bluuebunny/crossref_metadata_2025_split huggingface dataset:
1362-P: Puberty Changes Everything: Longitudinal Multitrajectory Modeling of Metabolic Control, Body Mass Index, and Insulin Dose among 9,239 Children with T1D from the DPV Registry
Authors: SCHWANDT ANKE , KUSS OLIVER , DUNSTHEIMER DESIREE P. , KARGES BEATE , KAPELLEN THOMAS M. , MEISSNER THOMAS , WITSCH MICHAEL , FLURY MONIKA , STRAUBINGER STEFANIE , HOLL REINHARD W. ,   DPV INITIATIVE
Published: June 2019

Worsening metabolic control, weight changes and increasing insulin dose during puberty have emerged as a challenge in diabetes care. However, individual variation is large. Data from the German/Austrian/Luxembourgian diabetes registry DPV were used to identify distinct patterns of hemoglobin A1c (HbA1c), age/sex-standardized body mass index (BMI-SDS) and daily insulin dose from childhood to young adulthood.
Longitudinal data from 9,239 participants with T1D aged 8 to 18 years with duration &gt;=2 years and &gt;=5 years of follow-up were analyzed. We applied group-based multitrajectory (GBMT) modeling, a generalization of the group-based trajectory approach, to identify latent groups of subjects following similar developmental curves over time across multiple variables (Nagin, 2018). The GBMT approach revealed five unique groups of heterogeneous HbA1c, BMI-SDS and insulin dose patterns over time (Fig1). Differences in age at onset, gender, migration background as well as height-SDS, insulin pump and CGM usage, frequency of SMBG and physical activity were found across all groups. The present study identified for the first time five distinct multitrajectories of HbA1c, BMI-SDS and insulin dose during puberty. This approach demonstrates that variability between individuals is obscured by statistics on central tendency.

Disclosure
A. Schwandt: None. O. Kuss: None. D.P. Dunstheimer: None. B. Karges: None. T.M. Kapellen: None. T. Meissner: None. M. Witsch: None. M. Flury: Other Relationship; Self; Pfizer Inc. S. Straubinger: None. R.W. Holl: None.

Funding
German Center for Diabetes Research; Robert Koch Institute; German Diabetes Association
1381-P: Psychological Characteristics of Caregivers Choosing Continuous Glucose Monitoring (CGM) for Their Children with Type 1 Diabetes (T1D)
Authors: ALKHALED LINA , ANN O'RIORDAN MARY , MACLEISH SARAH A. , HAZEN REBECCA A. , WOOD JAMIE R. 
Published: June 2019

The objective was to explore parental reason for adding CGM to child’s T1D management and relationships with parental anxiety and stress. Prior to CGM initiation as part of routine care, the primary caregiver of a child with T1D completed validated questionnaires including Fear of Hypoglycemia Scale, State-Trait Anxiety Inventory, Problem Areas in Diabetes Scale, as well as an investigator developed questionnaire assessing primary reason for starting CGM. Participants were grouped by primary reason for starting CGM. ANOVA methods were used to compare baseline characteristics and questionnaire scores (Table 1). Results of the Global F test are reported. Half of caregivers (16/32) were starting CGM with the goal of improving glycemic control and their children had a nominally higher HbA1c than the other groups. There were no differences in demographic characteristics or scores among the groups, although a nominally higher percentage of those who chose less fear of hypoglycemia had an elevated score (&gt;45) on the State-Trait Anxiety Inventory.
In summary, while not reaching statistical significance, results suggest that caregivers have different reasons for starting CGM in their children which may be found to be related to their emotional state in future studies with larger samples.

Disclosure
L. Alkhaled: None. S.A. MacLeish: None. R.A. Hazen: None. J.R. Wood: Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc.
1384-P: The Guided Transition of Care
Authors: LAL RAYHAN , MAAHS DAVID M. , DOSIOU CHRYSOULA , AYE TANDY , BASINA MARINA 
Published: June 2019

