bluuebunny/crossref_metadata_2025_split huggingface dataset:
1385-P: Utility of Hemoglobin A1c for Predicting Adverse Pregnancy Outcomes in Women with Gestational Diabetes Mellitus
Authors: SIMMONS DAVID , IMMANUEL JINCY , EAGLETON CARL , BAKER JOHN 
Published: June 2020

Aims: Despite current treatment strategies, gestational diabetes mellitus (GDM) remains a major risk factor for pregnancy complications. We examined whether the HbA1c measured at the time of oral glucose tolerance test (OGTT) predicts residual risk of adverse outcomes in women with treated GDM.
Methods: Women with GDM (defined using the New Zealand criteria) enrolled in the Diabetes in Pregnancy Registry in South Auckland, New Zealand at ≥ 20 weeks gestation were included. Glycaemic targets used were fasting ≤5.0 mmol/l and 2-hour post-meal ≤6.7 mmol/l.
Results: Of the 1403 women enrolled, 304 (21.7%) had an HbA1c 41-49 mmol/mol (5.9-6.6%). Women with higher HbA1c were significantly older, with higher BMI and fasting and 2-hour OGTT values. They were more likely to be multiparous, of Pacific ethnicity, and have a family history of diabetes. After adjusting for known risk factors, higher HbA1c was associated with increased risk of large for gestational age (LGA) babies (odds ratio (OR) 2.08 (1.47-2.93)) and preeclampsia (OR 2.09 (1.34-3.29)). The OGTT fasting glucose was predictive of LGA (OR 1.61 (1.17-2.21)), but not the 2-hour value (OR 1.12 (0.98-1.28)). The areas under the receiver operating characteristic curves for predicting LGA and preeclampsia by HbA1c, OGTT fasting, OGTT 2-hour, and 1-hour 50g polycose test were: LGA, 0.58 (0.51-0.65), 0.66 (0.59-0.73), 0.45 (0.37-0.52), and 0.59 (0.51-0.66) respectively; preeclampsia, 0.66 (0.57-0.75), 0.58(0.48-0.67), 0.46 (0.35-0.56), and 0.52 (0.42-0.62) respectively.
Conclusions: HbA1c, fasting, and 1-hour glucose at GDM diagnosis predict residual adverse outcomes in treated women with late GDM. Studies are needed to test whether earlier treatment, or targeting the 1-hour post-prandial glucose can reduce this residual risk.

Disclosure
D. Simmons: None. J. Immanuel: None. C. Eagleton: None. J. Baker: None.
1386-P: Long-Term Weight Change after Pregnancy and Type 2 Diabetes Risk in Women with a History of Gestational Diabetes
Authors: BADON SYLVIA E. , XU FEI , QUESENBERRY CHARLES , FERRARA ASSIAMIRA , HEDDERSON MONIQUE M. 
Published: June 2020

Women with a history of gestational diabetes (GDM) are at high risk for developing type 2 diabetes, which may be further increased with weight gain after pregnancy. Our objective was to determine associations of long-term weight changes after a GDM pregnancy and type 2 diabetes risk. We used data on a cohort of 139 women with a GDM pregnancy identified though the Kaiser Permanente Northern California (KPNC) GDM registry (1986-2009) who completed a follow-up study visit an average of 16 years later (2011-2013). Type 2 diabetes was identified through the KPNC diabetes registry, self-report during follow-up visit recruitment, or at least one abnormal value on a 75-gram, 2-hour oral glucose tolerance test (2015 ADA criteria) conducted at the follow-up visit. Clinically measured weights extracted from the electronic health record were used to calculate average BMI change per year between delivery and either type 2 diabetes identification date or follow-up visit date. We used modified Poisson regression to estimate relative risks of type 2 diabetes associated with BMI change categories. Twenty-six percent of women lost weight [mean -0.3 BMI units/year, equivalent to -0.8 kg/year for a woman of the average height in our cohort (1.6 m)], 24% maintained their weight (&lt;0.17 BMI units/year, mean 0.10 BMI units/year [0.3 kg/year]), and 50% gained weight (≥0.17 BMI units/year, mean 0.5 BMI units/year [1.3 kg/year]). Overall, 50% of women developed type 2 diabetes. Each additional BMI unit gained was associated with 28% greater risk of type 2 diabetes (95% CI: 0.98, 1.67) adjusting for age at delivery, race/ethnicity, pre-pregnancy BMI, and years since delivery. Women who lost weight had 39% lower risk of developing type 2 diabetes (95% CI: 0.33, 1.12) compared to women who maintained their weight, though estimates were imprecise. Our findings suggest that long-term weight gain after a GDM pregnancy may increase risk of type 2 diabetes, supporting postpartum weight loss intervention efforts.

