bluuebunny/crossref_metadata_2025_split huggingface dataset:
757-P: Intensive Lifestyle Intervention for Diabetes Patients with Food Insecurity: A Preplanned Subgroup Analysis of the REAL HEALTH Randomized Clinical Trial (RCT)
Authors: BERKOWITZ SETH , WEXLER DEBORAH J. , CHANG YUCHIAO , PORNEALA BIANCA C. , DELAHANTY LINDA M. 
Published: June 2019

Patients with type 2 diabetes who face food insecurity (limited access to nutritious food owing to cost) are at increased risk for diabetes complications. Intensive lifestyle interventions (ILI) are recommended for treatment of diabetes and obesity but it is unclear if these interventions are effective in patients with food insecurity, which can be a barrier to weight loss. We conducted a pre-planned subgroup analysis of the REAL HEALTH RCT, which compared a pragmatic group ILI (delivered in-person or by telephone) to medical nutrition therapy (MNT) in adults with type 2 diabetes. The analysis compared whether intervention effects differed by food security status, using mixed effects models to account for repeated measurements. The primary and secondary analyses examined percentage weight change from baseline at 6 and 12 months, respectively. Of 211 participants, those with food insecurity (n=28) were more likely to be racial/ethnic minorities (p&lt;0.001), have lower education (p&lt;0.001), and have lower income (p&lt;0.001) than those who were food secure (n=183). The intervention led to greater reduction in weight at 6 months (mean: 5.1% reduction, SD: 5.3%) than MNT (mean: 1.1% reduction, SD: 3.7%), p &lt;0.001. The ILI was similarly effective in those with versus without food insecurity (5.1% vs. 5.1% reduction, p for interaction 0.92). The ILI remained more effective at 12 months (4.7% reduction vs. 2.0% reduction for MNT), p=0.001, and remained similarly effective in those with versus without food insecurity (4.5% vs. 4.7% reduction, p for interaction 0.67). Adjusting for demographic differences in those who were and were not food insecure did not change the results at 6 (p for interaction 0.67) or 12 (p for interaction 0.88) months. The REAL HEALTH intensive lifestyle intervention yielded clinically significant weight loss at 6 and 12 months with similar effectiveness regardless of food security status.

Disclosure
S. Berkowitz: None. D.J. Wexler: Other Relationship; Spouse/Partner; APOLO1BIO. Y. Chang: None. B.C. Porneala: None. L.M. Delahanty: Advisory Panel; Self; Jana Care Inc., Omada Health, Inc., Weight Watchers International, Inc.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R18DK102737, K23DK109200)
759-P: Analysis of a Two-Year Continuous Care Intervention Including Nutritional Ketosis—Exploring Baseline Predictors of Diabetes Reversal and Remission
Authors: ATHINARAYANAN SHAMINIE J. , MCKENZIE AMY , ADAMS REBECCA N. , HALLBERG SARAH , MCCARTER JAMES P. , PHINNEY STEPHEN 
Published: June 2019

Background: We recently reported 55% of the patients reversed type 2 diabetes in the continuous care intervention (CCI) while 18% of the patients achieved remission at 2 years. In this post hoc analysis, factors identified in previous studies as predictors of diabetes reversal and remission were examined.
Methods: Baseline factors including diabetes duration, HbA1c, fasting glucose and a composite index (HbA1c, fasting insulin and ALT1) were examined as potential predictors of T2D reversal and remission in the CCI group along with percentage weight loss over the study period. Spearman correlation was used to assess relationships between predictors and 2 years reversal and remission. Factors with significant correlation were analyzed using logistic regression.
Results: Diabetes duration, baseline HbA1c, fasting glucose and the composite index were significantly correlated with diabetes reversal and remission (Table 1). Logistic regression analyses showed that diabetes duration (OR=1.2, p=7.0x10-6) and baseline HbA1c (OR=1.5, p=0.003) were associated with diabetes reversal at 2 years whereas weight loss percentage during the study period was not.
Conclusion: Shorter diabetes duration and lower baseline HbA1c are two factors strongly related to achieving diabetes reversal and remission in CCI participants at 2 years.

