bluuebunny/crossref_metadata_2025_split huggingface dataset:
716-P: Reduced Carbohydrate and Increased Protein and Fat in the Diet Augment the Positive Effect of Weight Loss on Glucose Control in Type 2 Diabetes Patients
Authors: THOMSEN MADS N. , SKYTTE MADS J. , SAMKANI AMIRSALAR , CARL MARTIN H. , WEBER PHILIP , ASTRUP ARNE , LARSEN THOMAS M. , FRYSTYK JAN , HOLST JENS J. , HARTMANN BOLETTE , THOMSEN HENRIK , CHABANOVA ELIZAVETA , MADSBAD STEN , HAUGAARD STEEN B. , KRARUP THURE 
Published: June 2020

Background: We hypothesized that dietary carbohydrate reduction will add to the effect of a diet-induced 6% body-weight loss on glycemic control and hepatic fat content in patients with type 2 diabetes (T2D).
Methods: Forty-four persons of mean HbA1c 56.4 mmol/mol and 9 years of T2D were randomized 1:1 for 6-weeks full food provision, a hypo-caloric carbohydrate-reduced high-protein (CRHP) or a conventional diabetes (CD) diet (carbohydrate 30E%/50E%, protein 30E%/17E% and fat 40E%/33E%). Body-weight loss was aimed at 6% and reinforced bi-weekly by adjustment of hypo-caloric diets. Hepatic fat content was estimated by Magnetic Resonance (MR) spectroscopy and analyzed by a MR research technician, blinded to the protocol.
Results: Six weeks of a hypo-caloric CRHP diet compared with a CD diet improved HbA1c (mean±SD) by further 2 mmol/mol (-8.7±4.6 mmol/mol vs. -6.7±3.9 mmol/mol, p=0.04) with comparable weight losses, 5.5±1.7 kg (5.6 %) and 5.6±2.2 kg (5.9 %) of body-weight, respectively. Hepatic fat content (median (IQR) was reduced significantly while consuming the CRHP diet (5.2% (1.3-6.9)) and CD diet (2.6% (1.6-6.5)), but with no difference between diets (p=0.40).
Conclusion: Reducing carbohydrate and increasing protein and fat adds clinical relevance to the positive effects of body-weight loss on glucose control in T2D patients.

Disclosure
M.N. Thomsen: None. M.J. Skytte: None. A. Samkani: None. M.H. Carl: None. P. Weber: None. A. Astrup: Advisory Panel; Self; Gelesis, Novo Nordisk A/S, Saniona, Weight Watchers International, Inc. Research Support; Self; Arla Food for Health, Gelesis, Novo Nordisk A/S. Speaker’s Bureau; Self; Arla Food for Health. Stock/Shareholder; Self; Gelesis. T.M. Larsen: Advisory Panel; Self; Advisor for Sense diet programme. J. Frystyk: None. J.J. Holst: Advisory Panel; Self; AstraZeneca, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Zealand Pharma A/S. Other Relationship; Spouse/Partner; Antag Therapeutics. B. Hartmann: None. H. Thomsen: None. E. Chabanova: None. S. Madsbad: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi-Aventis. Research Support; Self; Boehringer Ingelheim International GmbH, Novo Nordisk A/S. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S. S.B. Haugaard: None. T. Krarup: None.
717-P: The Levels and Related Factors of Advanced Glycation End Products in Korean Patients with Type 2 Diabetes Mellitus
Authors: YIM JUNG-EUN , KIM YOUNG SEOL , PARK JI SOOK 
Published: June 2020

