bluuebunny/crossref_metadata_2025_split huggingface dataset:
627-P: Efficacy and Safety of Allogeneic Platelet Rich Plasma in Treatment of Diabetic Patients with Lower Limb Ulcers: A Pilot Study
Authors: DENG WUQUAN , HE MIN , CHEN BING , MA YU , ARMSTRONG DAVID , BOEY JOHNSON 
Published: June 2019

Background and Objective: To observe the feasibility, efficacy and safety of al-PRP in the treatment of diabetic lower extremity ulcers. Furthermore, to explore the difference between au-PRP treatment, al-PRP treatment and only conventional treatment groups.
Methods: A total of 75 inpatients with diabetic lower limbs ulcer (DLLU) were divided into au-PRP group (n=20), al-PRP group (n=25), conventional treatment group (n=30). All three groups were administered basic diabetic treatments. In addition, the above three different treatment methods were given. The feasibility, curative effect and safety of au-PRP in the treatment of DLLU were evaluated by observing wound healing time, the average daily healing area and adverse reactions.
Results: No significant differences were observed in duration of diabetes, age, glycosylated hemoglobin, ankle brachial index, transcutaneous oxygen partial pressure, high-sensitivity C-reactive protein, IL-6, etc. among three groups (P&gt;0.05). There was no significant difference in ulcer area and ulcer number between the three groups (8.43±6.93 cm2 vs. 5.64±3.91 cm2 vs. 9.73±9.72 cm2, P=0.19); The times and average of PRP treatment between two PRP groups have no significant difference (P&gt;0.05). In the healing time, the al-PRP group and the au-PRP group were significantly shorter than the control group (56.9±29.22 days vs. 55.6±33.8 days vs. 88.0±43.4 days, P&lt;0.01), while there was no significant difference between the al-PRP group and the au-PRP group (P&gt;0.05). There was no significant difference in the average daily healing area (mm2) between the three groups (P&gt;0.05). No significant adverse reactions (infection, itchy skin, redness, rash, etc.) were observed in two PRP groups.
Conclusions: Al-PRP can effectively and safely promote the healing of diabetic lower extremity wounds. Al-PRP could be used as a beneficial cell therapy supplement when au-PRP is limited.

Disclosure
W. Deng: None. M. He: None. B. Chen: None. Y. Ma: None. D. Armstrong: None. J. Boey: None.

Funding
Natural Science Foundation of Chongqing (81500596)
63-OR: The Physiological Effects of Extrapancreatic Glucagon in Totally Pancreatectomized Patients Evaluated Using Glucagon Receptor Antagonism
Authors: JUEL CAROLINE T.B. , LUND ASGER B. , REHFELD JENS F. , WEWER ALBRECHTSEN NICOLAI JACOB , HOLST JENS J. , VILSBØLL TINA , KNOP FILIP K. 
Published: June 2019

We have recently shown a hyperglucagonemic response to meal test and oral glucose tolerance test (OGTT) in totally pancreatectomized (PX) patients. Here, we employed a glucagon receptor antagonist (GRA) to determine the physiological implications of extrapancreatic glucagon secretion in PX patients. In a double-blinded, randomized, cross-over study, 9 PX patients (age: 61.3±4.3 [mean±SEM] years; BMI: 22.6±1.6 kg/m2) and 9 matched healthy controls (age 65.9±2.9 years; BMI: 23.9±0.9 kg/m2) were examined during two 3-hour 75-OGTTs. Before the tests, subjects ingested 300 mg of the GRA, LY2409021 (Eli Lilly and Company), and placebo, respectively. Patients received their regular dose of insulin the night before each experimental day, but no insulin was given during the experiments. In the healthy controls, the GRA resulted in lower fasting levels of glucose (4.3±0.1 vs. 5.2±0.1 mmol/l, P=0.001), but higher post-OGTT plasma glucose excursions (as assessed by baseline-subtracted area under the curve (bsAUC): 926±92 vs. 467±72 mmol/l×min, P=0.002) compared to placebo. In the PX patients, the GRA and placebo resulted in similar fasting plasma glucose concentrations (11.3±0.9 vs. 12.5±0.8 mmol/l, P=0.266) and post-OGTT glucose excursions (bsAUC: 1,671±96 vs. 1,693±152 mmol/l×min, P=0.398), respectively. In the healthy controls, the GRA resulted in significantly higher fasting concentrations of glucagon (33.1±5.5 vs. 13.0±3.7 pmol/l, P=0.023), which, nevertheless, were suppressed by OGTT to similarly low levels as observed with placebo. In the PX patients, equal fasting glucagon concentrations (3.2±0.7 vs. 4.7±1.9 pmol/l, P=0.373) and similarly exaggerated plasma glucagon responses to OGTT were observed with the GRA and placebo (bsAUC: 1,636±573 vs. 1,034±542 pmol/l×min, P=0.113). In this study, antagonizing the glucagon receptor in totally pancreatectomized patients did not influence fasting or post-OGTT glucose levels.