Disclosure
S.E. Badon: None. F. Xu: None. C. Quesenberry: None. A. Ferrara: None. M.M. Hedderson: None.

Funding
National Institutes of Health (R01HD065904)
1399-P: Overuse of Glucose-Lowering Therapy Predicts Higher One-Year Mortality in Geriatric Patients with Type 2 Diabetes
Authors: CHRISTIAENS ANTOINE , BOLAND BENOIT J. , HENRARD SÉVERINE 
Published: June 2020

Background: The 2019 Endocrine Society guidelines for treatment of diabetes in older people define individualised HbA1c targets for glucose-lowering therapy (GLT) in older people with type 2 diabetes (T2D) according to their health status. Our study assessed the association between GLT appropriateness according to these guidelines (appropriate, overuse, underuse) and one-year mortality.
Methods: Retrospective study of all inpatients ≥75 years with T2D and GLT admitted to a geriatric ward of an academic hospital (Brussels) between 2008-2015. Factors associated with one-year mortality were tested in multivariable Cox proportional hazards regression.
Results: Among the 318 patients (84 years; 54% women), GLT overuse was detected in 57.2% and underuse in 17.9%. In multivariable analysis, one-year mortality was associated with poor health (HR: 1.59, p=0.033) and GLT overuse (HR: 1.73, p=0.023). One-year survival was the highest in patients in intermediate health with appropriate GLT and the lowest in those in poor health with GLT overuse (Figure 1; one-year survival [95%CI]: 0.87 [0.76-1.00] and 0.53 [0.45-0.62], respectively).
Conclusion: GLT overuse and poor health status are independent predictors of one-year mortality in geriatric patients with type 2 diabetes. As many of these patients met these two conditions, there is room to improve GLT individualisation and deprescribing.

Disclosure
A. Christiaens: None. B.J. Boland: None. S. Henrard: None.

Funding
Fund for Scientific Research (FC23595)
1407-P: Predictors of Glycemic Control among Older Adults with Type 2 Diabetes Stratified by Living Environment
Authors: DAWSON APRILL Z. , LU KAIWEI , WALKER REBEKAH J. , EGEDE LEONARD E. 
Published: June 2020

About 50% of adults with diabetes are ages 50 and older. As individuals age, their living situation changes which may impact self-care and glycemic control (GC). We examined predictors of GC among older adults with diabetes stratified by living environment; defined as living independently, living at home with a caregiver, or living in a nursing home.
Data on 2370 adults ages 50 and older with diabetes from the Health and Retirement Study (2006 - 2014) was analyzed. Generalized estimating equations were used to assess the association between HbA1c and living environment. GC was the outcome and living environment was the primary independent variable. Covariates were socioeconomic factors, cognitive impairment, functional limitations, health status, lifestyle, and comorbidities. We also identified predictors of GC stratified by living environment.
Unadjusted models showed no difference in HbA1c for individuals living with a caregiver compared to those living independently. Living in a nursing home was associated with lower HbA1c (β -0.33; p=0.011), however after adjusting for covariates the relationship was not significant. Predictors of GC among older adults living independently were: age (β -0.018; p&lt;0.001), being female (β -0.20; p=0.007), non-Hispanic Black (β 0.53; p&lt;0.001), Hispanic/Other (β 0.47; p&lt;0.001), no physical activity (β -0.20; p=0.032). Predictors of GC among older adults living at home with a caregiver were: having a GED/high school diploma (β -0.49; p=0.029), not being physically active (β -0.45; p=0.013), and ADLs (β 0.12; p=0.03). Predictors of GC among older adults living in a nursing home were being Hispanic/Other (β 0.94; p=0.048).
In this nationally representative sample, type of living environment does not have an effect on GC, however predictors of GC varied across living environment. Interventions need to be tailored to living environment of seniors.

