bluuebunny/crossref_metadata_2025_split huggingface dataset:
1235-P: Identifying Trends in the Management of Inpatient Diabetes at a University Teaching Hospital, 2008-2018
Authors: JANKOVIC IVANA , CHEN JONATHAN 
Published: June 2020

Introduction: A substantial proportion of inpatients experience hyperglycemia during hospitalization. Use of basal insulin has been recommended by ADA guidelines since 2007, however the uptake of this recommendation has been slow. Here, we characterize the adoption of basal insulin in inpatients at one adult academic hospital.
Methods: De-identified data from the hospital’s electronic health record repository was used to identify a cohort of patients who received subcutaneous insulin during their hospitalization between 03/26/2008 and 12/30/2018. To capture patients for whom a generalist could be expected to manage their hyperglycemia, we excluded patients receiving insulin via pump, U-500 insulin, single doses &gt;100U, or insulins ordered &lt; 10 times, as well as those with a creatinine &gt; 2mg/dL at any time during admission.
Results: In the cohort of 61,947 inpatient encounters in which insulin was given, no basal insulin was ordered in 61%, decreasing from a 78% in 2008 to 53% in 2018. The annual number of encounters in which insulin was given increased &gt;20% over the decade. The proportions of blood glucoses (BGs) &gt; 200 mg/dL (28% vs. 14%) or &lt;70 mg/dL (1.2% vs. 0.6%) were higher for patients ordered for basal insulin. Although hypoglycemia decreased over time (1.2% to 0.9% of BGs), hyperglycemia increased (16% to 26% of BGs).
Conclusions: Despite improvements since basal insulin became a guidelines recommendation, the rate of inpatient basal insulin orders remained &lt; 50% as of 2018 at one academic center. The number of patients receiving insulin and the proportion of hyperglycemia has increased, whereas the incidence of hypoglycemia in this population decreased over time.

Disclosure
I. Jankovic: None. J. Chen: None.

Funding
Diabetes, Endocrinology, and Metabolism Training Grant (5T32DK007217-44)
1241-P: Prevalence of Prediabetes and Type 2 Diabetes among a High-Risk Adolescent and Young Adult Population
Authors: OLSON MICAH , KONOPKEN YOLANDA P. , KELLER COLLEEN , PATRICK DONALD L. , WILLIAMS ALLISON , AYERS STEPHANIE , KNOWLER WILLIAM C. , PENA ARMANDO , SOLTERO ERICA G. , SHAIBI GABRIEL Q. 
Published: June 2020

Background: Despite the epidemic of pediatric obesity, the prevalence of type 2 diabetes (T2D) during childhood remains low. Although obesity in youth portends cardiometabolic disease later in life, longitudinal data describing the progression of T2D into young adulthood are scarce.
Methods: We evaluated glycemic status (normal, prediabetes, or T2D) in a cohort of Latino youth with obesity (n=396; age 14.5±1.4; 55.6% male, BMI 33.9±5.3), and in a sub-set of participants who were re-engaged as young adults (n=39; age 20.8±1.0; 38.5% male, BMI 41.7±8.1). Glycemic status was determined from an oral glucose tolerance test with hyperglycemia classified according to ADA criteria.
Results: Among adolescents, the prevalence rates for normal, prediabetes, and T2D were 69.9%, 28.1%, and 1.3% respectively; while prevalence rates in young adults after a 5-year follow-up period were 64.1%, 25.6%, and 10.3%, respectively. Of the adolescents with normal glucose status at baseline who returned as young adults (n=28), 5 (17.9%) developed prediabetes, and 1 (3.6%) developed T2D. Of those with prediabetes at baseline (n=11), 4 (36.4%) reverted to normal glucose status, 4 (36.4%) remained prediabetic, and 3 (27.3%) developed T2D. Young adults with T2D were more likely to have a parental history of T2D than those who did not develop T2D (50% vs. 11%, p=0.04).
Conclusion: Despite strong risk factors, the prevalence of T2D among a cohort of Latino adolescents with obesity was low (1.3%). Of those who had normal glucose status during adolescence, the prevalence rate of T2D after a 5-year follow-up period was similarly low (3.6%), while for those with prediabetes during adolescence, the prevalence rate of T2D at follow-up was substantially higher (27.3%). Stratifying obese youth by glycemic status significantly affects the long-term prediction of developing T2D, which may have important implications for medical-decision making and resource allocation when managing youth with multiple T2D risk factors.

