bluuebunny/crossref_metadata_2025_split huggingface dataset:
776-P: Low AMY1 Copy Number Variations Are Associated with Cardiometabolic Risk Factors in Overweight or Obese Adults
Authors: MARQUINA CLARA , MOUSA AYA , NADERPOOR NEGAR , BARBORA DE COURTEN 
Published: June 2019

Background: Low serum amylase has been implicated in the pathogenesis of obesity and insulin resistance. Copy number variations (CNVs) in the salivary amylase gene (AMY1) correlate with serum amylase, and CNVs &lt;4 have been associated with a higher risk of obesity and insulin resistance. However, the relationship between AMY1 and cardiometabolic risk has not been fully elucidated.
Objective: To examine whether AMY1 CNVs are associated with cardiometabolic risk factors.
Methods: In overweight or obese (BMI &gt;25kg/m2), otherwise healthy adults, we measured AMY1 copy numbers (qPCR); serum amylase (commercial assay); anthropometry (BMI; body composition by dual-energy X-ray absorptiometry); cardiovascular parameters (blood pressure, plasma lipids by ELISA); fasting and 2-h glucose levels post-75g oral glucose tolerance test (glucose oxidase method), insulin sensitivity (hyperinsulinemic-euglycemic clamp), insulin secretion (intravenous glucose tolerance test), and serum inflammation markers (LEGENDplex™, Biolegend).
Results: Fifty-nine adults (58% males) aged 31.27 ± 8.61 were included in the study. Based on previous studies and median values, participants were divided into low CNV and high CNV carrier groups for individuals with ≤4 and &gt;4 AMY1 CNVs, respectively. Low AMY1 CNV carriers (n=29) had a higher BMI (32.65 ± 5.37 vs. 30.28 ± 3.51 kg/m2, p = 0.04), % fat mass (40.76 ± 12.22 vs. 33.13 ± 8.60%, p = 0.008), and LDL-c (3.25 ± 0.80 vs. 2.87 ± 0.63 mmol/L, p = 0.04) compared with the high AMY1 CNV group (n=30), as well as higher levels of interleukins [IL]-6, -1β, -10, and tumor necrosis factor-alpha (all p&lt;0.05). Results remained significant after adjustment for age and sex. There were no differences between AMY1 CNV groups in glycaemic outcomes including insulin sensitivity or secretion as well as fasting and 2-hour glucose post-OGTT (p&gt;0.1).
Conclusions: Our results suggest that low AMY1 CNVs are associated with increased obesity, cardiovascular risk, and inflammation.

Disclosure
C. Marquina: None. A. Mousa: None. N. Naderpoor: None. B. de Courten: None.
78-OR: Automated Glycemic Control with a Bionic Pancreas Configured for Use in the Critical Care Setting
Authors: SHERWOOD JORDAN , HILLARD MALLORY A. , GRENNAN KERRY B. , EL-KHATIB FIRAS , DAMIANO EDWARD , RUSSELL STEVEN J. 
Published: June 2019

Tight glycemic control of hospitalized patients is difficult and labor intensive to achieve. We evaluated the feasibility of fully automated glycemic control with a version of the bionic pancreas (BP) designed for use in the critical-care setting. The fully automated BP controlled the intravenous delivery of insulin and 20% dextrose based on glucose values from the Abbott FreeStyle Navigator CGM. The same algorithm, initialized only with body mass, was used in all subjects. Adult subjects with type 1 (n=6) or type 2 (n=6) diabetes with a total daily dose (TDD) of insulin under usual care of 0.5-2.9 u/kg/day were under automated glucose control for an 8-hour period. Subjects started the study period fasted, later consumed an unrestricted meal of their choice, and still later took liquid nutrition nearly continuously for 2 hours before abruptly stopping, in order to simulate continuous enteral feeding and its interruption. Food intake was not announced to the BP. The primary outcome, mean plasma glucose (measured every 15 minutes), was 116±20 mg/dL. The % time within 70-180 mg/dL was 95±8% and the median (IQR) % of time &lt;70 mg/dL was 0 (0, 2.3) and &lt;54 mg/dl was 0 (0, 0). We concluded that the BP can achieve excellent glycemic control in volunteers with a wide range of insulin needs and in the face of realistic glycemic challenges. These results support feasibility testing of the critical care BP in the critical-care setting.

