bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes in Hospitalizations for Patients Admitted With Hyperosmolar Hyperglycemic State and Obesity: Analysis of National Inpatient Sample
Authors: Shaka Hafeez , Velazquez Genaro , Marcos-Abdala Hernan Gerardo , Edigin Ehizogie , Asemota Iriagbonse , Akuna Emmanuel , Murthi Mukunthan , Velagapudi Sujitha 
Published: May 2021

Abstract
Introduction: Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHS) is a highly lethal disease with an estimated mortality rate of up to 20%. Although mortality has decreased in recent years, its incidence has increased in the setting of a higher prevalence of underlying conditions that have been previously well described, such as uncontrolled diabetes, Obesity, and a high-carbohydrate diet. All these comorbidities usually overlap with acute complications such as infections or dehydration, which incite the onset of HHS. Currently, limited literature exists for the role of obesity in mortality, hospital stay, and other adverse outcomes in patients with HHS. It is important to know which underlying conditions truly affect outcomes for patients being treated for this condition so further studies can be done, and treatment optimized.
Objective: We aim to prove if obesity plays a role in increasing mortality and secondary adverse outcomes in patients with HHS compared to non-obese patients.
Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 and 2017. 42,740 hospitalizations who had HHS as primary diagnosis were enrolled and further stratified based on the presence or absence of Obesity as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes included length of hospital stay, total hospital charges, Sepsis, Septic Shock, Acute Kidney Injury (AKI), and Acute Respiratory Failure (ARF). Multivariate regression analysis was done to adjust for confounders.
Results: Out of the 42 740 hospitalizations with HHS, 9,630 had Obesity. The in-hospital mortality for patients with HHS was 45 overall, out of which 45 patients had Obesity as a secondary diagnosis. Compared with patients without Obesity, non-obese patients had similar in-hospital mortality (OR 0.77, 95% CI 0.39–1.52, p=0.45) when adjusted for patient and hospital characteristics. Patients with HHS and Obesity had similar lengths of hospital stay, total hospital charges, rate of Sepsis, Septic Shock, and ARF in comparison to patients without Obesity; however, non-obese patients had higher odds of developing AKI throughout hospitalization.
Conclusion: Although it is known and described that being obese plays a significant role in the onset of diabetes, and consequently HHS, there is no statistically significant difference in mortality or most other adverse outcomes compared to patients that are not obese and develop HHS. Although being obese plays a major role in inciting HHS in the general population, there is no need for a different approach to treatment, and outcomes are similar to non-obese patients with HHS.
Breastfeeding Is Associated With Lower Prevalence of Metabolic Syndrome in Women With Recent Gestational Diabetes in the Early Postpartum Period
Authors: Neves João Sergio , Blair Rachel , Nicklas Jacinda M , Horn Christine , Skurnik Geraldine , Seely Ellen W 
Published: May 2021

Abstract
Introduction: Women with gestational diabetes (GD) are at increased risk of future cardiovascular disease. The identification of factors that reduce metabolic syndrome (MetS) is important to improve cardiovascular outcomes. MetS has been shown to be associated with breastfeeding in women remote from pregnancy. We examined the association of breastfeeding with MetS in women with recent GD in the very early postpartum (pp) period. Methods: We performed a secondary analysis of the Balance After Baby (BAB) program which enrolled women with recent GD. GD was defined by Carpenter-Coustan criteria, a 50 gram glucose load test &gt;200 mg/dL or by clinician diagnosis. Data collected during an early (~6 weeks) pp visit was used in this analysis. At