bluuebunny/crossref_metadata_2025_split huggingface dataset:
1475-P: CA19-9, miR-200, and GIP in Patients with Diabetes Mellitus and Pancreatic Cancer
Authors: SKRHA PAVEL , HORINEK ALES , SKRHA JAN 
Published: June 2020

Introduction: Nearly 80 % of patients with pancreatic cancer (PAC) have diabetes mellitus or prediabetes (DM). New-onset DM can be the first symptom of PAC in majority of them. We compared CA 19-9, microRNAs and glucose-dependent insulinotropic polypeptide (GIP) as the PAC biomarkers in DM.
Patients and methods: Forty nine patients with and 31 without PAC were enrolled. All had DM confirmed by ADA criteria and PAC was histologically proven. Twenty five healthy persons were evaluated, too. CA 19-9, miR-192, -196, -200 and GIP were measured in serum samples. Mann-Whitney U test and Kruskal-Wallis ANOVA were used for statistical evaluation. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were determined in the individual markers and in their combinations.
Results: In DM patients with PAC the serum concentrations of CA 19-9 and miRNAs were elevated (p&lt;0.0003) and GIP decreased (p&lt;0.001) in comparison with both DM patients without PAC and non-DM controls. Sensitivity, specificity, PPV and NPV were calculated (Table). While CA 19-9 was not increased in 16 % of patients with PAC, its combination with GIP and miR-200 confirmed PAC diagnosis in all of them.
Conclusion: Addition of miR-200 and GIP to CA 19-9 caused an increase of NPV to 100 % meaning that three combined biomarkers could exclude the diagnosis of PAC. Combination of these biomarkers could be used for PAC screening in DM patients in risk.

Disclosure
P. Skrha: None. A. Horinek: None. J. Skrha: None.

Funding
Charles University
1491-P: Migrant Disparities in Atherosclerotic Cardiovascular Complications among Persons with Type 2 Diabetes
Authors: ANDERSEN GREGERS S. , BYBERG STINE , BJØRKMAN ANNE-SOFIE D. , ISAKSEN ANDERS A. , AMADID HANAN , CARSTENSEN BENDIX , JØRGENSEN MARIT E. 
Published: June 2020

Background: Non-western (non-w) migrants in Europe are at increased risk of type 2 diabetes (T2D) but it is not known if this translates into increased risk of atherosclerotic cardiovascular disease (ASCVD). We calculated age- and sex-specific incidence rates (IR) of ASCVD following T2D among 1st generation migrants in Denmark compared with Danish-born citizens.
Methods: Data were obtained from nationwide registers. A total of 346,947 people diagnosed with T2D between 1997-2016 were followed for a median (IQR) of 6.7 (8.8) yr, and classified as Danish-born citizens, western- or non-w migrants according to country of birth. IR of first ASCVD event and death from other causes were estimated separately using Poisson regression with risk time as offset, adjusting for T2D duration and education.
Results: Non-w migrants (n=27,693) were younger at T2D diagnosis than Danish-born (mean [SD], 50.8 [11.8] vs. 61.6 [13.5] yr). In total, 104,286 persons (30.1%) developed ASCVD. In adjusted models, ASCVD rates were higher for non-w migrant women at 40-60 yr but lower for both genders at 60-80 yr, compared to western migrants and Danish-born (Figure 1A-B). Non-ASCVD related mortality was also lower among non-w migrants (Figure 1C).
Conclusion: Non-w migrants had lower risk of developing ASCVD at 60-80 yr and lower mortality from other causes. This may reflect a ’healthy migrant effect’ or differences in lifestyle or medication.