Disclosure
A.Z. Dawson: None. K. Lu: None. R.J. Walker: None. L.E. Egede: None.

Funding
American Diabetes Association (1-19-JDF-075 to R.J.W.); National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699, R01DK118038, R01DK120861); National Institute on Minority Health and Health Disparities (R01MD013826)
1412-P: Change in Insulin Secretion Along with Aging in a General Japanese Population
Authors: FUJITA TOMOYUKI , DAIMON MAKOTO , MURAKAMI HIROSHI , NISHIYA YUKI , MURABAYASHI MASAYA , MIZUSHIRI SATORU , MATSUHASHI YUKI 
Published: June 2020

Objective: Although increase in type 2 diabetes (DM) along with aging is well documented, change in insulin secretion along with aging and factors related to its change in general, nondiabetic, population has not been well examined so far. Therefore, we evaluated the relationships between insulin secretion and age, or aging, in a general population.
Methods: 1. cross sectional study: Among participants of the population-based Iwaki study of Japanese people held in 2014-2017, those without diabetes were enrolled (gender (M/F): 536/882; age: 53.0±16.0) 2. longitudinal study: Among participants described above, those attended the study consecutively in 2014 and 2017 were enrolled (gender (M/F): 257/401; age: 53.7±14.1). Insulin secretion was evaluated using homeostasis model assessment (HOMA-β).
Results: 1: Univariate regression analyses revealed that the relationship between HOMA-β and age appeared to be non-linear but L-shaped, with an inflection point at about 55 and 50 years for men and women, respectively. Under the ages, HOMA-β are correlated with age (β= -0.32, p&lt;0.01, and β=-0.16, p&lt;0.01, for men and women, respectively), while above the age, such correlation was not observed (p=0.06 and 0.42, respectively).2: Analyses to evaluate factors associated with such decreases in HOMA-β in the 3-year duration showed no significant factor for men but HDL-c (β= -0.30, p&lt;0.01), FIB-4 index representing degree of fibrotic change of liver (β=0.25, p=0.01) and for women after adjustment for multiple factors such as BMI, serum lipid parameters, and, so on.
Conclusions: Insulin secretion seems to decrease along with aging till middle age, but after the age, it dose not decrease or stays similar throughout in a general Japanese population, indicating that aging per se may not be a major determinant for impaired insulin secretion in a general, or physiological condition. Further, factors related to abnormal liver function can be markers to predict decrease in insulin secretion, at least, in women.

Disclosure
T. Fujita: None. M. Daimon: None. H. Murakami: None. Y. Nishiya: None. M. Murabayashi: None. S. Mizushiri: None. Y. Matsuhashi: None.
1413-P: Uncovering the Disease Progression Profile of the Patients with Type 2 Diabetes Mellitus and Atrial Fibrillation
Authors: TANG ZEFANG , WANG JINGJING , ZHANG YUAN , HU PENGWEI , MEI JING , LI SHOACHUN 
Published: June 2020

Background: Type 2 diabetes mellitus (T2DM) is a risk factor of Atrial Fibrillation (AF). However, few publications studied the, especially the profile changes due to aging. In this study, we created a statistical strategy to delineate the disease progression profile of the T2DM patients with AF across different age groups.
Method: From IBM Explorys database, 0.48M patients with T2DM and AF were extracted. Patients were separated into 45-60 (54,793), 60-75 (199,944) and 75-90 (227,402) age groups, respectively. The statistical model utilized bootstrap strategy to calculate odds ratio of new developed diseases in 2 years after T2DM and AF diagnose for each group. Diseases with OR &gt; 3 were identified as the progressed diseases. For comparison, we filtered the progressed diseases calculated in T2DM patient cohort.
Result: We found 19 common progressed diseases such as the heart failure and coronary arteriosclerosis (Fig 1). Meanwhile, we also found 7, 17, 25 age-group specific progressed diseases, respectively. Patients in 45-60 tend to get moderate diseases such as syncope (OR = 3.3) and disorder of lung (OR = 3.7) after T2DM and AF diagnose while patients in 75-90 are more likely to get severe diseases such as chronic kidney disease stage 4 (OR = 10.6) and tricuspid valve disorder (OR = 9.5).
Conclusion: Overall, these 2-year progressed diseases could aid clinical decision making.

