bluuebunny/crossref_metadata_2025_split huggingface dataset:
899-P: Body Composition and Cardiometabolic Risk in South Asian Adolescents Compared with African American and White Peers
Authors: MANFREDO JACQUELYN A. , ANAND NEHA S. , ZEMEL BABETTE S. , KELLY ANDREA , MAGGE SHEELA N. 
Published: June 2021

Background: South Asian (SA) adults have greater cardiometabolic risk (CMR) at lower BMI compared to White (W) and African American (AA) ancestry groups, thought to be due to increased visceral fat (VFAT). Few studies have examined adolescents for early ancestry differences.
Objective: Examine ancestry-related differences in body composition and CMR factors in SA, AA, and W youth.
Methods: SA, AA and W youth, 12-21 y, BMI ≥ 80%ile (or ≥23kg/m2 if ≥18y) had pubertal staging (PUB), whole body DXA, and measurement of CMR factors, including fasting metabolic labs. Insulin and glucose were used to calculate HOMA-IR. ANOVA or Kruskal Wallis compared groups, and linear regression adjusted for covariates (age, sex, PUB, BMI-Z) and analyzed interaction by group.
Results: Participants (34 SA, 23 AA, 44 W) were similar in sex and PUB, but SA were older [median (IQR) 20.2y (18.9, 21.2)] and AA had higher BMI [37.0 kg/m2 (32.7, 39.8)] compared to SA [28.6 (25.7, 30.6)] and W [27.7 (15.2, 32.5)]. Lipid panel, glucose, BP, and VFAT were similar among groups. Insulin [SA 15.0 µIU/mL (10.2, 25.1); AA 19.3 (15.4, 33.9); W 10.9 (7.1, 16.4), p=0.0005] and HOMA-IR [SA 3.5 (2.2, 5.6); AA 4.2 (3.4, 7.2); W 2.5 (1.5, 3.4), p=0.0005] were higher in SA and AA compared to W. In adjusted models: SA and W had greater increases in VFAT with increasing BMI-Z (SA*BMI-Z p=0.006; W*BMI-Z p&lt;0.0005) and with increasing total body fat (BF) (SA*BF p=0.007; W*BF p&lt;0.0005) compared to AA. SA had higher fasting insulin [β 6.45, p=0.01] and HOMA-IR [β 1.56, p=0.009] compared to W, even after adjusting for BF (p=0.004) or VFAT (p=0.009).
Conclusion: SA and W adolescents had greater increases in VFAT with increasing BMI-Z and with increasing BF, compared to AA. For a given BMI-Z, SA youth had higher HOMA-IR than W, even after adjustment for BF or VFAT. Further mechanistic studies are needed to understand the etiology of this higher insulin resistance in SA youth.

Disclosure
J. A. Manfredo: None. N. S. Anand: None. B. S. Zemel: None. A. Kelly: Consultant; Self; Vertex Pharmaceuticals Incorporated, vTv Therapeutics. S. N. Magge: None.
90-OR: Vision-Threatening Diabetic Retinopathy (DR) Is Associated with Modifiable Risk Factors in Children with Type 1 Diabetes (T1D)
Authors: JACOBA CRIS MARTIN , SAMPANI KONSTANTINA , GILBERT CATHERINE , SILVA PAOLO S. , KEADY JOYCE , LAFFEL LORI M. , AIELLO LLOYD P. , SUN JENNIFER 
Published: June 2021

Vision-threatening DR (vtDR) is commonly defined as moderate nonproliferative or more severe DR, or the presence of diabetic macular edema (DME). Modifiable risk factors of DR and vtDR are well-established in adults. This study identified risk factors associated with DR and vtDR in a large pediatric cohort with T1D. Medical chart review was performed of baseline visits of pediatric (≤21 yrs old) patients at an academic eye center from 2005-2020 to collect demographic characteristics, medical history and DR severity. Analyses were adjusted for correlation between eyes of the same person. In total, 1735 subjects (3454 eyes) were included with mean±SD age 15.4±4.6 years, T1D duration 7.1±5.3 years, T1D onset 8.3±5.4 years, and A1c 8.4±1.3; 50.7% were female, 30.7% were overweight/obese and 4.1% had elevated/high BP. Any DR was present in 8.5% and vtDR in 2.4% of eyes. Unadjusted analyses found DR presence associated with higher A1c (p&lt;.0001), longer T1D duration (p&lt;.0001), younger age of T1D onset (p=0.0002), older age (p&lt;.0001), female sex (p=0.001), higher BMI (p&lt;.0001) and elevated/high BP (p&lt;.0001). After backwards elimination modeling, older age (p&lt;.0001), longer T1D duration (p=0.002) and higher A1c (p=0.01) were significantly associated with DR. In unadjusted analyses, vtDR was associated with higher A1c (p&lt;.0001), longer T1D duration (p&lt;.0001), younger age of T1D onset (p=0.001), older age (p&lt;.0001), female sex (p=0.009), higher BMI (p=0.009) and elevated/high BP (p&lt;.0001). Using backwards elimination modeling, older age (p&lt;.0001), younger age of T1D onset (p&lt;.0001) and elevated/high BP (p=0.0007) were significantly related to vtDR. In this pediatric cohort, DR or vtDR were present in 8.5% of eyes and were associated with modifiable risk factors of hyperglycemia and elevated BP. Future longitudinal studies can assess if early intervention to improve glycemic control and BP can reduce vtDR in youth with T1D.