Disclosure
C.T.B. Juel: None. A.B. Lund: None. J.F. Rehfeld: None. N.J. Wewer Albrechtsen: Research Support; Self; Mercodia, Novo Nordisk A/S. Speaker's Bureau; Self; Merck Sharp & Dohme Corp. J.J. Holst: Advisory Panel; Self; Novo Nordisk A/S. T. Vilsbøll: None. F.K. Knop: Advisory Panel; Self; AstraZeneca, MedImmune, Merck Sharp & Dohme Corp., Mundipharma, Novo Nordisk A/S, Sanofi. Consultant; Self; Amgen Inc., Carmot Therapeutics, Novo Nordisk A/S. Research Support; Self; AstraZeneca, Novo Nordisk A/S. Speaker's Bureau; Self; AstraZeneca, MedImmune, Merck Sharp & Dohme Corp., Mundipharma, Norgine, Novo Nordisk A/S.
630-P: Systemic Inflammatory Response Syndrome (SIRS) Criteria as a Predictor of Clinical Outcomes in Diabetic Foot Infections
Authors: AHN JUNHO , RYAN EASTON C. , WUKICH DANE , FONTAINE JAVIER LA , CRISOLOGO PETER A. , LAVERY LAWRENCE A. 
Published: June 2019

Aim: Previous investigations have identified presence of systemic inflammatory response syndrome (SIRS) as an indicator of severe foot infection in patients with diabetes mellitus (DM). The aim of this study was to assess whether SIRS is correlated with outcomes in patients with diabetic foot infections (DFI).
Methods: We retrospective reviewed 173 diabetic patients admitted to hospital with moderate and severe DFI according to Infectious Diseases Society of America (IDSA) guidelines confined to skin and soft tissue infection. We used SIRS criteria to define severe infection based on the presence of at least two of the following: heart rate &gt;90 beats per minute, temperature &gt;38°C or &lt;36°C, respiratory rate &gt;20 breaths per minute and white blood cell count &gt;12,000/mm3 or &lt;4,000/mm3.
Results: Of the 173 subjects, 50 (36.5%) met SIRS criteria. Patients with severe infections based on SIRS criteria were significantly younger (49.0±10.4 vs. 54.2±10.8 years, p=0.014), more often had type 1 DM (10.0% vs. 1.1%, p=0.032), less often had a history of a previous foot ulcer (48.0% vs. 66.7%, p=0.040) and had longer hospital stay (8.0±6.1 vs. 11.7±11.3 days, p=0.024). There was not a significant difference in the number of surgical procedures (1.1±1.4 vs. 1.2±1.4, p=0.40), amputation procedures (24% vs. 27.6%, (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.33, 1.720), duration of antibiotic treatment (30.1±42.5 vs. 31.6±48.5 days, p=0.47), proportion of healed wounds (74.0% vs. 66.7%, p=0.304), time to healing (142.6±102.8 vs. 131.9±103.1 days, p=0.67). reinfection (34.0% vs. 42.5%, p=0.29), hospital readmission (30.0% vs. 47.1%, p=0.072) or mortality (4.0% vs. 5.7%, p=1.0).
Conclusion: SIRS criteria for severe infections in diabetic patients with skin and soft tissue infections were not associated with worse outcomes other than longer hospital stay. Further investigation is needed to identify factors that portend worse outcome in those with foot STI in the setting of DM.

