bluuebunny/crossref_metadata_2025_split huggingface dataset:
1554-P: Abnormal Glucose Tolerance Due to Beta-Cell Failure Is Common in Nonobese Africans
Authors: HOBABAGABO ARSENE F. , HORMENU THOMAS , SHOUP ELYSSA M. , OSEI-TUTU NANA H. , DUBOSE CHRISTOPHER , MABUNDO LILIAN , CHUNG STEPHANIE T. , SUMNER ANNE E. 
Published: June 2020

Obesity and insulin resistance are the hallmarks of abnormal glucose tolerance (Abnl-GT) in African Americans and African Caribbeans. In contrast, prevalence, phenotype and etiology of Abnl-GT in African-born blacks are unknown. Working with African-born blacks living in America, we determined (a) the prevalence of Abnl-GT, and (b) the etiology of Abnl-GT by BMI category (i.e., primary β-cell failure vs. insulin resistance). OGTT was performed in 461 African-born blacks (male: 66%; age: 39±10 (mean±SD), range: 20-65y; BMI: 27.6±4.5, range: 18.4-42.4 kg/m2). Abnl-GT was diagnosed by glycemia: 0h glucose≥100 or 2h glucose≥140 mg/dL. Insulin resistance was defined by the cutoff at the lowest quartile of the Matsuda Index for the population (≤2.97). Primary β-cell failure was diagnosed if Abnl-GT was present and Matsuda Index was &gt;2.97. Obesity occurred in 27% (123/461). Abnl-GT occurred in 38% (173/461). By BMI category, Abnl-GT occurred in 35% (117/338) of the nonobese and 46% (56/123) of the obese. Overall, β-cell failure occurred in 61% (105/173) of participants with Abnl-GT (Figure). Yet, the odds of primary β-cell failure as the cause of Abnl-GT were 4 times higher in the nonobese than the obese (OR: 4.2; 95% CI: 2.2, 8.3). In short, the prevalence of Abnl-GT was high in both nonobese and obese African-born blacks. However, in nonobese Africans with Abnl-GT, primary β-cell failure was more common than insulin resistance.

Disclosure
A.F. Hobabagabo: None. T. Hormenu: None. E.M. Shoup: None. N.H. Osei-Tutu: None. C. DuBose: None. L. Mabundo: None. S.T. Chung: None. A.E. Sumner: None.
1555-P: Physiologic Stress Measured by Allostatic Load Score Is Associated with Abnormal Glucose Tolerance in African Immigrants
Authors: HORMENU THOMAS , HOBABAGABO ARSENE F. , SHOUP ELYSSA M. , OSEI-TUTU NANA H. , DUBOSE CHRISTOPHER , SUMNER ANNE E. 
Published: June 2020

The extent to which abnormal glucose tolerance (Abnl-GT) is associated with either physiologic stress measured by allostatic load score (ALS) or inflammation in African immigrants is unknown. Our goals were to determine in African-born blacks living in Washington, DC: a) the prevalence of physiologic stress measured by ALS and b) the association of ALS with Abnl-GT and key inflammatory markers. Enrollees were 324 African-born blacks who immigrated to the United States as adults (age of immigration ≥18years, current age 40±10y (mean±SD), range 21-65y, duration of stay in the United States 11±9y, range 0.2-43y, BMI 27.9±4.4 kg/m2, range 18.4-42.4 kg/m2, 70% male). ALS was calculated with 10 variables: cardiovascular (SBP, DBP, pulse, CHOL, HDL, homocysteine), metabolic (BMI, A1C, albumin), and immunological (hsCRP). Variables were divided into sex-specific quartiles with high-risk defined by the highest quartile for each variable except for albumin and HDL, which used the lowest quartile. One point was assigned if the variable was in the high-risk range and 0 if not. Physiologic stress was defined by ALS≥4 (upper quartile). Glucose tolerance was determined by the OGTT. The markers of inflammation were: TNF-alpha, IL-6 and MCP-1. Visceral adipose tissue (VAT) was measured by CT scan. High ALS occurred in 31% (102/324) of enrollees. The high ALS group were older than the low ALS group (45±9 vs. 39±9, P&lt;0.01). BMI, WC and VAT were higher in the high ALS group even after adjusting for age (all P&lt;0.01). Abnl-GT occurred in 41% (132/324). But the odds of Abnl-GT was higher in the high ALS than the low ALS group (OR= 2.6, CI: 1.63-4.67, P&lt;0.01). The three inflammatory markers were higher in the high ALS group but after adjustment for age, the difference only approached significance. Overall, nearly one-third of African immigrants experience physiologic stress measured by ALS and this may represent a predisposition to abnormal glucose tolerance.

