bluuebunny/crossref_metadata_2025_split huggingface dataset:
1566-P: Clinical Characteristics, Antihyperglycaemic Treatment Patterns, and Blood Glucose Control in Older Type 2 Diabetes Mellitus (T2DM) Patients in China: A Nationwide Cross-Sectional Study
Authors: SHEN JIE , LIU MENG , YE BINQI , LI QIANG , CLARK DOUGLAS , JI LINONG 
Published: June 2019

Aim: China has the largest diabetes population in the world at 114.4 million in 2017. However, data on the overall characteristics of older T2DM patients in China is limited. We aimed to investigate blood glucose control, potential factors associated with glucose control, albuminuria incidence, treatment patterns and hypoglycemia prevalence in Chinese T2DM patients, aged over 60 years.
Method: This nationwide cross-sectional study collected data from T2DM outpatients in 18 hospitals in China between March and December 2017. Descriptive analyses and logistic regression were performed to summarize data and identify potential associations, respectively.
Results: Our study included 1520 patients (mean age: 67.7± 5.86 years). Overall, 43.4% (660/1520) of patients had well controlled blood glucose (defined as HbA1c &lt;7%). Older age, albuminuria and longer duration of diabetes were associated with decreased HbA1c control. Albuminuria was reported in 34.7% of patients (27.6% with micro-albuminuria and 7.1% with macro-albuminuria). The most commonly-used OADs were biguanide (42.6%), α-glucosidase inhibitors (AGI [33.5%]) and sulfonylureas (SU [22%]) and the most common dual OAD-combinations were biguanide combined with SU, biguanide combined with AGI, and AGI combined with SU. Additionally, 43.8% of patients received insulin. Only 4.7% of patients received DPP-4 inhibitors; no patient received SGLT2 inhibitors. The proportion of patients who reported a history of hypoglycemia was 28.0%.
Conclusion: In this cross-sectional study of older Chinese T2DM patients, fewer than half had an HbA1c of &lt;7%. Around one third of patients had albuminuria, which was associated with a lower rate of HbA1c control. Given the relatively high risk of hypoglycemia in this population, increased use of OADs with low risk of hypoglycemia, such as DPP-4 inhibitors and SGLT2 inhibitors, should be considered.

Disclosure
J. Shen: None. M. Liu: None. B. Ye: None. Q. Li: None. D. Clark: None. L. Ji: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Bristol-Myers Squibb Company, Eli Lilly and Company, Merck KGaA, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi, Takeda Pharmaceutical Company Limited. Research Support; Self; AstraZeneca, Bristol-Myers Squibb Company, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Roche Pharma, Sanofi.

Funding
Boehringer Ingelheim; Eli Lilly and Company
1590-P: Parental and Sibling Age at Diabetes Diagnosis and the Risk of Diabetes in Denmark
Authors: SILVERMAN RETANA JOSE OMAR , HULMAN ADAM , NIELSEN JANNIE , CARSTENSEN BENDIX , SIMMONS REBECCA K. , BJERG LASSE , JOHNSTON LUKE , WITTE DANIEL R. 
Published: June 2019

Background: We assessed the effect of parental and sibling age at diabetes diagnosis on index individuals’ risk of developing diabetes.
Methods: We carried out a register-based closed cohort analysis of 869,489 initially diabetes-free index individuals living in Denmark between 1995 and 2012. We assessed the effect of parents’ and full siblings’ age at diabetes diagnosis on the incidence of diabetes in the index individual, beyond the general effect of a positive family history. We calculated incidence rate ratios (IRR) in sex-stratified Poisson regression models.
Results: A total of 58,339 index individuals developed diabetes during 14 million person-years of follow-up. Diabetes risk was highest when parents had a diabetes diagnosis at a younger age. Men and women with a mother diagnosed with diabetes at age 50 had an IRR of 3.62 (95% CI: 2.86 to 4.57) and 5.03 (95% CI: 3.90 to 6.49) respectively compared to people of the same age and sex without a mother with diabetes. At a maternal diagnosis age of 70, the IRRs were 1.56 (95% CI: 1.46 to 1.57) and 1.67 (95% CI: 1.53 to 1.82) for men and women respectively.
Conclusions: Diabetes early detection strategies might consider that younger parental age at diabetes diagnosis may reflect more severe forms of diabetes, conferring a higher risk of developing the disease.