Disclosure
M. Olson: None. Y.P. Konopken: None. C. Keller: None. D.L. Patrick: None. A. Williams: None. S. Ayers: None. W.C. Knowler: None. A. Pena: None. E.G. Soltero: None. G.Q. Shaibi: None.

Funding
National Institute on Minority Health and Health Disparities (P20MD002316, U54MD002316); National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK107579)
1266-P: Puberty Is Associated with a Rising HbA1c, Even in Healthy Normal Weight Youth
Authors: KELSEY MEGAN M. , HILKIN ALLISON M. , SEVERN CAMERON , PYLE LAURA , NADEAU KRISTEN J. , ZEITLER PHILIP 
Published: June 2020

Objective: ADA definitions of prediabetes are applied to children, yet little is known about the impact of the transient insulin resistance of puberty on glycemia. We aimed to evaluate the longitudinal trajectory of hemoglobin A1c (HbA1c) in youth with normal weight and with obesity as they progressed through puberty.
Methods: Youth with normal weight (n=47, 49% female) or obesity (n=37, 62% female) of mixed race/ethnicity (Non-Hispanic White 34%, Hispanic 45%, Non-Hispanic Black 13%) entered the study in Tanner stage 2-3 (T2-3) and were followed until T5. Study visits were done at T2-3, T4, and T5 and included an IV glucose tolerance test, DXA, and fasting laboratory studies. HbA1c was measured by high-performance liquid chromatography and insulin sensitivity (Si), acute insulin response to glucose (AIRg), and disposition index (DI) were calculated. Group differences in HbA1c over time and time-dependent predictors of HbA1c were evaluated by mixed models, with and without adjusting for sex, race/ethnicity, and DXA %Fat.
Results: Mean HbA1c was higher in youth with obesity (5.30±0.08%) vs. normal weight (5.10±0.06%, p=0.04) at baseline and each subsequent time point; differences were attenuated by adjusting for %Fat. HbA1c increased from T2/3 to T5 in the whole cohort (0.16±0.05%, p=0.004), and in youth with obesity (+0.18±0.08%, p=0.08), or normal weight (+0.14±0.05%, p=0.02); findings were similar after adjusting for sex, race/ethnicity, and %Fat. In a multivariate model adjusted for sex and race/ethnicity, HbA1c was associated with leptin (β=0.005, p=0.01) and adiponectin (β=-0.01p=0.02); these associations are similar after adjusting for %Fat. HbA1c was not associated with Si, AIRg or DI.
Conclusions: Obesity is associated with higher HbA1c than normal weight during puberty. However, HbA1c increased during puberty, independent of body weight and composition. This increase in HbA1c is associated with changes in adipokines, but not with typical predictors of progression to diabetes (Si, DI).

Disclosure
M.M. Kelsey: Other Relationship; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp. A.M. Hilkin: None. C. Severn: None. L. Pyle: None. K.J. Nadeau: None. P. Zeitler: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Eli Lilly and Company, Merck & Co., Inc.