Objective: Every year 500,000 youths in the U.S. with chronic disease need transfer to adult providers. Diabetes is a model of chronic illness that transcends age. For those with type 1 diabetes (T1D), 58% report a bad transition experience, the majority change adult providers and there is a 21% drop in clinic visits. Retrospective studies show unstructured transfers result in worse A1c. Despite the need, there is a lack of evidence-based interventions on the organization of care. Meta-analysis established engagement and retention in adult care as appropriate outcomes. Sustained continuity of care improves patient satisfaction and reduces hospital visits. We hypothesized that a physician trained in both adult and pediatric endocrinology would have greater show rates for patients transferred to adult care if he or she first provides care to the patient in the pediatric clinic. In this “guided transition” the doctor continues caring for the patient from pediatric to adult clinic.
Methods: We conducted a prospective cohort study of patients with T1D, age 16-26 years, referred to adult T1D clinic and seen by a physician trained in adult and pediatric endocrinology. Patients were grouped based on if their referral originated from another pediatric endocrinologist or if the dual-trained physician previously saw the patient in the pediatric T1D clinic. Transfer to adult care occurred when physician and patient felt it appropriate. The primary outcome was show rate at the first and second adult visits.
Results: Of 22 patients, 9 were referred from a different pediatric endocrinologist and 13 underwent guided transition. Both groups had similar initial A1c (p = 0.54). For patients seeing a different pediatric provider, the show rate to the first and second visit was 44% compared to 100% in the guided transition group (p = 0.003). The guided transition group maintained A1c (p = 0.79).
Conclusions: The guided transition group was significantly more likely to attend adult clinic than those seeing the provider for the first time. These findings deserve broader replication.

Disclosure
R. Lal: Consultant; Self; Abbott. D.M. Maahs: Advisory Panel; Self; Novo Nordisk Inc. Consultant; Self; Abbott, Sanofi. Research Support; Self; Dexcom, Inc., Tandem Diabetes Care. C. Dosiou: None. T. Aye: None. M. Basina: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007217)
1389-P: Nontargeted Metabolomics Reveal Novel Metabolites in Small- and Large-for-Gestational-Age Infants and Their Mothers Associated with Glucose and Lipid Metabolism
Authors: LIU JIEYING , ZHAI XIAO , XIAO XINHUA , YU MIAO , ZHAO NAN , LI ZHENGYAO , FU JUNLING , DENG MINGQUN , ZHOU LIYUAN 
Published: June 2019

Small-for-gestational-age (SGA) or large-for-gestational-age (LGA) infants have increased risk of type 2 diabetes mellitus in later life. The intrauterine environment provides a foundation on which chronic disease develop in adulthood, however, the molecular mechanisms still remained unsolved. We recruited 135 pregnant and their infants, and then selected 67 pairs for plasma metabolomics analysis according to the birthweight of newborns, SGA (&lt;10th percentile, n=16), AGA (∼50th percentile, n=28) and LGA (&gt;90th percentile, n=23). Non-targeted metabolomics were performed by UPLC-Q-TOF-MS, and the metabolites were screened by P value, fold change and VIP value in OPLS-DA model. We found a group of metabolites over-/low-expressed in both SGA and LGA groups when compared to AGA group. Cholesteryl acetate (CE) was negatively related to SGA and LGA (logistic regression, AGA=0, SGA and LGA=1) in both mothers (adj. r=-1.50, adj. p=0.03) and infants (adj. r=-1.22, adj. p=0.03). Citicoline was positively related to SGA and LGA (maternal adj. r=4.71, adj. p=0.18; fetal adj. r=0.97, adj. p=0.06). CE and citicoline were involved in glycerophospholipid metabolism (EHMN database). Dihydroxyfumaric acid (DA) reported as insulin inhibitor was over-expressed in SGA and LGA (maternal adj. r=0.72, adj. p=0.09; fetal adj. r=0.91, adj. p=0.09). Moreover, the fetal citicoline (r=-0.294, p=0.082) and CE (r=0.369, p=0.027) was associated with cord blood glucose. Fetal DA was negatively associated with HDL (r=-0.416, p=0.012) and total cholesterol (r=-0.345, p=0.039).
In conclusion, the abnormal expression of CE, citicoline and DA in SGA and LGA mothers might cause the same abnormality in fetus, and were involved in glycerophospholipid metabolism and insulin inhibition. These new findings indicated that a group of metabolites which can be passed from mother to offspring might affect the metabolic syndrome in both SGA and LGA infants.

Disclosure
J. Liu: None. X. Zhai: None. X. Xiao: None. M. Yu: None. N. Zhao: None. Z. Li: None. J. Fu: None. M. Deng: None. L. Zhou: None.