Advanced glycation end-products (AGEs) are known to be produced by the Maillard reaction, ingested through food. AGEs are actively generated and accumulated in the circulating blood and various tissues in diabetes mellitus patients by chronic hyperglycemia. AGEs play an important role in the development of diabetic vascular complications. The aim of this study was to assess levels and related factors of AGEs in Korean patients with type 2 diabetes mellitus.
A total of 310 Korean men (n=177) and women (n=133) with T2DM subjects were participated. This study was measured and analyzed anthrometric data, body composition, and biochemical parameters. Tissue accumulated AGEs can be evaluated a non-invasive methodology by skin autofluorescence reader.
The means age of total subjects was 58.9 ± 11.0 years, BMI was 25.8 ± 4.5 kg/m2. There is no difference between male and female patients in levels of AGEs, pulse wave velocity (PWV) and vein age. There is a significant correlation among AGEs, height, weight, body mass index, skeletal muscle mass, diastolic blood pressure and HDL cholesterol for male patients and among fasting blood sugar, glycated hemoglobin A1c, total cholesterol, LDL cholesterol, and systolic blood pressure for female patients. The correlation of AGEs for both male and female subjects is highly associated with age, duration of diabetes and PWV.
This study shows possibility of using AGEs as an index for clinical diagnosis, complications prediction, and diabetes management in Korean patients with type 2 diabetes mellitus. However, it is considered that a change in AGEs may be influenced by gender, age, and duration of diabetes.

Disclosure
J. Yim: None. Y. Kim: None. J. Park: None.
72-OR: Proinflammatory Intestinal Macrophages Are Increased in Obesity Potentially by Enhanced Recruitment of Blood Monocytes
Authors: ROHM THERESA V. , FUCHS REGULA , BAUMANN ZORA , KELLER LENA , SCHNEIDER ROMANO , LABES DANNY , CAVELTI-WEDER CLAUDIA 
Published: June 2020

Background: Our previous studies in mice showed that high fat diet leads to a pro-inflammatory phenotype of intestinal macrophages. Colon-specific depletion of intestinal macrophages led to improved glycemic control, suggesting a causal link between intestinal macrophages and glycemia. The aim of the current study was to validate our findings in human disease by assessing human gut biopsies and circulating blood monocytes from lean and obese individuals.
Research Design and Method: Peripheral blood monocytes were isolated using a Ficoll gradient and characterized by flow cytometry as classical (CD14++CD16-), intermediate (CD14++CD16+) and non-classical (CD14+CD16++) monocytes. Intestinal macrophages of the stomach, duodenum and colon were isolated from biopsies of lean (BMI &lt;27 kg/m2) or obese (BMI &gt;32 kg/m2) individuals undergoing colonoscopy or gastroscopy. Macrophages were characterized as CD14high or CD14low and further subdivided by HLA-DR, CD163 and CD209 into pro-inflammatory P1, P2, intermediate P3 and resident, anti-inflammatory subpopulations P4, P5.
Results: Depending on the anatomical location, the composition of intestinal macrophages varied: In the stomach of lean subjects, the ratio of CD14high/CD14low macrophages was 80/20%, while the colon comprised more resident, anti-inflammatory macrophages (CD14high/CD14low: 60/40%). Consistent with our results in mice, we detected an increase in the CD14high pro-inflammatory macrophage subpopulation P2 in obese individuals (Corpus: 1.55±0.61-fold, Duodenum: 1.79±0.45-fold, Colon transversum: 1.71±0.72-fold). Interestingly, also human CD14high intermediate blood monocytes were increased in obese patients.
Conclusion: Similar to our mouse data, pro-inflammatory intestinal macrophages are increased in gut biopsies of obese subjects. Higher CD14high blood monocytes suggest enhanced recruitment of monocytes to the gut as the prevailing mechanism.

Disclosure
T.V. Rohm: None. R. Fuchs: None. Z. Baumann: None. L. Keller: None. R. Schneider: None. D. Labes: None. C. Cavelti-Weder: None.

Funding
University of Basel
720-P: Prurigo Pigmentosa: An Acute Complication of Ketogenic Diet
Authors: LEVRAN NERIYA , MAZOR-ARONOVITCH KINERET , GRENBERGER SHOSHANA , LEVEK NOA , SHER BRURIA , MAUDA ELINOR , LANDAU ZOHAR , MONSONEGO-ORNAN EFRAT , PINHAS-HAMIEL ORIT 
Published: June 2020

