bluuebunny/crossref_metadata_2025_split huggingface dataset:
1226-P: Effectiveness of Frequency of Visits in the Internet plus Diabetes Shared Care Clinic on Glucose Improvement in Patients with Type 2 Diabetes: A Real-World Analysis
Authors: LI ANG , ZHANG WENFEI , GUO XIAOHUI , ZHANG JUNQING 
Published: June 2020

Background: Patients with diabetes need DSMS on the basis of systematic comprehensive management. However, there is no recommendation on how often regular follow-up visits patients should receive in China.
Objectives: To explore the effectiveness of frequency of visits in the Internet plus Diabetes Shared Care (IDSC) clinic on glycemic control among patients with type 2 diabetes followed-up more than 2 years.
Design: A retrospective single-center hospital-based propensity scores weighting (PSW) real-world analysis.
Methods: IDSC in Peking University First Hospital (PKUFH) provided individualized, systematic and continuous management with off-line and on-line support. Adult patients with type 2 diabetes who received at least second follow-up visit in IDSC clinic in the first semester of 2018 were eligible. All subjects were divided into three groups by actual follow-up visit times within 2018 Jan to 2019 Jan. Age, gender, diabetes duration, baseline metabolic profiles (BMI, HbA1c, LDL-c, BP), baseline Insulin usage and baseline costs of antidiabetic drugs were used as covariates for three-group PSW analysis to compare the average treatment effect in the population (ATE) of HbA1c in each group at 1-year and 2-year follow up.
Result: A total of 496 eligible subjects were included [Fv group (Four visits/y) n=330, Tv group (Three visits/y) n=128, TLv group (Two or Less visits/y) n=38]. After PSW, HbA1c of Fv group was improved in trend at 1-year follow up compared with Tv group (-0.25%, p=0.05) and TLv group (-0.34%, p=0.06) but was significantly improved at 2-year follow up (-0.34%, p=0.01 for Tv group; -0.55%, p=0.008 for TLv group). There was no significant difference in HbA1c between the Tv group and TLv groups at neither 1-year and 2-year follow-up.
Conclusions: Our findings indicate that regularly followed-up in IDSC clinic at least 4 times/year could efficiently improve glycemic control of among patients with type 2 diabetes.

Disclosure
A. Li: None. W. Zhang: Employee; Self; iHealth Labs. X. Guo: None. J. Zhang: None.
1227-P: Importance of Awareness and Treatment for Diabetes in Influenza Vaccination Coverage in Patients with Diabetes
Authors: KO SEUNG-HYUN , AHN YU-BAE , SONG KI-HO , LEE JUNG-MIN , KIM SUNG-KYOUNG , HAN KYUNGDO 
Published: June 2020

Influenza is a global public health problem causing considerable morbidity and mortality. Although vaccination is the most effective way to prevent infection, vaccination coverage is insufficient in people with chronic disease under 65 years, especially diabetes. The purpose of this study was to evaluate influenza vaccination coverage and identify factors associated with influenza vaccination in Korean diabetic adults under 65 years. Data were obtained from 24,821 subjects in the Korea National Health and Nutrition Examination Survey (2014-2017). Socioeconomic, health-related, and diabetic factors were investigated for their relations with influenza vaccination in diabetic patients under 65 years using univariate and multivariate analyses. Among 24,821 subjects, 1,185 were diabetic patients under 65 years and their influenza vaccination rate was 36.5%. Socioeconomic (older age, female gender, non-smoker, light alcohol drinker, lower educational level, and employed status), health-related factors (lower fasting glucose and HbA1c level, good self-perceived health status, recent health screening, and diet therapy), and diabetic factors (more awareness and getting treated) were associated with influenza vaccination. In multivariate analysis, more awareness and getting treated for diabetes were associated with influenza vaccination in diabetic patients under 65 years (odds ratio: 1.553 and 1.495; 95% confidence interval: 1.080-2.233 and 1.057-2.115, respectively). Influenza vaccination rate was low in diabetic patients under 65 years, especially in those with unawareness and not getting treated for diabetes. Active screening and treatment for diabetes may be helpful to improve the influenza vaccination rate in these patients.

Disclosure
S. Ko: None. Y. Ahn: None. K. Song: None. J. Lee: None. S. Kim: None. K. Han: None.