Disclosure
Z. Tang: None. J. Wang: None. Y. Zhang: None. P. Hu: None. J. Mei: None. S. Li: None.
1415-P: The Variation in Muscle Strength and Quality in Chinese Patients with Type 2 Diabetes
Authors: HE QINGHUA , GUO LIXIN 
Published: June 2020

Objective: To examine the characteristics of muscle strength and quality in Chinese patients with T2DM.
Methods: T2DM patients aged 50 years or older (Diabetes group, n=670, 320/350 males/females) were recruited from nine hospitals in Beijing, China. Age-matched nondiabetes participants (Control group, n=214, 54/160 males/females) were recruited from a cohort for routine physical examination. Body composition was determined by a bioimpedance analyzer. Low muscle mass was determined as the appendicular skeletal muscle mass index (ASMI) below the lower quintile of the homogeneity, same sex and healthy young reference group and the cutoff point was 7.18 kg/m2 in men and 5.73 kg/m2 in women. Low muscle strength was defined as handgrip strength below the lower quintile of the same sex subjects in this study and the cutoff value were 29.5 kg and 21.2 kg for males and females. Muscle quality was measured by ratios of muscle strength to appendicular skeletal muscle mass. Multivariate Logistic Regression was used for Correlation Analysis.
Results: (1)There was no difference in age and BMI between two groups. (2) Diabetes group showed higher significantly in FPG level[(5.6±0.7)mmol/l vs. (8.3±2.6)mmol/l], Waist to hip ratio[0.85(0.80,0.90) vs. 0.92(0.87,0.95)], the proportion combined with hypertension and coronary heart disease than control group. (3) Compared with control group, grip strength [(36.6±8.5)kg vs. (31.3±6.4)kg] and muscle quality[(12.4±2.8) vs. (10.8±2.7)] decreased significantly in diabetes group in male but not in female. (4) In male, BMI (t=-5.567, 95%CI -0.375∼-0.179) and HbA1c(t=-2.322 95%CI -0.420∼-0.035) showed negative correlated with muscle quality. Aging (OR=1.062, 95% CI 1.023-1.103) and HbA1c (OR=1.353, 95%CI 1.150-1.591)were risk factors associated with low muscle strength.
Conclusion: Muscle strength and quality decreased significantly in male T2DM Chinese patients. Aged, HbA1c and BMI were risk factors associated with low muscle quality and low muscle strength.

Disclosure
Q. He: None. L. Guo: None.

Funding
Beijing Science and Technology Commission
1416-P: Blood Pressure Variability and Risk of Heart Failure Events in ACCORD and the VADT
Authors: NUYUJUKIAN DANIEL S. , KOSKA JURAJ , REAVEN PETER , ZHOU JIN 
Published: June 2020

We examined the relationship between blood pressure variability and risk of heart failure (HF) in two cohorts of type 2 diabetes (T2D) participating in trials of glucose and/or other risk factor management. Data were drawn from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial and the Veterans Affairs Diabetes Trial (VADT). Coefficient of variation (CV) and average real variability (ARV) were calculated for systolic (SBP) and diastolic blood pressure (DBP) along with maximum and cumulative mean SBP and DBP during both trials. In ACCORD (Table), CV and ARV of SBP and DBP were associated with increased risk of HF, even after adjusting for other risk factors and mean blood pressure (e.g., CV-SBP: HR=1.15, p = 0.01; CV-DBP: HR=1.18, p = 0.003). In the VADT, DBP variability was associated with increased risk of HF (ARV-DBP: HR=1.16, p = 0.001; CV-DBP: HR=1.09, p = 0.04). Further, in ACCORD, those with progressively lower baseline blood pressure demonstrated a stepwise increase in risk of HF with higher CV-SBP, ARV-SBP, and CV-DBP (e.g., for CV-SBP: those with baseline SBP ≥ 140, &lt; 140, &lt; 130 and &lt; 120 mmHg, respectively had the following HRs; 1.03, 1.21, 1.50, and 1.69). Blood pressure variability is independently associated with HF risk and this relationship is most robust at low blood pressure in individuals with T2D. These results may have implications for optimizing blood pressure treatment strategies in those with T2D.

