bluuebunny/crossref_metadata_2025_split huggingface dataset:
1480-P: Increased Particle Size of Triglyceride Remnant Lipoproteins, but Not Plasma Concentration or Lipid Content, Boost Risk Prediction of Incident Type 2 Diabetes
Authors: CARVALHO LUIZ SERGIO F. , BENSENOR ISABELA M. , LOTUFO PAULO A. , SPOSITO ANDREI C. 
Published: June 2020

Importance: Predicting the risk of type 2 diabetes (T2DM) accurately allow allocation of resources to preventive strategies. Besides fasting blood triglycerides (TG) are highly predictive for T2DM, TG remnant lipoproteins (TRL) translate more accurately physiopathological events that underlie progression to T2DM such as pancreatic steatosis and inflammation.
Objective: We hypothesized TRL-related factors could improve risk prediction for T2DM.
Methods: Regression models were used to predict 4-year risk of incident T2DM, starting with clinical characteristics and metabolic syndrome traits (age, sex, parental history of diabetes, hypertension, waist circumference, HbA1c, blood TG, hsCRP and HDL-C), adding TRL-related measurements, including TRL plasma concentration, particle size, cholesterol and TG content. TRL features were derived from NMR spectroscopy. Discrimination was assessed with area under the ROC curves (AUROCs).
Results: Among 13,628 individuals (1,132 new T2DM cases during follow-up) we generated a 10-variable model with AUROC 0.890 (95%CI: 0.868-0.911). This was reproduced in a subset cohort of 4,466 individuals (353 new cases of T2DM) who had available sNMR, with AUROC 0.891 (95%CI: 0.870-0.913). TRL-related markers in general did not improve predictive capacity for T2DM, but only TRL particle size (TRLZ) increased AUROC particularly in individuals with Hba1c&lt;5.8% at baseline. In this subgroup, AUROC increased from 0.792 (95% CI: 0.764-0.813 - model without TRLZ) to 0.844 (95% CI: 0.802-0.869 - model with TRLZ) (p-value for the diff in AUCs = 0.00013). Further analyses showed that, in prediabetic individuals at baseline, TRLZ is highly correlated with obesity, insulin resistance and inflammatory activity, and less important in individuals with Hba1c&lt;5.8%.
Conclusions: TRL particle size improve predictive capacity for T2DM, particularly in non-prediabetic individuals.

Disclosure
L.F. Carvalho: None. I.M. Bensenor: None. P.A. Lotufo: None. A.C. Sposito: None.

Funding
Brazilian Ministry of Health; Brazilian Ministry of Science, Technology and Innovation; Brazilian National Council for Scientific and Technological Development
1487-P: Increased Identification of NASH among Diabetic and Nondiabetic Patients through Machine Learning in Real-World Settings
Authors: DOCHERTY MATT , TIETZ ANDREAS , REGNIER STEPHANE A. , BALP MARIA-MAGDALENA , CAPKUN GORANA , LOEFFLER JUERGEN , PEDROSA MARCOS , SCHATTENBERG JÖRN M. 
Published: June 2020

Background: Nonalcoholic fatty liver disease (NAFLD) and its progressive form nonalcoholic steatohepatitis (NASH) are under recognized due to low awareness and lack of specific symptoms. Machine learning techniques allow the creation of algorithms derived from large databases with many interacting features to predict outcomes of interest. The objective of this study was to estimate the patients who might have NASH in electronic health records (EHR) using a NASH machine learning model (NASHmap).
Methods: NASHmap is a predictive extreme gradient boosting model built and validated in two databases in the USA. The model has a test area under the curve of 0.82 and 0.76 in the training and validation database, respectively. It uses 14 features, ranked by importance: HbA1c, AST, ALT, total protein, AST/ALT, BMI, triglycerides, height, platelets, WBC, hematocrit, albumin, hypertension, and gender. The model was applied to a cohort of patients in Optum EHR meeting predefined inclusion (e.g., common NASH comorbidities) and exclusion criteria (e.g., any other liver disease) and had the 14 features available.
Results: Out of 86 million (M) patients in the Optum EHR, 14M met the inclusion and exclusion criteria and 3M had all 14 features. Among them ∼23,000 patients had a diagnosis of NASH or NAFLD based on ICD codes with 73% having type 2 diabetes (T2D), 65% female and 28% above 65 years. For the patients with no recorded NASH diagnoses, 56% had T2D, 54% were female and 46% were above 65 years. Among the 3M patients, NASHmap predicted ∼902,000 as potentially having NASH and among them 70% had T2D, 52% were female and 43% were above 65 years; median HbA1c was 7.1 for diabetics and 5.8 for nondiabetics.
Conclusion: High-performing machine learning models can be used to alert on patients likely to have NASH. In clinical practice, this could help physicians to identify patients at risk and direct them to appropriate diagnostic and therapeutic interventions.

