bluuebunny/crossref_metadata_2025_split huggingface dataset:
946-P: Unchanged Prevalence of Preeclampsia after Implementation of Prophylactic Aspirin to All Pregnant Women with Preexisting Diabetes: A Prospective Cohort Study
Authors: DO NICOLINE C. , VESTGAARD MARIANNE , ÁSBJÖRNSDÓTTIR BJÖRG , NOERGAARD SIDSE K. , RINGHOLM LENE , ANDERSEN LISE LOTTE TORVIN , JENSEN DORTE M. , DAMM PETER , MATHIESEN ELISABETH R. 
Published: June 2021

Aim: To evaluate the prevalence of preeclampsia before and after implementing a change from a risk-based aspirin prophylaxis to prophylactic aspirin to all pregnant women with pre-existing diabetes.
Methods: A prospective cohort study of 410 consecutive pregnant women with pre-existing diabetes (257 with type 1 and 153 with type 2 diabetes); 203 women (selected-cohort) prior to February 2018 where aspirin was prescribed to selected women at risk of preeclampsia followed by 207 women (all-cohort) who all were prescribed aspirin according to the new aspirin prophylaxis strategy. The primary outcome was preeclampsia.
Results: Documented prescription of aspirin at approximately 10 weeks increased from 25% (selected-cohort) to 88% (all-cohort). In the all-cohort vs. selected-cohort HbA1c (median 46 mmol/mol (interquartile range 42-53) vs. 47 (43-53), p=0.18), parity, chronic hypertension, home blood pressure, microalbuminuria/diabetic nephropathy and smoking were similar in early pregnancy. In the all-cohort fewer women had type 2 diabetes (32% vs. 42%, p=0.04) and BMI tended to be lower (p=0.05). The prevalence of preeclampsia was unchanged (12% vs.11%, p=0.69) in the all- vs. selected-cohort and similar results were seen when stratifying for diabetes type. Preterm delivery &lt;37 weeks (23% vs. 27%, p=0.30), preterm delivery with preeclampsia (7% vs. 7%, p=0.96), and large and small for gestational age infants (40% vs. 32% (p=0.07) and 7% vs. 6% (p=0.88), respectively) were similar in the two cohorts.
Conclusion: Implementation of prophylactic aspirin to all pregnant women with pre-existing diabetes was not followed by a decline in the prevalence of preeclampsia. The possible effect of aspirin prophylaxis in women with diabetes needs to be further evaluated in randomized controlled trials.

Disclosure
N. C. Do: None. M. Vestgaard: None. B. Ásbjörnsdóttir: Employee; Self; Novo Nordisk A/S. S. K. Noergaard: Research Support; Self; Novo Nordisk. L. Ringholm: Research Support; Self; Novo Nordisk. L. Andersen: None. D. M. Jensen: None. P. Damm: Advisory Panel; Self; Novo Nordisk A/S, Other Relationship; Self; Novo Nordisk A/S. E. R. Mathiesen: Advisory Panel; Self; Novo Nordisk, Research Support; Self; Novo Nordisk, Speaker’s Bureau; Self; Novo Nordisk, Sanofi-Aventis.
952-P: Deranged Liver Enzyme Levels and Indices of Hepatic Steatosis and Fibrosis on the Development of Gestational Diabetes
Authors: CHAI THORA Y.L. , PASUPATHY DHARMINTRA , GEORGE JACOB , CHEUNG N. WAH 
Published: June 2021