Disclosure
J. Silverman Retana: Other Relationship; Self; Danish Diabetes Academy, Steno Diabetes Center Aarhus. A. Hulman: None. J. NIelsen: None. B. Carstensen: Consultant; Self; Leo Pharma. Speaker's Bureau; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk Inc. R.K. Simmons: None. L. Bjerg: None. L. Johnston: None. D.R. Witte: None.

Funding
Danish Diabetes Academy (to J.O.S.R.); Novo Nordisk Foundation; Steno Diabetes Center Aarhus
1599-P: Glycated Albumin Identifies Dysglycemia Not Detected by A1C: The Case for Combining Glycated Albumin and A1C in Africans
Authors: MUGENI REGINE , ADUWO JESSICA Y. , BRIKER SARA M. , HORLYCK-ROMANOVSKY MARGRETHE F. , MABUNDO LILIAN , DUBOSE CHRISTOPHER , SUMNER ANNE E. 
Published: June 2019

As the diabetes (DM) epidemic spreads in Africa, affected adults are younger and less obese than in high-income regions of the world. A1C, a nonfasting marker of glycemia, is used to diagnose dysglycemia, a summary term for prediabetes and DM. However, independent of glycemia, A1C increases with age and BMI. Conversely, hemoglobinopathies common in Africa such as sickle cell trait (SCT) can lead to artefactually low A1C levels. Because of the challenges surrounding A1C, attention is turning to glycated albumin (GA). Our goal was to determine in Africans the value of A1C and GA when a) performed individually and b) combined. OGTT was performed and A1C and GA levels were measured in 366 African-born blacks currently living in the Washington, DC area (male: 67%). Diagnosis of dysglycemia was based on fasting glucose≥100 mg/dL or 2h glucose≥140 mg/dL. The ability of A1C≥5.7% and GA≥14.2% to diagnose dysglycemia was evaluated. Both A1C≥5.7% and GA≥14.2% represent the upper quartile cut-off for their distribution in the population. To assess the value of performing both GA and A1C, people with dysglycemia were divided into 2 groups: 1) A1C-group detected by A1C only or A1C and GA; 2) GA-group identified by GA only and not detected by A1C. Dysglycemia occurred in 36% (135/366) of participants. SCT occurred in 17% (62/366) of the cohort and 20% (27/135) of people with dysglycemia. Sensitivities of A1C and GA were only 43% and 33%, resp. However, combining A1C and GA led to a sensitivity of 60% and this was better than either test alone (P&lt;0.01). People identified by GA but not A1C were younger (age: 42±10 vs. 47±9y (mean±SD), P=0.05) and less obese (BMI: 26.7±2.5 vs. 30.3±4.5, P&lt;0.01). A1C identified 52% (14/27) of the people with SCT and dysglycemia. GA identified an additional 22% (6/27) of people with SCT and dysglycemia not detected by A1C. Overall, combining GA with A1C leads to improved detection of dysglycemia in Africans from three groups: SCT, the nonobese and younger adults.

