bluuebunny/crossref_metadata_2025_split huggingface dataset:
1541-P: Dietary Patterns Significantly Associated with Obesity in Japanese with Type 2 Diabetes: JDDM
Authors: HATTA MARIKO , FUJIHARA KAZUYA , IKEDA IZUMI , TAKEUCHI MIZUKI , NEDACHI RINA , MORIKAWA SAKIKO Y. , HORIKAWA CHIKA , KATO MITSUTOSHI , KATO NORIKO , MAEGAWA HIROSHI , SONE HIROHITO 
Published: June 2020

Although both average BMI and foods vary greatly between Asian and Western countries, few studies have examined the relationship between dietary patterns and obesity in Asians. We investigated dietary patterns significantly associated with obesity in Japanese with diabetes. Cross-sectionally analyzed were 2070 Japanese with type 2 diabetes (mean age, 62 y; men, 62%) who completed the Food Frequency Questionnaire. Principal component analysis was performed on 20 food groups to elucidate dietary patterns significantly associated with obesity. We also divided participants into quintiles according to factor scores of each dietary pattern. The adjusted odds ratios (ORs) for obesity, defined as BMI ≥25 according to the Asian cutoff, were calculated with other covariates including energy intake. Six dietary patterns were determined from eigenvalues (≥1) and screen plots. For Factor 1, characterized by a well-balanced food group with high intake of light-colored vegetables, green and yellow vegetables, sugar, seaweed, beans, fish and seafood, fruit and potato, the OR for obesity in Quintile5 compared to Quintile1 was 0.34 (95% CI: 0.22-0.53). Conversely, that of Factor 2, characterized by high intake of seasoning and spices, sugar-sweetened beverages, rice and eggs, was 2.56 (1.69-3.89) (Table).
In conclusion, a balanced diet with various food groups might help to avoid obesity in Japanese with type 2 diabetes.

Disclosure
M. Hatta: None. K. Fujihara: None. I. Ikeda: None. M. Takeuchi: None. R. Nedachi: None. S.Y. Morikawa: None. C. Horikawa: None. M. Kato: None. N. Kato: None. H. Maegawa: Speaker’s Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Sanofi K.K., Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Kyowa Hakko Kirin Co., Ltd., Novartis AG, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co.
1550-P: Whole-Exome Sequencing in Children with Suspected Maturity-Onset Diabetes of the Young (MODY)
Authors: TOSUR MUSTAFA , SABO ANIKO , KHAYAT MICHAEL M. , JHANGIANI SHALINI N. , REFAEY AHMAD K. , MUZNY DONNA , GIBBS RICHARD A. , BALASUBRAMANYAM ASHOK , REDONDO MARIA J. 
Published: June 2020

The yield of commercial gene panels for MODY has been reported as low as 27% suggesting the role of un-identified gene variants in MODY. We aimed to study novel genetic factors of MODY. We identified 10 probands who had clinical characteristics suggestive of MODY (i.e., positive family history of diabetes, negative islet autoantibodies, and diagnosis of diabetes at &lt;25 y/o) but negative genetic test results on a commercial MODY gene panel. We performed whole-exome sequencing (WES) in probands and their parents. In each trio, we prioritized rare protein-altering variants (stop-gain, frameshift indels, splicing and missense variants) in 70 neonatal diabetes and MODY candidate genes. Mean age at diabetes diagnosis was 10 (± 3.8) years. Six were females; 4 were non-Hispanic white, 5 Hispanic, and 1 Asian. Previously assigned diabetes types were type 1 diabetes (T1D) (n=7), unknown (n=2) and ketosis-prone diabetes (n=1). We found a likely pathogenic, de novo variant in INS gene (c.94G&gt;A, p.Gly32Ser), confirmed by Sanger sequencing, in a proband who was previously diagnosed with T1D at 3 y/o. This very rare variant, absent in the general population (gnomAD database), has been reported previously in multiple individuals with neonatal diabetes. We also identified a frameshift deletion (c.2650delC, p.Gln884AsnfsTer57) in RFX6 gene in a child with a previous diagnosis of T1D at 12 y/o. The variant was inherited from the mother, who was diagnosed with diabetes of unknown etiology at 25 y/o. Heterozygous protein-truncating variants in RFX6 gene have been recently reported in individuals with MODY.
In conclusion, we identified two new MODY cases, with a novel variant not previously associated with MODY in one of them, using WES in children who were initially diagnosed with T1D. Our study demonstrates clinical utility of exome sequencing in atypical cases of diabetes suspected of MODY.