Disclosure
T. Hormenu: None. A.F. Hobabagabo: None. E.M. Shoup: None. N.H. Osei-Tutu: None. C. DuBose: None. A.E. Sumner: None.
1559-P: Associations of Changes in Fat-Free Mass with Risk for Prediabetes and Type 2 Diabetes in the Hispanic Community Health Study/Study of Latinos
Authors: LECROY MADISON N. , HUA SIMIN , KAPLAN ROBERT , SOTRES-ALVAREZ DANIELA , QI QIBIN , THYAGARAJAN BHARAT , GALLO LINDA , PIRZADA AMBER , DAVIGLUS MARTHA L. , TALAVERA GREGORY A. , ISASI CARMEN R. 
Published: June 2020

Background: Loss of muscle mass may increase risk for type 2 diabetes (T2D), but few prospective studies have examined this association. The objective of this study was to determine whether loss of muscle mass (approximated with fat free mass [FFM]) is associated with risk for prediabetes and T2D in a population disproportionately burdened by T2D.
Methods: Participants were Hispanic/Latino adults (aged 18-74 years) in the Hispanic Community Health Study/Study of Latinos (6.1-year follow-up), a multi-site, community-based cohort in the United States. Eligible participants were free of T2D at baseline (2008-2011; n=6264). Fasting glucose, HbA1c, and fasting insulin were measured. Diabetes was defined according to American Diabetes Association criteria. Analysis: Survey-weighted Poisson regression models examined the association of percent change in relative FFM (FFM/total body weight; %∆FFM) with incident prediabetes and T2D. Survey-weighted linear regression models examined associations of %∆FFM with changes in glucose and insulin measures. Models were adjusted for age, sex, Hispanic/Latino background, site, nativity, education, income, physical activity, years between visits, and diabetic medication use (for lab values only).
Results: Relative FFM declined by 2.1% between visits. %∆FFM was inversely associated with incident prediabetes (p-for-trend=0.001) but not T2D. %∆FFM was inversely associated with changes in glucose and insulin measures (p-for-trend&lt;0.0001). After adjustment for 1) fat mass index or 2) BMI and waist circumference, only the association with HOMA-IR remained significant. Associations were generally stronger for individuals who were overweight/obese at baseline (p&lt;0.05).
Conclusions: Findings suggest that muscle mass maintenance/accumulation during adulthood may reduce T2D risk (primarily insulin resistance), particularly among individuals who are overweight/obese.

Disclosure
M.N. LeCroy: None. S. Hua: None. R. Kaplan: None. D. Sotres-Alvarez: None. Q. Qi: None. B. Thyagarajan: None. L. Gallo: None. A. Pirzada: None. M.L. Daviglus: None. G.A. Talavera: None. C.R. Isasi: None.

Funding
National Heart, Lung, and Blood Institute (N01HC65233, N01HC65234, N01HC65235, HHSN268201300003I, N01HC65236, N01HC65237, T32HL144456)
1560-P: Impaired Glucose Tolerance: Estimates for 2019 and Projections for the Years 2030 and 2045
Authors: SAEEDI POUYA , KAUNDAL ABHA , KARURANGA SUVI , MALANDA BELMA , MOTALA AYESHA A. , ASCHNER PABLO , RATHMANN WOLFGANG 
Published: June 2020