Disclosure
M. Docherty: Consultant; Self; Novartis Pharmaceuticals Corporation. A. Tietz: Employee; Self; Novartis AG. Stock/Shareholder; Self; Novartis AG. S.A. Regnier: Employee; Self; Novartis AG. Stock/Shareholder; Self; Novartis AG. M. Balp: Employee; Self; Novartis AG. G. Capkun: Employee; Self; Novartis AG. J. Loeffler: Employee; Self; Novartis Pharmaceuticals Corporation. Stock/Shareholder; Self; Novartis Pharmaceuticals Corporation. M. Pedrosa: Employee; Self; Novartis AG. J.M. Schattenberg: Consultant; Self; GENFIT, Gilead Sciences, Inc., Intercept Pharmaceuticals, Inc., Novartis Pharmaceuticals Corporation, Pfizer Inc., Roche Foundation.
1488-P: Closing the Racial/Ethnic Disparity Gap in Kidney Failure from Diabetes in the United States, 2000-2016
Authors: BURROWS NILKA RIOS , ZHANG YAN , HORA ISRAEL A. , PAVKOV MEDA E. , IMPERATORE GIUSEPPINA 
Published: June 2020

Diabetes-related end-stage kidney disease (ESKD-D) disproportionately affects U.S. racial/ethnic minority populations compared with whites. With the recent plateau in diabetes prevalence, we assessed ESKD-D trends by race/ethnicity to determine if disparity gaps have changed. From the U.S. Renal Data System, we obtained the number of adults (whites, blacks, Hispanics, Asians, and Native Americans [NAs]) aged ≥18 years with newly treated ESKD-D (with diabetes listed as primary cause) between 2000 and 2016. ESKD-D incidence rates by race/ethnicity were calculated using Census population estimates and age-adjusted to the 2000 U.S. standard population. Average annual percentage change (AAPC) in rates was estimated using joinpoint regression. From 2000 to 2016, the age-adjusted ESKD-D rates decreased by 53% for NAs (66.7 to 31.2 per 100,000, AAPC= -4.5%, p&lt;0.001); by 33% for Hispanics (50.0 to 33.3, AAPC= -2.1%, p&lt;0.001); by 20% for blacks (56.2 to 44.7, AAPC= -1.6%, p=0.02), did not change for Asians, and increased by 10% for whites (15.4 to 17.0, AAPC= 0.6%, p=0.01) (Figure). ESKD-D incidence declined for NAs, Hispanics, and blacks, narrowing the gap with whites, with NAs having the largest decline. However, in 2016, ESKD-D incidence rates in NAs, Hispanics, and blacks were about 2.0-2.5 times higher than whites. Continued efforts might be considered to sustain and improve ESKD-D trends in these populations.