A 22-year old female with type 1 diabetes (T1DM) presented with generalized rash. She was diagnosed at the age of 9 years and is treated with insulin pump and CGMS (continues glucose monitoring sensors), her recent HbA1c was 7.4%. Four weeks prior to her rash presentation she started a low carbohydrate diet (50 gr of carbs per day) in order to improve her glycemic control. Pruritic erythematous papules, papulovesicular, and vesicles appeared on her axillary region, upper back and groins. Lesions were associated with severe pruritus and negatively affected her quality of life. Various therapies were initiated by dermatologist as: antifungal agent, Itraconazole, and Betamethasone Esters, without any improvement. Her serum beta-hydroxybutyrate levels were between 1.1-1.2 mmol/l. Prurigo pigmentosa, a rare pruritic inflammatory dermatosis secondary to her high ketones levels was diagnosed. Her condition resolved after she increased her carbohydrate intake to 75 gr per day. Beta-hydroxybutyrate level decreased concomitantly to 0.1-0.2 mmol/l. When carbohydrate restriction was rechallenged, she again entered ketosis, followed by recurrence of the pruritic lesions. Carbohydrate intake was increased and subsequently all lesions resolved with remaining reticular hyperpigmentation. During the last few years low carb diets have gained popularity among patients with T1DM. This case illustrates the rare side effect of high ketones body levels. Health care providers should be familiar with this side effect.

Disclosure
N. levran: None. K. Mazor-Aronovitch: None. S. Grenberger: None. N. Levek: None. B. Sher: None. E. Mauda: None. Z. Landau: None. E. Monsonego-Ornan: None. O. Pinhas-Hamiel: None.
723-P: Effect of Low-Carbohydrate High-Fat vs. High-Carbohydrate Low-Fat Diet on HbA1c Control in Chinese Patients with Type 2 Diabetes
Authors: AN LINGWANG , WANG DANDAN , SHI XIAORONG , LIU CHENHUI , YEH KUEICHUN , LEE TAO-CHUN , JI LINONG 
Published: June 2020

Aims: To explore the effect of LCHF (C&lt;50%; F≥35%) diet vs. HCLF (C≥50%; F&lt;35%) diet on HbA1c control in patients with T2D in 3 Chinese diabetes hospitals.
Methods: Patients were enrolled if they had been assessed by professional dietitians and had electronic medical record on a diabetes share-care management database. A total of 1017 patients were eligible for this study with 44.1% in group LCHF and 55.9% in group HCLF.
Results: Compared with group HCLF (Carb 59%: Fat 28%: Pro 13%), group LCHF (41%: 44%: 15%) had higher calorie intake (1845 vs. 1691 kcal/day), higher proportions of patients exceeding calorie recommendation (69.5% vs. 52.3%) and lower baseline HbA1c levels (8.29 vs. 8.52 %). HbA1c improvements were found in both groups after diabetes share-care management with significantly lower HbA1c (7.87 vs. 7.36 %) and higher proportions of patients reaching HbA1c target (31.4% vs. 47.3%) in group HCLF. Binary logistic regression analysis showed that exceeding calorie recommendation [OR(95%CI): 0.703 (0.514∼0.961)]was a risk factor at baseline and LCHF diet was a risk factor [OR(95%CI): 0.549 (0.327∼0.924)] at follow up visit for reaching HbA1c target.
Conclusions: There were higher proportions of patients reaching HbA1c target in group HCLF than in group LCHF after share-care model management. LCHF diet was associated with lower likelihoods of achieving HbA1c target.

Disclosure
L. An: None. D. Wang: None. X. Shi: None. C. Liu: None. K. Yeh: None. T. Lee: None. L. Ji: None.
725-P: Effect of a Continuous Remote Care Intervention on Glycemic Target Achievement and Medication Use among Adults with T2D: A Post Hoc Analysis
Authors: ATHINARAYANAN SHAMINIE J. , ADAMS REBECCA N. , HALLBERG SARAH , PHINNEY STEPHEN , MCKENZIE AMY 
Published: June 2020

