bluuebunny/crossref_metadata_2025_split huggingface dataset:
1015-P: Cost of Diabetes Complications in U.S. Adults Aged 65 Years or Older
Authors: WANG YU , ZHANG PING , SHAO HUI , ANDES LINDA J. , IMPERATORE GIUSEPPINA 
Published: June 2021

This study estimated the cost associated with 17 diabetes complications and treatment procedures (hypoglycemia, ketoacidosis, photocoagulation, retinopathy intravitreal injections, nephropathy, dialysis, kidney transplantation, neuropathy, foot ulcer, lower-extremity amputation, retinopathy, blindness, congestive heart failure, myocardial infarction, stroke, angina, revascularization) among US Medicare beneficiaries. Data were from 100% Medicare fee-for-service claims from 2006 to 2017. ICD 9, ICD 10, and diagnosis-related group codes were used to identify persons ≥65 years old with diabetes by type and diabetes complications. We used a longitudinal cohort design in which persons with diabetes were followed from the index year until death, exiting the health plan, or December 31, 2017, whichever came first. The index year was the year when diabetes code first appeared in inpatient claims, or in outpatient claims combined with another diabetes claim in the following 2 years. We used person-level fix-effect regression models to estimate the cost of each complication in the year when the event occurred and the follow-up years for non-acute complications. All costs were standardized to 2017 dollars. Our study included 11,028,910 patients with type 2 diabetes (T2D) and 195,546 with type 1 diabetes (T1D) in 10 cohorts. The follow-up times of the 10 cohorts ranged from 3 to 10 years. Costs of the diabetes complications varied from $375 to $ 86,639. The top three costliest complications were kidney transplantation (T2D: year of occurrence $86,639 vs. following years $15,898, T1D: $78,684 vs. $8,545), dialysis (T2D: $63,079 vs. $42,751, T1D: $60,772 vs. $43,214), and lower-extremity amputation (T2D: $45,142 vs. $8,079, T1D: $44,813 vs. $8,025). Our cost estimates provide the cost parameter needed by type 1 and type 2 diabetes simulation models and by economic evaluation of efforts to prevent/delay diabetes complications.

Disclosure
Y. Wang: None. P. Zhang: None. H. Shao: Research Support; Self; Sanofi. L. J. Andes: None. G. Imperatore: None.
1019-P: Outcomes of Hospitalized DKA Patients with Hypocalcemia: An Analysis of National Inpatient Sample
Authors: MURTHI MUKUNTHAN , CORPUZ CARLOS GABRIEL D. , VELAGAPUDI SUJITHA , RAMIREZ MARCELO , ATLURI RAMTEJ , SHAKA HAFEEZ 
Published: June 2021

Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM), associated with significant mortality. Patients frequently develop a constellation of electrolyte disturbances, including hypocalcemia. We wanted to analyze the in-hospital outcomes of DKA patients with hypocalcemia.
Methods: We conducted a retrospective observational study using the National Inpatient Sample (NIS) from 2017 and 2018. Patients with type 1 and 2 DM with a principal diagnosis of DKA were selected and stratified based on the presence of hypocalcemia. The primary outcome was in-hospital mortality. The secondary outcomes included the development of sepsis, acute kidney injury (AKI), Acute respiratory failure(ARF), cerebral edema (CE), length of stay (LOS), and total charges. Confounders were adjusted for using multivariate regression analysis. We included AKI and Sepsis in the multivariate analysis for mortality since hypocalcemia can be seen in both conditions.
Results: Out of 379,614 DKA admissions during the study period, 6894(1.8%) had hypocalcemia. When adjusted to patient characteristics, co-morbidities and hospital characteristics, those with hypocalcemia had higher odds of AKI (aOR=1.28, CI=1.13-1.45, p=&lt;0.001), sepsis (aOR=2.88, CI=2.07-4.01, p=&lt;0.001), ARF (aOR=3.23, CI=2.59-4.03, p=&lt;0.001) and CE (aOR=2.51, CI=1.24-5.12, p=0.011) compared to those with only DKA. When adjusted to the occurrence of AKI and sepsis, patients with hypocalcemia and DKA had higher odds of in-hospital mortality (aOR= 2.61, CI=1.47-4.64, p=0.001), longer LOS (+1.01 day, CI 0.79-1.24, p&lt;0.001) and higher total hospital charges (+$14,649, CI $11,442-17,855, p&lt;0.001).
Conclusion: Hypocalcemia is associated with increased odds of mortality in patients admitted with DKA and it could be used as a disease severity marker. Further studies need to be done to determine if hypocalcemia in DKA is merely a predictive factor or a direct contributor to increased mortality.