this visit, weight, height, waist circumference (WC), blood pressure (BP), fasting plasma glucose (FPG) and lipid panel were obtained. MetS was classified per NCEP III. We defined breastfeeding as currently breastfeeding or not currently breastfeeding. We performed Student’s t-tests and Wilcoxon rank-sum tests as appropriate, and fit logistic and linear regression models. Models were adjusted for age, race/ethnicity, low household income, pre-pregnancy BMI, and weeks since delivery. An exploratory model further adjusted for postpartum weight retention. Results: Of 181 women enrolled in BAB, 178 were included in this analysis (3 excluded for missing lipid panels). The mean (± SD) age of participants was 33 ± 5 years and were 8.0 ± 1.8 weeks since delivery. Thirty-four % were Hispanic. Of non-Hispanics, 31.5% were White, 18.5% Asian and 12.9% Black/African American. The prevalence of MetS was 42.9% in women not breastfeeding versus 17.1% in women breastfeeding (P &lt; 0.001; adjusted odds ratio [aOR] 0.16 [95% CI 0.06–0.41]). Breastfeeding women had significantly lower odds of FPG ≥100 mg/dL (aOR 0.36 [95% CI 0.14–0.95], p=0.039), HDL &lt;50 mg/dL (aOR 0.19 [95% CI 0.08–0.46], p&lt;0.001), and triglycerides (TG) ≥150 mg/dL (aOR 0.26 [95% CI 0.10–0.66], p=0.005). There was no significant difference in WC or BP between groups. All ORs remained significant after adjusting for weight retention. When evaluated as continuous variables, WC, FPG, and TG were significantly lower and HDL significantly higher in women breastfeeding in the early pp period (vs not breastfeeding). Conclusion: In a diverse population of women with recent GD, there was a lower prevalence of MetS in women breastfeeding compared to those not breastfeeding in the early postpartum period. This study extends the findings of an association of breastfeeding with MetS previously reported at times remote from pregnancy. Further studies are needed to determine if there is a protective role of breastfeeding on the risk of MetS.
Cardiometabolic Outcomes of Women Exposed to Hyperglycaemia First Detected in Pregnancy at 3–6 Years Post-Partum in an Urban South African Setting
Authors: Nicolaou Veronique , Soepnel Larske , Levitt Naomi Sharlene , Huddle Kenneth , Klipstein-Grobusch Kirsten , Shane Norris 
Published: May 2021

Abstract
Objective: Comparison of cardiometabolic outcomes in women exposed to hyperglycaemia first detected in pregnancy (HFDP) and a control group 3–6 years post-partum in urban South Africa. Design and Methods: A comparative study was performed of 103 women exposed to HFDP and 101 not exposed to HFDP 3–6 years post-partum at Chris Hani Baragwanath Academic Hospital, Soweto. Index pregnancy data were obtained from medical records. Post-partum, participants were re-evaluated for biochemical analysis (two-hour 75gm OGTT, fasting insulin, lipids creatinine and glucose levels). Cardiovascular risk was assessed by estimation of the Framingham risk score (FRS). Carotid intima media thickness (CIMT) was used as a surrogate marker for subclinical atherosclerosis. Factors associated with progression to these cardiometabolic outcomes were assessed using multivariable logistic and linear regression models. Results: 46 (45.1%) HFDP-exposed women progressed to diabetes compared to 5 (5.0%) women in the control group (p&lt;0.001); only 20 (43.4%) of the HFDP group were aware of their diabetic status. Adjusted odds ratio (aOR, 95% confidence interval (CI)) of progressing to type 2 diabetes was 11.0 (3.3–36.2). Both 10-year estimated cardiovascular risk (FRS) and mean CIMT were statistically higher in the HFDP-exposed group (8.46 IQR 4.9–14.4; 0.48 mm IQR 0.44-0,53, respectively) compared to the control group (3.48 IQR 2.1–5.7; 0.46mm IQR 0.42–0.50 respectively) though mostly driven by age, systolic blood pressure and diabetes. Conclusion: African women with a history of HFDP have an increased risk of cardiometabolic conditions within 6 years post-partum in an urban sub-Saharan African setting.