Background: Impaired glucose tolerance (IGT) is an important risk marker for the development of type 2 diabetes. The 9th edition of the International Diabetes Federation (IDF) Diabetes Atlas provides updated estimates on the worldwide prevalence of IGT in 2019 and its projections for the years 2030 and 2045.
Methods: A literature review of studies reporting the age-specific prevalence of IGT between 1990 and 2019 was conducted. The number of studies that satisfied the selection criteria according to the analytical hierarchy process was limited to 62 studies (from 49 countries). A generalised linear regression model was used to estimate the prevalence of IGT in the world’s 211 countries and territories. IGT prevalence estimates for countries without high quality in-country data sources were extrapolated from countries deemed to be similar.
Results: In 2019, the estimated global prevalence of IGT in adults aged 20-79 years is 7.5% (374 million people). The vast majority (72.2%) of people with IGT live in low- and middle-income countries and 48.1% (180 million) are under the age of 50 years. The projected prevalences for 2030 and 2045 are estimated to be 8.0% and 8.6%, respectively. The IDF North America and Caribbean Region has the highest age-adjusted comparative prevalence of IGT (12.3%) in 2019, while the Europe Region has the lowest in 2019 (4.4%). The top three countries with the largest number of people in the age group 20-79 years with IGT in 2019 are China (54.5 million), the United States of America (37.4 million) and Indonesia (29.1 million), while Papua New Guinea (29.2%), Indonesia (17.8%) and New Zealand (17.5%) have the highest age-adjusted comparative prevalences of IGT in 2019.
Conclusion: The majority of people with IGT are living in low- and middle-income countries. Given that IGT signifies a risk for future diabetes, its early detection and intervention can play a crucial role in primary prevention of type 2 diabetes.

Disclosure
P. Saeedi: None. A. Kaundal: None. S. Karuranga: None. B. Malanda: None. A.A. Motala: None. P. Aschner: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Merck Sharp & Dohme Corp., Sanofi. Speaker’s Bureau; Self; Novo Nordisk A/S. W. Rathmann: Advisory Panel; Self; AstraZeneca. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Research Support; Self; Novo Nordisk Inc. Speaker’s Bureau; Self; Eli Lilly and Company, Novo Nordisk Inc.
1562-P: Predictive Risk Factors for Renal Dysfunction and Cardiovascular Disease: An Analysis Using Medical Checkup Data
Authors: TERAYAMA RYO , KOSHIZAKA MASAYA , SHIBATA TAKAHISA , BAN TOSHIAKI , MAEZAWA YOSHIRO , YOKOTE KOUTARO 
Published: June 2020

Objective: Early prevention of renal dysfunction progression and cardiovascular disease is important in diabetes. We aimed to determine the risk factors for renal dysfunction and cardiovascular disease among medical insurance subscribers between 40 and 74 years of age in Japan.
Methods: This retrospective study involved 1585 subjects, including 97 patients with diabetes, who had undergone a specific health checkup in 2013 and 2019. The primary composite outcome included decline in estimated glomerular filtration rate (eGFR) by ≥30%, increase in urine albumin-to-creatinine ratio (UACR) by ≥30 mg/gCre, and increase in the Framingham Risk Score by ≥5%. We categorized the subjects into groups with and without these outcomes. Univariate analysis was conducted using Welch’s t-test, Pearson’s correlation coefficient, and Fisher’s exact test. Based on the univariate analysis, principle component and logistic analyses were performed to determine the predictive risk factors.
Results: Significant between-group differences were noted in terms of age, BMI, waist circumference, blood pressure, hemoglobin, hematocrit, triglyceride, HDL-C, LDL-C, AST, ALT, γ-GTP, HbA1c, serum creatinine, eGFR, urine creatinine, UACR, urine protein-to-creatinine ratio, sex, antihypertensive medication, history of anemia, diabetes, smoking, alcohol consumption, weight change, exercise habits, the will to improve and others. Logistic analysis showed that age (odds ratio [95% confidence interval]: 1.04 [1.02-1.06], P &lt;0.0001), HDL-C (0.97 [0.96-0.98], P &lt;0.0001), HbA1c (1.35 [1.12 -1.63], P =0.0015), and male sex (3.90 [2.97-5.11], P &lt;0.0001) were predictive risk factors.
Conclusion: Lower HDL-C and higher HbA1c were detected as the risk factors for patients with diabetes and without diabetes. The results of this study indicate that the harmful effects of hyperglycemia and dyslipidemia may have started before the patients actively exhibit metabolic disorders.