Disclosure
G.S. Andersen: Stock/Shareholder; Self; Novo Nordisk A/S. S. Byberg: None. A.D. Bjørkman: None. A.A. Isaksen: Research Support; Self; Novo Nordisk Foundation. H. Amadid: None. B. Carstensen: Stock/Shareholder; Self; Novo Nordisk A/S. M.E. Jørgensen: Research Support; Self; Amgen, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi-Aventis. Stock/Shareholder; Self; Novo Nordisk A/S.
1513-P: Severity of Hypertension (HT) as a Predictor of Initiation of Dialysis among Study Participants with and without Diabetes Mellitus (DM)
Authors: OSAWA TAEKO , FUJIHARA KAZUYA , YAMADA MAYUKO H. , SATO TAKKAKI , KITAZAWA MASARU , YAGUCHI YUTA , MATSUBAYASHI YASUHIRO , IWANAGA MIDORI , YAMANAKA NAUTA , SEIDA HIROYASU , SONE HIROHITO 
Published: June 2020

Although both hyperglycemia and HT are highly predictive of kidney disease, only a few studies have investigated the associations between the severity of HT and risk of end-stage renal disease especially the initiation of renal replacement therapy in DM+ or DM- in the same cohort at the same time. Thus, we analyzed data from a nationwide claim database involving 258,874 participants during 2008-16. Multivariate Cox regression model was used to identify risks of starting dialysis. HT as a covariate was determined according to systolic blood pressure (SBP)(mmHg) diagnosed by seven different cut-offs (≥110, ≥115, ≥120, ≥125, ≥130, ≥140, ≥150). Hazard ratios (HRs) were compared among 10 groups divided according to combinations of DM+ or DM- and five levels of SBP (mmHg) (≤119, 120-129, 130-139, 140-149, ≥150). Among DM-, baseline age, percent of men, BMI, smoking rate, SBP, and percent of medication for HT were higher in those who started dialysis. In those with DM+, baseline percent of men, SBP, and percent of medication for DM and HT were higher in those who started dialysis. HT was significantly associated with the initiation of dialysis regardless of the presence or absence of DM. The incidence of starting dialysis in those with SBP ≤119 mmHg and DM+ was almost the same as in those with SBP ≥150 mmHg and DM-. In comparison with SBP ≤119 mmHg, SBP ≥150 mmHg significantly increased the risk of the initiation of dialysis about 2.5 times regardless of DM+ or DM-. Compared with DM- and SBP ≤119mmHg, the HR for DM+ and SBP ≥150 mmHg was 6.88 (95% CI 3.66-12.9). Although the risks of HT differed only slightly regardless of the presence or absence of DM, risks for the initiation of dialysis with DM+ and SBP ≤119 mmHg were equivalent to DM- and SBP ≥150 mmHg, indicating stricter blood pressure interventions in DM+ are needed to avoid dialysis. Future studies are needed to clarify the cut-off SBP level to avoid initiation of dialysis considering the risks of strict control of blood pressure.

Disclosure
T. Osawa: None. K. Fujihara: None. M.H. Yamada: None. T. Sato: None. M. Kitazawa: None. Y. Yaguchi: None. Y. Matsubayashi: None. M. Iwanaga: None. N. Yamanaka: None. H. Seida: None. H. Sone: Research Support; Self; Kyowa Hakko Kirin Co., Ltd., Novartis AG, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co.

Funding
Japan Society for the Promotion of Science
1546-P: Complex Relationships between Income, Food Insecurity, Dietary Behaviors, and A1C in U.S. Adults with Diagnosed Diabetes: NHANES, 2007-2014
Authors: MERCADO CARLA , SAYDAH SHARON , BULLARD KAI M. , SIEGEL KAREN R. , IMPERATORE GIUSEPPINA 
Published: June 2020