Disclosure
S.J. Athinarayanan: Employee; Self; Virta Health Corp. A. McKenzie: Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. R.N. Adams: Employee; Self; Virta Health Corp. S. Hallberg: Advisory Panel; Self; Atkins Nutritionals, Inc. Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. J.P. McCarter: Employee; Self; Virta Health Corp. S. Phinney: Advisory Panel; Self; Atkins Nutritionals, Inc. Board Member; Self; Virta Health Corp. Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. Other Relationship; Self; Beyond Obesity.

Funding
Virta Health Corp
76-LB: Adapting the Diabetes Prevention Program for Stroke
Authors: BAILEY RYAN R. , STEVENSON JENNIFER L. , SERRANO NATALICIO H. 
Published: June 2019

Objective: History of stroke increases risk for diabetes, which is of great concern for stroke survivors. The Diabetes Prevention Program (DPP) is an effective lifestyle modification intervention for ameliorating diabetes and cardiovascular risk factors. Participation in the DPP for stroke survivors could be challenging, however, due to stroke-related impairments. The purpose of this study was to determine appropriate adaptations to the DPP for stroke survivors.
Design and Methods: Qualitative description using focus groups. Fifteen community-dwelling stroke survivors and 10 caregivers participated. Focus groups were recorded and transcribed. Inductive content analysis was used to identify key themes to inform appropriate DPP adaptations.
Results: Three themes were identified. First, several stroke-specific impairments were identified that could influence DPP participation: hand and arm impairment, mobility impairment, impaired memory and attention, changes in taste and vision, and depression. Second, facilitators of existing group-based DPP models were identified and included small group discussion for peer support and physical activity and nutrition-related content repeated across sessions for reinforcement and repetition. Third, adaptations were suggested that included caregiver participation for the provision of physical and cognitive assistance; a need for stroke-specific physical activity and nutrition-related recommendations such as adapted gym and cooking equipment; and modified session content, including shorter, simplified session handouts and addition of online content to complement session handouts.
Conclusion: Current DPP content and structure are insufficient to meet the unique needs of stroke survivors. The suggested adaptations should be incorporated into a stroke-specific curriculum and tested for efficacy and eventual implementation into community-based programs to promote lifestyle modification and diabetes risk reduction among stroke survivors.

Disclosure
R.R. Bailey: None. J.L. Stevenson: None. N.H. Serrano: None.

Funding
National Institutes of Health (P30DK092950, 5T32HL130357)
760-P: Factors Associated with Resolution of Steatosis and Fibrosis in T2D Patients Following Two Years of Continuous Care Intervention
Authors: ATHINARAYANAN SHAMINIE J. , ADAMS REBECCA N. , MCKENZIE AMY , HALLBERG SARAH , PHINNEY STEPHEN , MCCARTER JAMES P. 
Published: June 2019

Introduction: Nonalcoholic fatty liver disease (NAFLD) is associated with type 2 diabetes (T2D) progression. Our 2-year study of T2D patients demonstrated a continuous care intervention (CCI) including nutritional ketosis improved non-invasive scores of steatosis and fibrosis, in addition to weight and glycemic control. This post hoc analysis assesses factors affecting steatosis and fibrosis resolution.
Methods: 262 T2D CCI patients were analyzed. Intent-to-treat correlation and ANCOVA assessed relationships between changes in selected variables (Table 1) and changes in NAFLD liver fat (NLF) and NAFLD fibrosis (NFS) scores, steatosis and fibrosis status.
Results: Changes in HOMA-IR, central abdominal fat (CAF) and beta-hydroxybutyrate (BHB) were correlated with changes in NLF, while changes in HbA1c, CAF and HDL-cholesterol were correlated with changes in NFS, even after adjustment for age, gender, race, diabetes duration and baseline BMI. ANCOVA confirmed that patients who resolved steatosis had greater BHB increase (p=0.01), HOMA-IR reduction (p=1.3x10-5) and CAF reduction (p=0.01) than those who did not.
Conclusions: Following the CCI, increased BHB and decreased insulin resistance are associated with steatosis resolution, while decreased visceral obesity is associated with steatosis and fibrosis reduction.