Disclosure
J. Sherwood: None. M.A. Hillard: None. K.B. Grennan: None. F. El-Khatib: Employee; Self; Beta Bionics. Stock/Shareholder; Self; Beta Bionics. E. Damiano: Advisory Panel; Self; Novo Nordisk A/S. Board Member; Self; Beta Bionics. Employee; Self; Beta Bionics. Stock/Shareholder; Self; Beta Bionics. Stock/Shareholder; Spouse/Partner; Beta Bionics. Other Relationship; Self; Ascensia Diabetes Care, Senseonics. S.J. Russell: Advisory Panel; Self; Companion Medical, Unomedical a/s. Consultant; Self; Flexion Therapeutics. Research Support; Self; Beta Bionics, MITRE Corporation, Novo Nordisk A/S, Zealand Pharma A/S. Other Relationship; Self; ADOCIA, Ascensia Diabetes Care, Ascensia Diabetes Care, Lilly Diabetes, Roche Diabetes Care, Senseonics.

Funding
Wallace H. Coulter Foundation
780-P: Effect of Partial Meal Replacement on Glycemic Variability in Patients with Type 2 Diabetes: A Randomized Clinical Trial
Authors: ZHOU JIAN , LU JINGYI , MA XIAOJING , PENG JIAHUI , YING LINGWEN , LU WEI , ZHU WEI , BAO YUQIAN 
Published: June 2019

Background: Glycemic variability (GV) has been demonstrated to contribute to the development of diabetic complications. The current study sought to investigate the effect of partial meal replacement (PMR) on GV in type 2 diabetes.
Methods: 123 individuals with newly diagnosed and untreated type 2 diabetes were randomized to receive either lifestyle intervention (LI) together with breakfast replacement with a liquid formula (LI+PMR, n=62) or LI alone (n=61) for 4 weeks. All participants underwent continuous glucose monitoring (CGM) for 72 hours both before and after intervention. GV metrics obtained from CGM included the incremental area under the curve of postprandial blood glucose (AUCpp), standard deviation of blood glucose (SDBG), glucose coefficient of variation (CV), and mean amplitude of glycaemic excursions (MAGE).
Results: At the end of the study, patients in LI+PMR exhibited more pronounced improvements in systolic blood pressure (P=0.046) and time in range (P=0.033) than those in LI. More importantly, LI+PMR led to significantly greater improvements in all GV metrics including SDBG (P=0.005), CV (P=0.002), MAGE (P=0.016) and AUCpp (P&lt;0.001) than did LI. In addition, multiple regression analysis revealed that LI+PMR (vs. LI) was independently associated with the improvements in GV after adjusting for covariates (all P&lt;0.05).
Conclusion: Our study showed that LI+PMR resulted in significantly greater improvements in GV than did LI, suggesting that LI+PMR could be an effective treatment to alleviate glucose excursions.

Disclosure
J. Zhou: None. J. Lu: None. X. Ma: None. J. Peng: None. L. Ying: None. W. Lu: None. W. Zhu: None. Y. Bao: None.