Objective: Nonalcoholic fatty liver disease has been associated with the development of gestational diabetes (GDM). We sought to determine whether abnormal liver enzyme levels and indices of hepatic steatosis and fibrosis in an entire pregnant population are associated with GDM development.
Methods: A retrospective cohort study was conducted on adult women (≥18 years) who delivered at 2 teaching hospitals in Sydney Australia from January 2016 to December 2017. Liver enzymes (aspartate aminotransaminase (AST), alanine aminotransaminase (ALT), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), albumin (ALB) and bilirubin (BIL)) obtained 12 months pre-gravid, or during pregnancy but prior to GDM screening, were extracted from the hospital pathology database and linked with oral glucose tolerance test results. The Fibrosis-4 (FIB-4) and Hepatic Steatosis Index (HSI) were calculated. Univariate analysis was undertaken to determine the association between deranged liver enzymes, FIB-4, HSI and GDM. Multiple logistic regression, with adjustment for age, ethnicity, pre-gravid body mass index (BMI), parity, prior GDM and family history of diabetes, was conducted to determine if any of these were independent predictors of GDM.
Results: Over 2 years, 1429 women had liver enzymes collected. As per IADPSG (2010) criteria, 255 had diagnosed GDM, of which 82 (32.2%) were obese (BMI &gt;30kg/m2), 243 (82.4%) were multiparous, and 223 (87.5%) had prior GDM. Elevated GGT (&gt;35IU/L, p=0.006) and HSI (p=0.005) were associated with development of GDM, whilst low ALB (&lt;35g/L) and elevated ALP (&gt;110IU/L), ALT (&gt;35IU/L), AST (&gt;35IU/L), BIL (&gt;19umol/L) and FIB-4 were not. On adjustment for confounders, elevated GGT (AOR 1.1, 95% CI 0.32-3.8, p=0.88) and HSI (AOR 0.6, 95% CI 0.26-1.3, p=0.21) were not independent predictors of GDM.
Conclusions: Our results indicate deranged liver enzymes or clinical indices of hepatic steatosis and fibrosis were not associated with GDM.

Disclosure
T. Y. L. Chai: None. D. Pasupathy: None. J. George: None. N. Cheung: None.
955-P: Postpartum Carbohydrate Intake Is Not Associated with Oral Glucose Tolerance Test Results
Authors: ROSENBERG EMILY A. , SEELY ELLEN W. , JAMES KAITLYN , CALLAHAN MICHAEL J. , NELSON STACEY , POWE CAMILLE E. 
Published: June 2021

Background: In pregnant and postpartum (PP) women, an oral glucose tolerance test (OGTT) is the diagnostic test of choice for glucose intolerance. Consistent with classic studies outside of pregnancy, we recently found that lower carbohydrate intake on the day before an OGTT in pregnancy was associated with higher post-load OGTT glucose. Here, we test for a relationship between carbohydrate intake and OGTT glucose in PP women.
Methods: PP women (N=84, median [IQR] = 9 [8-14] weeks PP) completed a 75 g OGTT and a validated self-administered 24-hr dietary recall. We tested for an association between carbohydrate intake in the day before the OGTT and 1-hr OGTT glucose using linear regression, with adjustment for age, race, BMI, time postpartum, and caloric intake. We also tested for associations with 30 minute and 2-hr OGTT glucose and glucose area under the curve (AUC). A subset of women (N=72) had completed the same protocol during pregnancy (median=26 weeks gestation).
Results: PP women with lower carbohydrate intake (&lt;median=230 g/day) had similar age, BMI, race, education, GDM status, time postpartum, and time fasting before OGTT to women with higher intake. We found a trend toward higher fasting glucose in those with lower carbohydrate intake (median=87 vs. 81 mg/dl, P=0.09), but no association between carbohydrate intake and post-load OGTT glucose (1-hr: β=1.2 mg/dl, P=0.74, 30 min: β=-2.0 mg/dl, P=0.39, 2-hr: β=1.0 mg/dl, P=0.74, AUC: β=66, P=0.83). Post-load results did not change with fasting glucose adjustment. In women with data available in pregnancy, we found similar results to those previously reported: at ~26 weeks gestation, lower carbohydrate intake was associated with higher OGTT glucose.
Conclusion: While carbohydrate intake in the day prior to an OGTT may alter gestational diabetes diagnosis, we found no relationship between carbohydrate intake and OGTT glucose among PP women. Metabolic factors that differentiate the pregnant and postpartum state may account for our findings.