Disclosure
N. Burrows: None. Y. Zhang: None. I.A. Hora: None. M.E. Pavkov: None. G. Imperatore: None.
1494-P: Prevalence and Incidence of Chronic Kidney Disease among Patients Newly Diagnosed with Type 2 Diabetes
Authors: AN JAEJIN , NICHOLS GREGORY A. , QIAN LEI , LI ZHUOXIN , MUNIS MERCEDES A. , WEI RONG , HARRISON TERESA , WEISS TRACEY , RAJPATHAK SWAPNIL , REYNOLDS KRISTI 
Published: June 2020

Patients with type 2 diabetes (T2D) are at increased risk of chronic kidney disease (CKD) or end-stage renal disease (ESRD). We estimated the prevalence and incidence of CKD/ESRD among adults with incident T2D within a U.S. integrated healthcare system.
Incident T2D between 2003-2014 was identified based on a validated algorithm. CKD was defined as eGFR &lt;60 ml/min/1.73m2 on ≥2 occasions 90 days apart and ESRD as initiation of chronic dialysis or renal transplant. Prevalence of CKD/ESRD was evaluated for the 2 years prior and 6 months after T2D diagnosis (index). Incidence of CKD/ESRD was evaluated from 6 months after index through 2018. Multivariable Cox proportional hazards models were used to study factors associated with CKD incidence.
We identified 135,199 incident T2D [mean age 58 years, 48% women, 36% White, 35% Hispanic, 12% Black, 13% Asian]. Median follow up was 6 years. Prevalence of CKD and ESRD was 12.3% and 0.2%, respectively. Median (IQR) eGFR closest to index was 86 (70-101) ml/min/1.73m2. The CKD/ESRD incidence rates decreased for recent diagnoses (2-year CKD incidence: 35.4 vs. 16.6 per 1000 person-years for those diagnosed in 2003-2004 vs. 2013-2014) (Table). Older age, white race, lower eGFR, higher A1c, and hypertension were associated with increased CKD incidence.
Though incidence rates are improving, a significant proportion of patients had reduced eGFR including CKD/ESRD at diagnosis.

Disclosure
J. An: Research Support; Self; Merck & Co., Inc., Novartis AG. G.A. Nichols: Research Support; Self; Boehringer Ingelheim International GmbH, Bristol-Myers Squibb, Merck & Co., Inc. L. Qian: None. Z. Li: None. M.A. Munis: None. R. Wei: None. T. Harrison: None. T. Weiss: Employee; Self; Merck & Co., Inc. S. Rajpathak: Employee; Self; Menarini Group. K. Reynolds: Research Support; Self; CSL Behring, Merck & Co., Inc., National Institutes of Health, Novartis Pharmaceuticals Corporation.
150-LB: Moving the Needle on the High-Risk T1D Panel: Lessons from the T1D Exchange Quality Improvement Collaborative (T1DX-QI)
Authors: RIOLES NICOLE , BUNKER CASSANDRA , CLEMENTS MARK A. , GALLAGHER KATHRYN , GARRITY ASHLEY , JONES NANA-HAWA , KAMBOJ MANMOHAN K. , MAJIDI SHIDEH , PRAHALAD PRIYA , SONABEND RONA Y. , THIVENER KATIE , EBEKOZIEN OSAGIE 
Published: June 2020

There is an increased risk of complications among “high risk” patients (having elevated HbA1c scores). Social, racial, and economic factors contribute to the difficulty in reducing HbA1c. The T1DX-QI is a type 1 diabetes learning health system with over 10 endocrinology centers working collaboratively on the goal of improving outcomes for people with type 1 diabetes. The program is coordinated by the T1D Exchange in Boston, MA.
“High-risk” patients are defined as having two clinic visits in the preceding 12 months and two HbA1cs above 9%. Centers shared data monthly with the coordinating office which used statistical process control charts to evaluate the effectiveness of the interventions. (Figure 1).
This abstract describes how 10 centers used QI principles and interventions to reduce the proportion of high-risk patients. Successful efforts include: utilizing a patient navigator, workflow redesign, developing insulin pump and CGM education classes, depression screening, and addressing social determinants of health.
The Collaborative set a goal to decrease percentage of high risk patients by 5% from baseline and made a significant 3% improvement; data is projected to meet goal by June 2020. Six of 10 centers met the goal, impacting over 200 patients. Continued efforts are needed to expand interventions to additional sites to reduce the number of high-risk patients.

