bluuebunny/crossref_metadata_2025_split huggingface dataset:
1073-P: Incidence of Type 2 Diabetes Mellitus in a Cohort of Transgender Persons
Authors: ISLAM NOREEN , GOODMAN MICHAEL 
Published: June 2021

Introduction: Risk of type 2 diabetes mellitus (T2DM) in transgender persons is an area of clinical and research importance. The objective of this analysis was to examine occurrence of T2DM in a cohort of transgender persons receiving gender affirming hormone therapy.
Methods: The current analysis uses data from an electronic health record-based cohort study of persons 12 years and older enrolled in three integrated health care systems. The cohort included 3271 transfeminine members matched to 32,366 cisgender women and 32,349 cisgender men, and 2778 transmasculine members matched to 27,422 cisgender women and 27,391 cisgender men. Matching was based on race/ethnicity, year of birth, study site, and calendar year of membership based on the index date (first evidence of transgender status). Cohort ascertainment spanned nine years from 2006 through 2014 and follow up extended through 2016. Data on T2DM incidence were analyzed using Cox proportional hazard models whereas prevalence was compared using logistic regression; all analyses were adjusted for BMI. Type 1 diabetes cases were excluded from the analysis.
Results: Incidence of T2DM was similar across all groups overall and in the analyses limited to a subcohort of transgender members receiving gender affirming hormone therapy. At baseline, there was a significant difference in the prevalence of T2DM in the transfeminine cohort versus reference cisgender men (odds ratio 1.80, 95% CL: 1.01 to 3.21, p-value 0.05). No significant differences in prevalence were found across the remaining comparison groups.
Conclusion: Transgender people do not appear to be at higher risk for T2DM compared to their cis-gender counterparts regardless of hormone therapy receipt.

Disclosure
N. Islam: None. M. Goodman: None.
1085-P: Defining the Role of Insulin Clearance in Dysglycemia: The Microbiome and Insulin Longitudinal Evaluation Study (MILES)
Authors: WOOD ALEXIS , JENSEN ELIZABETH T. , RAMESH GAUTAM , ARZUMANYAN ZORAYR , LAM KELVIN , BERTONI ALAIN , ROTTER JEROME I. , CHEN YII-DER IDA , GOODARZI MARK O. 
Published: June 2021

Insulin resistance and insufficient insulin secretion lead to type 2 diabetes. A role of reduced insulin clearance has been suggested, but few studies have investigated the contribution of insulin clearance while simultaneously examining insulin sensitivity and secretion. The goal of this study was to conduct such an investigation in 224 non-Hispanic White and 129 African Americans individuals from MILES (mean age 59, 62% female). Participants underwent oral glucose tolerance tests from which insulin sensitivity, insulin secretion, insulin clearance, and disposition index were calculated. Logistic regression models (controlling for age, sex, race, and BMI) examined the individual contributions of these traits separately, as well as the joint contribution of insulin sensitivity, clearance, and secretion, to early dysglycemia (prediabetes plus newly diagnosed diabetes; 46% of cohort). Models used standardized predictors such that odds ratios (OR) represent the change in odds of dysglycemia per standard deviation change. Model performance was assessed via Akaike’s Information Criterion (AIC) and area under the receiver operator characteristic curves (AUROC). In separate models, dysglycemia was associated with insulin sensitivity (OR 0.2; 0.14-0.30; P&lt;.001), disposition index (OR 0.13; 0.08-0.20; P&lt;.001) and insulin clearance (OR 0.66; 0.51-0.87; P&lt;.001). In a joint model, only reduced insulin sensitivity (OR 0.04; 0.02-0.08; P&lt;.001) and secretion (OR 0.15; 0.08-0.27; P&lt;.001) were associated with dysglycemia. Models with insulin sensitivity (AIC=376.7; AUROC=0.82), disposition index (AIC=324.8; AUROC=0.87), or three insulin traits (AIC=303.4; AUROC=0.89) had the highest discriminative value. These results suggest that in the race groups studied, insulin resistance and compromised insulin secretion are the main independent defects leading to dysglycemia, while reduced insulin clearance may have a minor contributory role.

Disclosure
A. Wood: None. E. T. Jensen: None. G. Ramesh: None. Z. Arzumanyan: None. K. Lam: None. A. Bertoni: None. J. I. Rotter: None. Y. Chen: None. M. O. Goodarzi: None.