Funding
Korean Ministry of Health and Welfare (HI18C0275)
123-LB: The Simplici-T1 Trial: Relationship between Glycemic Control and Insulin Dose
Authors: VALCARCE CARMEN , FREEMAN JENNIFER L. , DUNN IMOGENE , KLEIN KLARA , BUSE JOHN B. 
Published: June 2020

The Simplici-T1 trial (NCT03335371), designed to explore the safety and efficacy of TTP399 as an oral adjunctive therapy for T1DM, showed that addition of TTP399 to an optimized insulin regimen produced a statistically significant improvement in HbA1c (-0.32%, p&lt;0.01) and Daytime Time In Range (8%, p&lt;0.05) relative to placebo. The treat-to-target (FPG: ~80-130mg/dL; post meal glucose: &lt;180-200 mg/dL) design of the study allowed changes in insulin dose after the insulin-optimization period. To evaluate the effect that these changes could have on A1c, several pre-planned analyses were performed. A positive correlation was observed between reduction in A1c and both reduction in total insulin (p=0.008) (Figure 1) and bolus insulin dose (p=0.004) in the TTP399-treated group but not in the PBO group. A subgroup analysis, matching on changes in insulin use reveals that, relative to PBO, those treated with TTP399 who maintained the optimized insulin regimen improved A1c by -0.35%, p=0.04 (41%TTP399; 36% PBO). The group that reduced their total insulin dose by more than 0.06U/Kg (i.e.,&gt;10% reduction in total and &gt;20% reduction in bolus insulin dose; 47% TTP399; 33% PBO) improved A1c by -0.41%, p=0.013. These improvements occurred without increasing ketones in plasma or hypoglycemic events. During the 12-week treatment period, 12% of the TTP399 group and 31%of the PBO increased their insulin dose.

Disclosure
C. Valcarce: Employee; Self; vTv Therapeutics. J.L. Freeman: Employee; Self; vTv Therapeutics. Stock/Shareholder; Self; vTv Therapeutics. Stock/Shareholder; Spouse/Partner; vTv Therapeutics. I. Dunn: None. K. Klein: None. J.B. Buse: Consultant; Self; Cirius Therapeutics, CSL Behring, Neurimmune. Research Support; Self; American Diabetes Association, National Institutes of Health, Novo Nordisk A/S, Patient-Centered Outcomes Research Institute, Sanofi, Tolerion, Inc., vTv Therapeutics. Stock/Shareholder; Self; Mellitus Health, Pendulum Therapeutics, PhaseBio Pharmaceuticals, Inc., Stability Health. Other Relationship; Self; ADOCIA, AstraZeneca, Dance Biopharm Holdings, Inc., Eli Lilly and Company, MannKind Corporation, NovaTarg Therapeutics, Novo Nordisk A/S, Senseonics, Inc, vTv Therapeutics, Zafgen, Inc.

Funding
JDRF; vTv Therapeutics; National Institutes of Health (UL1TR002489)
123-OR: Short-Term Hyperglycemia Causes a Paradoxical Reduction in Sensory Neuron Excitability
Authors: CAMPANUCCI VERONICA A. , BAUTISTA MARICRIS , NEAPETUNG JOSEPH T. 
Published: June 2020

Peripheral neuropathy in diabetes is characterized by a constellation of sensory abnormalities, including numbness, tingling, as well as exacerbated responses to painful and non-painful stimuli. Particular interest has concentrated on voltage-gated sodium (Nav) channels since they play central roles in painful forms of neuropathy in long-term diabetes. However, their possible contributions to the onset of neuropathy are still under investigation. In the current study, we aimed at elucidating the contribution of Nav channels during early hyperglycemia in sensory neurons from the Dorsal Root Ganglion (DRG). We used cultured DRG neurons, maintained in either control (5 mM glucose) or in high glucose media (25 mM) for up to 14 days, and intact DRG tissues from streptozotocin (STZ)-induced hyperglycemic mice (at 1 and 3 months after induction). To study Nav channel function we used whole-cell patch-clamp electrophysiology and biochemical analysis by Western blotting for the detection of Nav subunit expression. Our results indicate that DRG neurons maintained in high glucose showed reduced action potential firing frequency and reduced inward currents. The later was consistent with the downregulation of the tetrodotoxin sensitive (TTX-S) Nav1.3, Nav1.6, and Nav1.7 subunits in intact DRG tissues from one-month STZ-hyperglycemic mice. The Navβ2 subunit, which has been shown to regulate the cell surface expressions of TTX-S Nav channels, also shows reduced expression levels. Interestingly, after three months of STZ-induced hyperglycemia, there was a significant upregulation in the expression level of the TTX-S Nav1.7 subunit, which has been linked to painful forms of neuropathy. Taken together, our data revealed that changes in expression and function of TTX-S Nav subunits take place from the early stage of pathologic hyperglycemia. Therefore, our data suggest that Nav channel may be involved in the development of positive and negative sensory symptoms in diabetic neuropathy.