Disclosure
R. Mugeni: None. J.Y. Aduwo: None. S.M. Briker: None. M.F. Horlyck-Romanovsky: None. L. Mabundo: None. C. DuBose: None. A.E. Sumner: None.
16-LB: N-Hydroxylethyl-1-Deoxynojirimycin (Miglitol) Infusion Rescues the Sympathoadrenal Response to Hypoglycemia following Antecedent Hypoglycemia in Rats
Authors: JOKIAHO ANNE J. , WINCHESTER MATTHEW , DONOVAN CASEY 
Published: June 2019

Antecedent hypoglycemia leads to a blunting of the sympathoadrenal response during subsequent hypoglycemia, which can largely be prevented by normalizing portal-mesenteric vein (PMV) glycemia during the antecedent bout. As SGLT3 has recently been implicated in PMV glucosensing, we hypothesized that PMV infusion of the imino sugar N-hydroxylethyl-1-deoxynojirimycin (miglitol), a potent SGLT3 agonist, during hypoglycemia would prevent or rescue the sympathoadrenal response to subsequent hypoglycemia.
Wistar rats underwent hyperinsulinemic-hypoglycemic clamps on two consecutive days. Control animals were exposed to either euglycemia (EUG-CON: 5.73 ± 0.37 mM) or hypoglycemia (HYPO-CON: 2.39 ± 0.07 mM) on Day 1 without miglitol infusion, followed by a hypoglycemic bout on Day 2. Treatment groups were exposed to hypoglycemia (2.52 ± 0.07 mM) on both days with miglitol (1.45 μmol/kg/min) infused either upstream, perfusing the PMV glucosensors (PORups), or adjacent to the liver, bypassing the PMV glucosensors (PORadj), on Day 1 (PORups1, PORadj1) or Day2 (PORups2, PORadj2). Serial plasma samples drawn on the Day 2 experiment were assayed for glucose, insulin, epinephrine (EPI) and norepinephrine (NE). Compared to EUG-CON, peak EPI responses for HYPO-CON on Day 2 were significantly blunted (34.1 ± 4.3 vs. 15.4 ± 3.5 nmol/L; P &lt; 0.05). EPI responses for PORups1 (11.8 ± 4.7 nmol/L) and PORadj1 (12.83 ± 3.4 nmol/L) were also suppressed on Day 2 compared with HYPO-CON (P&lt;0.05). In contrast, EPI responses for PORups2 (31.5 ± 8.2 nmol/L) and PORadj2 (32.9 ± 13.2 nmol/L) were not significantly different from HYPO-CON (P = 0.74 and 0.90, respectively). NE demonstrated a similar trend to EPI.
Conclusion: The impaired sympathoadrenal response following antecedent hypoglycemia in rats is restored by miglitol (NEOH-DNJ) treatment during a subsequent bout of hypoglycemia. Whether this is mediated via PMV glucosensors remains unclear.

Disclosure
A.J. Jokiaho: None. M. Winchester: None. C. Donovan: None.

Funding
JDRF
1603-P: Fasting Metabolomic Profiles Are Altered by Three Days of Standardized Diet and Restricted Physical Activity
Authors: PYLE LAURA , CARREAU ANNE-MARIE , RAHAT HASEEB , REYES YESENIA GARCIA , NADEAU KRISTEN J. , CREE-GREEN MELANIE 
Published: June 2019

Metabolomics has been used to identify biomarkers of diabetes development and progression and to investigate pathophysiological mechanisms; however, metabolomics profiles can be affected by diet and physical activity. We evaluated the effects of acute diet and physical activity on metabolomics profiles in a cohort of obese adolescent girls. Obese adolescents (n=21, 14.2 ± 1.6 years, BMI %ile 98.0 ± 1.7) were studied. At the first study visit (fasting visit), participants fasted for 12 hours prior to sample collection. Prior to the second visit (controlled visit), participants were provided a 3-day standardized isocaloric weight maintenance diet, and were asked to avoid exercising for 3 days, and samples were drawn after 12 hours of fasting. Untargeted metabolomics was performed in plasma samples. Multilevel sPLS-DA was used to identify compounds that discriminated between fasting and controlled visits. The sPLS-DA analysis showed excellent discrimination (Figure 1) between the fasting and controlled samples, resulting in 0% misclassification error. In ROC analysis, the AUROC of the sPLS-DA model was 1.00 (p&lt;0.0001). Acute diet and physical activity affect fasting metabolic profiles, and differences identified between samples may not be a result of underlying metabolism. Caution should be used in interpreting fasting metabolomics unless diet and physical activity are controlled.