Funding
National Natural Science Foundation of China (81870579); Fundamental Research Funds for the Central Universities (3332018015)
1393-P: Alterations in the Placental Proteome in Gestational Diabetes
Authors: ASSI EMMA , D'ADDIO FRANCESCA , NASR MOUFIDA BEN , LORETELLI CRISTIAN , MAESTRONI ANNA , USUELLI VERA , MANDÒ CHIARA , ROCCHIO FRANCESCA , CORRADI DOMENICO , FOLLI FRANCO , ZUCCOTTI GIANVINCENZO , CETIN IRENE , FIORINA PAOLO 
Published: June 2019

Gestational diabetes mellitus (GDM) is the most frequent metabolic complication during pregnancy, affecting 3% to 25% women, and it is associated with abnormal fetal growth. Interestingly, the mechanism behind altered fetal growth in GDM is only partially understood. In order to discover novel factors that may play a role in placental function and fetal development, we interrogated the placental proteomes of healthy (CTRL, n=5) and GDM-affected (n=5) pregnant women using an unbiased proteomic approach. We demonstrated that the placental proteome is altered in GDM, with at least 64 proteins differentially expressed to a high degree (p&lt;0.001) in GDM as compared to CTRL. Among those, 10 proteins are strictly involved in the mother-to-fetus crosstalk. While some of these proteins (e.g., C5, KRT8 and ATPSB) primarily exert protective effects of the trophoblast both in structure and function (e.g., invasion, angiogenesis, oxidative stress, barrier, energy support), others (e.g., CPAN6, TFRC and EZR) were importantly involved in fetal development (iron, muscle differentiation, nutrients) and protection from fetal loss (anticoagulant, regulation of epithelial-to-mesenchymal transition). These alterations in the GDM placental proteome suggest that placental dysfunction may be directly responsible for abnormal fetal growth/development during GDM. Targeting these proteins may thus offer therapeutic potentials for managing and treating GDM.

Disclosure
E. Assi: None. F. D'Addio: None. M. Ben Nasr: None. C. Loretelli: None. A. Maestroni: None. V. Usuelli: None. C. Mandò: None. F. Rocchio: None. D. Corradi: None. F. Folli: None. G. Zuccotti: None. I. Cetin: None. P. Fiorina: None.
1396-P: Lessons Learned from Implementing a Dietician-Led Low Risk Model of Care
Authors: MELONCELLI NINA J.L. , BARNETT ADRIAN G. , DE JERSEY SUSAN J. 
Published: June 2019

Research from the U.S. and Australia indicates that individualized medical nutrition therapy provided by a Registered Dietician over a minimum of three appointments can reduce pharmacotherapy requirements for women with GDM. We used an implementation science approach to develop a dietician-led model of care for low risk GDM women. Our evaluation used a pre-post intervention comparison, with primary outcomes of pharmacotherapy use and adherence to clinical guidelines which includes the recommendation of three dietician appointments. Although there were significantly more women who received best-practice dietetic care in the post-intervention cohort, pharmacotherapy use increased (Table). However, other changes over time need to be considered when interpreting these results. Women in the post-intervention cohort were more likely to: have been diagnosed before 24 weeks; have had previous GDM; and be prescribed metformin (Table). Lessons learned included: timing of dietician appointments; ongoing facilitation of the implementation process; workforce engagement; lower targets for commencing pharmacotherapy; and increased surveillance of low-risk women, all of which may have resulted in higher pharmacotherapy conversion rates. Our results have highlighted the importance of measuring process outcomes alongside clinical outcomes and using an implementation science approach when aiming to provide best-practice care.

Disclosure
N.J.L. Meloncelli: None. A.G. Barnett: None. S.J. de Jersey: None.

Funding
Health Practitioner Research Scheme
1402-P: Functional Data Analysis Reveals Differences in Temporal Glucose Profiles Hidden by Standard Continuous Glucose Monitoring Analysis: A Secondary Analysis of the CONCEPTT Trial
Authors: SCOTT ELEANOR M. , MURPHY HELEN R. , FEIG DENICE , LAW GRAHAM 
Published: June 2019

Background: The CONCEPTT randomized trial of CGM in pregnant women with type 1 diabetes showed significant improvement in pregnancy outcomes, but no difference in mean CGM glucose between those allocated to CGM vs. capillary glucose monitoring. Whilst summary statistics are recommended for the reporting of CGM data, they do not give dynamic information about the glucose profile across 24 hours.
Aim: To determine, using novel functional data analysis (FDA), if differences in the temporal glucose profile occurred in women randomized to CGM.
Methods: CGM data was available from 200 pregnant women (100 CGM intervention; 100 control) in the CONCEPTT study, at baseline, 24 and 34 weeks gestation. FDA was applied to the glucose data to generate functional glucose curves and multivariable statistical analysis applied.
Results: Despite having the same mean CGM glucose as those on capillary glucose monitoring alone 121 vs. 126 mg/dL; 6.7 vs. 7.0 mmol/l p=0.14, FDA revealed that pregnant CGM users were in fact running a significantly lower glucose (by 9-14mg/dL; 0.5-0.8 mmol/l) for a total of 8 hours a day (08.30-12.30 and 15.00-19.00).
Conclusion: Analysis of temporal glucose profiles gives key information about glucose control, missed by commonly reported CGM metrics. The women allocated to CGM ran a significantly lower glucose for 33% of the day.