Disclosure
M. Tosur: None. A. Sabo: None. M.M. Khayat: None. S.N. Jhangiani: None. A.K. Refaey: None. D. Muzny: None. R.A. Gibbs: None. A. Balasubramanyam: None. M.J. Redondo: None.

Funding
Mike Hogg Fund
1552-P: Machine Learning Approach to Decision-Making for Initial Insulin Use in Japanese Patients with Type 2 Diabetes
Authors: FUJIHARA KAZUYA , YAMADA MAYUKO H. , MATSUBAYASHI YASUHIRO , YAMAMOTO MASAHIKO , IIZUKA TOSHIHIRO , MIYAMURA KOSUKE , HASEGAWA YOSHINORI , YAMAZAKI TATSUYA , KODAMA SATORU , SONE HIROHITO 
Published: June 2020

We examined whether the machine learning approach could be used as support for decision-making by general physicians as to whether to use insulin as an initial therapy for patients with type 2 diabetes. Prescription data on different antidiabetic agents from December 2009 to March 2015 from diabetes specialists’ patient registries were used to compare the machine learning decision of initial insulin use to that of general physicians. Gold standard was defined as consensus, that is, 80% agreement among nine diabetes specialists based on patients’ information. Twenty-two general physicians chose the most suitable medication according to the patients’ information. Analyzed were data on 4,860 patients who received initial monotherapy with either insulin (293 patients) or non-insulin (4,567 patients) and had laboratory data. Accuracy was calculated by 5-fold cross validation in machine learning. The average predictive values of initial insulin use by machine learning were 0.40, 0.50 and 0.82, respectively, for under-sampling ratios of 1:2, 1:4 and 1:8. General physicians achieved a mean accuracy for initial insulin use of 51%. The overall accuracy was 43%, 57% and 86% for under-sampling ratios of 1:2, 1:4 and 1:8. The difference in the accuracy between general physicians and machine learning in the under-sampling ratio of 1:8 was significant (P&lt;0.05).
In conclusion, accuracy of machine learning with the sampling ratio of 1:8 was higher compared with that of general physicians in initial insulin use defined by diabetes specialists’ choice as the gold standard. Assistance by machine learning may be beneficial to any general physician in deciding upon initial insulin usage.

Disclosure
K. Fujihara: None. M.H. Yamada: None. Y. Matsubayashi: None. M. Yamamoto: None. T. Iizuka: None. K. Miyamura: None. Y. Hasegawa: None. T. Yamazaki: None. S. Kodama: 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 (18K17897)
1557-P: Eye Exam Rates for Patients with T2DM from a Large Population with Employer-Sponsored Insurance
Authors: SCHEUFELE ELISABETH , ROSARIO BEDDA L. , ROBERTS FREDERICK J. , RAJMANE AMOL B. , GEORGE JUDY , FELDMAN HENRY J. , RHEE KYU B. 
Published: June 2020

The ADA recommends eye exams for patients (Pt) with type 2 diabetes mellitus (T2DM) at diagnosis and annually thereafter, with an option to extend the timeline if the Pt has little to no retinopathy and is in good glycemic control. This retrospective descriptive study utilized the claims and member data from IBM® MarketScan® Commercial Research Database to examine the proportion of members with employer-sponsored insurance with T2DM, aged 18-64 years and in the U.S., who have medical claims for retinal or dilated eye exams in 2017. The dataset consists of 396,396 T2DM members enrolled continuously for 24 months in 2016-2017, with the following attributes: mean age is 54 years; females at 44.3%; ages of 18-44 at 18.1%, and 45-64 at 81.9%; regions of Midwest at 21.8%, Northeast at 16.7%, South at 49.8%, and West at 12.0%. The proportion of T2DM members with medical claims for eye exam is 35.8%. The proportion of T2DM Pts with eye exams by gender, age, and regional attributes are: females at 37.0% (numerator = 65,078), males at 34.8% (76,710); 18-44 at 25.0% (18,241), 45-64 at 38.0% (125,969); Midwest at 36.6% (31,578), Northeast at 43.6% (28,836), South at 33.6% (66,469) and West at 32.2% (15,362). About 2.1% (8,282) of T2DM Pts had a diagnosis of retinopathy, and of those, with eye exams by age group, are: 18-44 at 63.8% (812/1,272) and 45-64 at 72.8% (5,103/7,010). The average total cost per member by CPT codes are: $0.44 (Intermediate New Pt), $11.57 (Comprehensive New Pt), $9.50 (Intermediate Established Pt) and $34.06 (Comprehensive Established Pt). In this study, predominant factors for a higher rate of having a medical claim for an eye exam by members with T2DM are being female, ages 45-64, and from Northeast. There was a higher prevalence of retinopathy in the older age group. In this large sample, the majority of T2DM members did not have an eye exam. Future research should investigate the extent to which members with T2DM defer or obtain ADA recommended eye exams outside of their medical insurance coverage.