Disclosure
J. Ahn: None. E.C. Ryan: None. D. Wukich: Consultant; Self; Orthofix. Other Relationship; Self; Arthrex. J. La Fontaine: None. P.A. Crisologo: None. L.A. Lavery: Consultant; Self; Bayer US, Boehringer Ingelheim Pharmaceuticals, Inc., Medline Industries, Inc. Research Support; Self; Cardinal Health, EO2 Concepts, Integra LifeSciences, MedImmune, Osiris Therapeutics, Inc.
634-P: Poor Adherence to Medication and HbA1c Level Predict Risk of Amputation in Patients with Diabetes Mellitus—Historical Cohort Study Using a Nationwide Claims Database
Authors: KANEKO MASANORI , FUJIHARA KAZUYA , OSAWA TAEKO , HARADA MAYUKO , KITAZAWA MASARU , MATSUBAYASHI YASUHIRO , YAMADA TAKAHO , YAMANAKA NAUTA , SEIDA HIROYASU , SONE HIROHITO 
Published: June 2019

Poor adherence to medication is a clinically relevant issue closely associated with incidence and deterioration of complications in those with diabetes mellitus (DM). Although an elevated HbA1c level is an established risk factor for lower limb amputation, few studies have evaluated the impact of medication adherence combined with HbA1c levels on lower limb amputation. Thus, we analyzed data from 6,957 patients with DM whose records for oral hypoglycemic agents were available for at least 1 y. Medication adherence was evaluated by the proportion of days covered (PDC), with PDC &lt;70% defined as poor medication adherence. Lower limb amputation was defined by ICD-10 codes and medical procedures. Cox regression model identified variables related to the incidence of amputation. In a mean follow-up of 5.5 y, 9 amputations occurred (0.24/1000 person-years). Mean PDC was 55.7%, with 55.6% of patients non-adherent. Results of multivariate Cox regression analysis showed that HbA1c level and PDC were independently associated with the incidence of amputation (HR (95% CI) 1.19 (0.81-1.76), 0.06 (0.01-0.45)). Compared with PDC ≥70% and HbA1c &lt;9.0%, those with PDC &lt;70% and HbA1c ≥9.0% had an approximately 26 times higher risk for amputation (Figure). This implies the necessity of increasing adherence to medication to prevent lower limb amputation in DM.

Disclosure
M. Kaneko: None. K. Fujihara: None. T. Osawa: None. M. Harada: None. M. Kitazawa: None. Y. Matsubayashi: None. T. Yamada: None. N. Yamanaka: None. H. Seida: None. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.
635-P: Therapeutic Footwear Is the Main Way to Prevent Foot Ulcer Relapse, but Is Insufficiently Respected
Authors: LALOI-MICHELIN MARIE , VIDAL-TRÉCAN TIPHAINE , FÉRON FLORINE , KEVORKIAN JEAN-PHILIPPE , ACKER DIDIER , BOUCHE CLARA , GAUTIER JEAN-FRANCOIS , RIVELINE JEAN-PIERRE 
Published: June 2019

Therapeutic footwear (TFW) is essential to prevent diabetic foot ulcer (DFU) relapse after healing. Our retrospective study aimed at investigating patient’s compliance with TFW 1 year after complete healing, and whether the respect of this TFW in real life conditions was associated with a decrease of DFU recurrence during a 1-year follow-up. This is a retrospective study in which all consecutive patients attending our ambulatory foot unit between 01.2015 and 01.2016, were included if they had a TFW prescription after complete healing. The primary study endpoint was the percentage of compliant patients, who wear the TFW at 1 year. The proportion of patient with DFU relapse was compared in compliant versus non-compliant patients (secondary endpoint). The use of TFW was assessed by analyzing the points of wear and cleanliness of the shoes by the same podiatrist. We included 117 consecutive patients: age 63 ± 13 years, women 29/117 (24,7%), type 2 diabetes: 108/117 (92%), diabetes duration: 17.5 ± 12.5 years. After 12 months, 28/117 patients (24%) were lost of follow-up. TFW was respected in 60/117 cases (51.2%). None of these factors influenced the TFW compliance: sex, age, type of diabetes, diabetic treatment, diabetic duration or complications, HbA1c level, peripheral artery disease, neuropathy, amputations, ulcer localization, healing time, TFW type nor the lack of social insurance. DFU recurrence was observed in 24/89 cases (27%) and was significantly higher in non-compliant patients: 16/29 (55%) vs. 8/60 (13.3%) (P=0.05). The only factor predictive of DFU relapse was non-compliance for TFW. After complete DFU healing, TFW prescription is respected only by half of the patients at 1 year. Non-compliant patients are at higher risk of DFU. Further surveys need to be designed to determine the reasons of non-compliance and to conceive more adapted educational programs.