Disclosure
S.J. Athinarayanan: Employee; Self; Virta Health Corp. R.N. Adams: Employee; Self; Virta Health Corp. A. McKenzie: Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. S. Hallberg: Advisory Panel; Self; Atkins Nutritionals, Inc. Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. S. Phinney: Advisory Panel; Self; Atkins Nutritionals, Inc. Board Member; Self; Virta Health Corp. Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. Other Relationship; Self; Beyond Obesity. J.P. McCarter: Employee; Self; Virta Health Corp.

Funding
Virta Health Corp
763-P: Serum Fatty Acid Composition and Gut Microbiota Are Associated with Obesity in Type 2 Diabetes Patients
Authors: HIGA MARIKO , KAWAI MIKI , ETO RUMA , AYAKO FUCHIGAMI , SATO GENKI , HIJIKATA MAI , YAMASHITA KAORU , ICHIJO TAKAMASA 
Published: June 2019

Aim: Polyunsaturated fatty acids (PUFAs) are essential fatty acids, because they cannot be synthesized in the body and must be taken from food, but excessive intake may cause obesity. Therefore, the measurement of serum fatty acid composition is useful for monitoring the fat composition of the diet. In recent years, accumulating evidence has indicated the importance of gut microbiota in maintaining human health. The aim of our study was to evaluate the relationship between fatty acid composition and gut microbiota in obese patients with type 2 diabetes.
Research Design and Method: The subjects included 100 patients (age: 60.3±13.9 years, BMI 27.5±5.8 kg/m2) who were not taking EPA agents. They were divided into two groups, i.e., obese group (n=64) with a BMI of greater than 25 kg/m2 and non-obese group (n=36) with a BMI less than 25 kg/m2. Serum levels of fatty acids were measured using gas chromatography. In 45 of 100 patients, gut microbiota profiles were measured using T-RFLP methods.
Results: The serum levels of dihomo-gamma-linolenic acid (DGLA), which is an n-6 PUFA, and palmitic acid, a saturated fatty acid (SFA), were significantly higher in the obese group than in the non-obese group. No significant differences were observed in the serum levels of n-3 PUFA. The ratio of Firmicutes/Bacteroidetes in the fecal microbiota was significantly lower in the patients with high serum levels of DGLA. The rate of Bacteroidetes showed a significant positive correlation with serum DGLA and palmitic acid.
Conclusion: These results suggest that high levels of serum DGLA may play an important role in the development of not only obesity but also gut microbiota in type 2 diabetes patients. The fat quality in the diet might contribute to the development of obesity.

Disclosure
M. Higa: None. M. Kawai: None. R. Eto: None. F. Ayako: None. G. Sato: None. M. Hijikata: None. K. Yamashita: None. T. Ichijo: None.
770-P: Association between Diet Quality and Glycemic Control in African Americans with Type 2 Diabetes
Authors: TAHSIN BETTINA , KEIM KATHRYN S. , FOGELFELD LEON , FOGG LOUIS , LYNCH ELIZABETH 
Published: June 2019