Disclosure
N. Rioles: None. C. Bunker: None. M.A. Clements: Consultant; Self; Glooko, Inc. Other Relationship; Self; Glooko, Inc. K. Gallagher: None. A. Garrity: None. N. Jones: None. M.K. Kamboj: Research Support; Self; Type 1 Diabetes TrialNet, Unitio, Inc. S. Majidi: Advisory Panel; Self; Companion Medical. P. Prahalad: None. R.Y. Sonabend: None. K. Thivener: None. O. Ebekozien: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
1504-P: Is Dry Eye a Biomarker for Diabetes?
Authors: MOMEN DONIA , WU GLORIA , LAU CHAP-KAY K. , WONG JONATHAN , HAN JACQUELINE 
Published: June 2020

Background: Meibomian gland (MG) loss plays a role in dry eye. DM patients often complain of dry eyes. Infrared (IR) photography can image MGs in DM pts.
Purpose: To study Meibomian Glands in DM patients with dry eye.
Methods: A chart review (2017-2020) of T2DM pts and non-DM pts with Dry Eye was performed. IR imaging (820nm) and Corneal Topography (CT) was performed. T2DM Inclusion Criteria: HbA1c of &gt;6.6%. Control Inclusion Criteria: non-DM pts, HbA1c labs. Inclusion Criteria for T2DM and Controls: 1) Vision 20/15 - 20/80; 2) IR imaging; 3) % loss of MG per eye, then averaged; 4) CT per eye, then averaged. Exclusion Criteria: eye surgery, medication eye drops, &lt;18yrs old, &gt;90yrs old.
Results: n=100 pts, Avg=58.4 yrs (sd=15.2, range 23-89 yrs). DM: n=50 pts, Male=25, Female=25, Avg=64.2 yrs (sd=11.7, range 36-85 yrs). Control: n=50 pts, Male=20, Female=30, Avg=52.6 yrs (sd=16.2, range 23-89 yrs). Visual Acuity Avg: DM: OD=20/20 OS=20/25, Control: OD=20/40 OS=20/40. CT Avg: DM=45.34 Diopters (D), Control=43.87 D (p&lt;0.0001, t-test). MG % loss: DM=51.54%, Control=11.29% (p&lt;0.0001, t-test). Of the 50 DM pts, 31 with HbA1c &gt; 6.6% had an avg loss of 60% of their MGs, compared to all Controls with HbA1c &lt; 5.7% had an avg loss of 12%, (p=0.0001, t-test).

Conclusion: This small pilot study is the first to document Meibomian Gland loss in DM pts vs. HbA1c levels. Meibomian Gland loss may be a possible biomarker for DM. Infrared imaging may be useful for future evaluation of Meibomian Glands and diabetes.

Disclosure
D. Momen: None. G. Wu: None. C.K. Lau: None. J. Wong: None. J. Han: None.
1534-P: Protein Intake below the Individual Recommendation Is Associated with Lower Physical Functioning among Adults with Diabetes: 2005-2016, NHANES
Authors: THOMAS SARA , FANELLI STEPHANIE M. , KELLY OWEN , KROK-SCHOEN JESSICA L. , TAYLOR CHRISTOPHER A. 
Published: June 2020