Disclosure
E. Scheufele: Employee; Self; IBM. B.L. Rosario: None. F.J. Roberts: None. A.B. Rajmane: None. J. George: Employee; Self; IBM Watson Health. H.J. Feldman: Employee; Self; IBM. K.B. Rhee: Employee; Self; IBM.
1558-P: Sex-Specific Associations of Blood and Urinary Manganese with Glucose Levels, Insulin Resistance, and Kidney Function among U.S. Adults: Use of 2011-2016 NHANES Data
Authors: YANG JINGLI , YANG AIMIN , CHENG NING , BAI YANA 
Published: June 2020

Although the role of manganese (Mn) in the development of diabetes has been a concern, epidemiological studies directly linking Mn exposures to glucose homeostasis in a sex-dependent context are rare. We evaluated the associations of Mn levels in both blood and urine with glucose levels, insulin resistance, and kidney function among general populations and potential heterogeneities by sex. We performed a cross-sectional analysis of population-based data in the National Health and Nutrition Examination Survey (NHANES) involving 1417 adults in 2011-2016. We estimated the associations between blood and urinary Mn levels with fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), homeostasis model assessment for insulin resistance (HOMA-IR), insulin, and estimated glomerular filtration rate (eGFR) by using categorical and spline analyses. There were significant positive linear relationships between urinary Mn with FPG (P&lt;overall=0.003, P&lt;nonlinear=0.817) and HbA1c (P&lt;overall=0.023, P&lt;nonlinear=0.854) among women, while blood Mn levels were associated HOMA-IR (P&lt;nonlinear=0.042) and insulin (P&lt;nonlinear=0.014) with J-shaped dose-responses among men. For eGFR, positive linear relationships were observed with blood Mn in women (P&lt;overall=0.032, P&lt;nonlinear=0.549), and with urinary Mn in both men (P&lt;nonlinear=0.058) and women (P&lt;nonlinear=0.892). In sensitivity analysis, after excluding participants with diabetes, we still observed sex differences in the association between urinary Mn levels with FPG, HbA1c, insulin, HOMA-IR and eGFR.
In summary, blood and urinary Mn levels were independently associated with glucose-related biomarkers with potential heterogeneities by sex. The findings emphasize the probable role of Mn for the glucose-related biomarkers and kidney function, and call for more studies on the risk of diabetes in a sex-specific manner.

Disclosure
J. Yang: None. A. Yang: None. N. Cheng: None. Y. Bai: None.
156-LB: Effect of Maternal Obesity and GDM on Children’s Obesity and Fat Distribution
Authors: MARTIN SAMANTHA 
Published: June 2020

