.
1501-P: Patients with Diabetes Mellitus Hospitalized with Pancreatitis Have Reduced Mortality but Higher Overall Cost Compared with Patients without Diabetes
Authors: CHOI NICOLE , GARCIA MONIKA E. , ZAKHARY BISHOY L. , FIREK MATTHEW A. , KIM DANIEL I. , JACKSON CHRISTIAN S. , FIREK ANTHONY 
Published: June 2020

Introduction: Acute pancreatitis (AP) is the leading cause of admissions for gastrointestinal disorders in the United States with annual costs of nearly $2.6 billion. The identification of modifiable risk factors may help lower AP-related hospitalizations. Diabetes mellitus (DM) increases the risk of AP. To date, there have been limited single and multi-center studies with varying results on mortality difference in patients with AP and DM. Our primary aim was to evaluate trends in hospitalizations, mortality and costs in patients with DM and AP using a large national database.
Method: We extracted data from Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2012-2014. International Classification of Diseases 9th Version, Clinical Modification codes for adult patients hospitalized with primary diagnosis of AP were used.
Result: Between 2012 and 2014, 1,310,385 patients were admitted with a primary diagnosis of AP. 27.4% were diagnosed with AP-DM. Length of stay was four days for all patients. Cost of stay was $7467 for AP without DM, $7560 and $8482 for AP-DM without and with complications, respectively. Regression analysis for mortality controlling for age, gender, DM, and race showed AP-DM had less odds of mortality than patients without DM (p&lt;0.05). The AP patients who were older than age 65 had 2.5 greater odds of mortality (p&lt;0.05). The AP patients with greater Charlson score were at 1.5 greater odds of mortality (p&lt;0.05).
Conclusion: All patients had the same length of stay. The total mortality was lower in AP-DM but higher overall costs compared to patients without DM. The explanation for these differences is unclear but may relate to higher inpatient services for DM, modifying effects of DM on the course of AP, or the type of care patient received in different types of hospitals. Further studies are needed to determine the effects of DM on inpatient mortality, costs and outcomes in patients with AP.

Disclosure
N. Choi: None. M.E. Garcia: None. B.L. Zakhary: None. M.A. Firek: None. D.I. Kim: None. C.S. Jackson: None. A. Firek: None.
1510-P: Age at Menarche, Type 2 Diabetes, and Cardiovascular Disease Complications in U.S. Women Under 65 Years: NHANES, 1999-2016
Authors: LEY SYLVIA H. , LI YALING , REXRODE KATHRYN M. , ELIASSEN A. HEATHER , BUNDY JOSHUA D. , HE JIANG , BAZZANO LYDIA A. 
Published: June 2020

Background: Diabetes and diabetes complications are on the rise in U.S. adults under 65 years, while younger onset of menarche is also increasing. We examined the associations of menarche age with type 2 diabetes and with cardiovascular disease (CVD) complications among women with diabetes.
Methods: In the cross-sectional National Health and Nutrition Examination Survey (NHANES) 1999-2016, women aged 20-65 years free of cancer were included. CVD was defined as coronary heart disease and stroke.
Results: Of 15,619 participants, 1,545 (9.9%) reported having type 2 diabetes. Earlier age at menarche was associated with type 2 diabetes, compared to median menarche age 13 years, after multiple adjustment (Table). Among women with diabetes, earlier age at menarche was associated with CVD (Table). The association of earlier age at menarche was more pronounced with stroke among women with diabetes (table). When race stratified, the association between extremely early age at menarche (≤10 years) remained significantly associated with CVD among non-white women with diabetes (OR 2.27 [95% CI 1.11-4.62]), while the association among white women was attenuated (1.95 [0.88-4.30]).
Conclusion: Earlier age at menarche was associated with type 2 diabetes and with CVD among young and middle-aged women living with diabetes in the U.S.

Disclosure
S.H. Ley: None. Y. Li: None. K.M. Rexrode: None. A. Eliassen: None. J.D. Bundy: None. J. He: None. L.A. Bazzano: None.