Disclosure
M. Murthi: None. C. D. Corpuz: None. S. Velagapudi: None. M. Ramirez: None. R. Atluri: None. H. Shaka: None.
1024-P: Association, Prevalence, and Occurrence of Depression and Anxiety in Indian T2DM Patients
Authors: KUMAR NAWEEN , CHANDRA ABHISHEK K. , AHSAN SAJJAD , KUMAR ABHISHEK 
Published: June 2021

Background: Depression is found to be common among patients with diabetes and it is associated with poor outcomes in disease control. Mani objective of the study was to study the prevalence and occurrence of depression and anxiety in patients of type 2 diabetes mellitus (T2DM).
Materials:115 adults with T2DM without prior diagnosis of depression and 115 matched controls were evaluated. Sociodemographic and relevant clinical variables were collected. They were evaluated for depression and anxiety using Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale respectively.
Results: Significantly larger proportion of diabetic patients had depression [32 (27.8%) vs. 11 (9.57%), P = 0.005), anxiety (38 (33%) vs. 16 (13.9%, P = 0.005) and comorbid depression and anxiety (28 (24.3%) vs. 10 (8.7%), P = 0.005) as compared to healthy controls. The prevalence rate of depression was higher in age between 41 and 60 years (18.8% vs. 7.6%, respectively) in diabetic and healthy control group. Diabetic women had higher depression (21.2% vs. 8.7%) and anxiety (18.8% vs. 9.7%) than men. Depression was found significantly associated with retinopathy 28.6% (p=0.005), nephropathy 16.3% (p=0.005) and ischemic heart disease (IHD) 17.2% (p=0.005) in the present study. Comorbid depression and anxiety was significantly associated with age (40-60 years), obesity (BMI ≥ 25 kg/m2), poor glycemic control (≥7.5%), insulin therapy, nephropathy, neuropathy, and IHD but no significant association was found with education level.
Conclusion: This study found a high proportion of depression and anxiety among patients with T2DM. Public health measures are required to create more awareness for managing depression in diabetes.

Disclosure
N. Kumar: None. A. K. Chandra: None. S. Ahsan: None. A. Kumar: None.
1045-P: Impact of Type 2 Diabetes Mellitus with Hyperosmolar Hyperglycemic State on Patients Admitted for Heart Failure: Insights from the National Inpatient Sample
Authors: ASEMOTA IRIAGBONSE R. , SHAKA HAFEEZ , EDIGIN EHIZOGIE , ALMANI MUHAMMAD USMAN , AKUNA EMMANUEL 
Published: June 2021