Disclosure
E. A. Rosenberg: None. E. W. Seely: None. K. James: None. M. J. Callahan: None. S. Nelson: None. C. E. Powe: None.

Funding
National Institutes of Health (K23DK113218); Robert Wood Johnson Foundation (T32DK007028); Massachusetts General Hospital
961-P: Management of Gestational Diabetes (GDM): Are New Glycemic Targets Needed?
Authors: FESTA CAMILLA , VIOLATI MATTEO , AMOROSI FRANCESCA ROMANA , BITTERMAN OLIMPIA , CONVERTINO ALESSIO , GIULIANI CHIARA , MARAVALLE MAURIZIO , NAPOLI ANGELA 
Published: June 2021

Background and Aim: There is no consensus on glycemic targets for the management of GDM. Since women with GDM managed with current glycemic targets show still worse pregnancy outcomes than women without it, we aim to identify which glycemic levels are associated to normal pregnancy outcomes with particular reference to Large for Gestational Age (LGA) rate.
Methods: This is an observational study, involving women with GDM (IADPSG criteria) from 2016 to 2019. Glycemic values &lt;90 mg/dl at fasting and &lt;130 mg /dl 1h after a meal were "in target." Blood Glucose (BG) levels and clinical factors were related to LGA/GDM adverse outcomes through Data Analysis, Multiple Correspondence Analysis and conceptual maps. The RECPAM (RECursive Partitioning and Amalgamation) analysis was used to identify homogeneous and distinct groups of patients at risk for LGA/adverse outcome and to set the glycemic value cut-off discriminating for LGA/adverse outcome.
Results: We analyzed 386 women and 40844 glycemic values. We found 4 natural categories for fasting BG (&lt;78.2; ≥78.2 and &lt;84; 84-89; ≥90 mg/dl) and 5 for post-prandial BG. Women exceeding the cut-off of 84 mg/dl at fasting &gt; 2 times in the week, showed a high rate of LGA than those who did not (p 0.02), were more often overweight and needed insulin, enrolled earlier, had higher HbA1c values and an inadequate weight gain (p .001). The conceptual maps identified 3 clusters of women grouped homogeneously and distinctly according to BG and outcomes: women with fasting and postprandial BG included in the first two natural categories showed better outcomes than those with higher values, with a linear trend. BG&gt; 84 mg/dL in more than 2/7 measurements, BMI&gt; 25 kg/m2, and inadequate weight gain were predictive factors of LGA risk (OR 0.9 CI95% 1.2-5, p .012; OR 0.713 CI95% 1-3.8, p .029 OR 0.792 CI95% 1-4.8, p .04). Finally, RECPAM identified women with BMI&gt; 25 kg/m2 and/or with fasting blood glucose&gt; 97 mg/dl as a higher LGA risk subgroup.
Conclusions: Tighter glycemic targets for GDM management are needed.

Disclosure
C. Festa: None. M. Violati: None. F. Amorosi: None. O. Bitterman: None. A. Convertino: None. C. Giuliani: None. M. Maravalle: None. A. Napoli: None.
972-P: Trends in Rehospitalisation Rates for Myocardial Infarction, Heart Failure, and Stroke in People with and without Diabetes in Australia from 2012-2018
Authors: MORTON JEDIDIAH I. , ILOMAKI JENNI , WOOD STEPHEN J. , MAGLIANO DIANNA J. , SHAW JONATHAN E. 
Published: June 2021