Co-Morbidity of Type 1 Diabetes Promotes Endometriosis Status-A Pilot Study
Authors: Alhallak Iad , Graham Garrett L , Quick Charles M , Simmen Rosalia C M 
Published: May 2021

Abstract
Diabetes (DM) is a disease with significant morbidity and mortality and is a major public health problem worldwide. Endometriosis (ENDO) is a chronic estrogen-dependent gynecological condition that affects ~10% of reproductive-age women, causes debilitating pain and infertility, and carries an increased risk for ovarian cancer. Little is known about the co-morbidity of endometriosis and diabetes (Type 1, T1DM; Type 2, T2DM), despite both conditions sharing similar pathophysiology including chronic inflammation triggered by overactivation of the immune response. To evaluate if ENDO is promoted in women diagnosed with DM, we analyzed the expression of key molecular ENDO markers in endometriosis with no associated ovarian lesions collected from non-diabetic and diabetic patients at ENDO surgery. Formalin-fixed, paraffin-embedded sections, identified from analyses of TRINETX data set and retrieved from the Pathology Department, represented women with ENDO alone (n=10; mean age of 42 yo), ENDO/T1DM (n=6; mean age of 28 yo), and ENDO/T2DM (n=7, mean age of 42 yo). Body mass indices (kg/m2) were comparable for women with T1DM (mean of 44.8) and T2DM (mean of 42.5) and higher than for ENDO alone women (mean of 30.8). Endometriotic lesions were analyzed by immunohistochemistry for markers of cellular proliferation (Ki67, PTEN, NICD1) and steroid hormone receptor expression (ESR1, ESR2, PGR-Total, PGR-B) in the epithelial and stromal compartments. We found that immunoreactive ESR1 in lesion epithelial glands (cytoplasm and nuclei) were higher in ENDO/T1DM and ENDO/T2DM than in ENDO alone (P&lt;0.05). ENDO/T1DM lesions also showed higher immunoreactivity for ESR2 (epithelial cytoplasm and nuclei; P&lt;0.05) and Ki67 (epithelial and stromal nuclei; P&lt;0.05) than for ENDO alone and ENDO/T2DM. The nuclear levels of immunoreactive NICD1, the intracellular signaling component of NOTCH1, and of tumor suppressor PTEN tended to be higher and were lower (P&lt;0.05), respectively in lesion stroma of ENDO/T1DM than of the other groups. The nuclear levels of immunoreactive PGR-T in lesion stroma were highly attenuated in ENDO/T1DM compared to ENDO alone and ENDO/T2DM (P&lt;0.05). There were no differences noted in nuclear PGR-B levels among the groups. Limitations to the current study include the small size of patient cohorts, and the diagnosis of DM at, or close to, the time of ENDO surgery. Given the significant changes in key ENDO markers (lower PGR-T and PTEN; higher ESR1, ESR2, Ki67 and NICD1) associated with co-morbid T1DM in ectopic lesions, our findings suggest that women with T1DM show more significant ENDO progression than women without DM and with T2DM. Our results support synergistic co-morbidity of ENDO and T1DM, which while currently underdiagnosed, may have significant implications in ENDO disease management.
The Influence of Sleep on Glycated Hemoglobin in Pregnancy With Gestational Diabetes
Authors: Facanha Cristina Sampaio , De Bruin Veralice S , Lopes Fernando Henrique A , Faria Magno M P , Machado Paula S , Pinheiro Mariana V , Facanha Arthur S , Magalhaes Maria Leticia C , Macedo Rejane B , De Bruin Pedro F 
Published: May 2021

Abstract
Background: Sleep disturbances have been associated with poor glycemic control in differential clinical settings. Both short and long sleep duration, influence insulin resistance and blood glucose in diabetic patients. Pregnancy is an additional risk for reduced sleep quality and quantity, and the presence of hyperglycemia, as a complicating factor, has being increasingly frequent. Different measures of sleep evaluation, both objectively and subjectively, can provide additional information about the influence of sleep in metabolic control in Gestational Diabetes Mellitus (GDM). Objective: To investigate the influence of sleep quality and objective sleep measures on glycated hemoglobin (HBA1C) in patients with GDM. Methodology: This is a cross-sectional study examining patients with GDM from 2nd to 3rd trimester of pregnancy. Clinical data and behavior questionnaires were collected by a face-to-face interview. Self-Rated Sleep Quality was evaluated by Pittsburgh Sleep Quality Index- (PSQI). In order to improve the accuracy of the information, a 14-day sleep log was obtained, and objective sleep measurements were registered by actigraphic record (5 to 7 days). Results: Overall, GDM patients (N=311), aged from 20 to 46 y (33.1±5.6) were evaluated. Sleep duration ≤6 hours/night was found in 43.4%, and 63.9% reported poor sleep quality (PSQI&gt;5). Sleep duration measured by actigraphy was correlated with sleep duration registered by sleep log (r=.45, p=.04), and with PSQI (r=-.33, p=.002). Sleep quality and sleep duration registered by either actigraphy or sleep log were not correlated with Hba1c. Amongst all, Hba1c varied from 4.3 to 7.0 mg/dL (5.9 ±.53). Sleep fragmentation, measured by the length of time patient spends awake after sleep onset (WASO) was correlated withHba1c level in patients with GDM (r=.41, p=0.04). Conclusion: Sleep duration obtained from the sleep log was a reliable measure correlating with objective sleep parameters registered by actigraphy and with sleep quality. In GDM patients, increased wake time after sleep onset was correlated with higher Hba1c.