Disclosure
L. Pyle: None. A. Carreau: Advisory Panel; Self; Pfizer Inc. H. Rahat: None. Y. Garcia Reyes: None. K.J. Nadeau: None. M. Cree-Green: None.

Funding
National Institutes of Health; University of Michigan
1605-P: Profiling Risk among Sepsis Survivors with Diabetes in Home Care
Authors: WHITEHOUSE CHRISTINA R. , JORDAN LIZEYKA , BOWLES KATHRYN , MURTAUGH CHRISTOPHER M. 
Published: June 2019

Diabetes mellitus (DM) increases the risk of developing infectious complications, including sepsis. Little is known about sepsis survivors with DM. Overall, there are limited and conflicting information regarding outcomes of patients with diabetes after a hospitalization for sepsis. The purpose of this study was to profile the characteristics and outcomes for sepsis survivors with (n = 80,312) and without DM (n = 84,916). The sample included Medicare beneficiaries discharged from the hospital to home health care (HHC) after a sepsis admission between July 1, 2013 and June 30, 2014. We utilized Medicare administrative claims and the Outcome and Assessment Information Set Version C start of care assessments. The incidence of older adults with DM and sepsis in HHC was 48.6%; a much higher rate than the 20-30% reported in the general hospitalized population. Those with DM and sepsis had a higher proportion of 30-day rehospitalization (24.3% verse 20.8%, p &lt; .001) and were more likely to have a prior sepsis admission (9.28% verse 3.35%, p &lt; .001) than sepsis patients without DM. They had more comorbid conditions (5.19 versus 3.8, p&lt;.001) including higher rates of depression, vision loss, obesity, hypertension, heart failure, pulmonary disease, and renal failure than non-DM sepsis survivors. Approximately 50% were taking injectable medications and only 12.8% of them were able to do so independently. For those who required caregiver assistance over 25% of caregivers reported needing additional training. Sepsis survivors with DM experience significantly higher readmission rates than non-DM patients. HHC clinicians should flag the sepsis survivor with DM as high risk and target interventions to manage the increased comorbid conditions, medication management, and caregiver training issues that may be contributing to the higher readmission rates.

Disclosure
C.R. Whitehouse: None. L. Jordan: None. K. Bowles: None. C.M. Murtaugh: None.

Funding
National Institute of Nursing Research (R01NR016014); Visiting Nurse Service of New York; Ruth L. Kirschstein National Research Service Award; University of Pennsylvania School of Nursing
161-LB: Inhibition of Kidney SGLT2 Expression following Bariatric Surgery in Mice
Authors: AKALESTOU ELINA , LOPEZ NORIEGA LIVIA , CHABOSSEAU PAULINE L. , LECLERC ISABELLE , RUTTER GUY A. 
Published: June 2019

Background: Bariatric surgery is known to improve glucose tolerance and weight loss, but can also cause a postprandial increase in renal glucose excretion following oral glucose tolerance test. Both effects have also been observed following treatment with sodium glucose co-transporter 2 (SGLT2) inhibitors.
Aim: To investigate whether there is an effect of bariatric surgery (Vertical Sleeve Gastrectomy; VSG) on renal SGLT2 expression in mice.
Methods: Fourteen lean mice underwent VSG (n=8) or sham (n=6) surgery. Glucose Tolerance tests with or without treatment with the SGLT2 inhibitor dapagliflozin were performed four weeks post operatively, in order to assess if exogenous SGLT2 inhibition has the same euglycemic effects as bariatric surgery. Kidneys were harvested from fed mice and analysed using Quantitative real-time PCR (qRT-PCR) and immunofluorescence.
Results: VSG did not cause any weight loss when compared to sham operated mice (p=0.37, Mann-Whitney test). However, VSG mice displayed significantly improved glucose tolerance (AUC=103 ±6.8; AUC =66.6 ±2.9 in control and VSG mice, respectively; p&lt;0.001), which was not further affected by dapagliflozin (10 mg/kg; p&gt;0.05). In contrast, treatment of sham mice with dapagliflozin increased glucose tolerance, though to a lesser extent than VSG. Nevertheless, qPCR and immunofluorescence analysis on mouse kidneys demonstrated a significant lowering of SGLT2 expression at both the protein (n=5, p=0.0007) and mRNA (n=7, 0&lt;0.0001) levels four weeks after VSG. Correspondingly, glycosuria was observed in 2/5 VSG mice, but not in controls.
Conclusions: Both gastric and intestinal surgery in lean animals causes a significant inhibition of SGLT2 in the kidney cortex. These findings are in line with our previous results on the effects of Duodenal Jejunal Bypass in lean rats, and point towards a physiologically-relevant gut-kidney axis. SGLT2 inhibition may thus be an important mechanism through which bariatric surgery improves glucose tolerance in man.