Disclosure
V.A. Campanucci: None. M. Bautista: None. J.T. Neapetung: None.

Funding
Natural Sciences and Engineering Research Council of Canada (RGPIN-2015-03958)
1231-P: Type 2 Diabetes Care and Management: A Comparison of German and American Approaches
Authors: DINEGAR SARAH 
Published: June 2020

Within their multi-payer healthcare system, Germany has employed Disease Management Programs (“DMP”s) nationwide to manage T2D since 2002. Studies have suggested T2D financial burden reduction and improved health outcomes since DMP implementation. No such standardized programs exist in the fragmented U.S. healthcare-system. This study evaluated German and American primary care physicians’ opinions of efficacy of their nation’s respective T2D management methods in improving health outcomes, healthcare costs, and quality of care. German physicians reported consistent protocol and resource availability for T2D management, while American physicians’ responses varied widely by their clinical network and their patients’ insurers. Strengths of Germany’s T2D DMPs included lack of financial barrier to care and increased frequency of diabetic visits and patient accountability. Weaknesses included bureaucratic documentation and lack of customization. Strengths of American methods revolved around opportunity for innovation, resulting in increasing utilization of technological tools and motivational interviewing techniques. Weaknesses stemmed from systematic inequality of access, including lack of insurance-covered diabetes education, prohibitively high costs of medication, and lack of affordable preventive care. Despite these differences between German and American T2D care, both nations struggle with imperfect patient compliance and difficulty of achieving sustainable lifestyle changes. This study provides primary care physicians’ opinions on best directions forward for chronic disease management, particularly addressing these universal challenges. Recommendations included widespread insurance coverage of dieticians, intensive diabetes education courses, and mental health counselors, as well as increased use of team-based care, telemedicine and apps to improve patient accountability, and value-based reimbursement.

Disclosure
S. Dinegar: None.

Funding
Northwestern University
124-OR: Progressive Loss of Corneal Nerve Fibers and Sensitivity with Duration of Obesity Type 2 Diabetes in Sprague-Dawley Rats: Valid Marker for Peripheral Neuropathy and Treatment
Authors: YOREK MARK A. 
Published: June 2020

Purpose: Determine whether density of nerve fibers in the cornea and corneal function are valid markers for early detection and treatment of peripheral neuropathy in rat models of prediabetes and type 2 diabetes.
Methods: Rat models for prediabetes and type 2 diabetes were created and longitudinally studied for loss of structure and function of sensory nerves in the cornea and skin as well as nerve conduction velocity and vascular reactivity of epineurial arterioles. Reversibility of neuro and vascular pathology was also examined in these models following chronic obesity or type 2 diabetes after dietary intervention with menhaden oil a natural source of long chain omega-3 polyunsaturated fatty acids.
Results and Conclusions: Our longitudinal study demonstrated that vascular and neural dysfunction associated with obesity or type 2 diabetes occur early and are progressive. Decrease in cornea nerve fiber length and function were valid markers of disease in both the prediabetic and diabetic rat models and were more sensitive than decrease in intraepidermal nerve fiber density of the skin and thermal nociception of the hindpaw. Late intervention with menhaden oil reversed both vascular and peripheral damage induced by chronic obesity or type 2 diabetes. These studies provide support for examination of corneal structure and function as an early marker of peripheral neuropathy in prediabetes and diabetes. Furthermore, we demonstrate that omega-3 polyunsaturated fatty acids derived from fish oil as an effective treatment for peripheral neuropathy that occurs with chronic obesity or type 2 diabetes.

Disclosure
M.A. Yorek: Consultant; Self; Novo Nordisk Inc.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (DK107339); U.S. Department of Veterans Affairs (RX000889)
1242-P: Response Heterogeneity to Lifestyle Intervention in Latino Adolescents with Obesity
Authors: PENA ARMANDO , MCNEISH DANIEL , AYERS STEPHANIE , OLSON MICAH , VANDER WYST KILEY B. , WILLIAMS ALLISON , KONOPKEN YOLANDA P. , KELLER COLLEEN , CASTRO FELIPE GONZÁLEZ , PATRICK DONALD L. , SHAIBI GABRIEL Q. 
Published: June 2020