Funding
National Institutes of Health (R01DK109588)
1093-P: Incidence of Primary Nonadherence to Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) and Glucagon-Like Peptide-1 Agonists (GLP-1A) in an Integrated Health Care System
Authors: LUO JING , FELDMAN ROBERT , ROTHENBERGER SCOTT D. , FISCHER MICHAEL , KORYTKOWSKI MARY T. , GELLAD WALID F. 
Published: June 2021

Background: The incidence and predictors of primary nonadherence (when a medication is prescribed but not dispensed) for newer glucose lowering medications including SGLT2i and GLP-1a is not known.
Methods: Using a database that links electronic health records with commercial claims from an integrated health system in PA (UPMC), we identified patients with T2D newly prescribed an SGLT2i or GLP-1a from 2011-2019. We measured the incidence of 30-day primary nonadherence to both overall and by individual drug. We used multivariable logistic regression to examine patient and provider factors associated with primary nonadherence.
Results: Our cohort included 5,505 commercially insured adults (mean age 50[SD11]) with T2D newly prescribed an SGLT2i (n=2,844) or GLP-1a (n=2,661). Overall, 1,867(34%) patients did not fill their first prescription. Among the most commonly prescribed drugs, the incidence of primary nonadherence was lowest for dulaglutide(30%) and highest for canagliflozin(44%). In a multivariable model, age&gt;65 (OR 1.3, 95%CI:1.06-1.61), hypertension (OR 1.18, 95%CI:1.02-1.35), and number of hospitalizations (OR 1.39, 95%CI:1.16-1.65) was associated with an increased odds of primary nonadherence. Female sex (OR 0.88, 95%CI:0.77-0.99), PAD (OR 0.73, 95%CI:0.57-0.93), having a HbA1c value (OR 0.76, 95%CI:0.64-0.89), having a creatinine value (OR 0.82, 95%CI:0.71-0.94), and having an endocrinologist vs. PCP prescribe the index drug (OR 0.77, 95% CI:0.65-0.91) were associated with decreased odds of primary nonadherence.
Conclusions: In this integrated health system, 1 out of 3 patients prescribed a SGLT2i and GLP-1 agonist did not fill their prescription within 30 days. Older age and increasing morbidity predicted higher odds while more active engagement with providers, including diabetes specialists, was associated with reduced odds of primary nonadherence.

Disclosure
J. Luo: Consultant; Self; Alosa Health, Research Support; Self; Health Action International. R. Feldman: None. S. D. Rothenberger: None. M. Fischer: None. M. T. Korytkowski: None. W. F. Gellad: None.

Funding
National Center for Advancing Translational Sciences (KL2TR001856)
1098-P: Admission Blood Glucose but Not HbA1c Predicts Mortality in People with Diabetes Hospitalized with COVID-19 Infection
Authors: CHAUDHURI SOUMYABRATA ROY , MAJUMDER ANIRBAN , SANYAL DEBMALYA , BISWAS AJOY , BHATTACHARJEE KINGSHUK 
Published: June 2021

Background: Previous studies have documented several biochemical, clinical and radiological risk factors for mortality in patients with COVID-19. Early identification of the patients who are most likely to develop critical course will enable informed decisions and shall facilitate the provision of timely supportive treatment in advance and thus may reduce mortality.
Methodology: This is a multicentric retrospective study aimed to explore the role of hyperglycaemia (admission blood glucose and HbA1c) in predicting mortality in diabetic patients hospitalised for COVID-19.
Results: A total of 133 patient records were analysed retrospectively who were admitted to three tertiary care hospitals between 15/05/2020 to 15/11/2020. Multiple logistic regression indicated that the capillary blood glucose (CBG) on admission was an independent risk factor for mortality in DM patients with COVID-19 (Odds Ratio [OR] = 1.132, 95% confidence interval [CI]: 1.012-1.216), p=0.043 whereas HbA1c failed to predict mortality (Odds Ratio [OR] = 1.119, 95% confidence interval [CI]: 0.981-1.216), p=0.357. The optimal admission CBG level for predicting mortality was 243.50 mg/dL, with an area under the curve (AUC) of 0.879 (95% CI: 0.767-0.990) with a corresponding sensitivity of 88.9 and specificity of 72.7 at this cut-off. As revealed by the receiver-operating characteristic (ROC) analysis, HbA1c failed to predict mortality with an AUC of 0.565 (95% CI: 0.307-0.782).
Conclusion: The present study demonstrated that a high level of admission CBG and not HbA1c was an independent risk factor for mortality of COVID-19 patients with DM.