Funding
Shanghai Municipal Education Commission; Gaofeng Clinical Medicine Grant (20161430)
785-P: Effects of Metformin and Behavioral Weight Loss on Serum Short-Chain Fatty Acids (SCFAs)
Authors: MUELLER NOEL T. , ZHANG MINGYU , JURASCHEK STEPHEN P. , MILLER EDGAR , MARUTHUR NISA M. , APPEL LAWRENCE J. , HSIN-CHIEH “JESSICA” 
Published: June 2019

Background: Circulating SCFAs, produced by gut microbiota, have been associated with lower cardiometabolic disease risk factors. Evidence suggests metformin and behavioral weight loss alter gut microbiota, but no trials have examined their effects on circulating SCFAs.
Objective: To determine the effects of metformin and behavioral weight loss on serum SCFAs.
Methods: We conducted a parallel-arm, randomized trial, called SPIRIT. We enrolled overweight/obese adults who were previously treated for malignant tumors, but had no ongoing cancer treatment. We randomized 121 participants to 12 months of: 1) coach-directed behavioral weight loss, 2) metformin, or 3) self-directed weight loss (control). Targeted SCFAs were measured in serum by LC-MS/MS. We used ANCOVA to compare group differences in SCFA change from baseline to 6 months and 12 months.
Results: Groups did not differ by sex (79% female), race (45% black) or age (mean 60 years). At 6 months, mean weight loss was 3.9%, 2.7%, and 0.9% in coach-directed, metformin, and self-directed, respectively (both Ps&lt;0.05 compared to self-directed). Compared to self-directed, metformin and coach-directed interventions increased acetate at 6 months (not 12 months); metformin increased butyrate and valerate at 6 months (not 12 months); and coach-directed decreased methylbutyrate at 12 months (Figure).
Conclusion: Metformin and behavioral weight loss affect serum SCFAs.

Disclosure
N.T. Mueller: None. M. Zhang: None. S.P. Juraschek: None. E. Miller: None. N.M. Maruthur: Other Relationship; Self; Johns Hopkins HealthCare Solutions. L.J. Appel: None.

Funding
Maryland Department of Health and Mental Hygiene; National Institutes of Health (to N.T.M.)
8-LB: Outcomes of Type 2 Diabetes (T2D) Clustering Replicated in the DEVOTE Trial
Authors: KAHKOSKA ANNA R. , HACHMANN-NIELSEN ELISE , KLEIN KLARA , KONGSBAK KRISTINE G. , KVIST KAJSA , BUSE JOHN B. 
Published: June 2019

T2D is a heterogeneous disease. Individuals in the Swedish All New Diabetics in Scania (ANDIS) cohort with newly diagnosed T2D were grouped by 6 demographic and clinical variables to show 4 distinct T2D subtypes with differential risk for nephropathy and retinopathy. We tested the predictive validity of this clustering system for patients with advanced T2D in DEVOTE (a large, global, randomized, double-blind, cardiovascular outcomes trial; median observation time: 1.99 years) for major adverse cardiovascular event (MACE)-free survival, severe hypoglycemia (SH)-free survival, and overall survival rates. Subjects (N=7637, mean age=65.0 years, mean T2D duration=16.4 years, mean glycated hemoglobin [A1C]=8.43%) were assigned to a cluster for which they had the smallest Euclidean distance to the cluster center based on available baseline variables: A1C, BMI, age, age at diagnosis. Insulin resistance and sensitivity measures were not available. The 4 DEVOTE clusters showed baseline characteristics consistent with the original ANDIS clusters, with significant differences in MACE-incidence and SH-incidence (Table). The results were confirmed using data from the LEADER trial (data not shown). The study suggests that clusters derived from early T2D can be replicated in long-standing T2D. Future work should characterize differences in treatment response across clusters to improve outcomes across the heterogeneous T2D population.

Disclosure
A.R. Kahkoska: None. E. Hachmann-Nielsen: Employee; Self; Novo Nordisk A/S. K. Klein: None. K.G. Kongsbak: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. K. Kvist: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. J.B. Buse: Consultant; Self; Neurimmune AG. Research Support; Self; AstraZeneca, National Center for Advancing Translational Sciences, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk A/S, Sanofi, vTv Therapeutics. Stock/Shareholder; Self; Mellitus Health, PhaseBio Pharmaceuticals, Inc., Stability Health. Other Relationship; Self; ADOCIA, AstraZeneca, Dance Biopharm Holdings Inc., Eli Lilly and Company, MannKind Corporation, NovaTarg, Novo Nordisk A/S, Senseonics, vTv Therapeutics, Zafgen, Inc.