Disclosure
E.M. Scott: Advisory Panel; Self; Abbott. Speaker's Bureau; Self; Abbott, Eli Lilly and Company. H.R. Murphy: Advisory Panel; Self; Medtronic MiniMed, Inc. D. Feig: Advisory Panel; Self; Medtronic. Speaker's Bureau; Self; Medtronic. G. Law: None.

Funding
JDRF; Canadian Clinical Trials Network; National Institute for Health Research
1404-P: Fasting Hyperglycemia during Pregnancy: Outcomes According to Delay of Care—An Observational Study Including 471 Women
Authors: COSSON EMMANUEL , VICAUT ERIC , BANON DORIAN SANDRE , BAUDRY CAMILLE , CUSSAC-PILLEGAND CAMILLE , VALENSI PAUL , CARBILLON LIONEL 
Published: June 2019

Some guidelines, as the French one, recommend to screen early in pregnancy for hyperglycaemia first-diagnosed during pregnancy and to immediately care for high-risk women with a fasting plasma glucose level (FPG) higher than 92 mg/dL before 22 weeks of gestation (WG) (eFHG: early fasting hyperglycaemia). To date, no randomized study has shown any benefit of such a strategy. Among the women without known diabetes who delivered in our French center (2012-2016), we compared in those with eFHG the incidence of a predefined composite outcome (preeclampsia or large for gestational age infant or shoulder dystocia or neonatal hypoglycemia) by tertiles of delay of care. We performed a sensitivity analysis in the women with an early FPG ≥100 mg/dL. We included 471 women (88% with risk factor(s); 456 early gestational diabetes mellitus; 15 overt diabetes) whose delay of care was by increasing tertiles: 3.5±1.5 (T1), 9.5±2.3 (T2) and 20.1±8.8 weeks (T3). FPG (101±17/99±9/97±9 mg/dL for T1/T2/T3 respectively), rates of obesity (45/28/30%), age ≥ 35 years (42/37/26%), insulin treatment during pregnancy (63/50/38%), gestational age at insulin onset (21.7±7.1/23.5±5.2/31.0±4.8 weeks of gestation) statistically differed across tertiles. The incidence of the composite outcome was similar across tertiles in the 471 women (15.8 vs. 11.4 vs. 15.5%; p=0.45) and also in the 136 women with early FPG ≥ 100 mg/dL (13.0 vs. 7.3 vs. 22.9%; p=0.12) with however more neonatal hypoglycemia for T3 in this subpopulation (0 vs. 0 vs. 9.3%; p&lt;0.05).This observational study shows that a long delay of care of women with FPG ≥ 100 mg/dL early in pregnancy is associated with a high rate of neonatal hypoglycemia. This stands in favor of screening for this condition which should be immediately cared for. Adjustment of our results for propensity scores is ongoing.

Disclosure
E. Cosson: Board Member; Self; Abbott, Boehringer Ingelheim Pharmaceuticals, Inc., LifeScan, Inc., Lilly Diabetes, Medtronic, Merck Sharp & Dohme Corp., Novartis France, Novo Nordisk A/S, Roche Diagnostics France, Sanofi. Research Support; Self; Air Liquide, Lilly Diabetes, Novo Nordisk A/S, Roche Diagnostics France, Roche Foundation, Sanofi. E. Vicaut: Consultant; Self; Abbott, Bristol-Myers Squibb Company, Lilly Diabetes, Novartis France, Pfizer Inc., Pierre FABRE, Roche Pharma. D. Sandre Banon: None. C. Baudry: None. C. Cussac-Pillegand: None. P. Valensi: None. L. Carbillon: None.

Funding
Lilly France; Roche Diagnostics France
1412-P: Racial Differences of Incident Diabetes Postpartum in Women with a History of Gestational Diabetes
Authors: SHEN YUN , HOU LIFANG , LIU HUIKUN , WANG LEISHEN , LENG JUNHONG , LI WEIQIN , HU GANG 
Published: June 2019