Background: Lifestyle change is the cornerstone for preventing type 2 diabetes (T2D) in high risk populations. However, there is significant biological variability in how individuals respond. The purpose of this secondary analysis is to characterize response heterogeneity in high-risk youth after a lifestyle intervention that led to significant increases in insulin sensitivity.
Methods: Latino adolescents with obesity (N=90, age 15.4±0.9 y, BMI% 98.0±1.5) were enrolled in a 3-month lifestyle intervention and followed for 1 year. Insulin sensitivity (IS) was estimated by glucose and insulin response to OGTT at 0, 3, 6, and 12 months. Covariance pattern mixture models identified response phenotypes. Baseline T2D risk factors were compared among response phenotypes using one-way ANOVA.
Results: Four distinct response phenotypes were identified: Long-Term Responders (LTR, N=13), Short-Term Responders (STR, N=29), Slow Responders (SR, N=30), and Non-Responders (NR, N=18). LTRs exhibited the greatest increase in IS (β±SE linear, 0.51±0.2, p=0.002), STR exhibited early, non-significant increases in IS (-0.08±0.3, p=0.5), SRs exhibited a slow increase (0.09±0.03, p=0.002), and NR did not change over time (0.002±0.02, p=0.9). Attendance during the intervention was not different across response phenotypes (p=0.1) and groups did not differ by age (p=0.9) sex (p=0.5), or prediabetes status (p=0.2). Comparing baseline characteristics between the most extreme response phenotypes (NR vs. LTR), NR exhibited significantly lower IS (p&lt;0.001) and higher BMI% (p=0.001), waist circumference (p=0.001), TRGs (p=0.006), fasting and 2-hr insulin (p&lt;0.001), and 2-hr glucose (p=0.009) compared to LTR.
Conclusion: Results highlight the heterogeneous response to lifestyle intervention in Latino youth and suggest that the highest risk youth require more aggressive efforts to improve insulin sensitivity. Precision approaches are warranted to meet the T2D prevention needs in this population.

Disclosure
A. Pena: None. D. McNeish: None. S. Ayers: None. M. Olson: None. K.B. Vander Wyst: None. A. Williams: None. Y.P. Konopken: None. C. Keller: None. F. González Castro: None. D.L. Patrick: None. G.Q. Shaibi: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK10757901, 3R01DK107579-03S1); National Institute on Minority Health and Health Disparities (P20MD002316, U54MD002316)
1244-P: Impact of Maternal Fasting Glucose in Pregnancy on Excess Weight at Preschool Age in the Offspring
Authors: KAUL PADMA , SAVU ANAMARIA , MOORE LINN E. , YEUNG ROSEANNE O. , RYAN EDMOND A. 
Published: June 2020

Aim: To examine the association between elevated maternal fasting plasma glucose (FPG) during pregnancy and obesity in the offspring.
Methods: For women without pre-existing diabetes in 2 zones in Alberta, Canada with births between 2005 - 2013, maternal data were linked to offspring’s birth registry and preschool immunization records (w/height, weight) between 2009-2017. A 50-g glucose challenge test (GCT) followed by a 75-g OGTT was used to diagnose GDM. Pregnancies were grouped as follows: 1) GCT negative; 2) OGTT negative; 3) elevated FPG on the OGTT; and 4) elevated 1-hour and/or 2-hour OGTT only. WHO criteria were used to identify children who were overweight, obese, or extremely obese.
Results: Of 79,156 pregnancies, 80.3% were GCT negative, 14.7% were OGTT negative, 1.3% had elevated FPG, and 3.7% had elevated post-load glucose only. Both LGA and pre-school obesity rates were highest in pregnancies with abnormal FPG (Figure). Relative to children of GCT negative pregnancies, children of pregnancies with elevated maternal FPG had adjusted odds ratio (aOR, 95% CI) 3.0, (2.6-3.6) for LGA; and aOR 1.3 (1.1 - 1.6) for overweight, aOR 2.4 (1.9 - 3.0) for obesity, aOR 3.5 (2.7 - 4.7) for extreme obesity at preschool age.
Conclusion: The effect of elevated maternal FPG in pregnancy on offspring weight extends to early childhood. These children may be candidates for early pediatric weight and health interventions.

Disclosure
P. Kaul: None. A. Savu: None. L.E. Moore: None. R.O. Yeung: Research Support; Self; AstraZeneca, Novo Nordisk Inc. Speaker’s Bureau; Self; Merck & Co., Inc. E.A. Ryan: None.