Contemporary estimates of readmission rates and trends over time following cardiovascular events are required to prioritise clinical care. We estimated the incidence of readmission for myocardial infarction (MI) and heart failure (HF) following an MI, and of readmission for stroke following a stroke, stratified by diabetes status. We included everyone who was discharged from a hospital following an MI or stroke between 1 July 2012 and 30 June 2017 in Victoria, Australia (n=102323). Individuals were followed from discharge following an MI until readmission for MI or HF, or followed from discharge after a stroke until readmission for stroke, censoring at death or 1 year of follow-up. The incidence (per 100 person-years) of readmission for MI decreased in both people with and without diabetes (from 28.9 [95% CI: 27.4, 30.5] to 27.0 [25.6, 28.5] and from 18.5 [17.8, 19.3] to 15.2 [14.5, 16.0] from 2012 to 2016 [years beginning 1 July] in people with and without diabetes, respectively), but the incidence of readmission for HF only improved in people without diabetes (from 23.4 [22.0, 24.9] to 22.5 [21.1, 23.9] and 4.5 [4.1, 4.9] to 3.2 [2.9, 3.5]), and the incidence of readmission for stroke did not change (from 11.0 [9.5, 12.9] to 10.6 [9.2, 12.2] and 10.3 [9.3, 11.3] to 11.2 [10.3, 12.2]). However, the incidence rate ratio for people with vs. without diabetes increased for readmission for MI and HF. The excess risk for readmission for MI and HF for people with diabetes persisted after adjustment for age, sex, socioeconomic status, polypharmacy, comorbidity, and the competing risk of death: with subhazard ratios of 1.32 (1.28, 1.37) for MI and 3.77 (3.57, 3.98) for HF. The effect of diabetes on readmission for MI, but not HF or stroke, was stronger for women than men. Thus, improvements in rates of readmission for MI and HF were greater in people without diabetes than people with diabetes, therefore the excess risk for people with diabetes worsened from 2012-2018.

Disclosure
J. I. Morton: None. J. Ilomaki: Consultant; Self; AstraZeneca, Research Support; Self; Amgen Inc., Research Support; Spouse/Partner; GlaxoSmithKline plc. S. J. Wood: None. D. J. Magliano: None. J. E. Shaw: Advisory Panel; Self; Eli Lilly and Company, Merck Sharp & Dohme Corp., Pfizer Inc., Research Support; Self; AstraZeneca, Speaker’s Bureau; Self; AstraZeneca, Eli Lilly and Company, Novo Nordisk.

Funding
Australian Government Research Training Program (to J.I.M.); Monash University (to J.I.M.)
973-P: Unmet Social Needs and Emergency Department Visits and Hospitalization among U.S. Safety-Net Health Center Patients with Both Diabetes and Hypertension
Authors: YAN ALICE , OZIEH MUKOSO N. , SHI ZUMIN 
Published: June 2021

Introduction: Diabetes and hypertension coexist in approximately 40 to 60% of patients with type 2 diabetes. This study examined the association between unmet social needs and emergency department (ER) visits and hospitalizations for this high group.
Methods: Cross-sectional data on adults (aged≥18 years) with self-reported diabetes from the 2014 National Health Center Patient Survey (HCPS) was analyzed. The HCPS is a nationally representative survey of patients who receive care at safety-net health centers. Outcomes (binary) were the ER visits or hospitalizations due to diabetes and hypertension (HBP) in prior 12 months. The independent variables were 17 SDOH unmet social factors clustered three domains: (1) basic needs; (2) Health-related social needs (i.e., transportation, medical interpreter) and (3) adverse income or assets factors (food stamps and unstable housing). Responses were coded as binary (unmet or met). Logistic regression models with complex sampling design tested the association between adverse SDOH and the outcome, adjust for sociodemographic covariates.
Results: The prevalence of HBP was 74.7% among diabetic adults. Among 910 participants (61.3% female and 25.6% Blacks) with comorbidities of diabetes and hypertension (16.9% weighted prevalence), 40.0 % were unstably housed and 52.1% were food stamp recipients and their top 3 unmet were home visit, find a job, and basic clothing/shoes. In the fully adjusted model, receiving food stamps and unmet needs in obtaining free medications were positively associated with, and unmet needs in free service outside health center were inversely associated with HBP related ER or hospitalization.
Conclusions: Interventions that address unmet financial needs and help with obtaining free/affordable medications may improve health outcomes for this high-risk group.