Characterization of Viral Insulin-Like Peptides Reveals Unique White Adipose Tissue Specific Characteristics
Authors: Chrudinova Martina , Francois Moreau , Noh Hye Lim , Panikova Terezie , Zakova Lenka , Friedline Randall H , Alsina-Fernandez Jorge , Kim Jason K , Jiracek Jiri , Kahn Ronald C , Altindis Emrah 
Published: May 2021

Abstract
The members of the insulin superfamily are well conserved across the evolution tree. We recently showed that four viruses in the Iridoviridae family possess genes that share high similarity with human insulin and IGF-1. By chemically synthesizing single chain (sc, IGF-1 like) forms of these viral insulin/IGF-1 like peptides (VILPs), we previously showed that sc VILPs have insulin/IGF properties in vitro and in vivo. However, characteristics of double chain (dc, insulin-like) VILPs remain unknown. In this study, we characterized dc forms of VILPs for Grouper iridovirus (GIV), Singapore grouper iridovirus (SGIV) and Lymphocystis disease virus-1 (LCDV-1). We showed that GIV and SGIV dcVILPs bind to both isoforms of human insulin receptor (IR-A, IR-B) and they bind to IGF-1R with a higher affinity than human insulin. These dcVILPs stimulate receptor phosphorylation and post-receptor signaling in vitro and in vivo. LCDV-1 dcVILP stimulated a weak response in in vitro signaling experiments, although we could not determine binding competition. Both GIV and SGIV dcVILPs stimulated glucose uptake in mice. In vivo infusion experiments in awake mice revealed that while insulin (2.5 mU/kg/min) and GIV dcVILP (125 mU/kg/min) stimulate a comparable glucose uptake in heart, skeletal muscle and brown adipose tissue, GIV dcVILP stimulates ~2 fold higher glucose uptake in white adipose tissue (WAT) compared to insulin. This is due to increased Akt phosphorylation and glucose transporter type 4 (GLUT4) expression compared to insulin specifically in WAT. Taken together, these results show that dc GIV and SGIV dcVILPs are active members of the insulin superfamily with unique characteristics. This observation evokes questions about their potential roles in human disease including diabetes and cancer. Elucidating the mechanism of tissue specificity for GIV dcVILP will help us to better understand insulin action and design new analogues that specifically target the tissues.
Employing User-Centered Design and Learning Science Theory to Enhance Remote Delivery of Diabetes Education and Survival Skills at Hospital Discharge
Authors: Prince Grace , Lewis Daniel Rees , Pollack Teresa , Karam Susan , Touma Emilie , Khorzad Rebeca , Bailey Stacy , Gatchell David , Ankenman Bruce , Holl Jane , Wallia Amisha 
Published: May 2021

Abstract
Learning diabetes mellitus (DM) survival skills is critically important, especially for those newly diagnosed upon discharge. COVID-19 has created new educational challenges, as DM self-management education and support is difficult to deliver remotely and can be time intensive. Content and format have not been re-designed for remote delivery; however, learning sciences research can help us create effective remote education strategies. We conducted interviews with users to identify critical needs in assuming immediate DM self-care at discharge from the hospital. We then mapped these user needs to relevant learning science theories to inform potential re-designs for remote delivery of DM education and survival skills at discharge.