Disclosure
C. Jacoba: None. K. Sampani: None. C. Gilbert: None. P. S. Silva: Research Support; Self; Hillrom, Optomed, Optos plc. J. Keady: None. L. M. Laffel: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompe, Insulogic LLC, Janssen Pharmaceuticals, Inc., Laxmi Therapeutic Devices, LifeScan, Lilly Diabetes, Medtronic, Provention Bio, Inc. L. P. Aiello: Consultant; Self; KalVista Pharmaceuticals, Novo Nordisk, Regeneron Pharmaceuticals Inc., Stock/Shareholder; Self; KalVista Pharmaceuticals. J. Sun: Other Relationship; Self; Novo Nordisk, Roche Pharma, Research Support; Self; Adaptive Sensory Technology, Boehringer Ingelheim Pharmaceuticals, Inc., KalVista Pharmaceuticals, Optovue, Roche Pharma.
902-P: Screening for Gastric Motor Abnormalities in Pediatric Patients with Type 1 Diabetes: A Cross-Sectional Study
Authors: MASHALI GAMAL , KAUL AJAY A. , DOLAN LAWRENCE M. , KHOURY JANE C. , SHAH AMY S. 
Published: June 2021

Diabetes is the 2nd most common cause of delayed gastric emptying in adults. As a result, patients with type 1 diabetes are at increased risk of gastric motor abnormalities that can include delayed gastric emptying (gastroparesis) and the related symptoms. Limited information exists regarding presence of gastric motility disorders in youth with type 1 diabetes. An improved understanding of whether these gastric motility symptoms are present may influence screening, diagnosis, treatment, and quality of life.
A cross sectional study was conducted to assess symptoms suggestive of gastroparesis in pediatric patients with type 1 diabetes using the standardized Gastroparesis Cardinal Symptom Index (GCSI) questionnaire. The GCSI consists of 9 questions to assess the presence and severity of gastric motility symptoms. Severity is rated from none (0) to very severe (5) using a likert scale and three symptom subscale (presence of nausea/vomiting, fullness/early satiety, and bloating). The total GCSI score is calculated as the mean of the three subscales. A GCSI score ≥ 1.9 has been associated with delayed gastric emptying.
Initial data from 247 patients with type 1 diabetes; mean±SD age 18.1±3.4 years (range 15-20 years old), 61% female, 90% Caucasian, duration of the disease 8.4 ±5.3 years, A1c 8.1±1.8% who answered the GCSI questionnaire found 190 (77%) had at least one symptom associated with gastric motility disorder. Nausea was the most common symptom (75%) followed by stomach fullness (63%). Of those with at least one positive symptom, 37 (20%) had a score ≥ 1.9. Those with a GCSI score ≥ 1.9 were older (19.5 vs. 17.8, p=0.008), but there was no association with race, sex, body mass index, duration of the disease, or glycemic control, as measured by HbA1c.
Gastrointestinal symptoms suggestive of gastric motor abnormalities, as measured by the GCSI questionnaire are present in youth with type 1 diabetes. Older patients may be at higher risk.