Background: Only about half of patients with type 2 diabetes (T2D) achieve the HbA1c &lt;7% target, and maintenance often requires medication intensification over time. A continuous remote care intervention (CCI) including ketosis via carbohydrate restriction nutrition therapy was previously demonstrated to improve glycemic outcomes in adults with T2D for at least two years; here, we assess the proportion of patients meeting glycemic targets and accompanying medication use.
Methods: Adults with T2D selected to receive the CCI (n=262) or usual care (UC; n=87). We utilized GEE to assess change in the proportion of patients at HbA1c &lt;7% target and accompanying medication use at 1 and 2 years compared to baseline. Analyses were conducted among completers and on an intent-to-treat basis with missing data considered as missing the HbA1c target.
Results: The proportion of CCI patients meeting the HbA1c &lt;7% target significantly increased at 1 and 2 years (Table 1). A similar improvement trend was seen among those treated with a single drug (monotherapy), and the proportion of patients at target without the use of medication approximately tripled. No changes occurred among patients who selected UC.
Conclusion: This suggests the CCI is an effective means to help more patients achieve the HbA1c &lt;7% target, including with monotherapy or no medication, among those who choose it.

Disclosure
S.J. Athinarayanan: Employee; Self; Virta Health Corp. R.N. Adams: Employee; Self; Virta Health Corp. S. Hallberg: Advisory Panel; Self; Atkins Nutritionals, Inc. Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. S. Phinney: Advisory Panel; Self; Atkins Nutritionals, Inc. Stock/Shareholder; Self; Beyond Obesity LLC (publishing), Virta Health Corp. A. McKenzie: Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp.
730-P: At-Home Randomized Crossover Comparison of Automated Insulin Delivery vs. Conventional Therapy with Scheduled Meal Challenges
Authors: PINSKER JORDAN E. , DESHPANDE SUNIL , CHURCH MEI MEI , PIPER MOLLY , ANDRE CAMILLE C. , MASSA JENNIFER S. , DOYLE FRANCIS J. , EISENBERG DAVID M. , DASSAU EYAL 
Published: June 2020

Automated Insulin Delivery (AID) hybrid closed-loop systems have not been well studied in the context of prescribed meals. We evaluated our interoperable artificial pancreas system (iAPS) with scheduled meal challenges in a randomized crossover trial in an at-home setting.
Ten adults with type 1 diabetes completed two weeks of AID-based control and two weeks of conventional therapy (sensor-augmented pump/predictive low-glucose suspend) at home in random order. During each period, subjects consumed pasta or white rice as part of a complete dinner meal on six different occasions (each meal three times in random order).
The AID system increased time in range 70-180 mg/dL from 70.6 to 74.0% (3.4, 95% CI -2.3 to 9.1, p=0.22), while sensor time &lt;70 mg/dL significantly decreased from 3.5 to 2.3% (-1.2, 95% CI -2.1 to -0.2, p=0.02). Postprandial glucose AUC difference between meals in conventional therapy was 10,919.0 mg/dL x min (95% CI 3,190.5 to 18,648.0, p=0.009) while for AID it was 6,522.1 mg/dL x min (p=0.24), highlighting the ability of AID to minimize glycemic excursions postprandially. The AID system decreased insulin delivery at 0-2h by 0.45 units (p=0.001) for pasta, while it increased at 2-4h by 0.47 units (p=0.18) for white rice (Table 1).
The AID system improved postprandial glucose control over conventional therapy in the handling of challenging meals in the at-home setting.

Disclosure
J.E. Pinsker: Advisory Panel; Self; Medtronic. Consultant; Self; Eli Lilly and Company, Tandem Diabetes Care. Research Support; Self; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Tandem Diabetes Care. Speaker’s Bureau; Self; Tandem Diabetes Care. S. Deshpande: None. M. Church: None. M. Piper: None. C.C. Andre: None. J.S. Massa: None. F.J. Doyle: Research Support; Self; DreaMed Diabetes, Tandem Diabetes Care, Xeris Pharmaceuticals, Inc. Stock/Shareholder; Self; Mode AGC. Other Relationship; Self; Dexcom, Inc., Insulet Corporation, Roche Diabetes Care. D.M. Eisenberg: Consultant; Self; Barilla Center For Food and Nutrition, Italy. E. Dassau: Consultant; Self; Eli Lilly and Company. Research Support; Self; Dexcom, Inc., DreaMed Diabetes, Tandem Diabetes Care, Xeris Pharmaceuticals, Inc. Speaker’s Bureau; Self; Roche Diabetes Care. Other Relationship; Self; Dexcom, Inc., Insulet Corporation, Roche Diabetes Care.