In people with diagnosed diabetes (DM), pathways between income, diet, and glycated hemoglobin levels (A1c) are unclear. Performing mediation analysis using structural equation modeling, we investigated cross-sectional total effects (direct + indirect effects), shown as standardized coefficients in this conceptual model of household poverty-to-income ratio (PIR), household food insecurity (FI), and individual consumer-related dietary behavior [# of meals prepared away from home (#meals) and % of #meals from fast food/pizza place (%FFpizza) in last 7 days] associated with A1c (Figure). Data from 2,343 participants aged ≥21 years with DM in 2007-2014 National Health and Nutrition Examination Survey were used. Among U.S. adults with DM; 43% had PIR&lt;200%, 16% were FI, and 42% and 37%, respectively, reported ≥3 #meals and more than 50% %FFpizza. Greatest absolute magnitude of association was PIR with FI (-0.41), which was more than 1.5 times greater than next largest, PIR with #meals (0.25). Only FI (0.11) and #meals (0.07) had significant total effect with A1c. Though #meals had a positive total effect on %FFpizza, %FFpizza had no significant total effect on A1c. Complex relationships between PIR, FI, #meals, and %FFpizza in adults with DM suggest the need for a better understanding of dietary behaviors that can influence healthier options for better DM management.

Disclosure
C. Mercado: None. S. Saydah: None. K.M. Bullard: None. K.R. Siegel: None. G. Imperatore: None.
1556-P: Trend and Prevalence of Underweight, Overweight, Obesity in Chinese Patients with Type 2 Diabetes, Aged 20-89 Years
Authors: LV FANG , CAI XIAOLING , JI LINONG 
Published: June 2020

Background: Both underweight and obesity are associated with highly elevated risks of adverse health outcomes. Gender, and age differences of overweight and obesity prevalence had been identified in overall population. However, less data was specialized evaluate the body mass index (BMI) characteristics, gender and age differences in patients with type 2 diabetes (T2D).
Methods: We analyzed six hospital-based studies that had recorded height and weight in adults with T2D aged between 20 and 89 years. We calculated the trends of mean BMI and the prevalence of BMI categories defined by World Health Organization (WHO) and Working Group on Obesity in China (WGOC) criteria stratified by sex, age and provinces.
Results: According to WGOC standard, the crude prevalence of general obesity (BMI ≥28 kg/m2) and overweight (24 kg/m2 ≤ BMI &lt; 28 kg/m2) ranged from 10.3% to 16.4%, and 42.0% to 45.2%, respectively. According to WHO standard, the prevalence of general obesity (BMI ≥ 30 kg/m2) and overweight (25 kg/m2 ≤ BMI &lt;30 kg/m2) ranged from 3.9% to 7.0%, and 34.3% to 37.8%, respectively. The crude prevalence of underweight (BMI &lt;18.5 kg/m2) ranged from 1.7% to 2.4%. Age-stratified analysis revealed BMI and prevalence of obesity peaked in men aged 20 to 29 years, thereafter gradually declined. However, in women, BMI and trends of obesity were not consistent. The prevalence of underweight was higher in younger and older patients in both men and women. Geographic heterogeneity of obesity, overweight and underweight were observed across different provinces in mainland China.
Conclusion: Gender, age and regional differences of BMI and prevalence of underweight, overweight, obesity were observed in Chinese patients with T2D, aged 20-89 years. Further studies are warranted to investigate the better BMI cutoff value in T2DM of different gender and age to plan health services and promote scientific decision-making in T2D.

Disclosure
F. Lv: None. X. Cai: None. L. Ji: None.

Funding
National Natural Science Foundation of China (81970698, 81900805), National Key Research and Development Program of China (2016YFC1304901)
1563-P: Neighborhood Drivability and Diabetes Incidence in Toronto, Canada
Authors: BRAVER NICOLE DEN , BEULENS JOLINE , LAKERVELD JEROEN , GOZDYRA PETER , WU FANGYUN , RUTTERS FEMKE , FAZLI GHAZAL S. , MOINEDDIN RAHIM , BOOTH GILLIAN 
Published: June 2020