Literature is lacking on the impact of diet quality on glycemic control in those with type 2 diabetes (T2DM), especially African Americans with T2DM. 211 African American adults with T2DM and A1c ≥ 7.0% were randomized into intervention (26 sessions) and control (2 sessions) for an 18-month randomized community-based control trial, Lifestyle Improvement Through Food and Exercise (LIFE), assessing the impact of culturally-relevant lifestyle education on glycemic control. Participants lived in low-income Chicago-area neighborhoods and had regular medical care. Diet quality was assessed via 24-hour recall and translated into the Alternative Healthy Eating Index 2010 (AHEI-2010). AHEI-2010 total scores (0-110: higher score=healthier pattern) for intervention (n=95) and control (n=92) respectively were baseline: 47.4 ± 1.1 vs. 51.2 ± 1.1, 12 months: 51.4 ± 1.0 vs. 50.5 ± 1.1, 18 months: 50.3 ± 1.2 vs. 51.6 ± 1.2. Using repeated measures ANOVA, the AHEI-2010 18 month increase from baseline was significantly higher in the intervention group, df (2, 370), F (3.18), p=0.043. A1c% decline over 18 months (intervention: 9.1 ± 0.2 to 8.5 ± 0.2; control: 8.9 ± 0.2 to 8.6 ± 0.2, p&lt;0.001) was significant but there was no difference between groups. Absolute AHEI-2010 scores by hierarchical multilinear regression, regardless of study group, accounted for improved glycemic control by 1.6% at 12 months and by 2.3% at 18 months after adjusting for age, insulin use, and number of diabetes complications at baseline. While the impact of higher diet quality on glycemic control was small, overall dietary change in this study was also small. With 41.2% of participants living below the poverty line, limited access to healthy foods might have hampered greater dietary change.

Disclosure
B. Tahsin: None. K.S. Keim: None. L. Fogelfeld: None. L. Fogg: None. E. Lynch: None.

Funding
National Institutes of Health
781-P: Glycemic Response to Diabetes-Specific Formulas and Associations with Sex, Age, Body Mass Index, and A1c in Adults with Type 2 Diabetes: A Subgroup Analysis
Authors: ALISH CAROLYN J. 
Published: June 2019

Background: Diabetes-specific formulas (DSF) are designed to improve glycemic control in people with diabetes. We evaluated the relationships between study participant characteristics and impact on postprandial glycemic (PPG) response of Glucerna® formulas, other DSF, and typical foods consumed by adults with type 2 diabetes.
Methods: Fasting plasma glucose and PPG response data were extracted for analysis from 10 randomized, placebo-controlled, crossover studies conducted between 2003 and 2010. Interventions included Glucerna® formulas (Abbott Nutrition, Columbus, Ohio, U.S.), other non-Abbott DSF, and typical foods (oatmeal and a standard high carbohydrate breakfast). First period data for maximal change from baseline for glucose were analyzed for sex, body mass index (BMI), and A1c.
Results: A total of 505 participants were included in the analysis (median age, 59 years; median BMI, 31.7 kg/m2; and median A1c, 7.3%). Compared to other DSF and to food, Glucerna products elicited an improved PPG response (mean + standard error of the mean. Glucerna: 2.18 + 0.10 mmol/L; other DSF: 3.38 + 0.24 mmol/L, p&lt;0.0001; foods: 2.98 + 0.21 mmol/L, p=0.0001). Glucerna products produced an improved PPG response compared to other DSF in overweight (p=0.002) and obese (p=0.0001) subjects. Among subjects with A1c &lt; 7.3%, there was a trend for a better PPG response than among subjects with A1c &gt; 7.3%, regardless of treatment (p=0.05).
Conclusions: Glucerna products elicited a better PPG response compared to other DSF and selected foods in adults with type 2 diabetes irrespective of sex, age or BMI. There appears to be variability in PPG responses to Glucerna and other DSF in overweight and obese adults with type 2 diabetes; this variability could be due to differences in nutrient composition and ingredients.