Disclosure
G. Mashali: None. A. A. Kaul: None. L. M. Dolan: None. J. C. Khoury: None. A. S. Shah: None.
904-P: Discordance between Youth and Parent Report of Diabetes Distress in Type 1 Diabetes (T1D): The Importance of Youth Perceptions
Authors: WENTZELL KATHERINE , FU MEI R. , VOLKENING LISA K. , LAFFEL LORI M. 
Published: June 2021

Diabetes Distress (DD) can be experienced differently by family members living with T1D. We examined concordance and discordance between youth and parent report of DD and the relationship with youth glycemic control, diabetes-specific family conflict and parent involvement in diabetes tasks in a sample of youth starting real-time continuous glucose monitoring (CGM).
Youth (N=120, 51% male) with T1D ages 8-17 years and their parents (84% mothers) completed surveys assessing DD, family conflict and parent involvement. Previously validated cut-points of &gt;41 (PAID-Peds, youth) and &gt;56 (PAID-PR, parents) identified clinically significant DD. Youth/parent dyads were classified as concordant when both youth and parents scored below (Youth Low/Parent Low) or above (Youth High/Parent High) the cut-points. Youth/parent dyads were classified as discordant when youth scored below and parent scored above (Youth Low/Parent High) or youth scored above and parent scored below (Youth High/Parent Low) the cut-points.
Youth had a mean±SD age of 12.7±2.7 years, T1D duration 6.1±3.6 years and A1c 8.0±0.8%; 84% were pump treated. About ¼ of youth (26%) and parents (23%) reported clinically significant DD with 62% of dyads concordant for low DD, 10% concordant for high DD and 28% discordant for DD. Concordant groups did not differ significantly from discordant groups. In the 2 discordant groups, A1c and youth-reported family conflict differed significantly; A1c: 7.5±0.9% vs. 8.3±0.7% (p=.043) and family conflict: 5.6±5.1 vs. 22.9±22.0 (p=.036) in the Youth Low/Parent High and Youth High/Parent Low groups, respectively. Parent involvement did not differ across the groups.
DD can be perceived differently by youth with T1D and their parents. When youth perceive high DD and parents do not, youth appear at risk for adverse outcomes, highlighting the importance of youth perceptions.

Disclosure
K. Wentzell: None. M. R. Fu: None. L. K. Volkening: None. L. M. Laffel: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompe, Insulogic LLC, Janssen Pharmaceuticals, Inc., Laxmi Therapeutic Devices, LifeScan, Lilly Diabetes, Medtronic, Provention Bio, Inc.

Funding
National Institutes of Health (R01DK089349, K12DK094721, P30DK036836)
928-P: Psychosocial Factors in Diabetes-Specific Risk Taking among Adolescents with Type 1 Diabetes
Authors: THOMAS COURTNEY , ENLOW PAUL , WASSERMAN RACHEL M. , MILKES AMY , PIERCE JESSICA , GURNURKAR SHILPA , CARAKUSHANSKY MAURI , DOYLE DANIEL A. , PENDLEY JENNIFER S. , WYSOCKI TIM , ALDERFER MELISSA A. 
Published: June 2021

Background: Diabetes-specific risk taking (DSRT) refers to unhealthy, risky behaviors that put someone with diabetes at increased risk for suboptimal health outcomes (e.g., drinking alcohol with others who are unaware you have T1D). DSRT is associated with less engagement in T1D management and higher HbA1c. This study set out to determine if lower levels of parental involvement in T1D care and higher levels of diabetes distress, also associated with less optimal T1D outcomes, were associated with DSRT among adolescents with T1D.
Methods: Participants were 104 adolescents with T1D (Mage = 13.50 years, SDage = 1.69 years, 53.8% female, MHbA1c = 8.74%, SDHbA1c = 1.24%) who enrolled with their caregivers in a randomized controlled trial integrating psychologists and dietitians into T1D care visits (35% enrollment). Adolescents completed baseline measures of parental involvement, diabetes distress, and DSRT; caregivers reported demographics; and HbA1c was collected from the electronic medical record. Hierarchical linear regression was used to examine whether parental involvement and diabetes distress predicted DSRT after controlling for participants’ sex, race, ethnicity and HbA1c.
Results: The full model was statistically significant and accounted for 29.7% of the variance in diabetes-specific risk taking (F(2, 91)= 19.1, p &lt; .001). Neither HbA1c, sex, race nor ethnicity were statistically significant predictors of DSRT. Higher levels of diabetes distress (β = .23, p = .01) and lower parental involvement (β = -.44, p &lt; .001) predicted more frequent DSRT.
Conclusions: Adolescents with more diabetes distress and less collaborative parental involvement in T1D management reported more diabetes-specific risk taking. While causality cannot be asserted, these results can inform targeted behavioral interventions to help youth who are more likely to take risks in their T1D care. Future research should consider other factors contributing to diabetes-specific risk taking.