Funding
American Diabetes Association (1-11-JF-23 to M.M.K.); Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD057022-04); University of Colorado Center for Women’s Health Research; Children’s Hospital Colorado Research Institute; National Institute for Diabetes and Digestive and Kidney Diseases (DK048520-13); National Center for Advancing Translational Sciences (UL1TR001082)
1282-P: Assessment of Pancreas Volume and Shape Dynamics Longitudinally after T1D Diagnosis
Authors: VIROSTKO JOHN , WILLIAMS JONATHAN M. , HILMES MELISSA A. , WRIGHT JORDAN J. , DU LIPING , KANG HAKMOOK , RUSSELL WILLIAM E. , MOORE DANIEL J. , POWERS ALVIN C. 
Published: June 2020

The pancreas is smaller in individuals with T1D, but the correlation between pancreas volume and disease progression is not well established. Longitudinal pancreas volume measurements indicate that pancreas volume declines over the first year after diagnosis with T1D. To further assess pancreas volume and shape, we performed MRI imaging in 55 participants imaged at the onset of T1D and at multiple timepoints up to 5 years after diagnosis. In this cohort, 106 MRIs were performed in the first year after diagnosis, 52 MRIs in the second year, 26 in the third year, 4 MRIs in the fourth year, and 4 MRIs in the fifth year. In a primarily adolescent population, controls without T1D had increasing pancreas volume measured over a year of follow up (p = 0.01), but individuals with T1D followed up to 5 years after diagnosis showed no increase (p = 0.598). When normalizing pancreas volume by body weight (referred to as pancreas volume index) to control for adolescent weight gain, pancreas volume index declined in the 5 years after T1D diagnosis (p &lt; 0.0005), compared with a stable pancreas volume index over time in controls (p &lt; 0.05, difference in slopes over time). A separate cohort of individuals with longstanding T1D (n = 22, mean duration = 23 years, range 13 - 57 years) were imaged a single time. Pancreas volume index in individuals with T1D duration greater than 10 years was significantly smaller than in individuals with duration shorter than 10 years (p &lt; 0.001). In addition to alterations in pancreas volume, we found changes in pancreas shape in T1D. The surface area to volume ratio of the pancreas is higher in T1D than in controls, indicating a thinner pancreas in T1D (p &lt; 0.001). Furthermore, the surface area to volume ratio was stable over time in T1D, but decreased over follow up in controls (p &lt; 0.05). These data indicate altered longitudinal pancreas dynamics in the 5 years after T1D onset compared with controls, indicating impaired pancreas growth in adolescents with T1D.

Disclosure
J. Virostko: None. J.M. Williams: None. M.A. Hilmes: None. J.J. Wright: None. L. Du: None. H. Kang: None. W.E. Russell: None. D.J. Moore: None. A.C. Powers: None.

Funding
JDRF (3-SRA-2019-759-M-B, 3-SRA-2015-102-M-B)
1291-P: Characterization of Gut Microbiota in Lean Type 1 Diabetes, Overweight Type 1 Diabetes, and Healthy Controls
Authors: GOWDA SHASHIKALA B. , FARRELL RYAN M. , MACLEISH SARAH A. , SALEM IMAN , RETUERTO MAURICIO A. , GHANNOUM MAHMOUD A. 
Published: June 2020

Background: The incidence of type 1 diabetes (T1D) and overweight/obesity is on the rise. Previous studies showed altered gut microbiota in children with T1D where gut microbial differences between obese and lean children without diabetes were reported. The purpose of the study was to characterize the microbial composition of lean and overweight children with T1D at disease onset in comparison to healthy controls.
Methods: We enrolled 26 children with T1D at disease onset including 15 lean and 11 overweight T1D and compared them with age, gender and BMI matched 14 lean and 8 overweight controls. Stool swabs were collected and DNA extraction was performed using Qiagen DNA mini kit. Bacterial regions v3, v4 were amplified using 16s primers. Amplicons were cleaned, barcoded, size selected and sequencing was completed on Ion Torrent S5 sequencer.
Results: The four most abundant phyla in both groups were Proteobacteria, Firmicutes, Bacteroidetes and Actinobacteria. At the genus level, noted significant increase in pro-inflammatory microbes such as Serratia in T1D compared to controls without diabetes (P value= 0.047). Overweight T1D had marked decrease in the beneficial genus Lactobacillus compared to overweight controls. Similar observation was reported when lean T1D was compared to matched lean controls. Although not significant, anti-inflammatory genera like Clostridium had lower relative abundance in obese T1D compared to their lean counterparts. At the species level, when overweight T1D were compared to their matched controls, there was a marked reduction in L. brevis and L. Zeae known for their anti-inflammatory effects (P value = 0.038, 0.046 respectively).
Conclusion: Our study showed alterations in the gut microbiome in children with T1D with significant increase in pro-inflammatory microbes. Additionally, being overweight negatively impacted the microbiome.