Background: Diabetes and Congestive Heart Failure frequently coexist in the same patients. This aim of the study was to compare the adverse outcome rates of diabetic patient admitted for hyperosmolar hyperglycemic state with concomitant heart failure compared to those without heart failure.
Method: Data were obtained from The National Inpatient Sample (NIS) 2016 and 2017 Database. The NIS was searched for hospitalization for HF as principal diagnosis with and without a secondary diagnosis of diabetes mellitus type 2 with hyperglycemic hyperosmolar state (DM2 with HHS) using International Classification of Diseases, Tenth Revision (ICD-10) codes. Multivariate logistic and linear regression analysis was used accordingly to adjust for possible confounders.
Results: The combined 2016 and 2017 NIS database contained 2,586,684 hospitalizations for adult patients (aged ≥ 18 years) with a principal ICD-10 diagnosis for DM2 with HHS. Among this group, 500 (1.1%) had co-existing HF. Of note, patient admitted for HHS with secondary diagnosis of HF had increased inpatient mortality but did not reach statistical significance (2.0% vs. 0.7%, AOR:1.66, 95% CI 0.41-6.67, p&lt;0.474) compared to those without HF. The adjusted mean LOS in patients with HHS and coexisting HF increased by 2.7 days (7.4 days vs. 3.7 days, 95% CI 1.15-4.24, p=0.001) longer than those without HF. Patient hospitalized with HHS with coexisting HF had higher adjusted mean total hospital charge of $31,287 ($71,589 vs. $32,082, CI 9,677-52,897, p=0.005) compared to those without HF.
Conclusion: Patients admitted for HHS with co-existing heart failure have similar inpatient mortality, however Total hospital charges and LOS were increased in those with HF compared to the patients without HF. Patients with concomitant heart failure and diabetes have diverse pathophysiological mechanism that may contribute to worse outcomes that need to be explored further.

Disclosure
I. R. Asemota: None. H. Shaka: None. E. Edigin: None. M. Almani: None. E. Akuna: None.
1048-P: Factors Contributing to Early Mortality in Persons with Type 2 Diabetes with Lower Extremity Amputation
Authors: CHAN JEFFREY , YAN KUN 
Published: June 2021

Introduction: Type 2 diabetes continues to be one of the most common and costly conditions in the United States. Complications and co-morbidities that develop, such as amputations, add to the financial toll and can reduce the life expectancy of these individuals. The aim of this study was to identify risk factors that lead to early mortality (12 months or less) following subacute inpatient, interdisciplinary rehabilitation at a VA Community Living Center (CLC).
Methods: A retrospective medical chart review was conducted on forty-seven Veterans who had a lower extremity amputation and died between 2015-2018. Demographic variables collected included age, months between discharge and death, and social support at home. Conditions on status of hypertension, type 2 diabetes, coronary artery disease, congestive heart failure, smoking status, end-stage renal disease and chronic renal disease were gathered at date of death.
Results: The mean age at CLC admission was 68 years and the average time of death was 14.2 months after discharge. It was shown that 50.5% of the patients returned home to social support. Mean HbA1c was 7.1% prior to amputation. A multiple logistic regression was performed associating status of persons with type 2 diabetes (P=.043, 95% CI = .09 - 5.25) and concurrent chronic renal disease (P=.02, 95% CI = .33 - 4.79) leading to death at less than 12 months. There was no significant relationship between hypertension, smoking, age, end-stage renal disease, congestive heart failure with mortality after discharge from the CLC. No association was found between pre-operative HbA1c status and survivorship.
Conclusion: There was a relationship between those who died within 12 months and diagnosis with both type 2 diabetes and chronic renal disease after an inpatient stay at a VA Community Living Center. These results suggest diabetes along with concurrent chronic renal disease management needs to be maintained after an inpatient stay to prevent premature death.

Disclosure
J. Chan: None. K. Yan: None.
1057-P: Predictors of Food Insecurity among Ambulatory Patients with Diabetes
Authors: ALVER AMALIE , BASU ARPITA , CAPURRO ANTONINA , GEWELBER CIVON L. , BACA KRISTIN , WILLIAMS SHELLEY J. , EBERSOLE JEFFREY L. , BATRA KAVITA , PATEL AMRITA M. , IZUORA KENNETH 
Published: June 2021