Disclosure
C.J. Alish: Employee; Self; Abbott Laboratories.
783-P: Correlations between Serum 25-Hydroxy Vitamin D and Vascular Disease in Type 2 Diabetics
Authors: LI NAN , XU LU , WANG YANRU , YANG SHAOLING , YANG PENG , DONG JIAQI , LI HONG , QU SHEN 
Published: June 2019

Objective: Vascular lesions caused by type 2 diabetes (T2DM) is unquestionable, but the relationship with serum 25-hydroxyvitamin D (25(OH)D) is controversial. Our study intends to analyze the association between the vascular disease of T2DM and the level of 25(OH)D.
Methods: A total of 576 patients with T2DM and 532 healthy people in our hospital from 2016 to 2017 were enrolled. The level of 25(OH)D between T2DM group and non-DM group was compared. Patients with T2DM were divided into carotid intimal thickening group(472 cases, IMT&gt;1.0mm) and normal carotid artery group(104 cases, IMT&lt;1.0mm) by ultrasonography. According to whether hemorrhage or exudation in fundus photography, they were divided into microvascular disease group(226 cases) and non-microvascular disease group(350 cases). Furthermore, we analyzed the association between the level of 25(OH)D and clinical characters by SPSS22.0.
Results: The level of 25(OH)D in T2DM group was significantly lower than non-DM group(42.66±13.81 vs.66.00±11.53, P&lt;0.001). Serum 25(OH)D concentration increased in carotid intimal thickening group(42.80±13.96 vs.42.07±13.16, P=0.626), but was lower in microvascular disease group(41.17±14.02 vs.43.63±13.60, P=0.036). Levels of HbA1c, FPG, FINS, FCP, Alanine aminotransferase, Aspartate aminotransferase, Creatinine, Uric acid, TC, TG, HOMA-IR in the low 25(OH)D group were higher than normal group, but HOMA-IS, HOMA-β were lower. Therein, levels of FPG(P=0.010), FCP(P=0.006), TC(P&lt;0.001), TG(P&lt;0.001), HOMA-IS(P=0.002)had significant difference. In addition, gender, age and duration of disease was not related to 25(OH)D.
Conclusion: The 25(OH)D in patients with T2DM is lower than healthy people and the incidence of microvascular disease is increased, but there is no definite correlation with macrovascular disease. In the T2DM population, supplementation of 25(OH)D may improve vascular lesions by regulating glycolipid metabolism, which needs further study.

Disclosure
N. Li: None. L. Xu: None. Y. Wang: None. S. Yang: None. P. Yang: None. J. Dong: None. H. Li: None. S. Qu: None.
795-P: Effect of Protein Intake (PI) on Postprandial Glycemia in Children and Adolescents with Type 1 Diabetes Mellitus
Authors: DALLE DALIA , SHAHMIRIAN SARINE G. , O'RIORDAN MARYANN , ZIMMERMAN TERESA N. , WOOD JAMIE R. 
Published: June 2019

Dietary PI contributes to PPH in T1D patients. Current recommendations are to increase insulin dose for mixed meals containing ≥ 40 gm of protein, and consider insulin dosing for pure-protein meals containing ≥75 gm of protein. There are no studies to date that investigate this effect specifically in children and in relation to body weight. Our aim was to explore the role of weight and other demographic factors in the relationship between PI and PPH in children with T1D, hypothesizing that the protein amount that causes PPH in children with T1D is weight based. We conducted a self-controlled, prospective study, in children with T1D who were given Whey protein isolate drinks (carbohydrate and fat free) of varying protein amounts (0, 12.5, 25, 37.5, 50, and 62.5 gm) on 6 different nights based on a protocol approved by UHIRB. The glucose levels were monitored with the participants’ personal continuous glucose monitors for 5 hours post PI. PPH was defined as glucose elevations ≥ 50 mg/dL above baseline. Thirty-eight subjects were recruited and 11 subjects (6 females, 5 males) completed the intervention. Subjects had a mean (SD) age of 11.6 (3.5) years, diabetes duration of 6.1 (4.7) years, HbA1c of 7.2 (0.8) %. BMI %ile ranged from 8th to 87th. PPH was detected at 5 hours post PI in 1/11, 5/11, 6/10, 6/9, 5/9, and 8/9 subjects after receiving 0, 12.5, 25, 37.5, 50, and 62.5 gm, respectively. There were no significant correlations between the rise in glucose and body weight, however for those with BMI %ile &gt; 50% (n=8), BMI %ile was strongly correlated with change in glucose for doses 37.5 (all rs &gt; 0.85, all p &lt;0.01) and 50 gm (all rs &gt; 0.64, all p &lt;0.08) for all times. The correlation was somewhat less for 62.5 gm (all rs &gt; 0.52). This suggests that the protein amount associated with PPH in children with TID is less than the threshold (75 gm) found in previous studies mainly consisting of adults.