Disclosure
S.B. Gowda: None. R.M. Farrell: Research Support; Self; TODAY study. Stock/Shareholder; Self; Dexcom, Inc., Tandem Diabetes Care. S.A. MacLeish: None. I. Salem: None. M.A. Retuerto: None. M.A. Ghannoum: None.
1303-P: Comparative Performance of a Recurrent Neural Network (RNN) and Logistic Regression (LR) Model to Predict Diabetic Ketoacidosis (DKA) among Youth Postdiagnosis with Type 1 Diabetes (T1D)
Authors: WILLIAMS DAVID D. , DASS SARINA , BASS JONATHAN , PATTON SUSANA R. , MEHTA SANJEEV N. , MCDONOUGH RYAN , MULLANEY COLIN , DAVOLIO LEONARD , CLEMENTS MARK A. 
Published: June 2020

Preventing dangerous and costly episodes of DKA is a goal of diabetes care, but clinicians lack tools to predict DKA events. We sought to compare performance characteristics of an RNN model with that of a LR model to predict hospital admission for DKA in the next 180 days. We developed an RNN model using training (n=1453) and testing (n=1530) datasets restricted to youth &lt;18 yo with T1D &gt;30 days. In this sample, 6% (90/1530) of youth were admitted for DKA over 180 days. The model considered &gt;500 features per quarter from discrete medical record data and free-text clinical documents. For comparative purposes, we developed an LR model using a testing dataset derived from the same sample (n=1388). The LR model included 10 evidence-based variables derived from critical review of the literature: number of previous DKAs (p&lt;0.001), most recent A1c (p&lt;0.001), age, gender, race, ethnicity, duration of T1D, days since most recent A1c, multiple daily injections vs. pump therapy, and public vs. private insurance. We used model output parameters to produce probability of DKA admission. RNN yielded an AUC=0.77 [95% CI: 0.71,0.83] while LR produced an AUC=0.79 [95% CI: 0.74,0.85]. We generated rank-ordered lists of the 90 youth with highest probability of DKA admission for both models and measured performance at different thresholds in rank-ordered lists. For ranks 1-5, RNN yielded precision (Pr)=100% (all 5 members on the list experienced a DKA admission) and LR yielded Pr=80%. For ranks 1-10, RNN yielded Pr=100% and LR yielded Pr=70%. For ranks 1-25, RNN yielded Pr=48% and LR yielded Pr=44%. An RNN model, in terms of precision, performs favorably relative to LR in predicting future DKA for a rank-ordered list of youth. Patient lists rank-ordered by DKA risk can be used by clinicians to identify youth with T1D for intensive intervention.

Disclosure
D.D. Williams: None. S. Dass: None. J. Bass: Employee; Self; Cyft, Inc. S.R. Patton: None. S.N. Mehta: None. R. McDonough: None. C. Mullaney: Employee; Self; Cyft. L. Davolio: Employee; Self; Cyft Inc. M.A. Clements: Consultant; Self; Glooko, Inc. Other Relationship; Self; Glooko, Inc.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust (G-2017PG-T1D019)
1306-P: Impacting Youth with Poorly Controlled Type 1 Diabetes
Authors: CHAMBERS MELISSA , SHAIBI GABRIEL Q. , KAPADIA CHIRAG R. , HOEKSTRA FRAN , PUFFENBERGER SYNTHIA S. , TOUGER LESLIE , RADCLIFFE IVY K. , HOLZMEISTER LEA ANN , OLSEN KIRI A. 
Published: June 2020