Disclosure
A. Yan: None. M. N. Ozieh: None. Z. Shi: None.
978-P: Prevalence of Diabetic Cardiomyopathy in Adults with Diabetes or Prediabetes and Its Association with the Risk of Overt Heart Failure: A Multicohort Analysis
Authors: SEGAR MATTHEW W. , PATEL KERSHAW , KONDAMUDI NITIN , PANDEY AMBARISH 
Published: June 2021

Introduction: Diabetic cardiomyopathy (DbCM) is characterized by abnormalities in cardiac structure or function in the absence of cardiovascular (CV) disease. The prevalence of DbCM and its independent contribution to the risk of heart failure (HF) among community-dwelling individuals with prediabetes or diabetes (Pre-DM/DM) is not well known.
Methods: Adults without prevalent CAD or HF were pooled from 3 community-based cohort studies (ARIC, CHS, and CRIC cohorts). Presence of DbCM in patients with Pre-DM/DM was defined by elevated NT-proBNP levels (&gt;125 in normal/overweight or &gt;100 pg/mL in obese) plus either ≥1 or ≥2 echocardiographic abnormalities (left atrial enlargement, left ventricle hypertrophy, diastolic dysfunction). The DbCM definition with ≥2 echo abnormalities was used for the primary analysis and the cohort was stratified into three groups: euglycemia, pre-DM/DM without DbCM, and pre-DM/DM with DbCM. Kaplan-Meier and Cox models adjusted for demographics, CV risk factors, and kidney function were used to evaluate the risk of overt HF across the study groups.
Results: The study included 10,208 individuals, of which 6,852 had pre-DM/DM. The prevalence DbCM in the overall cohort was 6.6% and 19.5% based on the presence of ≥2 or ≥1 echocardiographic abnormalities with elevated NT-proBNP levels. Over 10-year follow up, individuals with pre-DM/DM had a higher risk for overt HF than euglycemic individuals (10.1% vs. 6.4%). Among individuals with pre-DM/DM, presence of DbCM identified a higher risk subset of individuals with significantly greater risk for developing overt HF as compared with pre-DM/DM without DbCM in unadjusted (19.6% vs. 9.1%) as well as adjusted analysis (HR [95% CI] pre-DM/DM without DbCM = 1.32 [1.12-1.55], pre-DM/DM with DbCM = 2.28 [1.81-2.86], ref: euglycemia).
Conclusions: Presence of DbCM in individuals with pre-DM/DM identifies a high-risk subgroup for development of overt HF.

Disclosure
M. W. Segar: None. K. Patel: None. N. Kondamudi: None. A. Pandey: None.

Funding
Applied Therapeutics
980-P: Existing Microvascular Complications and Risk of Subsequent Heart Failure (HF) in Type 1 Diabetes (T1D)
Authors: GUO JINGCHUAN , COSTACOU TINA , MILLER RACHEL G. , ORCHARD TREVOR J. 
Published: June 2021