We conducted 12 semi-structured interviews with “users,” which included 18 participants (8 minority; 6&gt;65 years): patients newly diagnosed with DM at discharge (N=6 [33%]), their caregivers (N=4 [22%]), and laypersons new to DM (N=8 [45%]). Users were asked about their discharge needs, laypersons about perceived needs. Three investigators performed iterative rounds of inductive coding of the transcripts (using MAXQDA software), utilizing a constant comparative method to identify codes describing dominant user needs. Learning science theory was applied to identify potential re-designs for remote delivery.
Dominant user needs during hospitalization included being overwhelmed with DM self-care information (6/12 sessions) and difficulty organizing self-care equipment (5/12 sessions). Dominant user needs at home included remembering DM self-care steps (6/12 sessions), understanding correct insulin dosing (9/12 sessions), feeling fearful injecting insulin (9/12 sessions), with some noting difficulty in tracking glucose (4/12 sessions) and confusing insulin types (4/12 sessions). When learning science theory was applied, analysis mapped to three discrete educational strategies, most dominant of which is the spiral design approach—cycles of teaching the same topic but with increasing complexity. This design follows the pre-teaching principle—curriculum-based conceptual overview of self-care. Self-care at home mapped to the need for segmented learning and goal directed practice and feedback, with the potential need for behavioral therapies to reduce fear.
Learning sciences has demonstrated that learning complex procedures and concepts, such as DM self-care, requires time, repetition, and continued support. With short hospital stays and the complexity of learning DM self-care, patients cannot gain needed knowledge structures to organize the information received during hospitalization. This study suggests specific learning science strategies for the design of an effective remote delivery of DM education and skills.
Hypothalamic Gliosis in Adolescents With Type 1 Diabetes and Disordered Eating Behaviors
Authors: Ying Nip Angel Siu , Pihoker Catherine , Schur Ellen A , Melhorn Susan , Roth Christian L 
Published: May 2021

Abstract
Background: The hypothalamus and brainstem are thought to be the principal homeostatic brain areas responsible for regulating appetite and weight. Research suggests that inflammation plays a role in the onset and maintenance of eating-related maladaptive behaviors. Hypothalamic inflammation and reactive gliosis mediate disruptions in energy homeostasis, especially with obesity. Data from SEARCH in Youth for Diabetes has demonstrated high prevalence of disordered eating behaviors (DEB) including insulin omission and binge eating, in individuals with type 1 diabetes (T1D). Limited studies have used neuroimaging techniques for investigation of hypothalamic gliosis in individuals with T1D and DEB.
Objectives: To determine the feasibility of assessing hypothalamic gliosis with structural MRI in adolescents with T1D with and without DEB.
Research Design and Methods: Adolescents with T1D with and without DEB, aged 13–19, were invited to participate. Participants with current use of medications known to alter appetite were excluded. They completed the Diabetes Eating Problem Survey - Revised (DEPS-R). A score ≥ 20 was indicative of DEB. Height, weight and waist circumference were obtained, and BMI was calculated. HbA1c was obtained from their prior clinic visit, within 2 months of the study visit. Basal insulin (glargine) was administered the night before, and participants on insulin pump continued with their basal insulin infusion. Participants received rapid-acting insulin prior to the MRI study, and blood glucoses were measured before and after the MRI. Mediobasal hypothalamic (MBH) gliosis was measured by T2 relaxation time.
Results: Eight subjects (50% female, mean age 17.8±2.3 years) have completed the study without adverse outcomes. Mean HbA1c was 8.5% (range 7.3–10%). Five subjects screened positive for DEB. There was no significant difference in BMI between DEB and non-DEB groups. In this cohort, females had longer T2 relaxation times in left MBH than males (p=0.035). Compared to non-DEB group, participants with DEB had longer T2 relaxation time in left MBH, adjusted for sex and age (p=0.001). In this initial sample, relationships between MBH T2 relaxation times and glycemic control, BMI or waist circumference did not emerge.
Conclusion: The study protocol with insulin injection and MRI to study the hypothalamic gliosis in individuals with T1D is feasible. Structural MRI indicates increased T2 relaxation times as a marker of hypothalamic gliosis in participants with DEB. Further studies with larger sample size are crucial to validate these findings and to study specific eating behaviors and their associations with MBH gliosis in individuals with T1D.