Background: Youth with poorly controlled type 1 diabetes (T1D) are at increased risk for morbidity yet very few interventions have targeted this vulnerable population. The purpose of this study was to test the feasibility, acceptability and preliminary efficacy of an intensive, team-based intervention program for youth with HbA1c ≥ 9.5%.
Methods: Forty patients (age 14.1±2.3 years, 53% male) with T1D (duration 6.5±4.3 years) were enrolled in an intensive, 4-month team-based intervention that included a visit with their primary endocrinologist and a pediatric psychologist at baseline as well as up to 6 encounters (in-person visits and calls) with a Certified Diabetes Educator (CDE). The CDE encounters were designed to establish goals, support behavior changes, review glucose logs, and make interim dose adjustments as needed. Feasibility was measured by the number of patients approached and the number of patients who ultimately agreed to participate, acceptability was measured by attendance and attrition rates, and preliminary efficacy was assessed by changes in HbA1c and diabetes-related Quality of Life (QoL). Data were collected at baseline and 4 months.
Results: Of the 42 patients who were approached, 40 agreed to participate, and 35 (87.5%) completed the 4-month program. CDE engagement with patients included an average of 3 phone calls and 3 in-person visits. Compared to baseline, HbA1c reduced from 12.0%±1.6 at baseline to 11.0%±1.9 at the 4 month visit (p&lt;0.001) and QoL increased from 61.0±12.3 to 64.7±11.0 (P&lt;0.05).
Conclusion: Intensive team-based interventions in pediatric patients with poorly controlled T1D can improve glycemic control and QoL.

Disclosure
M. Chambers: None. G.Q. Shaibi: None. C.R. Kapadia: None. F. Hoekstra: None. S.S. Puffenberger: None. L. Touger: None. I.K. Radcliffe: None. L. Holzmeister: None. K.A. Olsen: None.

Funding
Thomas J. Beatson, Jr. Foundation
1308-P: Parental Resilience Is Linked to Parental Mental Health and Glycemic Control in Adolescent with Type 1 Diabetes
Authors: LUO DAN , LI MINGZI 
Published: June 2020

Background: Parents of adolescent with type 1 diabetes experience increased levels of diabetes distress and depression, which is linked to adolescent glycemic control. Parental resilience might be able to improve parental mental health and facilitate adolescent glycemic control. Nevertheless, these relationships have not yet been confirmed.
Objective: To examine relationships between parental resilience, mental health (diabetes distress and depression), and adolescent glycemic control, as well as determine if parental resilience is the mediator of the association between parental mental health and adolescent glycemic control.
Methods: Parents of adolescents with type 1 diabetes (age 13-19) completed a measure of resilience, diabetes distress and depressive symptoms as part of a screening questionnaire. Adolescents’ HbA1c was obtained from medical records.
Results: Parental resilience was negatively related to maternal depressive symptoms, diabetes distress, and positively related to adolescents’ HbA1c value (all P &lt; 0.01). In multivariate analyses, resilience was the only significant predictor of glycemic control.
Conclusions: Given the links between parental resilience, parental mental health, and youth’ glycemic control, parental resilience may be important to consider when targeting both parents’ and adolescents’ adaptation to type 1 diabetes.