Disclosure
S. Roy chaudhuri: None. A. Majumder: None. D. Sanyal: None. A. Biswas: None. K. Bhattacharjee: None.
1103-P: Risk Factors for Visit Cancellations in a Tertiary Care Referral Clinic Specializing in Diabetic Eye Disease
Authors: GILBERT CATHERINE , FICKWEILER WARD , ADAM ATIF , SUN JENNIFER 
Published: June 2021

Patient cancellations of scheduled visits may result in missed opportunities for timely treatment and counseling and adversely impact quality of patient care. Identification of risk factors for cancellations might allow clinicians to define subgroups more likely to miss visits and interventions that prevent lapses in care. The purpose of this study was to identify patient factors associated with visit cancellations in patients followed at a tertiary care referral center for diabetes eye care. A retrospective review of the Joslin Diabetes Center’s Beetham Eye Institute electronic medical record was performed for patients with a first visit in 2016 and subsequent follow-up data. Analyses adjusted for repeated measures from the same patient. A total of 1,785 patients with diabetes (46.5% type 1, 53.5% type 2) were evaluated with baseline mean ± SD diabetes duration 24.5 ± 0.6 yrs, A1c 8.0 ± 0.1; 44.0% were female, 64.7% White, 10.3% Black and 4.0% Asian. Baseline diabetic retinopathy (DR) severity in the eye with more advanced disease was no DR in 40.3%, nonproliferative DR in 40.8% and proliferative DR (PDR) in 19.0%. Over the study time period, 333/13,085 (2.5%) visits were cancelled by patients. Bivariate analyses revealed increased cancellations were associated with older age (OR:1.00, p = 0.02), Asian versus White race (OR:3.77, p = 0.003), longer DM duration (OR:1.01, p &lt; 0.05), the presence of DM complications (OR:1.43, p = 0.02), not being insured by Medicare (OR:1.29, p = 0.01), and the presence of PDR (OR:2.28, p = 0.004). After backwards elimination analysis, only PDR remained significantly associated with cancellations. These findings suggest that patient cancellations may be associated with DR severity. Future studies should explore this relationship in expanded patient datasets and the relationship of cancelled to missed visits in order to better understand potential barriers to follow up for patients undergoing diabetes eye care.

Disclosure
C. Gilbert: None. W. Fickweiler: None. A. Adam: None. J. Sun: Other Relationship; Self; Novo Nordisk, Roche Pharma, Research Support; Self; Adaptive Sensory Technology, Boehringer Ingelheim Pharmaceuticals, Inc., KalVista Pharmaceuticals, Optovue, Roche Pharma.

Funding
Massachusetts Lions Eye Research Fund
1115-P: Household Food Insecurity and Cognitive Function in Youth and Young Adults with Type 1 Diabetes
Authors: LIESE ANGELA D. , BROWN ANDREA D. , SHAPIRO ALLISON , FRONGILLO EDWARD A. , WILKENING GRETA , FRIDRIKSSON JULIUS , MERCHANT ANWAR , HENKIN LEORA , JENSEN ELIZABETH T. , REBOUSSIN BETH A. , SHAH AMY S. , MARCOVINA SANTICA M. , DOLAN LAWRENCE M. , DABELEA DANA , PIHOKER CATHERINE , MENDOZA JASON A. 
Published: June 2021

Household food insecurity (HFI) is the limited or uncertain availability of nutritionally adequate and safe foods and has been associated with decreased cognitive function in persons without diabetes. In persons with diabetes, little is known about the impact of HFI, but cognitive function is known to decline with diabetes duration and poorer glycemic control. We evaluated the cross-sectional association of HFI with cognitive function in youth and young adults (YYA) with type 1 diabetes (T1D), focusing on executive function as measured with the NIH Toolbox Cognition Battery (score range 39-146) and a potential interaction of HFI with glycemic control (high risk &gt;9% vs. optimal/suboptimal ≤9% HbA1c). Age-adjusted composite fluid cognition score was modeled using multivariable linear regression, with HFI (≥3 affirmations on US Household Food Security Survey Module) as the predictor, controlling for covariates. Among 1,272 YYA with T1D (mean age 21, diabetes duration 11 years, 57% non-Hispanic white), 55% had high-risk glycemic control and 18% were food insecure. Food insecure T1D YYA had a 2.7 (SD=1.2) lower fluid cognition score than their food secure peers (93.7 vs. 96.4, p=0.03). Adjustment for sex, race/ethnicity, diabetes duration, site, and glycemic control attenuated this association (β=1.2, p=0.30). However, glycemic control turned out to modify the association of HFI with cognition (multiplicative interaction in adjusted model p&lt;0.01). Among YYA with HbA1c ≤9%, food insecure individuals had a lower mean fluid cognition score than the food secure (99 vs. 104, p&lt;0.02); for YYA with high-risk glycemic control, no association was observed. In this cross-sectional study, food insecurity has a detrimental relationship with cognition among T1D YYA, particularly among those with optimal/suboptimal glycemic control levels. Longitudinal research is needed to further delineate the temporal relationships between household food insecurity, glycemic control, and cognition.