Disclosure
M. Laloi-Michelin: None. T. Vidal-Trécan: Board Member; Self; Novo Nordisk Inc. F. Féron: None. J. Kevorkian: None. D. Acker: None. C. Bouche: None. J. Gautier: None. J. Riveline: Board Member; Self; Abbott, Lilly Diabetes, Novo Nordisk Inc. Consultant; Self; Novo Nordisk Inc. Research Support; Self; Air Liquide, Amgen Inc. Speaker's Bureau; Self; Abbott, Lilly Diabetes, Sanofi.
637-P: Angiopoietin-Like 2 Is a Potential Biomarker for Diabetic Foot Patients
Authors: WANG YAN , YANG LONGYAN , ZHENG ZHAOHUI , WANG XIN , ZHAO DONG 
Published: June 2019

Angiopoietin-like 2 (ANGPTL2) is a proinflammatory protein belonging to the angiopoietin-like family. ANGPTL2 is secreted and detected in the systemic circulation. Serum levels of ANGPTL2 increase significantly in various chronic inflammatory diseases and show associations between ANGPTL2 levels and diagnosis and/or prognosis of cardiovascular diseases, diabetes, chronic kidney disease, and various types of cancers. However, no data regarding the relationship between ANGPTL2 and diabetic foot are available. Here, we explored the potential link between ANGPTL2 and diabetic foot. We recruited 66 participants, including 16 patients with diabetic foot and 50 patients with type 2 diabetes mellitus without diabetic foot. Serum ANGPTL2, CRP, VEGF, ICAM-1 and TNF-α were measured using enzyme-linked immunosorbent assay (ELISA) kits. We demonstrated that serum levels of ANGPTL2 in diabetic foot patients were higher than those in diabetes controls (6.696±0.6759 vs. 4.444±0.2135, p&lt;0.0001). In the spearman correlation analysis, serum ANGPTL2 level had strong positive correlation with CRP (r=0.4924, p&lt;0.0001), VEGF(r=0.4116, p=0.0006), ESR (r=0.5282, p&lt;0.0001) among all subjects. After adjusted for age, sex, smoking and duration of diabetes, ANGPTL2 was demonstrated to be an independent risk factor for diabetic foot (OR, 3.835, 95% CI 1.608-14.81, p=0.0002). In addition, serum ANGPTL2 was still positively correlated diabetic foot stage after adjusting age, sex, smoking, HbA1c, duration of diabetes and use of drugs (β=0.3838, p=0.002).
In conclusion, serum ANGPTL2 acted as a contributor for diabetic foot and had strong association with diabetic foot progression in all stages. Blockade of ANGPTL2 may postpone the onset and development of diabetic foot.

Disclosure
Y. Wang: None. L. Yang: None. Z. Zheng: None. X. Wang: None. D. Zhao: None.

Funding
National Natural Science Foundation of China; National Science Funding in China
640-P: Willingness to Adopt Devices for Prevention of Foot Ulcers in High-Risk Diabetic Patients
Authors: NOVICE TAYLOR , VEMURI CHANDU , GILBERT CATHERINE , FICI ANTHONY J. , VANWIEREN ELIZABETH F. , SCHMIDT BRIAN M. 
Published: June 2019

The objective was to evaluate whether high risk diabetic patients are willing to implement wearable technology to prevent diabetic foot ulcer (DFU) formation. There is increasing evidence that self-monitoring devices for DFU prevention may be effective. However, there is a paucity of literature assessing the willingness of patients to employ these technologies for DFU prevention. We analyzed patient interest around advancing wearable technology through an anonymous, voluntary survey. Adult diabetic patients 18 years or older with a history of peripheral neuropathy, foot deformity, and those with and without DFU who presented to a tertiary care center were included. Surveys were performed consecutively. Descriptive statistics were calculated to describe survey responses. We used a combination of t-tests and chi-square tests to compare the responses of diabetic patients with and without DFUs. One hundred and forty-nine patients met the inclusion criteria for this study. One hundred patients completed the questionnaire, a response rate of 67%. Fifty-four patients had a history of a previous DFU, while 46 patients had no history of previous ulceration. Patients with no history of a prior DFU were significantly more interested in preventing foot ulcers (p=0.003) when compared to those with a prior history of a DFU. Patients without a history of ulcer formation were significantly more likely to obtain a self-monitoring device compared to patients with a prior history of a DFU (86.97% v 68.52%, p=0.02) Our results suggest that diabetic patients with no history of a prior DFU are more motivated to prevent foot ulcers and more likely to adopt technologies. However, since home-monitoring devices are most efficacious in those with a history of a previous foot ulcer, providers should develop strategies to better educate these high-risk patients. Our findings strongly support that inclusion of advancing self-monitoring technology in the management of diabetic foot ulcer prevention is warranted.