Funding
Barilla Center for Food & Nutrition Foundation; National Institutes of Health (DP3DK104057, DP3DK113511); Harvard Accelerator; Dexcom, Inc. (IIS-2018-019)
731-P: Impact of 3 Weeks of a Low-Carbohydrate Diet and Exercise on Overweight and Obese Adults: A Randomized Clinical Trial
Authors: ZHOU JIAN , CAI LINGLI , YIN JUN , MA XIAOJING , MO YIFEI , CHENG LI , LU WEI , BAO YUQIAN , JIA WEIPING 
Published: June 2020

Background: Lifestyle interventions, including dietary adjustment and exercise, are important for weight loss in the context of obesity.
Objective: This study aimed to compare the short-term effects of a low-carbohydrate diet (LCD) and exercise nondiabetic overweight and obese adults.
Design: A total of 45 eligible subjects were randomized into a low-carbohydrate diet group (LC, n=22) and an exercise group (EX, n=23); the participants adopted a LCD (carbohydrate intake &lt; 30 mins/day) for 3 weeks. Weekly follow-ups were conducted and flash glucose monitoring sensors were used.≥50 g/day) or performed moderate-to-vigorous exercise (
Results: After the 3-week intervention, body mass index, total fat% and total fat mass (FM), waist circumference, visceral fat area and subcutaneous fat area decreased significantly in both the LC and EX, but the LC lost 2.32 kg more weight than the EX. Total fat-free mass (FFM) and total body water (TBW) in the LC were significantly reduced but remained unchanged in the EX. Triglycerides (TGs), total cholesterol and low-density lipoprotein cholesterol (LDL-c) decreased in the EX, while TGs decreased and LDL-c increased in the LC. Glycemic variability and insulin resistance were improved in both groups, but the effect in the LC was faster and greater. Mean sensor glucose declined significantly in the LC. Three days after stopping the intervention, body weight, FM and FFM increased significantly in the LC, and most of the FFM regained was TBW, which remained stable in the EX.
Conclusion: A short-term LCD was more effective for weight loss and glycemic stability than exercise, and it mainly reduced body fat and body water. However, body weight was regained to a greater extent after stopping the LCD, which was due to body water retention. Exercise was less effective for fat loss than LCD and had no significant influence on body water.

Disclosure
J. Zhou: None. L. Cai: None. J. Yin: None. X. Ma: None. Y. Mo: None. L. Cheng: None. W. Lu: None. Y. Bao: None. W. Jia: None.
734-P: Prevalence of Low and Borderline Levels of Vitamin B12 in Type 2 Diabetic Patients Treated with Metformin: A Cross-Sectional Study in Argentina
Authors: CELA CINTHIA , LANGUS MARIANA 
Published: June 2020

Background: Vitamin B12 deficiency, a common cause of megaloblastic anemia, has been associated with cognitive decline and increasing risk of depression. Metformin therapy has been associated with vitamin B12 (B12) deficiency in several populations. However, information regarding this adverse effect in Argentina populations is limited. The aim of this study was to examine the relation between metformin use and B12 status in individuals with type 2 diabetes mellitus (T2DM) in Argentina.
Design and Setting: Cross-sectional study at a public university hospital.
Results: At present 190 patients were included (See Table 1). Serum vitamin B12 levels were low (&lt; 200 ngl/mL) in 28 patients (14.7%) and borderline (200-300 ng/ml in 48 patients (25.26 %). Only one patient showed laboratory findings consistent with anemia megaloblastic.
Conclusions and Future Directions: Our study showed low or borderline levels of vitamin B12 in 14.7.3% and 25.26 % of patients, respectively. This large number of patients with low o borderline levels of B12 suggests that a high proportion of patients may be at risk of B12 deficiency related conditions. Close monitoring of B12 level, and measurement of other biomarkers of cellular B12 deficiency may help to identify these patients at risk.