Disclosure
C. Thomas: None. T. Wysocki: None. M. A. Alderfer: None. P. Enlow: None. R. M. Wasserman: None. A. Milkes: None. J. Pierce: None. S. Gurnurkar: None. M. Carakushansky: None. D. A. Doyle: None. J. S. Pendley: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK113235)
929-P: A Population-Based Study of Long-Term HbA1c Associated with Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Western Australian Children
Authors: CLAPIN HELEN , SMITH GRANT J. , VIJAYANAND SATHYAKALA , JONES TIM , DAVIS ELIZABETH A. , HAYNES AVENI 
Published: June 2021

Background: In addition to the acute illness associated with DKA at diagnosis of T1D in children, there is some evidence of its association with poor long-term glycaemic outcomes, increasing risk of complications. With growing global interest in screening for pre-diabetes in children, long-term outcomes are an important consideration in terms of economic viability but there is limited high quality data. This population-based study helps to address this gap.
Methods: All children &lt;16 years presenting to Perth Children’s Hospital with new onset T1D 2000-2019 were included and followed up for ≤ 14 years. Moderate-severe DKA at diagnosis was defined as serum pH &lt;7.2 or bicarb &lt;15mmol/l in the presence of hyperglycaemia and ketosis. HbA1c was recorded at each clinic visit, ~3 monthly from diagnosis. A linear mixed model, adjusted for sex, diagnosis age, socioeconomic status and metro/regional area of residence, was used to examine long-term HbA1c associated with DKA at diagnosis at each year of duration.
Results: The population-based cohort included 2063 patients and median [IQR] follow-up time was 5.4 [3.0-8.4] years. The incidence of DKA at diagnosis was 25%. Patients presenting with DKA had a higher mean HbA1c at diagnosis as expected but from 2 to 7 years post-diagnosis there was no difference between the two groups. Mean HbA1c of patients presenting with DKA increased relative to the remainder from 7 years. The only comparable study, conducted in Colorado in 2017, reported an immediate and sustained relationship between DKA severity at onset and HbA1c over 15 years.
Conclusion: The difference in findings for similar cohorts in Australia and the US raises questions regarding the variables that influence long-term glycaemic outcomes in children diagnosed with T1D. Further studies are required to explore the association between DKA at diagnosis and HbA1c over time and to understand the importance of sociodemographic, physiological and other factors.

Disclosure
H. Clapin: None. G. J. Smith: None. S. Vijayanand: None. T. Jones: None. E. A. Davis: None. A. Haynes: None.
931-P: Supporting Physical Activity in Children with Type 1 Diabetes: A Survey of Health Care Professionals
Authors: COCKCROFT EMMA , NARENDRAN PARTH , WOODING EVA , ANDREWS ROBERT C. 
Published: June 2021

Background: The risk of some of the co-morbidities associated with type 1 diabetes (T1D) can be mitigated through physical activity. Despite benefits, research shows that children and adolescents with T1D are not meeting recommended levels of physical activity. Health Care Professionals (HCPs) have an important role in supporting and encouraging children and adolescents to be physically active. Therefore it is important to understand the perspectives of HCPs in relation to understanding physical activity behaviours in children and adolescents, prior to designing interventions to support physical activity.
Methods: An online mixed methods survey of HCPs in England and Wales. Respondents were asked questions about how they support physical activity in the clinic and their perceptions of barriers/enablers of physical activity. Quantitative data were analysed descriptively, qualitative data were analysed using a combined deductive framework and inductive thematic analysis using the Capability, Opportunity, Motivation model of behaviour (COM-B).
Results: Responses were received from 114 individual HCPs, representing 45% of paediatric diabetes units in England and Wales. Results show that HCPs felt that the promotion of physical activity is important in their clinic (90%) and advise children and adolescents to increase levels of physical activity (88%). Many respondents (43%) felt there was lack of education opportunities for HCPs on this topic. Qualitative responses highlighted three key areas of behaviour that might be a barrier to physical activity in their patients: (1) psychological capacity (i.e., fear of hypoglycaemia and lack of understanding of how to manage insulin and glucose levels), (2) physical opportunity (i.e., time, cost, and access to resources), and (3) social opportunity (i.e., family, school, and peer support).
Conclusion: This understanding will help develop future interventions to support physical activity in children and adolescents with T1D.

Disclosure
E. Cockcroft: None. P. Narendran: Speaker’s Bureau; Self; Novo Nordisk Inc., Sanofi. E. Wooding: None. R. C. Andrews: None.