Disclosure
T. Novice: None. C. Vemuri: Consultant; Self; Cook Medical. C. Gilbert: None. A.J. Fici: None. E.F. Vanwieren: None. B.M. Schmidt: None.
648-P: Developing a National Competency-Based Diabetes Curriculum in Undergraduate Medical Education: A Delphi Study
Authors: SHAH SAPNA , MCCANN MAGGIE , YU C. 
Published: June 2019

Introduction: In recent years there has been an increased emphasis on competency-based medical education (CBME) internationally, as can be seen with the implementation of competency-based curriculums for postgraduate medical education (PGME) through the Royal College of Physicians and Surgeons of Canada. Currently, no Canada-wide consensus exists on educational competencies relating to diabetes in undergraduate medical education (UGME).
Objective: To develop a list of competencies and objectives for diabetes teaching in medical school using a modified Delphi method.
Methods: Representatives involved in the development of the diabetes curriculum at all 17 medical schools across Canada were contacted. A draft list of competencies and objectives was developed by the research team using the existing curriculums at nine Canadian medical schools and was organized using the CanMEDS framework. A Delphi method was used, with two iterations in order to reach consensus. The first survey was conducted in May 2018. The data was analyzed and the survey was revised to include the opinions and remarks of respondents. The revised version of the survey was then sent to the respondents in July 2018.
Results: Out of 17 medical schools contacted, 12 (70.6%) agreed to participate. One school declined participation and four did not respond. Out of 12 surveys sent in the first round, eight responses were received (response rate 66.7%). The revised version was then resent to the eight respondents in July 2018 and seven responses were received (response rate 87.5%). A list of nine competencies and 65 objectives was finalized.
Conclusion: A competency-based consensus curriculum for diabetes education for medical students was developed using a modified Delphi method. The final consensus syllabus will be disseminated throughout the country. This curriculum serves as a step in the transition to CBME and in ensuring that future medical school graduates are proficient in diabetes care.

Disclosure
S. Shah: None. M. McCann: None. C. Yu: None.
654-P: Effect of a Streamlined Diabetes Device Clinic Model on Education Utilization and Glycemic Control among Insulin Pump Patients
Authors: PARK CANDICE K. , ZAPPE JANET G. , SNYDER ELIZABETH , DUNGAN KATHLEEN M. 
Published: June 2019

Objective: As diabetes technologies increase in prevalence and complexity, flexible models of care are needed to provide ongoing support. The objective of this study is to determine whether a streamlined Diabetes Device Clinic (DDC) model is associated with improvement in glycemic control and education utilization among insulin pump users.
Research Design and Methods: The DDC was available for patients in need of focused device-related education; all patients had previously received comprehensive education and insulin pump training. The DDC consists of an abbreviated visit with a certified diabetes educator (CDE, 40 minutes) followed by a hand-off and visit with the endocrinologist (20 minutes). Participants were compared to insulin pump users who received traditional care. Pre- and post-HbA1c values were obtained within 6 months prior to and 6 months after the DDC visit. The two most recent HbA1c values at least 3 months apart were obtained for non-device clinic patients.
Results: A total of 437 patients were identified, 79 of whom attended the DDC. Of the non-attendees (n=358), 48.7% were referred to the CDE and 39% completed an education visit. Among patients with a baseline HbA1c &gt;8.0%, those who attended the DDC witnessed a significant reduction in HbA1c (-0.52% +/- 0.71, p=0.002) whereas non-attendees saw no such improvement (-0.14% +/- 1.29, p=0.29). For patients with a baseline HbA1c &lt;8.0%, there was a slight increase in HbA1c in DDC attendees and no change in non-attendees (0.20% +/- 0.66, p=0.028, vs. 0.04% +/- 0.54, p=0.24 respectively). Multivariable analysis confirmed a significant interaction between baseline HbA1c and DDC. Results were similar in patients receiving traditional education.
Conclusions: These data illustrate that the streamlined DDC model of care may improve glycemic control and education utilization among established insulin pump patients. Additional study is needed to address ongoing education needs.

Disclosure
C.K. Park: None. J.G. Zappe: None. E. Snyder: None. K.M. Dungan: Advisory Panel; Self; Eli Lilly and Company, Elsevier, Sanofi-Aventis. Research Support; Self; Eli Lilly and Company, GlaxoSmithKline plc., Novo Nordisk Inc., Sanofi-Aventis, Viacyte. Other Relationship; Self; DKBmed, UpToDate.