The aim of the present study was to investigate the race-specific association between a history of GDM and incidence of type 2 diabetes and evaluate how the risk changed over different years after delivery. We performed two large cohorts - the Coronary Artery Risk Development in Young Adults (CARDIA) cohort with African Americans and whites in the U.S. (188 GDM and 1625 non-GDM women), and the Tianjin GDM Observational Study with Chinese in China (1263 GDM and 705 non-GDM women). The multivariate cox regression model was used to assess the risk of incident diabetes postpartum between women with and without GDM. During a mean follow-up of 13.9 years, 419 women developed type 2 diabetes. After adjustment for multiple confounding factors, Chinese women with GDM had a higher risk of incident diabetes within 5 years postpartum than African Americans with GDM compared with Chinese and African Americans without GDM (Hazard ratio 71.5 in Chinese vs. 11.0 in African Americans). When the risk of incident diabetes was analyzed within 10 years, white women with GDM seemed to have a higher hazard ratio than African American and Chinese women with GDM compared with women without GDM of different race. In comparison to African American women without GDM, different racial women with GDM showed an increased risk of type 2 diabetes within 10 years postpartum, however, white women without GDM had a decreased risk of type 2 diabetes. The largest increased risk of type 2 diabetes over 10 years postpartum appeared in Chinese women with GDM (Hazard ratio 23.9), followed by African American women with GDM (Hazard ratio 4.92), and the smallest was seen in white women with GDM (Hazard ratio 3.57). Chinese women with a history of GDM had the highest risk of incident diabetes postpartum. The different genetic backgrounds and other risk factors among different races might contribute to the racial differences in the incidence of diabetes postpartum among women with GDM.

Disclosure
Y. Shen: None. L. Hou: None. H. Liu: None. L. Wang: None. J. Leng: None. W. Li: None. G. Hu: None.

Funding
Tianjin Women’s and Children’s Health Center; Tianjin Public Health Bureau; European Foundation for the Study of Diabetes/Chinese Diabetes Society; Lilly Program for Collaborative Research between China and Europe; National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100790 to G.H.); National Institute of General Medical Sciences (U54GM104940 to G.H.)
1428-P: Longitudinal Changes in Glucose during Pregnancy in Women with Gestational Diabetes Risk Factors
Authors: MILANA A BOCHKUR DRATVER , JAMES KAITLYN , ARENAS JULIANA , CAYFORD MELODY , CALLAHAN MICHAEL J. , TANGREN JESSICA S. , BERNSTEIN SARAH N. , HIVERT MARIE-FRANCE , POWE CAMILLE E. 
Published: June 2019

Background: It is unclear what diagnostic criteria for hyperglycemia should be applied in early pregnancy; some suggest applying criteria used outside of pregnancy, while others suggest applying gestational diabetes mellitus (GDM) criteria. Prior studies have reported inconsistent changes in glucose levels across pregnancy.
Methods: We recruited women with at least 1 risk factor for GDM. We performed 75-gram oral glucose tolerance tests on 40 non-pregnant (NP) women and serially on 71 pregnant women [completed visits: 71 at 10-14 (mean 12.8) weeks gestation (V1), 46 at 24-28 (mean 26.8) weeks gestation (V2), 32 at 6 weeks-6 months postpartum (V3)]. We tested for differences in glucose levels between the NP and pregnant women at V1, V2, and V3 using linear regression, with adjustment for age and family history of diabetes. We tested for longitudinal differences in glucose levels across pregnancy and postpartum (V1, V2, and V3) using mixed effects models.
Results: Fasting glucose was lower in pregnant compared to NP women by 5.0 mg/dl at V1 (P=0.01) and 5.7 mg/dl at V2 (P=0.01). Fasting glucose was lower by 2.8 mg/dl at both V1 and at V2 compared to postpartum values (V1 vs. V3, P=0.04; V2 vs. V3, P&lt;0.05). Post-load glucose at V1 did not differ from V3 or NP women. At V2, 30 minutes and 1 hour post-load glucose levels were higher in comparison to both V3 and NP levels (30 minutes: V2 vs. V3 9.7 mg/dL P=0.02, V2 vs. NP 12.0 mg/dL P=0.04; 1 hour: V2 vs. V3 13.0 mg/dl P=0.04, V2 vs.NP 21.1 mg/dL P=0.02). Two-hour post-load glucose did not differ between V2 and NP or V3 levels (P&gt;0.3 for all comparisons). There were no differences between V3 and NP glucose levels (P&gt;0.1 for all comparisons).
Conclusion: We confirmed reduced fasting glucose in pregnant women, with stability from the late 1st trimester through the early 3rd trimester. In contrast, early post-load glucose values increased in late pregnancy. This implies that establishing pregnancy- and gestational age- specific diagnostic criteria for hyperglycemia is imperative.

Disclosure
M.A. Bochkur Dratver: None. K. James: None. J. Arenas: None. M. Cayford: None. M.J. Callahan: None. J.S. Tangren: None. S.N. Bernstein: None. M. Hivert: None. C.E. Powe: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (K23DK113218); Robert Wood Johnson Foundation; Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD094150)