Funding
Novo Nordisk
806-P: Quantifying Carbohydrate Intake: A Reliable, Valid, Sensitive Alternative to 24-Hour Dietary Recall
Authors: COX DANIEL , MONCRIEF MATTHEW A. , BANTON TOM , NGO VICTORIA M. , SINGH HARSIMRAN , DIAMOND ANNE M. , MCCALL ANTHONY L. 
Published: June 2019

Carbohydrate (carb) ingestion strongly influences postprandial glucose (PPG). With recent interest in the role PPG plays in A1c and diabetic complications, there are research and clinical needs to quantify routine carb consumption. The 24-hour dietary recall is the gold standard for estimating carbs eaten, but it is tedious and narrowly focused. We developed a simple self-report to measure carbs routinely consumed (CRC). We hypothesized that the CRC would: 1) be reliable, 2) correlate with the 24-hour dietary recall, 3) be sensitive to a PPG-lowering intervention, and 4) reflect changes in A1c. Adults with type 2 diabetes (n = 116; mean age: 56 ± 11.6 years; mean disease duration: 5.3 ± 3 years; mean A1c: 8.2 ± 1.0) participated in a clinical trial comparing weight reduction to PPG reduction. At baseline and 3-month follow-up, participants completed the CRC, 3 days of ASA24 dietary recall, and A1c. The CRC score was the sum of the number of servings of 16 different high-carb food classes eaten (e.g., dried fruits) in an average week. The CRC mean was 35.9 ± 16.1. One-week test-retest reliability (r) was .96 (p = .02). Validity: At baseline, carbs eaten by CRC and ASA24 dietary recall were correlated (r = .43, p &lt; .001). Change in CRC from baseline to follow-up was significantly lower for the PPG group (36.8 to 20.3, p &lt;.001) but not for the weight-lowering group (33.0 to 34.4, p = .7). Correlation of pre-post change in A1c with CRC and ASA24 were r = .39 (p = .002) and r = -.03 (p = .8) respectively. Regression analysis indicated only the change in CRC predicted change in A1c. These data indicate the CRC is reliable and shows concurrent, discriminant and predictive validity - only changes in CRC reflected changes in A1c. The CRC may be useful to researchers in evaluating programs designed to lower carb intake. Clinicians might use it to evaluate a patient’s routine consumption of carbs and responsiveness to lifestyle interventions. Limitation: the CRC is not a comprehensive nutritional analysis.

Disclosure
D. Cox: None. M.A. Moncrief: None. T. Banton: None. V.M. Ngo: None. H. Singh: None. A.M. Diamond: None. A.L. McCall: None.

Funding
National Institutes of Health (R01DK108957); Dexcom, Inc. (IIS-2016-047)
81-LB: Patient Perspectives on the Impact of Diet on Glycemia in GCK-MODY
Authors: LETOURNEAU LISA R. , CHAN KAREN , SALGUERO BERMONTH MARIA V. , NAYLOR ROCHELLE N. 
Published: June 2019