Disclosure
A. D. Liese: None. B. A. Reboussin: None. A. S. Shah: None. S. M. Marcovina: None. L. M. Dolan: None. D. Dabelea: None. C. Pihoker: None. J. A. Mendoza: None. A. D. Brown: None. A. Shapiro: None. E. A. Frongillo: None. G. Wilkening: None. J. Fridriksson: None. A. Merchant: None. L. Henkin: None. E. T. Jensen: None.

Funding
National Institutes of Health (1R01DK117461, 1UC4DK108173)
1116-P: Macronutrient Intake and Risk of Progression to Type 1 Diabetes in TrialNet
Authors: LUNDGRIN ERIKA L. , VISWANATHAN ANURADHA , JOHNSON SUZANNE B. , NORRIS JILL M. , ISMAIL HEBA M. , WOOD JAMIE R. , THOMAS ALICIA J. , BECKER DOROTHY J. 
Published: June 2021

Background: Prior research found that children at risk for type 1 diabetes (T1D) with increased dietary intake of sugar and higher glycemic index foods had quicker progression from islet autoimmunity (IA) to T1D diagnosis. However, this has not yet been studied in another population.
Objective: To investigate the role of macronutrients in the progression to T1D in TrialNet’s cohort of individuals with IA, including older children and adults.
Methods: Baseline dietary data derived from a food frequency questionnaire (FFQ) estimating intake over the past year, and longitudinal clinical data until development of T1D were obtained for individuals with IA from TrialNet’s Pathway to Prevention Study. Proportional hazard regression analysis stratified by age group (1-4 yrs, 5-12 yrs, 13-22 yrs, and 23+ yrs old) was used to evaluate the time from IA detection to T1D diagnosis, with regard to average daily dietary intake of carbohydrates, protein, fat, sugar, fiber, glycemic index, and glycemic load, after adjusting for confounders.
Results: A total of 881 individuals age 1-51 years with at least one autoantibody were included, among whom 73/138 toddlers, 160/388 children, 48/166 adolescent/young adults (AYA), and 27/189 adults developed T1D. Given multiple comparisons, there was no significant association between rate of progression from IA to T1D and daily dietary intake of any macronutrients analyzed, after adjusting for baseline age, BMI, and number of autoantibodies, high risk HLA, and time from IA detection to FFQ completion. Borderline association with higher protein intake among AYA (HR 1.04, 95% CI 1.00-1.08) persisted after sensitivity analysis restricted to those with 2+ autoantibodies (HR 1.05, 95% CI 1.01-1.09).
Conclusions: Baseline dietary macronutrient intake does not appear to influence rate of T1D diagnosis in children, adolescents, or adults with IA. Further study of dietary factors’ complex role in T1D progression is warranted, including effects of a change in diet over time.

Disclosure
E. L. Lundgrin: None. A. Viswanathan: None. S. B. Johnson: None. J. M. Norris: None. H. M. Ismail: None. J. R. Wood: Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Insulet Corporation, Speaker’s Bureau; Self; Xeris Pharmaceuticals, Inc. A. J. Thomas: None. D. J. Becker: None.

Funding
Rainbow Babies & Children’s Foundation; National Institute of Diabetes and Digestive and Kidney Diseases; National Institute of Allergy and Infectious Diseases; Eunice Kennedy Shriver National Institute of Child Health and Human Development; JDRF
1119-P: Improving Clinical Utility of GAD65 Autoantibodies by Electrochemiluminescence Assay When Identifying Autoimmune Adult-Onset Diabetes
Authors: JIA XIAOFAN , GU YONG , VARTAK TANWI , MIAO DONGMEI , DONG FRAN , JERRAM SAMUEL T. , REWERS MARIAN , FERRARA ASSIAMIRA , LAWRENCE JEAN M. , YU LIPING , LESLIE RICHARD D. ,   THE ACTION LADA CONSORTIUM,   THE DIABETES IN YOUNG ADULTS (DIYA) STUDY GROUP
Published: June 2021