Disclosure
D. Luo: None. M. Li: None.
131-OR: GLP-1R in the Nodose Ganglion Modulate Intestinal Lipoprotein Production via a Neuroendocrine Mechanism
Authors: HOFFMAN SIMON S. , ADELI KHOSROW 
Published: June 2020

Diabetic dyslipidemia is characterized by overproduction of ApoB48-containing chylomicron particles, which are an independent risk factor for the development of cardiovascular disease. Chylomicron production is regulated in-part by gut-derived hormones such as glucagon-like peptide (GLP)-1. Notably, we have shown that GLP-1 acts in a neuroendocrine manner; activating GLP-1 receptor (GLP-1R) containing vagal neurons in the portal vein thereby reducing postprandial lipemia. GLP-1Rs have also been identified in the vagal nodose ganglion (NG), however their relevance to lipoprotein metabolism is yet unknown.
Syrian Golden hamsters received bilateral NG injections of either PBS vehicle, the GLP-1R agonist exendin-4, the GLP-1R antagonist exendin 9-39, or a combination of both. To investigate the propagation of vagal signalling from the portal bed hamsters received injections of GLP-1 or PBS vehicle into the portal vein, and concurrent NG injections of either exendin-4 or exendin 9-39. In addition, selective deafferination of GLP-1R-containing NG neurons was achieved via nodose injection of the cytotoxin saponin conjugated to exendin-4. After treatment, all animals received a gavage of olive oil, and an intravenous infusion of tyloxapol to prevent lipoprotein clearance. Postprandial accumulation of TG-rich lipoproteins was assessed via blood draws over a 6-hour period. Triglyceride-rich lipoprotein (TRL) fractions were then isolated via density ultracentrifugation for biochemical analysis.
NG injection of exendin-4 significantly reduced postprandial plasma TG and TRL. The ability of portal GLP-1 to reduce postprandial lipemia was lost with 9-39 injection into the NG, suggesting that active GLP-1R in this ganglion are requisite to elicit this effect. Finally, selective deafferination of NG GLP-1R containing neurons caused significant rises in postprandial TG and TRL, underscoring the importance of vagal signalling in intestinal lipoprotein regulation.

Disclosure
S.S. Hoffman: None. K. Adeli: None.

Funding
Canadian Institutes of Health Research (967131)
1310-P: Trends in Pediatric Admissions for Diabetic Ketoacidosis in the U.S.: Analysis of the 2006-2016 Kid Inpatient Database
Authors: EVERETT ESTELLE M. , COPELAND TIMOTHY , MOIN TANNAZ , WISK LAUREN E. 
Published: June 2020

Background: Rates of diabetic ketoacidosis (DKA) have been rising despite many medical advances. National studies in the U.S. describe higher rates in younger populations, although studies have not closely characterized U.S. trends in pediatrics.
Methods: We conducted a study using the national Kids’ Inpatient Database to identify pediatric admissions for DKA in years 2006, 2009, 2012, and 2016. Newborn admissions were excluded. We used descriptive statistics to describe prevalence of DKA admissions, DKA rates and trends among all pediatric admissions. Logistic regression was used to evaluate differences in DKA rates overtime within subgroups and determine factors associated with DKA trends.
Results: We identified 12,271,107 admissions of which 149,713 were for DKA. Among those with DKA, there was a high prevalence of those 15-20yo (58%), female sex (54%), white race (50%), and publicly insured (44%). Most were from urban areas (81%), the bottom two income quartiles (58%) and hospitalized in large (60%), private hospitals (71%), and in southern states (40%). When compared to all pediatric admissions, rates of DKA were highest in those 12-14yo, of male sex, black race, second income quartile and with charity care. Patients from non-urban areas and those hospitalized in private and small hospitals also had higher rates. There was a large rise in DKA admissions rates per 10,000 admissions from 94.6 in 2006 to 184.6 in 2016. The rate of change was similar within most subgroups. The characteristics positively associated with DKA admission after adjustment were age 12-14yo, male sex, black race, publicly insured or self-pay, lower income, and hospitals that were private, small, or located outside the northeast.
Conclusions: Rates of DKA admission have increased from 2006 to 2016. Although there were disparities among subgroups admitted, the rise in rate overtime was similar within most subgroups. Further studies are needed to understand drivers of admission in this population.

Disclosure
E.M. Everett: None. T. Copeland: None. T. Moin: None. L.E. Wisk: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (1K01DK116932-01)