Background: Limited access to adequate, affordable, and nutritious foods can drive adverse outcomes in patients with diabetes mellitus (DM). Understanding factors that impact food insecurity is vital in developing strategies to improve holistic health outcomes among patients with DM.
Method: Seventy-one ambulatory patients with type 2 DM were recruited using an investigator-administered questionnaire and chart review. Variables on demographics, oral health, DM outcomes, and accessibility to healthy food were collected. Their oral health was inspected. Data were analyzed using multiple logistic regression.
Results: Among study participants, 60.6% were female, 63.4% were non-white, mean age: 64.10±10.3 years, mean duration of diabetes: 15.80 ±9.1 years, and mean HbA1c: 7.80 ±1.5%. Vascular complications were present among 66.2% of participants. The logistic regression model was statistically significant (p &lt; 0.0001) and explained 44.5% of food insecurity variance. Significant predictors of food insecurity include having less than high school education (OR 12.6, p = 0.04), living below the federal poverty threshold (OR 4.3, p = 0.04), and younger age (OR 0.91, p = 0.01). Race/ethnicity, gender, oral health indicators, and DM complications did not significantly predict food insecurity.
Conclusions: In our study sample, younger patients with less than high school education and living below the federal poverty threshold were at higher risk of food insecurity. These findings underscore the need for targeted interventions among this high-risk group to reduce food insecurity and improve DM outcomes.

Disclosure
A. Alver: None. K. Izuora: None. A. Basu: None. A. Capurro: None. C. L. Gewelber: None. K. Baca: None. S. J. Williams: None. J. L. Ebersole: None. K. Batra: None. A. M. Patel: None.
1064-P: Trends in Heavy Metal Mixtures among U.S. Adults by Diabetes and Cardiovascular-Renal Diseases in NHANES, 1999-2016
Authors: YANG JINGLI , LO KENNETH , YANG AIMIN 
Published: June 2021

Background: Growing evidences have linked the exposure to heavy metals to the risk of type 2 diabetes (T2D), cardiovascular diseases (CVD), and chronic kidney disease (CKD). In the present analysis, we examined secular trends in levels of four toxic metals (arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg)) in urine among adults aged 20 years or above from nine cycles of National Health and Nutrition Examination Survey (NHANES 1999-2016).
Methods: We calculated the age- and sex-standardized geometric means of urinary metal levels, and further stratified them by comorbidities including T2D, CVD and CKD. Joint-point regression model was used to estimate trends over time.
Results: A total of 17,083 participants were included. Urinary Cd (4.35*10-2-3.70*10-2 μg/g creatinine; AAPC=-1.1, 95% CI= -1.5, -0.7), Pb (6.53-4.62 μg/g creatinine; AAPC=-2.2, 95% CI= -2.6, -1.9), Hg (6.58-3.80 μg/g creatinine; AAPC=-2.7, 95% CI= -3.6, -1.8) declined during 1999 and 2016, and urinary As (2.58-2.34 μg/g creatinine; AAPC=-0.9, 95% CI= -2.1, 0.2) declined during 2003 and 2016. When stratified by comorbidities, in 2009-2010, urinary As was higher among participants with T2D, CVD or CKD. Urinary Cd was higher among participants with T2D in the 2003-2004 survey, among participants with CVD in the 1999-2000 survey, and among participants with CKD in the 2007-2008 survey. In the 1999-2000 survey, urinary Pb was higher among participants with T2D, CVD or CKD. Urinary Hg was higher among participants with T2D in the 2005-2006 survey, among participants with CVD in the 2001-2002 survey, and among participants with CKD in the 1999-2000 survey.
Conclusion: The levels of toxic heavy metal in urine have inclined among U.S. adults in the past 18 year but the extent varied by comorbidities.

Disclosure
J. Yang: None. K. Lo: None. A. Yang: None.
108-OR: Islet-Derived Preproinsulin T Cell Receptor Sequences Are Present throughout the Stages of Type 1 Diabetes Development
Authors: BASCHAL ERIN E. , MITCHELL ANGELA M. , MCDANIEL KRISTEN , ALKANANI AIMON , ARMSTRONG TAYLOR , LANDRY LAURIE , WAUGH KATHLEEN , REWERS MARIAN , NAKAYAMA MAKI , MICHELS AARON W. 
Published: June 2021