Aims: It is important to differentiate the two major phenotypes of adult-onset diabetes, autoimmune type 1 diabetes (T1D) and non-autoimmune type 2 diabetes (T2D). Serum GAD65 autoantibodies (GADA) are the most sensitive biomarker for adult-onset autoimmune T1D, but the clinical value of GADA by current standard radio-binding assays (RBA) remains questionable. The present study focused on the clinical utility of GADA differentiated by a new electrochemiluminescence (ECL) assay in patients with adult-onset diabetes.
Methods: Two cohorts of individuals recently diagnosed with diabetes at ≥20 years of age were analyzed including 771 patients 30-70 years olds from the Action LADA study and 2,063 patients 20-45 year olds from the Diabetes in Young Adults (DiYA) study. Clinical characteristics including requirement of early insulin treatment, BMI, and development of multiple islet autoantibodies were analyzed according to the status of RBA-GADA and ECL-GADA, respectively.
Results: GADA was the most prevalent and predominant autoantibody, &gt;90% in both cohorts with any positive autoantibody. GADA positivity by either RBA or ECL assay significantly discriminated clinical T1D from T2D. However, patients with ECL-GADA in both cohorts were at greatest risk of insulin treatment, multiple islet autoantibodies and lower BMI (all p&lt;0.0001). Among patients GADA positive by RBA, 32.4% (90/278) in the Action LADA study and 25.6% (32/125) in the DiYA study were negative by ECL assay. Patients with GADA detectable by RBA, not confirmed by ECL, had a phenotype more similar to T2D and these RBA-GADA had lower affinity compared to GADA confirmed by ECL assay.
Conclusion: The ECL-GADA assay offers advantages over the RBA-GADA in identification of adult-onset diabetes patients at higher risk of early insulin dependency.

Disclosure
X. Jia: None. L. Yu: None. R. D. Leslie: None. The action lada consortium: n/a. The diabetes in young adults (diya) study group: n/a. Y. Gu: None. T. Vartak: None. D. Miao: None. F. Dong: None. S. T. Jerram: None. M. Rewers: Advisory Panel; Self; Provention Bio, Inc., Consultant; Self; RTI, Research Support; Self; Janssen Research & Development, LLC, JDRF. A. Ferrara: None. J. M. Lawrence: None.

Funding
JDRF (2-SRA-2019-695-S-B); National Institutes of Health (DK32083); 5th Framework Program of the European Union; Centers for Disease Control and Prevention (1U18DP006289)
1121-P: Unmet Social Needs and Depressive Symptomatology among Youth and Young Adults with Type 1 Diabetes
Authors: BROWN ANDREA D. , MENDOZA JASON A. , FRONGILLO EDWARD A. , FLORY KATE , REBOUSSIN BETH A. , JENSEN ELIZABETH T. , DOLAN LAWRENCE M. , BELLATORRE ANNA , MALIK FAISAL , MARCOVINA SANTICA M. , LIESE ANGELA D. 
Published: June 2021

Youth and young adults (YYA) with type 1 diabetes (T1D) may be at risk for unmet social needs and depression due to the disease-associated cost and stressors. Little is known about how unmet social needs are linked to depressive symptomatology. These cross-sectional analyses used data from the SEARCH Food Security ancillary study (2018-2020) to examine the association of unmet social needs on depressive symptoms among 685 YYA with T1D. The USDA Household Food Security Survey Module was used to measure household food insecurity (HFI) over the past 12 months (food insecure (≥3 affirmations) vs. food secure). Participants were queried about their primary mode of transportation (personal vehicle vs. other form of transportation) and if they had stable housing (all the time vs. some or none of the time) over the past 90 days. Total number of unmet social needs (0-3) were calculated by summing these items. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression (CES-D) scale (scores 0-60). Linear regression was used to examine the association between number of unmet social needs and depressive symptom scores. Among YYA with T1D (mean age 23.4, SD 4.6 years), 17.1% had HFI, 14.0% lacked adequate transportation, and 4.3% experienced unstable housing; 23.5% had one, 5.1% had two, and 0.9% had three unmet social needs. Mean (SD) CES-D score was 14.3 (11.9), which is below the cutoff score of 16 for risk of depression. Compared to YYA with no unmet social needs, those with 1 and 2-3 unmet social needs had depressive symptom scores 5.9 and 15.9 points higher, respectively (p&lt;0.0001 for both exposure values), after adjusting for age, sex, race/ethnicity, diabetes duration, clinic site, parental education, and household income. Social needs among YYA with T1D are confluent and are jointly and cumulatively associated with depressive symptoms. Future studies should investigate the impact of alleviating unmet social needs on depressive symptomatology among YYA with T1D.

Disclosure
A. D. Brown: None. S. M. Marcovina: None. A. D. Liese: None. J. A. Mendoza: None. E. A. Frongillo: None. K. Flory: None. B. A. Reboussin: None. E. T. Jensen: None. L. M. Dolan: None. A. Bellatorre: None. F. Malik: None.

Funding
National Institutes of Health (R01DK117461, T32GM081740)