Background: Women with obesity or gestational diabetes (GDM) and their children are at risk for type 2 diabetes. Given that obesity and fat distribution are correlated with insulin resistance, we examined whether there are differences in total adiposity and fat distribution among women who were lean (NW) or obese (Ob) with no GDM history, verses women with prior GDM, and their children. We hypothesized that dyads in the GDM group would have greater adiposity and more centralized fat distribution compared to dyads in the NW and Ob groups.
Methods: Mother-child dyads were enrolled 4-10 years after a pregnancy complicated by GDM (N=73), or without GDM and NW (N=76) or Ob (N=76). Body weight, height, and anthropometric measures of adiposity were collected. ANCOVA were used to assess group differences in BMI, BMIz (in children), sum of skinfolds (SS), waist to hip ratio (WHR), and central (suprailiac + subscapular) to peripheral (thigh + tricep) skinfold ratio (CvP). Models were adjusted for age and race for mothers, along with tanner stage and sex for children.
Results: Women with prior GDM had greater BMI and SS compared to women in the NW group (P&lt;0.0001), but did not differ from Ob. Despite similar total adiposity for GDM and Ob groups, the GDM group had greater WHR and CvP as compared to Ob (P&lt;0.05). Among children, BMIz and WHR were greater in the GDM versus NW offspring (P&lt;0.05), with children in the Ob group having a mean BMIz and WHR that was in between NW and GDM.
Conclusion: Results support the hypothesis that women with prior GDM exhibit more central adiposity despite having similar BMI as women with Ob without prior GDM. Among children, BMIz and central adiposity increased progressively when comparing offspring of NW, Ob, and GDM mothers. The results indicate that both Ob and GDM in mothers during pregnancy may affect total and central adiposity in children. While additional research is needed, attention to maternal health before and during pregnancy is vital to mitigate against a cardiometabolic disease phenotype in children.

Disclosure
S. Martin: None.

Funding
American Heart Association (336101011); University of Alabama at Birmingham (DK079626, DK056336)
1569-P: Prevalence, Risk, and Management of Diabetes in Friedreich’s Ataxia
Authors: TAMAROFF JACLYN , DEDIO ANNA , WADE KRISTIN L. , RUMMEY CHRISTIAN , PINNEY SARA E. , LYNCH DAVID , KELLY ANDREA , MCCORMACK SHANA 
Published: June 2020

Background: Friedreich’s Ataxia (FA) is a neuromuscular disorder caused by either GAA triplet repeat expansions of both alleles of the gene frataxin, or less commonly, by a point mutation in one allele and triplet expansion on the other. FA is associated with an increased incidence of diabetes (DM), but risk factors and management are not well described.
Objective: To report the prevalence of, identify risk factors for, and describe management of DM in FA using the large (N=1,020) multi-site, longitudinal, observational FA Outcomes Measures Study (FACOMS).
Methods: FACOMS was queried for self-reported DM status and the modified FA Rating Scale (mFARS), which rates severity. For the subset at the Children’s Hospital of Philadelphia (CHOP), past medications were noted via EMR. Point mutation status and mFARS were compared in DM vs. non DM with chi-square and Wilcoxon signed rank tests, respectively. Independent risk factors for DM were tested by logistic regression including mFARS, age, point mutation, and age of FA diagnosis (dx).
Results: Median age of FA dx was 14y (IQR 10-21), 5.7% had a point mutation, and 8.8% had DM. In those with DM, median age at DM dx was 27y (IQR 17-41) and mean HbA1c since dx was 7% (SD 1). Point mutations were more common in DM vs. non DM (13.9% vs. 4.9%; p&lt;0.001). Those with DM had more severe disease (median mFARS, 70, IQR 58,78) vs. without (55, IQR 41,68) (p&lt;0.001). In logistic regression, severe disease (mFARS 4th vs. 1st quartile, OR 4.54, 95%CI: 1.75,11.77, p=0.002), older age (OR 1.05, 95%CI: 1.02,1.07, p&lt;0.001), and point mutation (OR 4.49, 95%CI: 2.11,9.53, p&lt;0.001) were associated with a greater risk of DM. In FACOMS, 76% (61/80 with DM and current medication data) used insulin. At CHOP, 47% (14/30 with DM and past medication data) had ever tried Metformin.
Conclusions: DM in FA was associated with more severe disease, older age, and a point mutation. Many require insulin. Future studies will evaluate the pathophysiology of FA-related DM to inform screening practices and management decisions.

Disclosure
J. Tamaroff: None. A. DeDio: None. K.L. Wade: None. C. Rummey: None. S.E. Pinney: None. D. Lynch: None. A. Kelly: None. S. McCormack: Advisory Panel; Self; Reata Pharmaceuticals, Rhythm Pharmaceuticals. Other Relationship; Self; Levo Pharmaceuticals.