Type 1 diabetes (T1D) results from the T cell-mediated destruction of insulin-producing pancreatic β-cells as evidenced by CD8 and CD4 T cells being present within the inflamed islets of recent-onset T1D organ donors. We isolated, sequenced the T cell receptor (TCR) from ∼3,500 T cells in the residual islets of T1D organ donors (n=9), and determined antigen specificity to 41 preproinsulin-reactive T cells from these islet sequences. Among the T1D organ donor islet sequences, 32% are shared (identical Vβ, Jβ, CDR3β) within the peripheral blood of new-onset T1D patients that had sequencing done from whole blood DNA (n=162, 34x106 TCR sequences, Adaptive Biotechnologies). Similar numbers of sequences are shared between both CD4 and CD8 T cells. Furthermore, 53 unique sequences were disease-specific, as they were identified in &lt;1% of TCR sequences from controls (n=786, 275x106 sequences), whereas they were detected in 54% of new-onset T1D patients (p&lt;0.001). These disease-specific and preproinsulin-reactive TCR sequences are good candidates for biomarkers in T1D. Therefore, we next sequenced the TCR beta chains throughout the disease course of five participants in the Diabetes AutoImmunity Study in the Young (DAISY) at 4 time points (early in life, prior to islet autoantibody seroconversion, post-autoantibody seroconversion, and at T1D onset). 10% of these insulin-reactive TCR sequences, including those to hybrid insulin peptides, are present throughout the disease course. Interestingly, insulin-reactive CD4 TCRs were predominant early in life, while higher frequencies of both insulin-reactive CD8 and CD4 were present at clinical T1D diagnosis. With continued TCR sequencing from longitudinal patient samples across the stages of T1D and identifying antigen specificity to more islet-derived T cells outside of preproinsulin, TCR sequences from genomic DNA have the potential to be a powerful disease biomarker during the progression to clinical type 1 diabetes.

Disclosure
E. E. Baschal: None. A. W. Michels: Stock/Shareholder; Self; IM Therapeutics. A. M. Mitchell: None. K. Mcdaniel: None. A. Alkanani: None. T. Armstrong: None. L. Landry: None. K. Waugh: None. M. Rewers: Advisory Panel; Self; Provention Bio, Inc., Consultant; Self; RTI, Research Support; Self; Janssen Research & Development, LLC, JDRF. M. Nakayama: None.

Funding
National Institutes of Health (DK108868, DK110845, DK032083, DK099317, DK032493)
1106-P: Glycemic Burden and Obesity Independently Increased Risk of Liver Cancer in Type 2 Diabetes: Hong Kong Diabetes Register (1995-2019)
Authors: MAO DANDAN , LAU ERIC S.H. , YANG AIMIN , WU HONGJIANG , SHI MAI , KONG ALICE P. , MA RONALD C. , CHOW ELAINE , LUK ANDREA , CHAN JULIANA C. 
Published: June 2021

The incidence of liver cancer and related mortality is increasing globally. Liver is a major site for glucose metabolism. People with type 2 diabetes (T2D) had increased risk of liver cancer. However, the association of glycemic burden (GB) with liver cancer in T2D remains unclear. We calculated GB using area under the curve above 5.7% of HbA1c (AUC_A1c) in patients with T2D enrolled in the prospective Hong Kong Diabetes Register established since 1995. Structured baseline data were linked to laboratory and hospitalization records in a territory-wide electronic medical record system with data censored in 2019. We performed Cox regression analysis to investigate the association of GB with incident liver cancer defined as first hospitalization with ICD9 code (155). We included 18,173 patients (50.93% male, age: 58.43±12.48 years, HbA1c: 7.58±1.66%, BMI: 25.51±4.06 kg/m2, disease duration: 20.68 ±7.63 years), who had ≥ 10 years of disease duration, &gt; 3 years of observation, and ≥ 5 HbA1c measurements (21.98±12.33). During a median (IQR) follow up period of 10.62 (8.09, 15.88) years (218,381patient-years), 160 patients developed liver cancer with an incidence of 7.33 per 10,000 patient-years. We excluded 3 years of HbA1c values prior to incident liver cancer to avoid reverse causality. After adjusting for confounders, every 1 unit increase in AUC_A1c increased the hazard ratio (HR) of liver cancer by 1.22 (95% CI: 1.01-1.47), while AUC_A1c top quantile group had a HR of 1.78 (1.01-3.13) versus the lowest quantile group. In subgroup analysis, obese patients (BMI&gt;25 kg/m2) had a HR of 1.34 (1.05-1.70) for liver cancer versus non-obese subjects. Amongst patients who developed liver cancer (n=1420) within 3 years of enrolment, one unit increase of AUC_A1c was associated with a HR of 1.49 (1.07-2.07) for liver cancer. GB and obesity independently increased the risk of liver cancer in T2D, emphasizing the importance of metabolic control for cancer risk reduction.