Disclosure
R. Terayama: None. M. Koshizaka: None. T. Shibata: None. T. Ban: None. Y. Maezawa: None. K. Yokote: Research Support; Self; Astellas Pharma Inc., Daiichi Sankyo, Eli Lilly Japan K.K., Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Mochida Pharmaceutical Co., Ltd., Nippon Boehringer Ingelheim Co. Ltd., Novartis Pharma K.K., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Pfizer Japan Inc., Sanofi K.K., Shionogi & Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. Speaker’s Bureau; Self; Abbott, Astellas Amgen, AstraZeneca K.K., Bayer Inc., FUJIFILM Pharmaceuticals U.S.A., Inc., Kaken Pharmaceutical Co., Ltd., Sanwa Kagaku Kenkyusho.
1571-P: Cadmium and Type 2 Diabetes in a Superfund Site Lead Smelter Community in Dallas, Texas
Authors: LITTLE BERT B. , REILLY ROBERT F. , WALSH BRAD 
Published: June 2020

Introduction: Six of 14 prior studies reported significant associations between cadmium (Cd) and type 2 diabetes mellitus (T2DM).
Materials and Methods: In a Superfund Cleanup community, Phase II screening included physical examination and laboratory tests. Participants were African Americans aged ≥19 years to ≦89 years. Multiple logistic regression was used.
Results: Of 873 subjects environmentally exposed, 109 T2DM individuals who lived in the community for an average of 21.0 years, and 766 non-T2DM individuals resident in the study community for 19.0 years. Most T2DM individuals (70.3%) were ≥50 years old (p&lt;0.00001). Blood Cd levels were significantly higher among T2DM subjects (p&lt;0.006). T2DM status was regressed on age ≥50 years, Cd, other metals, decades of residence in smelter community, gender, abnormal GGT, and smoking. T2DM predictors were age ≥ 50 years (OR = 3.10; 95% CI: 1.91-5.02, p&lt;0.0001), Cd level (OR = 1.85; 95% CI: 1.14 - 2.99, p &lt; 0.01), and BMI (OR=1.07; CI: 1.04-1.09).
Discussion: Cd exposure is associated with T2DM in an EPA Superfund community, controlling for covariate effects. Comparing our findings with 14 prior Cd and T2DM studies shows that T2DM rates less than 10% were not sufficiently powered, unless OR ≥ 3.0 (See Figure). Findings suggest that Cd is associated with T2DM, and studies failing to show a significant effect may have a Type II error, and not an indication of no association.

Disclosure
B.B. Little: None. R.F. Reilly: None. B. Walsh: None.
1575-P: Health-Related Quality of Life in Patients with Type 2 Diabetes: A Case-Control Study
Authors: MURAKAMI HIROSHI , FUJITA TOMOYUKI , MURABAYASHI MASAYA , MIZUSHIRI SATORU , OSONOI SHO , MATSUHASHI YUKI , DAIMON MAKOTO 
Published: June 2020

Background: Health-related quality of life (HR-QOL) assessment is considered an important aspect of outcome in diabetes treatment.
Objective: We investigated the association between QOL and clinical characteristics of patients with diabetes.
Methods: Among 571 patients with type 2 diabetes and 958 healthy control subjects, the target subjects who were matched by age and sex were divided into two groups (504 in the diabetic group and 504 in the nondiabetic group). The 36-Item Short Form Health Survey questionnaire (SF-36) was used to evaluate HR-QOL. Unpaired Student’s tests and Pearson’s chi-square test were used for statistical analyses.
Results: (1) Scores of physical functioning, role physical (physical and mental), general health, and social functioning were significantly lower in the diabetic group than in the nondiabetic group (P&lt;0.01). (2) The physical component summary score (PCS) was significantly lower in the diabetic group (P&lt;0.01). There was no significant difference in the mental component summary score (MCS) between the two groups. (3) The PCS score was significantly decreased (P&lt;0.01) with age in both groups. Reduction in the PCS score was faster in the diabetic group than the nondiabetic group, with an approximate difference of 11 years. (4) In the diabetic group, patients with retinopathy, nephropathy, or neuropathy demonstrated a significant reduction in the PCS score (P&lt;0.01); however, no difference was observed in the MCS score. (5) Regarding the association of complications, such as retinopathy, nephropathy, or neuropathy, more were the complications, significantly lower was the PCS score (P&lt;0.01).
Conclusions: QOL was significantly decreased in patients with type 2 diabetes compared with that in healthy subjects. QOL of patients with diabetic complications was significantly decreased; thus, such conditions should be taken into account when providing treatment to patients with diabetes.