Disclosure
D.S. Nuyujukian: None. J. Koska: None. P. Reaven: Consultant; Self; Boston Heart Diagnostics, Intercept Pharmaceuticals, Inc. Research Support; Self; Bristol-Myers Squibb, Lysulin. J. Zhou: None.

Funding
National Institutes of Health (R01067690, R01094775)
146-LB: Increasing Insulin Pump Use across Five National Diabetes Centers: Results from the T1D Exchange Quality Improvement Collaborative (T1DX-QI)
Authors: EBEKOZIEN OSAGIE , RIOLES NICOLE , INDYK JUSTIN A. , LYONS SARAH , MAJIDI SHIDEH , PROFFITT TAYLOR , LEE JOYCE M. 
Published: June 2020

The T1DX-QI is a type 1 diabetes learning health system including over 10 diabetes centers across the U.S. The program is coordinated by the T1D Exchange in Boston, MA.
Several research studies have demonstrated the impact of insulin pump use and frequent insulin bolusing on diabetes-related clinical outcomes. Five centers in the T1DX-QI used QI methodology including Plan - Do- Study - Act (PDSA) cycles to test and expand insulin pump use initiatives among patients aged 12 - 26 years at their centers. Successful interventions include developing mobile technology classes, redesigning workflow, coaching patients to bolus for meals and corrections, and removing barriers to adoption.
The centers shared data monthly with the coordinating office. These data were used for ongoing QI coaching and to promote the cross-sharing of best practices. Statistical Process Control charts with the relevant rules for fundamental improvements were used to evaluate project effectiveness. Two examples appear in Figure 1.
Three of five participating centers had substantial improvement in this process, ranging from 6% - 17%. There was a 10% significant change among the collaborative cohort in 20 months. Successful QI interventions improved pump use. Further expansion is needed to increase the percentages of patients meeting bolusing goals.

Disclosure
O. Ebekozien: None. N. Rioles: None. J.A. Indyk: None. S. Lyons: Other Relationship; Self; Springer Publishing Company. S. Majidi: Advisory Panel; Self; Companion Medical. T. Proffitt: None. J.M. Lee: Advisory Panel; Self; Goodrx. Consultant; Self; T1D Exchange. Research Support; Self; Lenovo.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
146-OR: Specific Metabolomic Signatures Associate with Diabetes Remission after Weight Loss
Authors: KWEE LYDIA C. , ILKAYEVA OLGA , MUEHLBAUER MICHAEL , WOLFE BRUCE M. , PURNELL JONATHAN Q. , PI-SUNYER XAVIER , CHEN HAIYING , NEWGARD CHRISTOPHER B. , SHAH SVATI H. , LAFERRERE BLANDINE 
Published: June 2020

The response to weight loss intervention is heterogeneous both in weight loss amount and improvement in metabolism. We seek to identify biomarkers predictive of long-term weight loss and type 2 diabetes (T2D) remission in the Longitudinal Assessment of Bariatric Surgery (LABS) and the Look AHEAD (Action for Health in Diabetes) studies.
Methods: LABS is a longitudinal observational study of 2458 consecutive cases (2006-2009) of bariatric surgery. Look AHEAD is an RCT comparing an intensive lifestyle intervention to T2D support and education in 5,145 U.S. adults with obesity and T2D enrolled between 2001-2004. Targeted mass spectrometry-based profiling of 135 metabolites was performed in pre-intervention blood samples from individuals selected based on sustained T2D remission (N=93 LABS, N=80 Look AHEAD) and extremes (top and bottom 13th percentile) of weight loss (N=151 LABS, 23 with T2D) at 4 or 5 years. We used PCA for dimensionality reduction of metabolites and logistic regression models to determine association between metabolic factors and phenotype. Improvement in model fit and net reclassification index analyses were performed to determine if metabolites improved a clinical model for predicting remission.
Results: One factor composed of branched chain amino acids (BCAA) and tyrosine (p=0.045), and one composed of betaine and choline (p=0.02) were associated with T2D remission. Inclusion of these factors in a clinical prediction model improved the fit (p=0.04). Only one factor, composed of C31:1-C37:1 sphingomyelins, associated with weight loss at 5 years (p=0.036).
Conclusions. Our findings define novel associations between metabolites in the BCAA and trimethylamine-N-oxide-microbiome-related pathways that are independently and incrementally associated with sustained T2D remission after weight loss. Future studies of these analytes could help in the discovery of metabolic regulatory mechanisms, and guide more personalized weight loss interventions in individuals with T2D.