Disclosure
E. Akalestou: None. L. Lopez Noriega: None. P.L. Chabosseau: None. I. Leclerc: None. G.A. Rutter: Consultant; Self; Sun Pharma.

Funding
UK Wellcome Trust
1627-P: Glycemic Control From 2013 to 2016 among U.S. Adults with Type 2 Diabetes (T2D): A National Estimate Stratified by Age, eGFR Category, and Comorbidities
Authors: XI YUZHI , WANG TONGTONG , KORO CAROL 
Published: June 2019

The adequacy of adherence to ADA guidelines, as reflected in glycemic control, has not been assessed for the U.S. adult T2D population by different risk factors, such as age, CVD, obesity and eGFR categories. The aim of this study was to provide such estimates. Using NHANES 2013-2016 data, we conducted a cross-sectional analysis of an adult sample with diagnosed and undiagnosed T2D (n=1705), aged ≥ 18 years. We aggregated HbA1c measures to 4 levels: &lt;7%, 7-&lt;8%, 8-&lt;9%, and ≥9%. Appropriate sample weights were used to obtain national projections. Results of glycemic control stratified by age, eGFR categories and comorbidities in U.S. adults with T2D are presented in Table 1. The overall glycemic control rate, defined as HbA1c &lt;7%, was 51.9%. Among T2D aged 45-64 years, 46.6% had an HbA1c &lt;7%; while 60.3% of T2D aged ≥75 years had an HbA1c &lt;7%. Among T2D with renal impairment, the glycemic control rate was similar across eGFR categories, remaining at above 50%. Among T2D with different comorbidities, glycemic control rate ranged from 48.5% for those with both obesity and CVD to 69.5% for those with CVD only. Overall, 14.8% of T2D had an HbA1c ≥9%, with 22.7% among aged 18-44 years and 20.3% among those with eGFR &gt;90 ml/min/1.73m2. Our data shows only about 50% of T2D patients are at HbA1c goal of &lt;7% with currently available treatments, ranging from 47-70% depending on risk factors.

Disclosure
Y. Xi: Research Support; Self; Merck & Co., Inc. T. Wang: Employee; Spouse/Partner; Johnson & Johnson. Employee; Self; Merck & Co., Inc. C. Koro: Speaker's Bureau; Self; Merck & Co., Inc.
163-LB: Impact of SGLT2 Inhibitors on Liver Function Test in Type 2 Diabetes and Nonalcoholic Fatty Liver Disease: A Systemic Review and Meta-analysis
Authors: THAVARAPUTTA SUBHANUDH , WIRUNSAWANYA KAMONKIAT , LAOVEERAVAT PASSISD 
Published: June 2019