Adequate protein intakes are important for preventing and treating sarcopenia. Age-related sarcopenia is associated with altered physical functioning, and hyperglycemia is associated with an increased risk for sarcopenia, possibly due to increased muscle loss related to metabolic changes. Impairments in physical functioning may be manifested as falls, fractures, and limited mobility. Therefore, this study examined the differences in physical functioning in U.S. adults by glycemic status and protein intake. Data were examined from 23,487 non-institutionalized adults, aged 31 years and older, from the 2005-2016 National Health and Nutrition Examination Survey (NHANES). Hemoglobin A1c (%) was used to classify glycemic status: nondiabetes (&lt;5.7%); prediabetes (5.7-6.4%); diabetes (≥6.5%). Dietary data were collected using 24-hour dietary recalls. Participants were further categorized by mean individual protein intake as either ’met’ or ’did not meet’ the protein recommendation of 0.8 g/kg/d. NHANES questionnaire data containing 19 discrete physical tasks were used to assess functional limitations. For those without diabetes, 35.9% had protein intakes below 0.8 g/kg/d while 46.8% of adults with prediabetes and 51.3% of adults with diabetes had protein intakes below 0.8 g/kg/d. Adults with diabetes had more functional limitations than those without, and even more if below the protein recommendation. Likewise, adults who consumed &lt; 0.8 g/kg/d protein had more functional limitations, regardless of glycemic status. The most common physical limitation reported across all glycemic groups was stooping, crouching, and kneeling; and 52% of adults with diabetes who did not meet the protein recommendation reported this specific limitation. Assessment of dietary protein intakes are encouraged for adults, especially those with diabetes, to encourage optimal physical functioning and prevent sarcopenia.

Disclosure
S. Thomas: Employee; Self; Abbott. S.M. Fanelli: None. O. Kelly: Employee; Self; Abbott. Employee; Spouse/Partner; Abbott. J.L. Krok-Schoen: None. C.A. Taylor: Research Support; Self; Abbott Laboratories.

Funding
Abbott Nutrition
1535-P: Associations between Eating Patterns and Meeting ABC Goals among U.S. Adults with Diagnosed Diabetes
Authors: SIEGEL KAREN R. , BULLARD KAI M. , SAYDAH SHARON , MERCADO CARLA , ALI MOHAMMED K. , ALBRIGHT ANN L. , IMPERATORE GIUSEPPINA 
Published: June 2020

Nutrition is important for individuals with diabetes (DM), as healthful eating patterns may help to attain individual glycemic, blood pressure (BP), and lipid goals (ABC goals) and to delay or prevent complications. Using data from 2,805 non-pregnant adults aged ≥20 years with self-reported diagnosed DM and complete data on diet (one day of 24-hour recall), A1c, BP, and non-HDL cholesterol in the National Health and Nutrition Examination Surveys 2007-2016, we examined associations between five American Diabetes Association-recommended eating patterns and meeting ABC goals. Adjusting for age, sex, race/ethnicity and daily calorie intake, we used logistic regression to calculate the proportion of individuals meeting ABC goals (defined as A1c&lt;8%, BP &lt;140/90 mmHg, non-HDL cholesterol &lt;130 mg/dL, and meeting all three), as well as prevalence ratios, by adherence to each eating pattern. Overall, following a Mediterranean-style diet or a low-fat diet was significantly associated with meeting A1c. Following a vegetarian diet was significantly associated with meeting BP goal. Following a Mediterranean-style diet was also significantly associated with meeting all ABC goals. These results suggest that improved nutrition among adults with DM may help with meeting treatment goals, and that overall healthy eating patterns may be as important for meeting goals than diets that focus on a single macronutrient.

Disclosure
K.R. Siegel: None. K.M. Bullard: None. S. Saydah: None. C. Mercado: None. M.K. Ali: Research Support; Self; Merck & Co., Inc. A.L. Albright: None. G. Imperatore: None.
1540-P: Paternal Obesity Is Associated with Offspring Obestatin Levels in Young Participants of the Nutritionists’ Health Study
Authors: FREITAS RENATA G. , VASQUES ANA CAROLINA J. , RIBEIRO FRANCIELI B. , SOLAR ISABELA , BARBOSA MARINA G. , HANADA ALFREDO S. , VALENTE ANGÉLICA M. , ALMEIDA-PITITTO BIANCA , NETO BRUNO G. , FERREIRA-VIVOLO SANDRA ROBERTA G. 
Published: June 2020