Background: Reliance on cars contributes to physical inactivity, and therefore may be a risk factor for type 2 diabetes. We investigated whether living in neighborhoods that are highly conducive to driving is associated with an increased incidence of diabetes.
Methods: Working age adults (20-64 yrs) who were living in Toronto, Canada on April 1st 2011, were followed over 6 yrs for incident diabetes using a validated algorithm based on hospital records and physicians’ services claims. For neighborhood drivability, we used a novel index capturing three factors of the built environment: urban sprawl, pedestrian unfriendliness and parking options. Cox regression was used to examine the association between neighborhood drivability quintiles (Q) and diabetes incidence, adjusting for age, sex, income, ethnicity, immigration status and comorbidity, and censoring for death.
Results: Among 1,473,994 individuals in our sample (mean age 40.9±12.2, 48.5% male), 77,835 developed diabetes. Overall, there was a direct relationship between drivability and diabetes incidence, however the magnitude of this effect varied by age and income. Among young adults (20-34 yrs), those living in the most drivable neighborhoods (Q5) had a 58% higher incidence of diabetes (adjusted HR: 1.58 (95%CI: 1.47-1.69)) relative to those in the least drivable neighborhoods (Q1), whereas the same comparison in older adults (55-64 yrs) yielded smaller differences (HR: 1.31 (95%CI: 1.26-1.36)). High drivability was most strongly associated with diabetes risk in the middle income neighborhoods with 96% increased risk for young residents (HR:1.96 (95%CI: 1.64-2.33) and a 46% increased risk for older residents (HR: 1.46 (95%CI:1.32-1.62). Associations between drivability and diabetes incidence were significant but of a lesser magnitude in low- and high-income neighborhoods.
Conclusion: In our setting, neighborhood drivability is a risk factor for the diabetes incidence among working age adults, especially younger, middle-income populations.

Disclosure
N. den Braver: None. J. Beulens: None. J. Lakerveld: None. P. Gozdyra: None. F. Wu: None. F. Rutters: None. G.S. Fazli: None. R. Moineddin: None. G. Booth: None.
1566-P: Association of Demographic Factors with Emergency Department Use among Adults with Diabetes, 2009-2017
Authors: UPPAL TEG S. , FERNANDES GAIL , HAW JEEHEA SONYA , SHAH MEGHA K. , TURBOW SARA , RAJPATHAK SWAPNIL , VENKAT NARAYAN K.M. , ALI MOHAMMED K. 
Published: June 2020

There are limited data which examine the current trends in emergency department (ED) use among adults with all-type diabetes by demographic characteristics. We analyzed data from the nationally representative Medical Expenditure Panel Survey (MEPS), which uses a rotating panel design—a new cohort is initiated annually, and health care use is recorded over the course of 2 years. We pooled panels, each with 2-year follow-up into years 2009-2012 and 2014-2017 to improve precision. We identified adults with diabetes by self-report, presence of diabetes-specific ICD-codes, or prescriptions of antidiabetic agents and used all-cause event-level ED data to estimate weighted counts and age-adjusted rates of average annual ED visits per 1000 persons with diabetes. We then compared rates of ED use between the two time periods by calculating absolute and percent change. Increases in use were greatest among the groups: 65-74 yrs (38.1%), 75+ yrs (28.6%), West (27.3%), Midwest (16.5 %), Female (19.4%), and White (15.9%). The share of visits by the uninsured dropped (10.1% to 5.3%), while share of visits increased (29% to 36.3%) for those covered by Medicaid (data not shown). Further analysis will be conducted to analyze the trend over time from earlier time periods (2004-2007), understand the type of event (nondiabetes vs. diabetes-related) and stratify by potentially preventable visit and insurance type.

Disclosure
T.S. Uppal: None. G. Fernandes: Employee; Spouse/Partner; Janssen Pharmaceuticals, Inc. Employee; Self; Merck Sharp & Dohme Corp. J. Haw: None. M.K. Shah: None. S. Turbow: Research Support; Self; Gilead Sciences, Inc. S. Rajpathak: Employee; Self; Menarini Group. K. Narayan: None. M.K. Ali: Research Support; Self; Merck & Co., Inc.
1568-P: One Methylation Risk Score Model, Two Racial Populations
Authors: MINNIEFIELD BRE A. , IRVIN MARGUERITE , HIDALGO BERTHA , TIWARI HEMANT K. , PATKI AMIT , CHAUDHARY NINAD 
Published: June 2020