Disclosure
C. Cela: None. M. Langus: None.
735-P: Visible and Invisible Spousal Support in Daily Diabetes Self-Care
Authors: SORIANO EMILY , LAURENCEAU JEAN-PHILIPPE 
Published: June 2020

Aim: Prior research has yielded inconsistent findings on the effects of spousal support in type 2 diabetes (T2D) management, yet most studies were cross-sectional and relied exclusively on patient perceived support. This study aimed to examine the within-person effects of daily perceived and enacted spousal support in T2D self-care on glycemic control.
Method: Adults with T2D (N = 63; age M = 61; 67% male; 70% Caucasian) and their spouses participated in a parent study. Patients wore continuous glucose monitors (CGM) for 7 days and concurrently, each evening, both partners responded to the following item: Did you/your partner say or do anything TODAY to try to influence your/spouse/partner’s behavior with regard to managing your/his/her diabetes? The patient item version represents perceived and spouse version enacted support, respectively. CGM data were used to calculate 4 indices of daily glycemic control: mean (M), standard deviation (SD), coefficient of variation (CV), and time in range (TR).
Results: A multilevel dynamic structural equation model was estimated for each outcome. Within-person effects of perceived and enacted support were allowed to vary between persons and time was a covariate. Enacted support significantly predicted better glycemic control across all outcomes (βM = -.32, βSD = -.30, βCV = -.19, βTR = .42, ps &lt; .05). Conversely, perceived support was unrelated to most outcomes (βM = .06, βSD = .17, βCV = .12, ps &gt; .05), but significantly related to lower TR (βTR = -.40, p = .004).
Conclusion: Results echo research on invisible (enacted, not perceived) versus visible (enacted, perceived) support: the former is consistently linked to positive outcomes, whereas visible support is often ineffective or detrimental. Indeed, perceiving support receipt may undermine patient self-efficacy for T2D management and in turn, reduce self-care adherence (e.g., medication, diet). Replication and more research are needed to determine the extent to which the support visibility model applies to the context of T2D.

Disclosure
E. Soriano: None. J. Laurenceau: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R21DK098679, F31DK120201)
739-P: The Mediating Role of HbA1c and the Moderating Role of Social Support in the Relation between Peer Victimization and Number of Diabetes-Related ER Visits
Authors: STROMBERG SARAH , FAITH MELISSA A. , FELDMAN MARISSA 
Published: June 2020

Objective: Routine screening of diabetes-specific and general psychosocial factors is recommended by ADA. While depression and family functioning have been associated with poorer adherence and metabolic control, research linking peer relations and T1D management is mixed and victimization is not consistently assessed. Youth with T1D are at higher risk of victimization, and those that experience diabetes-specific bullying found to have poorer metabolic control. This study tests a moderated mediation model where peer victimization, moderated by perceived social support, predicts diabetes-related ER visits and whether A1C mediates the relation.
Method and Results: At routine clinic visits, 198 children (ages 7-18) completed the Multidimensional Scale of Perceived Social Support and The Way Kids Are. Chart review was completed. A moderated mediation model explained 18% of the variance in ER visits (p &lt; .001). Social support moderated the relation between victimization and diabetes-related hospitalizations, with strong social support mitigating the relation between victimization and hospitalizations (p = .005). Additionally, A1C mediated the positive relationship between victimization and diabetes-related ER visits; peer victimization was positively related to A1C (p =0.021), which in turn positively predicted ER visits (p &lt; .001).
Conclusions: HbA1C helped explain the positive relationship between peer victimization and diabetes-related ER visits. Additionally, social support appeared to be a protective against hospitalizations. Victimization is a stressor that may directly or indirectly impact blood glucose levels via self-management. Youth who experience greater peer victimization may be less likely to engage in diabetes management in social situations. Victimization should be screened and youth helped to build self-efficacy and confidence related to managing their diabetes around peers.

Disclosure
S. Stromberg: None. M.A. Faith: None. M. Feldman: None.