Background: Nonalcoholic fatty liver disease (NAFLD) has been found to be a chronic and precarious metabolic complication from diabetes mellitus. Due to the limitation of treatment options for NAFLD, we postulated that SGLT2 inhibitors would have a potential benefit for NAFLD. None of the previous studies have comprehensively addressed multiple different classes of SGLT2 inhibitor in type 2 DM individuals with NAFLD. We conducted the first meta-analysis investigating the impact of SGLT2 inhibitors on liver function test in type2DM and NAFLD.
Methods: We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane databases. The inclusion criteria were published randomized control trials (RCT), prospective studies, and retrospective studies comparing SGLT2 inhibitors to placebo or controls in NAFLD and type 2 DM individuals. The primary outcome was the differences in the change of ALT and AST. We also examined the changes of NAFLD risk factors including body composition, lipid profile, HbA1C as secondary outcomes. Pooled odds ratio and 95% confidence interval were calculated using a random-effects model (generic inverse variance method). The between-study heterogeneity of effect size was quantified using the Q statistic and I.
Results: Eight RCTs, one prospective study, and one retrospective study with 4698 patients were included in the analysis. There was a statistically significant reduction of AST (MD=-2.09, 95% CI:-3.65to-0.52) and ALT (MD=-6.02, 95% CI: -8.35to-3.70) favoring SGLT2 inhibitor groups.
Conclusion: SGLT2 inhibitor groups were shown to have a statistically significant reduction of ALT and AST compared to placebo or control groups. SGLT2 inhibitor might be considered as a conjunctive treatment for NAFLD in type2DM individuals. Further studies regarding the optimal dosage and duration of SGLT2 inhibitors are helpful to assess potentially favorable effects in type 2 DM individuals and NAFLD.

Disclosure
S. Thavaraputta: None. K. Wirunsawanya: None. P. Laoveeravat: None.
1631-P: Glycaemic Deterioration, a Clue to Occult Cancer
Authors: KANEKO SHIZUKA , UEDA YOUHEI , TAHARA YUMIKO 
Published: June 2019

Background/Objective: Hyperglycemia/hyperinsulinemia promote carcinogenesis. Cancer associated factors worsen insulin resistance. Either way, glycaemic control of cancer bearing diabetic patients often deteriorates, which is believed to help in finding occult cancer in diabetic patients.
Methods: We investigated whether it applies to every type of cancer. We analysed cancer bearing type 2 diabetes patients (T2DM) medical records going back 10 years. HbA1c levels in connection with occult cancer were analysed in relation to organs and stages of cancer based on TMN criteria. Cancers with 20+ diagnosed patients were analysed.
Result: 1155 T2DM patients were newly diagnosed with cancer. Lung cancer totaled 247, colorectal 218, gastric 218, hematologic (leukemia/lymphoma) 81, prostate 75, pancreas 65, hepatocellular 60, kidney or urethro-bladder 49, and uterine 43, breast cancers 32, esophageal 29, gall-bladder/biliary tree 28. No patients were diagnosed with pancreatic cancer at stage 1. The HbA1c of pancreatic cancer patients rose significantly. The HbA1c of lung cancer patients was not elevated even in stage 4, although HbA1c tended to rise significantly as the stage advanced. HbA1c was mildly elevated in almost all stages of colon/rectum and gastric cancer. Gastrointestinal bleeding causes apparent decreases in HbA1c regardless of elevated glycaemic levels in stage 3 and may mask these cancers. HbA1c of hepatocellular carcinoma (HCC) patients decreased with advanced stages.
Discussion: HbA1c elevation can be promising in pancreatic cancer detection. However, lung, prostate, gastrointestinal cancers had little effect on it even in advanced stages with no relation to food intake. Due to masking effects, it was recommended colorectal and gastric cancer patients undergo periodic testing for gastrointestinal bleeding. HCC patients with liver cirrhosis do not have elevated HbA1c levels due to masking effects. The ability to focus on these tests may also save medical expenditure in future. Previous version was presented at EASD.

Disclosure
S. Kaneko: Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Mitsubishi Tanabe Pharma Corporation, Novo Nordisk Inc., Sumitomo Dainippon Pharma Co., Ltd. Y. Ueda: None. Y. Tahara: None.