Metabolic Syndrome (MetS) is a cluster of conditions that can increase the risk of chronic diseases like, type 2 diabetes. Multiple reports show alterations in DNA methylation patterns are associated with the condition. Using cross-sectional data from Hypertension Genetic Epidemiology Network (HyperGEN) (N=614 African Americans (AA)) and Genetics of Lipid Lowering Drugs and Diet Network (GOLDN) (N=995 European Americans (EA)), we created a risk score model for MetS. First, we selected specific cytosine-guanine dinucleotides (CpG) sites measured on Illumina Methyl450 arrays previously found to be significantly associated to MetS (CPT1A cg00574958, PHOSPHO1 cg02650017, ABCG1 cg06500161, SREBF1 cg11024682, SOCS3 cg18181703, TXNIP cg19693031). Using the HyperGEN parameter estimates for the single CpGs as weights, we calculated a methylation risk score in HyperGEN which was validated in GOLDN. We then conducted an association analysis using a generalized linear mixed model to test the association between the methylation risk score (MetS-score) and MetS, adjusting for age, sex, study site, 4 ancestry principal components, and family structure. In HyperGEN we performed a 100,000-permutation test to determine statistical significance of the score with MetS. Results showed the risk score was significantly associated with MetS in both populations (HyperGEN p=6.36x-10; GOLDN p=2x-16), with a 1 standard deviation increase in the score being associated with 2.25 (95% CI, 1.79 - 2.86) higher odds of having MetS in HyperGEN and a 2.45 (CI 95%, 2.02 - 3.00) higher odds of having MetS in GOLDN. Lastly, we compared the model fitness of the GOLDN MetS model with and without the MetS-score. AIC criterion suggested the model including the score was a better fit (no score = 1173.99; with score = 1112.61).
In conclusion, we created a methylation risk score strongly associated with MetS which should be further investigated for its ability to predict MetS risk in both AAs and EAs.

Disclosure
B.A. Minniefield: None. M. Irvin: None. B. Hidalgo: None. H.K. Tiwari: None. A. Patki: None. N. Chaudhary: None.

Funding
National Heart, Lung, and Blood Institute (3R01HL123782-02S1)
1587-P: The Impact of Cannabis Use on Glucose Tolerance
Authors: ALSHAARAWY OMAYMA 
Published: June 2020

Cannabis use prevalence has increased in the United States (U.S.) and worldwide. Cannabis exerts its effects on human function primarily through activating the cannabinoid system. In recent years, the cannabinoid system has emerged as an important regulator of energy balance. Pharmacological deactivation or genetic deletion of the cannabinoid-1 receptor in animals improved various metabolic outcomes. Human epidemiological studies, however, suggests a paradox. Increased caloric intake and decreased physical activity were observed in cannabis users. Surprisingly, cannabis use was associated with attenuated weight gain and lower levels of fasting insulin. The aim of this study is to examine the association of cannabis use and glucose clearance as indicated by glucose tolerance test among adults participating in the National Health and Nutrition Examination Survey (NHANES). NHANES is designed to recruit, interview and examine a nationally representative sample of the U.S. non-institutionalized population. For this study, we used publicly available NHANES data generated through surveys conducted in 2007-2016. After a 9-hour fast, a subsample of participants were asked to drink a calibrated dose (75 grams of glucose) of TrutolTM and had a second venipuncture 2 hours after drinking. Cannabis use questions were self-administered using the Audio Computer-Assisted Self-Interview in NHANES mobile examination center. Results from generalized regression modelling indicated an inverse association between cannabis use in the 30 days prior to NHANES and 2-hr blood glucose levels (β= -5.9; 95% CI = -9.9, -1.8). Adjusting for tobacco smoking, alcohol drinking or body mass index minimally affected the estimates. The relationship between 2-hr glucose levels and cannabis use frequency was stronger for occasional users compared to heavy users.
In conclusion, cannabis use is associated with improved glucose clearance. Additional studies are needed to confirm the results of this study and to investigate the underlying mechanisms.

Disclosure
O. Alshaarawy: None.