GCK-MODY is characterized by stable, mildly elevated glycemia. Microvascular complications are exceedingly rare and treatment is not recommended outside of pregnancy. Diet alteration is not expected to have significant impact on glycemia as glucose homeostasis is preserved. Yet, some subjects with GCK-MODY in the University of Chicago National Monogenic Diabetes Registry report decreased freedom to eat scores on quality of life questionnaires. The purpose of this study was to understand the perceptions of those with GCK-MODY on the impact of diet on glycemia through thematic analysis of Registry discussion groups transcripts. Participants were 56 individuals, ages 23-75 years, and 80% female. Emergent themes revealed division in views commonly held by respondents. One group was characterized as seeing the diagnosis of GCK-MODY liberating their choices and perceptions about food, often accompanied by personal examples of ineffectiveness of diet on changing glycemia. Conversely, a theme of restriction and rigidity was seen in others, with some respondents following strict, regimented diets, and practicing frequent self-monitoring of blood glucose. Fear of complications or health symptoms attributed to GCK-MODY were common motivators for dietary choices. Emotional distress was also frequently encountered. This qualitative study demonstrates dichotomous views held by respondents in regard to the impact of diet on glycemia in GCK-MODY with associated psychological impact. The themes seen in this discussion group are not necessarily generalizable to all individuals with GCK-MODY. Of 388 eligible participants, only 56 people have joined the GCK-MODY discussion group. It may be that those with high convictions in their beliefs about diet are overrepresented in this group. Nevertheless, the significant division in perceptions, focus on diets, and frequency of restrictive diets highlights the need for additional studies into the efficacy of diet on glycemia in this unique subset of hyperglycemia.

Disclosure
L.R. Letourneau: None. K. Chan: None. M.V. Salguero Bermonth: None. R.N. Naylor: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK104942, P30D70, DK020595, K23DK114564)
81-OR: Depressive Symptomatology Is a Major Predictor of Incident Disability in a Cohort of Childhood-Onset Type 1 Diabetes
Authors: COSTACOU TINA , ORCHARD TREVOR J. 
Published: June 2019

Type 1 diabetes (T1D) is associated with numerous complications, which may in turn cause significant disability. However, little evidence is available on the proportion of T1D patients affected by disability in the U.S. We thus assessed incidence and predictors of disability in a childhood onset T1D cohort (n=658, mean baseline age, 28 and diabetes duration, 19 years) during a 25 year follow-up. Disability was assessed via self-report in response to the question: “Do you have any disabilities that limit the type or amount of work you can do at home, school or on the job?” Of 509 free of disabilities at baseline, 49.7% (n=253) reported a disability during follow-up. Incident cases were more likely to be older at baseline, with longer diabetes duration, higher HbA1c, non-HDLC, triglycerides, and albumin excretion rate (AER). They were also more likely to be women, current smokers, have hypertension, depressive symptoms (Beck Depression Inventory), and prevalent complications (i.e., cardiac autonomic neuropathy, proliferative retinopathy (PR), distal symmetric neuropathy (DSP), lower extremity arterial disease, and increased albuminuria). In multivariable Cox models, independent predictors of disability incidence comprised diabetes duration (HR=1.05, 95% CI: 1.02-1.07), female sex (1.99, 1.46-2.72), current smoking (1.40, 0.99-1.97), HbA1c (1.24, 1.12-1.38), non-HDLC (1.007, 1.003-1.011), log AER (1.12, 1.03-1.23), DSP (1.59, 1.10-2.29), coronary artery disease (1.84, 1.00-3.38) and depressive symptoms (mild/moderate HR=1.38 (0.98-1.94); moderate/severe HR=2.25 (1.24-4.09)). The addition of depressive symptoms to models including traditional risk factors and complication status significantly enhanced the prediction of incident disability (Uno’s concordance statistic p=0.02).
In conclusion, modifiable risk factors, depressive symptoms and diabetes complications predicted disability incidence, which affected almost half of this T1D cohort.

Disclosure
T. Costacou: None. T.J. Orchard: Consultant; Self; Boehringer Ingelheim International GmbH.