Funding
Canadian Institutes of Health Research; University Hospital Foundation
1255-P: Parental Socioeconomic Status and Risk of Impaired Fasting Glucose and Obesity of Children by Sex in Korea
Authors: LEE SOMIN , HAN KYUNGDO 
Published: June 2020

Objective: To assess relations between parental socioeconomic status (SES) and impaired fasting glucose (IFG) and obesity of children by sex in Korea population.
Method: This study was based on the data from the Korean National Health and Nutrition Examination Survey, conducted by the Korean Ministry of Health and Welfare from 2007 to 2017. Data of 28747 participants (6605 children, 4969 fathers, and 6387 mothers) were analyzed. The SES was assessed with household income level and education level. The household income level was categorized into three groups: high, middle, and low. The education level was categorized into two groups: graduated post-secondary school or not. The prevalence of IFG was defined as &gt;=100 fasting blood sugar. The prevalence of obesity was defined with the Korean Pediatrics Growth Chart from 2017. The relationship of SES to the risk of IFG and obesity was assessed with multivariate logistic regression analysis.
Result: In female children participants, a higher risk of IFG was associated with 1) low household income level (OR: 2.874, 95% CI:1.315, 6.279) and 2) low education level of mother (OR: 1.923, 95% CI: 1.062, 3.744), while the risk was not associated with low education level of father (OR: 1.395, 95% CI: 0.893, 2.18). Risk of obesity of female children was also associated with these two factors: low household income level (OR: 2.262, 95% CI: 1.182, 4.328) and education level of mother (OR: 1.484, 95% CI: 1.081, 2.036). Unlike female, in male children participants, risk of IFG and obesity was not associated with either factors.
Conclusions: For girls, low household income and low mothers’ education level may increase the incidence of IFG and obesity while boys are not affected by either factors. These differences should be considered when raising children and managing risk of diabetes and obesity of children to ultimately prevent risk of diabetes.

Disclosure
S. Lee: None. K. Han: None.
1257-P: Impact of Parental Smoking on Adipokine Profiles and Cardiometabolic Risk Factors in Chinese Children: The Beijing Child and Adolescent Metabolic Syndrome Cohort Study
Authors: LI MING , ZHANG QIAN , GAO SHAN , WILLI STEVEN M. , GROUP BCAMS 
Published: June 2020

Exposure to secondhand smoke has relatively recently been recognized to be an important modifiable risk factor for obesity and cardiovascular disease, along with unhealthy diet, sedentary lifestyle and insufficient sleep. The mechanism(s) by which passive smoking imparts this risk and the tissues involved still require elucidation. We aimed to evaluate the association between parental smoking exposure (PSE), secretion of adipokines and cardiometabolic risk in Chinese children. A total of 3150 children (6-18ys) from the Beijing Child and Adolescent Metabolic Syndrome (MetS) study with data on PSE and potential confounders (pubertal stage, physical activity, diet and socioeconomic factors plus family history) were included. Six adipokines related to insulin resistance and MetS (leptin, adiponectin, retinol binding protein 4 (RBP4), fibroblast growth factor 21 (FGF-21), resistin and osteonectin) were measured. Of those children studied, nearly 65% reported PSE, defined as smoking in either parent. After adjusting for covariates, including pubertal stage, lifestyle factors, and family history, PSE was independently associated with increases of 39.2% in leptin and 3.9% in RBP-4 and decreases of 11.4% in FGF-21 and 4.6% in adiponectin levels (P &lt; 0.05 for all). The risks of central obesity (OR 1.59, 95% CI 1.33-1.90, P &lt; 0.001), hyperglycemia (OR 1.30, 95%CI 1.02-1.66, P&lt;0.05), hypertension (1.22, 1.02-1.46, P = 0.001) and MetS (1.43, 1.11-1.85, P &lt; 0.001) were all increased with PSE. However, the associations of PSE with hypertension and MetS were abolished after adjusting for adiposity parameters or the above-mentioned adipokines. In contrast, PSE was still associated with increased risk of hyperglycemia after adjusting for BMI in boys (OR 1.42, 95%CI: 1.01-2.00, P&lt;0.05). Our findings suggest that PSE was associated with dysregulation of adipokine levels, which may mediate the development of MetS in early life.

Disclosure
M. Li: None. Q. Zhang: None. S. Gao: None. S.M. Willi: Advisory Panel; Self; Boehringer Ingelheim International GmbH. Research Support; Self; Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Tolerion, Inc. Other Relationship; Self; Caladrius Biosciences, Inc.

Funding
National Natural Science Foundation of China (81970732); National Key Research and Development Program of China (2016YFC1304801); Key Program of Beijing Municipal Science and Technology Commission (D111100000611001, D111100000611002); Beijing Natural Science Foundation (7172169); Beijing Science and Technology Star Program (2004A027); Novo Nordisk Union Diabetes Research Talent Fund (2011A002); National Key Program of Clinical Science (WBYZ2011-873); Central Research Institute Fund of Chinese Academy of Medical Sciences (2017PT32020, 2018PT32001)