Disclosure
H. Murakami: None. T. Fujita: None. M. Murabayashi: None. S. Mizushiri: None. S. Osonoi: None. Y. Matsuhashi: None. M. Daimon: None.
158-OR: Calcium Channel Blockade Protects against Severe Hypoglycemia–Induced Fatal Cardiac Arrhythmias in Rats
Authors: RENO CANDACE M. , HUANG YIQING , CHRISTENSEN CAMILLE G. , OXSPRING MILAN B. , BAYLES JUSTIN , FISHER SIMON J. 
Published: June 2020

It was hypothesized that in response to insulin-induced severe hypoglycemia, excess calcium influx into the heart causes fatal cardiac arrhythmias. To test if blocking the calcium channels would decrease fatal cardiac arrhythmias during severe hypoglycemia, L-type calcium channel blocker (Verapamil; 1 mg/kg, n = 25) or saline (n = 24) were infused into Sprague Dawley rats during a hyperinsulinemic (0.2 mU/kg/min) severe hypoglycemic (10-15 mg/dl) clamp for 3 hours with ECG. During severe hypoglycemia, verapamil completely prevented mortality compared to 21% mortality in controls (p &lt; 0.05; Figure). Decreased mortality was associated with a 99% decrease in 2nd degree heart block (Figure) and prevention of 3rd degree heart block compared to saline (p &lt; 0.05). Glucagon and epinephrine were similar between the groups suggesting verapamil does not affect hypoglycemic counterregulation. Consistent with the notion of calcium-mediated arrhythmias, separate experiments demonstrated that pharmacological blockade of ryanodine receptor-mediated calcium signaling also reduced heart block by 97% and prevented mortality due to hypoglycemia.
In summary, blocking calcium channels protects against severe hypoglycemia-induced fatal cardiac arrhythmias. Blockade of cardiac calcium channels could be a potential approach to prevent arrhythmias in people with diabetes at risk for hypoglycemia.

Disclosure
C.M. Reno: None. Y. Huang: None. C.G. Christensen: None. M.B. Oxspring: None. J. Bayles: None. S.J. Fisher: None.

Funding
National Institutes of Health (5T32DK091317, R01NS070235); JDRF (3-APF-2017-407-A-N)
1588-P: Therapy Trends in Initial 6 Months of the First Large-Scale Longitudinal Nationwide Study on Management and Real-World Outcomes of Diabetes in India (LANDMARC)
Authors: GHOSH ROMIK , DAS ASHOK K. , MITHAL AMBRISH , JOSHI SHASHANK , PRASANNA KUMAR K.M. , KALRA SANJAY , UNNIKRISHNAN AMBIKA GOPALAKRISHNAN , THACKER HEMANT , SETHI BIPIN , MOHANASUNDARAM SENTHILNATHAN , MENON SHALINI K. , NAIR ARJUN , RAIS NADEEM , WANGNOO SUBHASH KUMAR , CHOWDHURY SUBHANKAR , ZARGAR ABDUL H. 
Published: June 2020

Therapy patterns were examined across various subgroups during the first 6-months of this 3 year prospective longitudinal study (LANDMARC; CTRI/2017/05/008452). During the observational period investigators were free to modify treatment in adults with T2D controlled/uncontrolled on ≥2 antihyperglycemic medications. Treatment patterns were analyzed using descriptive statistics and paired t-test. From baseline to 6-months (visit 2 [V2]), glycemic parameters analyzed for 5703 subjects improved significantly (p&lt;0.001) across all treatment types (Table). This improvement was more evident in the insulin subgroup vs. insulin naïve subgroup (p&lt;0.0001). No difference (p=0.7746) in mean A1C values of those receiving &gt;3 OADs vs. ≤3 OADs was noted in insulin naïve subgroup. Notably, in participants receiving insulin along with OADs, PPG improved more in basal vs. premix regimen (p=0.0024). Overall, insulin regimen was more effective than OADs. Intensification of treatment with &gt;3 OADs may not be effective in improving glycemic parameters. In real-world setting, adding basal insulin may be more effective than premix.