Funding
National Institutes of Health (DK34818); Rossi Memorial Fund
814-P: Determinants of Diabetes Self-Care in Two Populations of Arabs with Type 2 Diabetes Living in Their Country of Origin or in the United States: A Comparative Analysis
Authors: SUKKARIEH-HARATY OLA ALI , JABER LINDA , KHARMA JOELLE ABI , FARRAN NATALI , BASSIL MAYA 
Published: June 2019

Optimal diabetes management requires daily activities of self-care. Thus, understanding the sociodemographic determinants of diabetes self-care is crucial to improve diabetes control.
The aim of this study is to compare diabetes self-care activities and their determinants in 2 populations of Arabs with type 2 diabetes (T2DM) living in their country of origin (Lebanon) or in the United States (U.S.). A total of 334 patients (59 ± 13 years; 52.1% M) living in Lebanon and 181 patients (62 ± 12 years; 52.5% M) living in the U.S. were recruited. Diabetes self-care activities were assessed using Summary of Diabetes Self-Care Activities Assessment (SDSCA); dimensions of diabetes distress were measured with the Diabetes Distress Scale (T1-DDS). Half of the population in Lebanon were employed, 61.6% had health insurance and 42.3% were smokers; while among those living in the U.S., 23.7% were employed, 96.1% had health insurance and 26.5% were smokers. There were no significant group differences for gender, marital status and education. Compared to those in Lebanon, patients living in the U.S. had significantly higher mean scores on various SDSCA subscales, including general diet (t = 5.24, p &lt; 0.001), exercise (t = 3.31, p = 0.001), blood glucose testing (t = 4.41, p &lt; 0.001), and foot care (t = 8.84, p &lt; 0.001) indicating better diabetes self-care. Multiple regression analyses showed that total SDSCA scores correlated significantly with age (β= 0.06, p = 0.015) and education (β= 3.02, p=0.006) in patients living in Lebanon; whereas predictors of total SDSCA scores among participants living in the U.S. were education (β= 8.46, p = 0.005) and management distress subscale of T1-DDS (β= - 2.92, p &lt; 0.001).
In conclusion, Arab patients with T2DM living in the U.S. showed better diabetes self-care activities compared to those living in their country of origin. Predictors of self-care varied between the 2 populations. Further exploring other determinants is warranted.

Disclosure
O.A. Sukkarieh-Haraty: None. L. Jaber: None. J. Abi Kharma: None. N. Farran: None. M. Bassil: None.
824-P: Ecological Momentary Assessment of Diabetes Self-Management: A Systematic Review of Methods and Procedures
Authors: NAM SOOHYUN , WHITTEMORE ROBIN , VLAHOV DAVID , DUNTON GENEVIEVE 
Published: June 2019

Ecological momentary assessment (EMA) is a mHealth method of real-time data collection in which people report on behavior and the context of the behavior at multiple time points in their natural environment. It is an innovative counterpart to traditional research methods that have relied on retrospective measures. The aim of this systematic review is to describe EMA methodology that has been used in studies of diabetes self-management. PubMed, CINAHL, PsycINFO, and EMBASE were searched for studies published between January 2000 and December 2018. We identified six studies that met the inclusion criteria. We evaluated the following areas of EMA methodology: 1) sampling and study design, 2) primary measures, 3) delivery technology, 4) EMA schedule and prompting strategy, and 5) EMA compliances. Five out of six studies were conducted in the U.S. with adolescents with type 1 diabetes. One study was conducted in Japan with adults with type 2 diabetes. Four studies used a prospective observational study design with a monitoring period ranging from 3 to 14 days (a total 1,000 to 2,128 observations:). Two studies were integrated with ecological momentary interventions (30 days and 6 months) with real-time biobehavioral feedbacks. All studies assessed diabetes self-management behaviors via EMA surveys. Most studies (78%) reported the relationship among psychosocial contexts, mood, affect, eating, and glucose monitoring. Three studies used handheld computers; two used automated telephone response systems; and one used a smartphone app. The prompt frequency ranged from twice a day to 1-2 times per hour using interval-contingent prompting strategy. Most studies failed to report EMA compliance rates. For those who reported, compliance rates ranged 59-96%. There has been limited research using EMA methodology to assess diabetes self-management and contextual factors. More research with standardized EMA reporting may help to develop personalized diabetes intervention.

Disclosure
S. Nam: None. R. Whittemore: None. D. Vlahov: None. G. Dunton: None.