Funding
National Institutes of Health (P20GM109036)
1515-P: Epidemiology and Treatment of Chronic Kidney Disease among Commercially-Insured Patients in the U.S.
Authors: KAUF TERESA , WANG WEIYING , DILLON ALLISON , SINGH INDERJIT , ODEGARD JOHN T. , RINGEMANN CHRISTIAN , HALDRUP STEFFEN 
Published: June 2020

Objectives: Early diagnosis and treatment of chronic kidney disease (CKD) may delay disease progression and reduce the burden of disease. This study examined the epidemiology and treatment of CKD among commercially-insured patients in the U.S.
Methods: A retrospective cohort study was conducted using January 2010-December 2018 MarketScan® data. Patients with ≥2 outpatient (≥ 30 days apart) and/or ≥1 inpatient claims containing a diagnosis code for CKD were eligible for analysis. The earliest CKD diagnosis date served as the index date. Continuous enrollment for ≥6 months pre- and post-index was required. Baseline characteristics and use of ACE inhibitors and/or ARBs pre/post-index were analyzed for the overall CKD population and patients with pre-existing diabetes (Types 1 and 2). Annual CKD prevalence and incidence were calculated from the total enrollee population in a given year.
Results: Of 753,097 CKD patients identified, 310,837 (41.3%) had pre-existing diabetes. More CKD patients with pre-existing diabetes had hypertension (81.7% vs. 75.7% for overall CKD). Approximately 45% of patients in both cohorts were diagnosed at Stage 3. Overall CKD prevalence per 1,000 enrollees increased from 11.7 in 2011 to a high of 16.7 in 2016 before decreasing to 13 in 2018. Among persons with pre-existing diabetes, prevalence was 2.0 per 1,000 enrollees in 2011, falling to 1.6 in 2018, with a high of 2.83 in 2015. In the pre-index period, 55.3% of CKD patients overall and 66.2% of CKD patients with pre-existing diabetes received an ACE/ARB. Following CKD diagnosis, use of ACE/ARBs increased to 63.2% and 73.7% for the overall CKD and diabetes populations, respectively.
Conclusions: On a population basis, the annual incidence of new CKD patients enrolled in commercial plans is not inconsequential. Greater efforts are needed to identify patients at earlier stages of disease and ensure that treatment guidelines are being followed.

Disclosure
T. Kauf: Consultant; Self; Roche Diabetes Care. W. Wang: Consultant; Self; Roche Diabetes Care. A. Dillon: Consultant; Self; Roche Diabetes Care. I. Singh: Employee; Self; Roche Diabetes Care. J.T. Odegard: None. C. Ringemann: Employee; Self; Roche Diabetes Care. S. Haldrup: Employee; Self; F. Hoffmann-La Roche Ltd.
1518-P: Worsening of Microvascular Reactivity and Markers of Endothelial Activation and Oxidative Stress in Patients with Stabilized Type 1 Diabetes: 3-Year Follow-Up
Authors: SKRHA JAN , SOUPAL JAN , FLEKAC MILAN , PRAZNY MARTIN , SKRHA JAN 
Published: June 2020