Funding
National Center for Complementary and Integrative Health (AT009156)
1601-P: Cardiovascular Risk Profiles among Women by Gestational Diabetes Status, 2007-2016
Authors: DORANS KIRSTEN S. , BAZZANO LYDIA A. , HE JIANG 
Published: June 2020

Background: Women with prior gestational diabetes (GDM) are at elevated risk of type 2 diabetes and cardiovascular disease. We sought to compare cardiometabolic risk factors among parous U.S. women ages 20 to 44 by history of GDM.
Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) from 2007-2016. We included 3562 parous women. We compared anthropometric measures, glycemic markers, blood pressure and lipids by self-reported history of GDM, both with and without adjusting for demographic and behavioral factors and waist circumference. Analyses took NHANES multi-stage survey design into account.
Results: Women without history of GDM were younger and, in crude analyses, had more favorable cardiometabolic risk factor profile than women with history of GDM (Table). Similar patterns were observed after adjusting for age, race/ethnicity, education and smoking. After also adjusting for waist circumference, only hemoglobin A1c, fasting glucose, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were significantly higher among women with history of GDM compared to women without GDM.
Conclusions: Among parous U.S. women ages 20 to 44, those with a history of GDM had less favorable cardiometabolic risk factor profiles than did women without GDM, though results were attenuated after adjusting for markers of demographics, behavior, and central obesity.

Disclosure
K.S. Dorans: None. L.A. Bazzano: None. J. He: None.

Funding
Tulane Center of Biomedical Research (P20GM109036)
1624-P: Family History of Type 1 Diabetes (T1D) and Comorbidity Status in Individuals with T1D: A Computational Deep Exploratory Data Mining Approach
Authors: TALLON ERIN M. , CLEMENTS MARK A. , LIU DANLU , BOLES KATRINA , STUCK RACHEL A. , SHYU CHI REN 
Published: June 2020

T1D is a progressive, autoimmune-mediated condition associated with numerous comorbidities and significant premature mortality. The offspring of fathers diagnosed with T1D exhibit a 2-3 times higher risk of developing T1D than the offspring of mothers diagnosed with T1D. Individuals with T1D who have an affected father present with a more aggressive disease phenotype at diagnosis. Yet the impact of paternal T1D (P-T1D) vs. maternal T1D (M-T1D) on health outcomes in individuals with T1D is unknown.
We previously developed and validated a subgroup discovery algorithm that identifies highly contrasted patterns occurring with a significant difference in prevalence between two subgroups (e.g., P-T1D vs. M-T1D). Here we used this computational deep exploratory data mining method to analyze publicly-accessible data from the T1D Exchange Clinic Registry (2010-12; 2015-17). We used an Apache Spark high performance computing environment to apply our algorithm to family history, gender, and medical conditions data in the Registry.
We identified multiple phenotypic contrasts between individuals with P-T1D (2010-12 data: n = 1011; 2015-17 data: n = 652) vs. M-T1D (2010-12 data: n = 528; 2015-17 data: n = 342). Using Fisher’s exact tests to determine statistical significance, P-T1D associated with hypothyroidism and male gender in 7.2% of cases (47/652), compared to 3.2% of cases (11/342) of M-T1D (p = 0.01). M-T1D was associated with hypertension (HTN) in 36.0% of cases (123/342), compared to 22.3% of cases (146/652) in P-T1D (p &lt; 0.001). M-T1D was associated with diabetes-related neuropathy and HTN in 10.8% of cases (37/342), compared to 4.9% of cases (32/652) in P-T1D (p = 0.001).
Complex patterns generated with this algorithm may yield contrast patterns that provide insights about personalized interventions to improve health outcomes. Whether contrast mining can be used to predict health trajectories of individuals with T1D remains to be determined.

Disclosure
E.M. Tallon: None. M.A. Clements: Consultant; Self; Glooko, Inc. Other Relationship; Self; Glooko, Inc. D. Liu: None. K. Boles: None. R.A. Stuck: None. C. Shyu: None.

Funding
National Institutes of Health (5T32LM012410)