Disclosure
R. Ghosh: Employee; Self; Sanofi. A.K. Das: Advisory Panel; Self; Novo Nordisk A/S, Sanofi. A. Mithal: Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Johnson & Johnson, Lilly Diabetes, Novo Nordisk A/S. S. Joshi: Advisory Panel; Self; Novo Nordisk A/S, Roche Pharma, Sanofi. K. Kumar: None. S. Kalra: Advisory Panel; Self; Eli Lilly and Company. Speaker’s Bureau; Self; Novo Nordisk A/S, Sanofi-Aventis. A. Unnikrishnan: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi. Speaker’s Bureau; Self; Eli Lilly and Company, Ipca Laboratories, Merck Sharp & Dohme Corp., Novartis AG. H. Thacker: None. B. Sethi: None. S. Mohanasundaram: Employee; Self; Sanofi. S.K. Menon: None. A. Nair: Employee; Self; Sanofi. N. Rais: None. S. Wangnoo: None. S. Chowdhury: Advisory Panel; Self; Novo Nordisk A/S. A.H. Zargar: None.

Funding
Sanofi India Limited
16-LB: Patient and Paramedic Experiences with a Direct Electronic Referral Program for Hypoglycemia (HG) Education following Paramedic Service Assist–Requiring HG: A Qualitative Study
Authors: LIU SELINA L. , ROSA ANDREW , SIBBALD SHANNON L. , MAHON JEFFREY , CARTER DUSTIN R. , PEDDLE MICHAEL , SPAIC TAMARA 
Published: June 2020

Hypoglycemia requiring paramedic assistance negatively impacts outcomes in people with diabetes. Prior studies have shown only a small proportion of those with paramedic assist-requiring HG are brought to hospital. These episodes are thus “invisible” to the health care system. An innovative direct electronic referral program in which paramedics sent a referral for focused HG education to the Diabetes Education Centre (DEC) at the time of paramedic assessment was implemented for 18 months. Program uptake was lower than expected (133 referrals, 79 scheduled, and 50 attended). This qualitative study examines barriers and facilitators of DEC attendance for HG education after paramedic assist-requiring HG. We conducted semi-structured interviews of patients with paramedic-assisted HG and surveyed paramedics about their experiences. Of 34 paramedics, 30 (88%) attended at least 1 HG call in the study period and 26 (76%) used the referral program. Fourteen patients (18% response rate) participated: 8 men (57%); 13 (93%) age ≥ 50 yrs. Eight patients (57%) recalled the paramedic referral, 6 (43%) did not, and 4 (29%) thought they were referred by their family doctor. One patient thought attendance was mandatory to keep their drivers’ license. Themes identified from patient responses included: positive impact of diabetes education especially if delivered early after diagnosis, importance of spousal support and in-person education. Barriers to attendance were prior DEC attendance especially in those with long diabetes duration and embarrassment (failure to self-manage, memory loss around the HG event). While patients felt that focused HG education is an excellent strategy to reduce recurrent episodes, many had already attended similar sessions and felt further education was not needed. Hence, an important gap in providing HG education to patients with severe HG may be both system-based and disease-related.

Disclosure
S.L. Liu: Consultant; Self; Merck & Co., Inc., Novo Nordisk Inc., Sanofi. Research Support; Self; Novo Nordisk Inc., Sanofi. A. Rosa: None. S.L. Sibbald: None. J. Mahon: None. D.R. Carter: None. M. Peddle: None. T. Spaic: Research Support; Self; Novo Nordisk Inc. Speaker’s Bureau; Self; Dexcom, Inc., Sanofi.

Funding
Academic Medical Association of Southwestern Ontario (INN16-004)