Endothelial activation accelerated by oxidative stress (OxS) is believed to be the major step in development of diabetes angiopathy. The aim of this follow-up study was to measure microvascular reactivity (MVR) and markers of OxS.
Our study involved 87 patients with type 1 diabetes (aged 37 ± 15 yrs, HbA1C 7.8 ± 1.5 % DCCT, DM duration 18 ± 11 yrs). MVR was evaluated from post-occlusive reactive hyperemia (PORH) by Laser-Doppler fluxmetry (Perimed) and skin autofluorescence (SAF), reflecting advanced glycation endproducts (AGEs) accumulation, was assessed by AGE-Reader (Diagnoptics). OxS was evaluated by malondialdehyde (MDA), derivatives of reactive oxygen metabolites (d-ROMs) test and plasma antioxidant test (PAT) (FRAS4). Markers of endothelial activation (ICAM-1, VCAM-1, vWF) and routine biochemical and biometrical parameters were evaluated in all patients during 3 years of follow-up.
Diabetes control slightly improved during the study period (HbA1c 7.8 ± 1.5 vs. 7.5 ± 1.4 % DCCT, p&lt;0.05), while SAF remained almost unchanged (2.1 ± 0.5 vs. 2.3 ± 0.5 AU, ns). Worsening of MVR was observed (Time to max PORH 12.7 vs. 17.5 s, p&lt;0.05). Significant increase in VCAM-1 was present (718 ± 186 vs. 918 ± 550 pg/L, p&lt;0.005), while ICAM-1 and vWF did not change significantly. Both higher MDA (0.70 ± 0.26 vs. 0.81 ± 0.23 µmol/L, p&lt;0.05) and PAT (2431 ± 645 vs. 2944 ± 466 U Cor, p&lt;0.0001) were observed. Skin autofluorescence was positively associated with vibration perception threshold (r=0.45, p&lt;0.0001) and HbA1c (r=0.24, p&lt;0.005).
Although diabetes control slightly improved, we observed further progression of endothelial dysfunction and oxidative stress in our T1D patients. Higher AGEs accumulation in patients with worse glucose control was associated with impaired vibration perception threshold. It is questionable whether boosted human antioxidant capacity in subject with increased OxS could be considered protective and beneficial.

Disclosure
J. Skrha: Advisory Panel; Self; Boehringer Ingelheim International GmbH. Speaker’s Bureau; Self; Eli Lilly and Company, Merck Sharp & Dohme Corp. J. Soupal: Advisory Panel; Self; Abbott. Consultant; Self; Medtronic, Roche Diabetes Care. Speaker’s Bureau; Self; Dexcom, Inc. M. Prazny: Speaker’s Bureau; Self; Novartis Pharmaceuticals Corporation, Roche Diabetes Care. Other Relationship; Self; Abbott, Boehringer Ingelheim International GmbH, Lilly Diabetes, Medtronic, Novo Nordisk A/S, Sanofi, Teva Pharmaceutical Industries Ltd.

Funding
RVO VFN64165, Progres Q25
153-LB: Physician Well-being Related to Diabetes Technology and Clinic Workflow
Authors: SHAH VRUSHALI , PINKHASOVA DIANA , FRENCH ESRA KARSLIOGLU 
Published: June 2020

Background: Endocrinology physicians and clinic staff are burdened by workload created during the download of diabetes devices (insulin pumps, glucometers, and sensors). Inefficiencies caused by data interoperability can impact physician well-being and clinic workflow. The aim of this study is to identify physician wellbeing related to Diabetes Technology (DT) and determine whether the use of a single software platform to upload and view diabetes data improves efficiency.
Methods: Physician satisfaction survey related to DT was sent to providers at a single academic endocrinology office. Tidepool®, a free software, was implemented to enable data upload from multiple devices onto a single platform. The time required to have this data available to the provider was recorded pre and post-implementation. The provider was then able to view this data in the patients’ electronic chart.
Results: All providers (n=14) completed the survey. Only 7% felt that pumps were always downloaded on time. Related to DT, 21% felt a sense of dread at work, 36% experienced a lack of enthusiasm, and 43% experienced emotional exhaustion. Almost 80% felt that clinic workflow due to DT contributed to spending less time with patients. Data from a total of 90 devices pre and 144 devices post-Tidepool® were included in the study. There was a significant improvement in the average time of sensor and glucometer data availability; 4.95 vs. 3.2 minutes (CI -2.48 to -1.01, p-value &lt;0.0001). There was no significant change in average time for insulin pump data availability; 8.8 vs. 8.46 minutes (CI -2.6 to 2.1, p-value 0.7) post Tidepool®. Time and resources related to printing the data were saved as well. 100% of staff at the download station felt that Tidepool® was an easier software to use.
Conclusion: Our study shows a high prevalence of physician dissatisfaction and symptoms of burnout related to DT among the providers even at a university academic office with access to the best resources. The use of Tidepool® could potentially improve clinic workflow.

Disclosure
V. Shah: None. D. Pinkhasova: None. E. Karslioglu French: None.

Funding
University of Pittsburgh Medical Center