Disclosure
D. Dalle: None. S.G. Shahmirian: None. M. O'Riordan: None. T.N. Zimmerman: Research Support; Spouse/Partner; Merck & Co., Inc., Novo Nordisk Inc. Speaker's Bureau; Spouse/Partner; Merck Foundation. J.R. Wood: Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc.
797-P: Composition of Morning and Afternoon Meals Affects Metabolism and Inflammation in Human Adipose Tissue
Authors: KESSLER KATHARINA , JÜRCHOTT KARSTEN , RUDOVICH NATALIA N. , PFEIFFER ANDREAS F. , RAMICH OLGA 
Published: June 2019

Meal timing is an important factor for metabolic regulation. We recently showed that a diet where fat is mainly eaten in the morning and carbohydrates mainly in the evening worsens glycaemic control in subjects with prediabetes. Here, we investigated the effects of the day time of carbohydrate and fat intake on the subcutaneous adipose tissue (SAT) transcriptome in humans. In a cross-over study 34 non-obese men without diabetes (age 47.4 ± 2.4 years, BMI 27.4 ± 0.7 kg/m2) consumed two 4-week isocaloric diets - (1) HC/HF diet consisted of a high-carb breakfast and lunch (65 EN% carbohydrates, 20 EN% fat, 15 EN% protein) and a high-fat snack and dinner (35 EN% carbohydrates, 50 EN% fat, 15 EN% protein) or (2) inverse sequence of meals (HF/HC). After both dietary interventions, SAT samples were collected at 8.40, 12.20 and 19.00 hr. Gene expression was analyzed by microarrays and validated by PCR. Sinus model was fitted to expression levels of each transcript to predict the 24h rhythm. Out of 1345 SAT transcripts with a significant cosine rhythm, 37.8% transcripts were rhythmic on both diets, whereas 27.3% and 34.9% transcripts were rhythmic only on the HC/HF and HF/HC diet, respectively. Diets neither affected the oscillations of clock genes in SAT nor the salivary cortisol rhythm used as a central clock marker. However, dietary effects on a large set of oscillating and non-oscillating genes involved in glucose (e.g., IRS1, IRS2, PCK1, PDK4) and lipid metabolism (e.g., ACACA, ACAT1, ACOX2, PPARA) were found. Consumption of a HC/HF diet increased the expression of numerous inflammatory genes (e.g., CCL5, IL1B, ITGAX, CD3E) in SAT. Mechanisms underlying this remodeling included the change of activity of the insulin signaling, I-kappa B kinase/NF-kappa B and MAPK pathways. Collectively, our study revealed that the composition of the morning and afternoon meals strongly affect adipose tissue transcriptome in humans including the alteration of glucose and lipid metabolism and inflammatory pathways.

Disclosure
K. Kessler: None. K. Jürchott: None. N.N. Rudovich: None. A.F. Pfeiffer: Advisory Panel; Self; Abbott, Berlin-Chemie AG, Novo Nordisk A/S. Speaker's Bureau; Self; Lilly Diabetes, Novartis AG, Sanofi-Aventis Deutschland GmbH. O. Ramich: None.

Funding
German Science Foundation (KFO218 PF164/16-1 to O.R., A.F.P.); German Diabetic Association (to O.R.); German Center for Diabetes Research (82DZD0019G to O.R.)