Disclosure
D. Mao: None. J. C. Chan: Consultant; Self; Bayer AG, Boehringer Ingelheim International GmbH, MSD Corporation, Sanofi, Other Relationship; Self; Asia Diabetes Foundation, GemVCare, Research Support; Self; Applied Therapeutics, AstraZeneca, Hua Medicine, Lilly Diabetes, Merck KGaA. E. S. H. Lau: None. A. Yang: None. H. Wu: None. M. Shi: None. A. P. Kong: Advisory Panel; Self; Lilly Diabetes, Speaker’s Bureau; Self; Abbott, AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Lilly Diabetes, Sanofi, Stock/Shareholder; Self; Aptorum. R. C. Ma: Other Relationship; Self; AstraZeneca, Medtronic, Research Support; Self; AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Novo Nordisk, Pfizer Inc., Sanofi-Aventis, Tricida, Inc. E. Chow: Research Support; Self; Medtronic, Speaker’s Bureau; Self; Novartis Pharmaceuticals Corporation, Sanofi-Aventis. A. Luk: None.
111-OR: Macrophage IPLA2ß-Derived Lipid (iDL) Signaling Promote Type 1 Diabetes Development
Authors: ALMUTAIRI ABDULAZIZ , GAI YING , LEI XIAOYONG Y. , STEPHENSON DANIEL , CHALFANT CHARLES , RAMANADHAM SASANKA 
Published: June 2021

Type 1 diabetes (T1D) is a consequence of autoimmune-mediated destruction of pancreatic β-cells, and the leading causes for this process are incompletely understood. Our previous work revealed that Ca2+-independent phospholipase A2β (iPLA2β), which hydrolyzes membrane phospholipids at the sn-2 position and releases bioactive lipids, modulates polarization of macrophages (MΦ). Several of the iPLA2β derived lipid signals (iDLs) are proinflammatory, which can initiate immune cell infiltration and β-cell damage. Our recent work suggests that MΦ-derived from spontaneous-T1D prone nonobese diabetic mice (NOD) produce a proinflammatory lipids including (PGE2, 5-HETEs, 20-HETEs, DHETs, LTB4) at the early stage of the disease (4 weeks), interestingly, the proinflammatory lipid signature is similar to a high-risk T1D individuals. Here, we examined the effects of MΦ-iPLA2β iDLs by generating a select conditional decrease in iPLA2β in NOD MΦ (NOD.cMiPLA2&#120573;;;;;+/-). We found that (1) that the selective decrease of iPLA2β in MΦ significantly reduces T1D incidence and immune cell infiltration to the islets in the NOD mice. (2) NOD.cMiPLA2&#120573;;;;;+/- bone marrow-derived (BMD) MΦ are skewed towards an anti-inflammatory phenotype in comparison to NOD BMD MΦ, favoring an anti-inflammatory phenotype. (4) Selective inhibition of (PGE2 and DHETs) shifted NOD MΦ towards an anti-inflammatory phenotype. These findings suggest that MΦ-iDLs contribute to T1D development, and inhibition of select iDLs production can be targeted to counter T1D development.

Disclosure
A. Almutairi: None. Y. Gai: None. X. Y. Lei: None. D. Stephenson: None. C. Chalfant: None. S. Ramanadham: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK110292); National Institute of Allergy and Infectious Diseases (R21AI146743)