Funding
National Institute for Health Research Applied Research Collaboration South West Peninsula (to E.C.)
932-P: Impact of Insurance Source on Health Care Transition Progress in College Youth with Type 1 Diabetes
Authors: TSEVAT REBECCA K. , WEITZMAN ELISSA R. , WISK LAUREN E. 
Published: June 2021

Background: The transition from pediatric to adult models of care can be challenging for adolescents with chronic diseases, like type 1 diabetes (T1D). Among the challenges they often face is the issue of health insurance, which can be difficult to navigate, and which may affect access to effective transitional care. In this study, we examined the impact of insurance source on healthcare transition (HCT) progress in college youth with T1D.
Methods: Data are from 138 respondents to a multi-national, web-based study of college youth with T1D recruited via social media platforms and direct outreach. Participants were asked to report their health insurance source and answer questions about the HCT process and their diabetes care team. Descriptive statistics and multivariable regression were used to evaluate HCT measures as a function of sociodemographic variables, adjusting for confounders.
Results: Participants were from 85 universities across 30 states and Canada, and 87.0% were covered on a parent’s insurance plan. Those not covered on a parent’s insurance plan were more likely to list a general adult practitioner as their main diabetes care provider (22.2% vs. 8.3%, p=0.067) but were less likely to have received help with finding an adult provider than their counterparts (44.4% vs. 76.3%, p=0.042). Participants not covered on a parent’s insurance plan (vs. those who were) also were more likely to have discussed obtaining health insurance with their provider (61.1% vs. 25.0%, p=0.002). These differences persisted after adjustment.
Conclusion: College youth with T1D demonstrate differences in indicators of HCT progress according to insurance source. Lack of parental insurance may instigate independent - though not necessarily smooth - transitions, potentially leaving an increasing number of adolescents with dependent coverage vulnerable to a prolonged HCT. Efforts to improve the HCT process should consider insurance source to advance HCT preparation for all college youth with T1D.

Disclosure
R. K. Tsevat: None. E. R. Weitzman: None. L. E. Wisk: None.

Funding
Boston Children’s Hospital (FP01017994)
938-P: A Human Gut Commensal, Parabacteroides Distasonis, Enhances Type 1 Diabetes Autoimmunity via Molecular Mimicry
Authors: GIRDHAR KHYATI , HUANG QIAN , CHOW I-TING , BRADY CLAUDIA , RAISINGANI AMOL , TRAN TU , KWOK WILLIAM , ATKINSON MARK A. , KAHN C. RONALD , ALTINDIS EMRAH 
Published: June 2021

Type 1 diabetes (T1D) is an autoimmune disease characterized by the selective destruction of pancreatic β-cells by autoreactive T-cells. Genome-wide association studies (GWAS) have identified over 150 regions that influence the risk of developing T1D, but genetics alone cannot account for the increasing incidence of T1D. Various environmental factors have been examined to identify their potential contributions, however, no report has demonstrated a direct role of these environmental factors in T1D onset. In the nonobese diabetic (NOD) mouse model of T1D, over 90% of the anti-insulin CD4+ T-cell clones target amino acids 9-23 of the insulin B chain (insB:9-23). More importantly, insB:9-23 specific T-cells have been identified in islets obtained from human organ donors with T1D as well as peripheral blood lymphocytes of living T1D patients.
In this study, focusing on the main insulin epitope, insB:9-23, we explored whether a microbial insB:9-23 mimic could modulate T1D. We demonstrate that a microbial insB:9-23 mimic of Parabacteroides distasonis, a human gut commensal, exclusively stimulates NOD mouse T-cells specific to insB:9-23. Indeed, immunization of NOD mice with either the bacterial mimic peptide or insB:9-23 further verified the cross-reactivity in vivo. P. distasonis colonization of the female NOD mice gut accelerated T1D onset. In addition, adoptive transfer of splenocytes from NOD mice colonized with P. distasonis to NOD.SCID recipients conferred the enhanced disease phenotype. Integration analysis of published DIABIMMUNE T1D gut microbiome data revealed that P. distasonis is lacking in the gut microbiota of the children below age 1 who will eventually develop T1D in Russia and Estonia. Notably, P. distasonis insB:9-23 mimic can stimulate human T-cell clones specific to insB:9-23. Taken together, our studies define a potential molecular mimicry link between T1D pathogenesis and the gut microbiota.

Disclosure
K. Girdhar: None. E. Altindis: None. Q. Huang: None. I. Chow: None. C. Brady: None. A. Raisingani: None. T. Tran: None. W. Kwok: None. M. A. Atkinson: None. C. Kahn: Advisory Panel; Self; ERX Pharmaceuticals, Kaleido Biosciences, Inc., Consultant; Self; Flagship Pioneering, Sana/Cobalt.

Funding
National Institutes of Health (1K01DK117967-01, R01DK031026, R01DK033201, P01AI042288); G. Harold & Leila Y. Mathers Foundation; Iacocca Family Foundation