Funding
National Institutes of Health (T32DK063688-16); Uplifting Athletes; McCormack Children’s Hospital of Pittsburgh Metabolism, Nutrition, and Development Research Affinity Group; McCormack Friedreich’s Ataxia Research Alliance
1582-P: Glycemic Change from Baseline in 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

Glycemic change from baseline to 6-months was examined across various subgroups during first 6-months observational period in this 3 year prospective study (LANDMARC; CTRI/2017/05/008452). Descriptive statistics was used to assess glycemic trends in adults with T2D controlled/uncontrolled on ≥2 antihyperglycemic medications. Of 6236 enrolled participants, 5703 completed 6-month follow-up (visit 2 [V2]). A significant (p&lt;0.0001) decrease in all glycemic parameters was noted at V2 from mean (SD) baseline A1C (8.05% [1.59]), FPG (142.80 [50.35]) mg/dL, and PPG (205.70 [72.26]) mg/dL; however, only 18.9% had reached optimum glycemic control (A1C&lt;7%) (Table). On A1C subgroup stratification, significant reduction in number of participants was seen in 8-8.9% and ≥9% groups with more participants entering the 7-7.9% group (Table). In the CV risk factor and complications subgroups, glycemic parameters worsened in participants with family history of coronary disease and history of stroke. Interestingly, only participants with heart failure had optimal glycemic control and showed maximum reduction in FPG and PPG (Table). Within 6 months of study initiation, there was a marked improvement in the glycemic parameters in people with T2D; however notably only few had reached optimum control levels.

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
1593-P: Real-World Inpatient Use of Oral Antidiabetes Drugs: A Multicenter, Retrospective, Hospital-Based Cohort Study
Authors: PASQUEL FRANCISCO J. , MAGEE MICHELLE F. , HOCHBERG IRIT , FORTIN CHARLIE , MIGDAL ALEXANDRA , CARDONA SAUMETH , FAYFMAN MAYA , GUO YI , PENG LIMIN , UMPIERREZ GUILLERMO E. 
Published: June 2020

Professional guidelines recommend insulin therapy for treatment of type 2 diabetes (T2D) in the hospital. However, oral antidiabetes drugs (OAD) are commonly used despite the lack of safety and efficacy data. We analyzed individual level data from non-critically ill patients with T2D admitted to three large healthcare systems between 2008-2018 (N=187,396). We conducted propensity score matching analyses to determine the relative efficacy and safety of OAD. Patients were treated with basal insulin (20%), sliding scale insulin alone (28%), basal insulin with OADs (23%), metformin (21%), sulfonylureas (11%), or DPP-4 inhibitors (4%). Less than 1% were treated with thiazolidinediones or SGLT2 inhibitors. Patients started on basal insulin had more comorbidities and had higher glucose levels on admission. After matching for age, BMI, Charlson Comorbidity Index, and admission blood glucose, exposure to OADs, with or without basal insulin, was associated with non-clinically meaningful differences in glycemic control compared to basal insulin use alone (183.1± 53.8 vs. 175.7± 53.9 vs. 180.3± 54.9, p&lt;0.001). The use of OADs with SSI was associated with a lower incidence of hypoglycemia. However, among OADs without basal insulin, sulfonylureas were associated with the highest rate of hypoglycemia (30%), compared to Metformin (16%), DPP-4i (15%) or TZDs (14%), p&lt;0.001. There were no differences in lactic acidosis between groups. Patients treated with basal insulin had a higher mortality (2%) compared to basal insulin+ OAD (0.3%) or OAD alone (0.6%).
In summary, the use of OADs with or without basal insulin is associated with acceptable glycemic control compared to insulin therapy. Basal insulin use and the use of sulfonylureas is associated with a high incidence of hypoglycemia.

Disclosure
F.J. Pasquel: Advisory Panel; Self; AstraZeneca, Eli Lilly and Company. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp. Research Support; Self; Dexcom, Inc., Merck Sharp & Dohme Corp., National Institutes of Health. M.F. Magee: Consultant; Self; Mytonomy. Employee; Spouse/Partner; U.S. Food and Drug Administration. Research Support; Self; AstraZeneca, Eli Lilly and Company, National Institute of Diabetes and Digestive and Kidney Diseases. Speaker’s Bureau; Self; American Diabetes Association, Pri-Med LLC. Other Relationship; Self; Endocrine Society. I. Hochberg: None. C. Fortin: None. A. Migdal: None. S. Cardona: None. M. Fayfman: None. Y. Guo: None. L. Peng: None. G.E. Umpierrez: None.

Funding
Jacobs Family Funds