Disclosure
L.C. Kwee: None. O. Ilkayeva: None. M. Muehlbauer: None. B.M. Wolfe: None. J.Q. Purnell: Advisory Panel; Self; Novo Nordisk A/S. H. Chen: None. C.B. Newgard: None. S.H. Shah: Research Support; Self; AstraZeneca, Verily Life Sciences LLC.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK108580)
1463-P: Relationship between Hepatic and Adipose Tissue Insulin Resistance with Liver Fibrosis in Patients with Type 2 Diabetes Mellitus (T2DM) and Nonalcoholic Fatty Liver Disease (NAFLD)
Authors: KALAVALAPALLI SRILAXMI , LOMONACO ROMINA , GODINEZ EDDISON , FANOUS NADA , TEJERA LAZARO J. , MCCAULEY ALLISON , MANSOUR LYDIA , SHRESTHA SULAV , MARTE JONATHAN S. , FAKHRY JONATHAN , WANG HANNAH , VARGAS ALEJANDRA , BARB DIANA , BRIL FERNANDO , CUSI KENNETH 
Published: June 2020

The ADA recommends screening for liver fibrosis in all patients with T2DM and with elevated ALT or steatosis. However, the factors that may predispose to hepatic fibrosis, such as comorbid conditions or insulin resistance (IR), have not been carefully examined. To this end, we studied patients with T2DM and NAFLD/fibrosis screened in an outpatient clinical setting. Screening for steatosis was done by controlled attenuation parameter (CAP), fibrosis by liver stiffness (LSM) with vibration-controlled transient elastography (VCTE). Out of 527 patients screened, 350 (66%) had steatosis (age: 60±12 years; BMI: 33±6 kg/m2; A1c: 7.5±1.7%). Based on VCTE, they were divided into LSM ≥ 7.0 kPa (moderate-to-severe fibrosis; n=69) or LSM ≤ 7.0 kPa (no or mild fibrosis; n=281). We measured hepatic (HOMA) and adipose tissue (Adipo-IR: fasting FFA x insulin) IR, FIB-4 and CK-18 (biomarkers of liver fibrosis).
Results are summarized in the Table. Patients with fibrosis had more steatosis, worse HOMA/Adipo-IR and more severe metabolic syndrome. Presence of fibrosis was not evident in most patients by AST/ALT &gt;40 U/L (elevated in just 26%) or FIB-4, but CK-18 was higher.
In conclusion, clinicians should strongly suspect liver fibrosis in patients with T2DM that have the most unfavorable metabolic profile.

Disclosure
S. Kalavalapalli: None. R. Lomonaco: None. E. Godinez: None. N. Fanous: None. L.J. Tejera: None. A. McCauley: None. L. Mansour: None. S. Shrestha: None. J.S. Marte: None. J. Fakhry: None. H. Wang: None. A. Vargas: None. D. Barb: None. F. Bril: None. K. Cusi: Consultant; Self; Allergan plc., AstraZeneca, Bristol-Myers Squibb, Genentech, Inc., Gilead Sciences, Inc., Merck & Co., Inc. Research Support; Self; Cirius Therapeutics, Echosens, Eli Lilly and Company, Inventiva Pharma, Janssen Pharmaceuticals, Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Poxel SA, Zydus Pharmaceuticals, Inc.

Funding
Echosens