Discovery of adipose-produced cytokines and gut hormones has improved the understanding obesity-related mechanisms. The developmental origins of diseases theory also helped to explain the obesity risk in adults exposed to adverse intrauterine environment. In contrast to maternal conditions, the role of paternal characteristics for outcomes has been less investigated. Whether paternal adiposity is associated with obesity biomarkers in adults prior to the development of metabolic disturbances is unknown. This cross-sectional analysis included 124 women (28±5yrs) who participated in the NutriHS baseline. Early life events questionnaire, anthropometry, DXA-determined body composition and blood sample were obtained. Associations of paternal BMI with outcomes were tested by multiple linear regression, using the minimal sufficient adjustments (pre-gestational maternal, paternal education levels and current family income) suggested by Directed Acyclic Graphs. Participants had mean BMI of 25±5 kg/m2 (49% were overweight but metabolically healthy). Blood pressure and biochemical values were within the normal range. Mean obestatin and visfatin levels were 58.9±22.2 mg/dl and 18.8±8.1 mg/dl, respectively; these values did not differ between subsets with BMI &lt;25 and ≥25 kg/m2. Pre-gestational maternal BMI was correlated to paternal BMI (r=0.344, p=0.001) and 11.3% of mothers and 39.0% of fathers were overweight/obese. In linear regression model, offspring obestatin levels was inversely associated with paternal BMI (β=-0.22, p=0.049). No significant association was observed with visfatin levels. The inverse association of paternal BMI with offspring obestatin levels in healthy women raises a possibility of being a marker of protection against obesity-related disturbances in adulthood. Further analyses of the NutriHS cohort should investigate this hypothesis.

Disclosure
R.G. Freitas: None. A.J. Vasques: None. F.B. Ribeiro: None. I. Solar: None. M.G. Barbosa: None. A.S. Hanada: None. A.M. Valente: None. B. Almeida-Pititto: None. B.G. Neto: None. S.G. Ferreira-Vivolo: None.

Funding
Fundação de Amparo à Pesquisa do Estado de São Paulo (2018/11433-9); Fundação de Amparo à Pesquisa do Estado de São Paulo (2018/11401-0)
1543-P: Dietary Inflammatory Index Associated with Complications in Long Duration Type 1 Diabetes
Authors: SHAH HETAL , WOLFSON EMILY , YU MARC GREGORY , ADAM ATIF , HU FRANK , KING GEORGE L. 
Published: June 2020

Cognitive impairment, micro and macrovascular complications contribute to the high morbidity and mortality of type 1 diabetes (T1D) in an aging population. The dietary inflammatory index (DII), a validated measure of the inflammatory potential of dietary nutrients, has not been evaluated for its relationship to complications in T1D. To this end, validated semiquantitative food frequency questionnaires were administered at baseline to 591 individuals of the Joslin 50-year Medalist Study (“Medalists”), a well-characterized cohort having ≥50 years of T1D. The DII score was derived for each Medalist as a weighted summary score from 35 nutrients that have been associated with inflammatory markers in literature. A higher score indicated the pro-inflammatory potential of the diet. Logistic and linear regression models were applied to test cross-sectional relationships between the DII and complications. A higher DII was significantly (p&lt;0.05) associated with 1.6 and 1.4 times increased odds of nephropathy (eGFR≤60 ml/min/1.7m2) and neuropathy (MNSI score &gt;2) respectively, independent of glycemic control, diabetes duration, or other confounders. The DII was not associated with baseline self-report history of cardiovascular disease, nor with proliferative diabetic retinopathy (ETDRS &gt;53). In a subset (n=69) who were given a cognitive battery, a higher DII was significantly associated (p=0.02) with worse working memory (Wechsler memory scale) but not with motor skills (Grooved Pegboard), executive function (Delis Kaplan) or immediate or delayed recall (Rey Auditory Verbal Learning Tests). To conclude, in aging adults with chronic T1D, a pro-inflammatory diet is associated with nephropathy, neuropathy and worse working memory, signaling a need for further studies examining diet and inflammation to eventually inform better strategies to lower morbidity in populations with long duration T1D.

Disclosure
H. Shah: None. E. Wolfson: None. M. Yu: None. F. Hu: None. G.L. King: Research Support; Self; Janssen Pharmaceuticals, Inc.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (1DP3DK112192-01, 1DP3DK094333-01); Beatson Pledge Fund