We aimed to quantify the association between existing microvascular diseases and risk of subsequent HF in adults with T1D. Participants from Pittsburgh Epidemiology of Diabetes Complication (EDC) Study without known baseline HF (n=655) were classified into 4 groups based on the number (n=0-3) of existing microvascular diseases, i.e., overt nephropathy, proliferative retinopathy, and confirmed distal symmetric polyneuropathy (CDSP). Overt nephropathy was defined as an AER &gt;300mg/24h in ≥ 2 of three validated timed biennial urine collections. Proliferative retinopathy was based on stereoscopic fundus photographs or a history of receiving laser therapy for proliferative diabetes retinopathy. CDSP was identified by following the Michigan Neuropathy Screening Instrument and the Michigan Diabetes Neuropathy Score. HF was determined by hospitalization, cause-of-death records, clinic exams, and/or self-reports of physician diagnosis. We applied Cox PH models to quantify the association between the number of existing microvascular diseases and risk of subsequent HF over 25 years follow-up controlling for diabetes duration (or age), sex, HbA1c, and CAD comorbidity. Mean baseline age and T1D duration were 27 years and 19 years. The 25-year cumulative incidence of HF was 6.6% (43/655). Over half didn’t have any microvascular disease at baseline; 19.7%, 16.7% and 10.8% had 1, 2 and 3 microvascular diseases, respectively. In participants with 1, 2, and 3 microvascular diseases, the adjusted HR (95%CI) of any clinically defined HF was 3.1 (1.3, 7.6), 2.5 (0.9, 6.9), and 4.0 (1.3, 11.9), compared with those without any microvascular disease. The HR (95%CI) of hospitalization or death for HF was 2.0 (0.6, 7.3), 2.2 (0.6, 8.7), and 4.1 (1.0, 16.4). As microvascular disease burden increases so does the risk of HF, independently of diabetes duration, sex, HbA1c, and CAD among adults with long-duration childhood-onset T1D.

Disclosure
J. Guo: None. T. Costacou: None. R. G. Miller: None. T. J. Orchard: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK034818)
985-P: Black New Yorkers with Type 2 Diabetes: Afro-Caribbean Immigrants Have Better Cardiometabolic Health than African Americans
Authors: FARAG MARIA , KHOSLA LAKSHAY , BHAT SONALI , MONTIEL ISHINO FRANCISCO A. , WILLIAMS FAUSTINE , HORLYCK-ROMANOVSKY MARGRETHE F. 
Published: June 2021

Using the 2013/14 New York City Health and Nutrition Examination Survey population sample, this study compared Afro Caribbean immigrants and US-born African American New Yorkers to determine a) whether prevalence and odds of type 2 diabetes (T2DM) differed between ethnic groups; and b) whether cardiometabolic health profiles differed among those with T2DM. T2DM was defined by prior diagnosis, HbA1c≥6.5%, or fasting glucose ≥126mg/dL. Weighted logistic regression estimated odds of T2DM adjusting for BMI, waist circumference, age, sex, education, income, marital status and physical activity. T2DM prevalence in Afro Caribbeans (n=81, age (Mean±SE) 49±2y, BMI 29.2 ±0.7kg/m2) was 31%, and 21% in African Americans (n=118, age 46±2years, BMI 30.3±0.9kg/m2). Afro Caribbeans had more than three times greater odds of T2DM than African Americans [aOR=3.32 (95%CI 1.11-9.88), P=0.0313]. Compared to African Americans with T2DM (n=21, Age 60.3±3.3y, BMI 34.6±1.7kg/m2), Afro Caribbeans with T2DM (n=23, Age 57.9±2.5y, BMI 29.9±0.8kg/m2) were less likely to have obesity (33.2% vs. 74.7%) and had lower waist circumference (102±2cm vs. 114±3cm, P=0.002). Although fewer Afro Caribbeans with T2DM met HP2010 physical activity goals (42.9% vs. 75.5%, P=0.0335), their mean HDL levels tended to be higher than those of African Americans with T2DM (50.6±2.5 mg/dL vs. 42.5±3.2mg/dL, P=0.0519). Afro Caribbean immigrants in New York City have higher odds of T2DM than African Americans. Nevertheless, Afro Caribbeans with T2DM have better cardiometabolic health than African Americans with T2DM. Differences in anthropometrics, blood lipids and health behaviors illustrate important intraethnic variations which affect future risk of T2DM complications among populations of African descent.

Disclosure
M. Farag: None. L. Khosla: None. S. Bhat: None. F. A. Montiel ishino: None. F. Williams: None. M. F. Horlyck-romanovsky: None.